Cochlear Implant Decisions in South Africa: Parental Views, Barriers, and Influences

Background: Cochlear implants (CIs) have become a widely used intervention for Deaf and hard-of-hearing (DHH) children, particularly for developing spoken language. However, parental decision-making regarding CIs is influenced by a range of factors, including socio-economic status, healthcare accessibility, cultural beliefs, and societal attitudes. While extensive research on parental perceptions of CIs exists in high-income countries (HICs), there is limited research on these perspectives in low- and middle-income countries (LMICs), like South Africa, where disparities in healthcare access significantly impact CI uptake. Objectives: This study aimed to explore the views and perceptions of South African parents regarding CIs for their DHH children, with a specific focus on how financial, cultural, and informational barriers influence decision-making. Methods: A mixed-methods approach was used, combining Q-methodology for quantitative data and thematic analysis for qualitative insights. Nine parents of DHH children participated. The Q-set survey ranked parental attitudes toward CI risks, benefits, and accessibility, while semi-structured interviews provided deeper insights into decision-making processes. Factor analysis grouped participants into clusters based on their perceptions, and qualitative data were analysed using a thematic framework approach. Results: Findings revealed two distinct parental clusters: (a) Cluster 1 parents viewed CIs as essential for speech development and strongly supported implantation, and (b) Cluster 2 parents recognized CI benefits but emphasized that outcomes vary based on individual circumstances. Three overarching themes emerged from thematic analysis: (1) financial barriers restricting CI access, (2) parental reliance on medical professionals for decision-making, and (3) persistent stigma and cultural beliefs influencing CI perceptions. Conclusions: This study highlights critical barriers to CI access in South Africa, including socio-economic inequities, limited healthcare infrastructure, and persistent stigma. While parents largely recognized the benefits of CIs, their decisions were shaped by financial constraints and concerns about Deaf identity and societal acceptance. This study calls for the expansion of publicly funded CI programmes, the development of culturally tailored parental counselling protocols, and targeted public awareness campaigns to reduce stigma surrounding hearing restoration devices. These interventions can help mitigate financial and cultural barriers to CI adoption in South Africa.