Ear and hearing care programs for First Nations children: a scoping review

BACKGROUND: Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs. METHOD: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services. RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases. CONCLUSION: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs

INFLATE : a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children

Background: Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. Methods/design: This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3–16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. Discussion: INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12617001652369. Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.</p

The Blow Breathe Cough campaign : a learning partnership to develop a message about healthy hearing

This presentation will report on a student design project to promote ear health by 4th year design students in the professional studio at Western Sydney University, in a learning partnership with Samantha Harkus, Principal Audiologist, Aboriginal and Torres Strait Islander Services, Australian Hearing. Design students developed a campaign to promote the use of a Blow Breathe Cough animation to schools with Aboriginal and Torres Strait Islander peoples who are at risk of middle ear disease. Blow Breathe Cough (2017) is a smart board animation by Oliver Abbott to illustrate an established teacher-led activity aimed to clear kids’ airways and get faces and hands clean at the start of the school day. It is not thought to reduce the length or severity of an individual child’s ear infection, but it is thought of being a good way of controlling the spread of the respiratory germs that cause ear disease. The students designed a logo, social media and email campaign, a flyer, stickers and other merchandise ideas, to address primary and secondary audiences; to promote uptake of the animation among principals and class room teachers, and secondly to increase community awareness among families about ear disease, and indirectly increase awareness of the audiology services of Australian Hearing. The presentation will explain the role that design can play in making visible what is invisible about hearing loss and encourage a culture of healthy hearing observation to reach those most at risk. It will explore the learning partnership between the student team in the Rabbit Hole design studio, the animator, and the client the Aboriginal and Torres Strait Islander Services at Australian Hearing, and opportunities to include community evaluation and consultation in developing this campaign message

A program to respond to otitis media in remote Australian Aboriginal communities: a qualitative investigation of parent perspectives

Abstract Background Indigenous infants and children in Australia, especially in remote communities, experience early and chronic otitis media (OM) which is difficult to treat and has lifelong impacts in health and education. The LiTTLe Program (Learning to Talk, Talking to Learn) aimed to increase infants’ access to spoken language input, teach parents to manage health and hearing problems, and support children’s school readiness. This paper aimed to explore caregivers’ views about this inclusive, parent-implemented early childhood program for 0–3 years in an Aboriginal community health context. Methods Data from in-depth, semi-structured interviews with 9 caregivers of 12 children who had participated in the program from one remote Aboriginal community in the Northern Territory are presented. Data were analysed thematically. Caregivers provided overall views on the program. In addition, three key areas of focus in the program are also presented here: speech and language, hearing health, and school readiness. Results Caregivers were positive about the interactive speech and language strategies in the program, except for some strategies which some parents found alien or difficult: such as talking slowly, following along with the child’s topic, using parallel talk, or baby talk. Children’s hearing was considered by caregivers to be important for understanding people, enjoying music, and detecting environmental sounds including signs of danger. Caregivers provided perspectives on the utility of sign language and its benefits for communicating with infants and young children with hearing loss, and the difficulty of getting young community children to wear a conventional hearing aid. Caregivers were strongly of the opinion that the program had helped prepare children for school through familiarising their child with early literacy activities and resources, as well as school routines. But caregivers differed as to whether they thought the program should have been located at the school itself. Conclusions The caregivers generally reported positive views about the LiTTLe Program, and also drew attention to areas for improvement. The perspectives gathered may serve to guide other cross-sector collaborations across health and education to respond to OM among children at risk for OM-related disability in speech and language development

The Hearing and Talking Scale (HATS) : development and validation with young Aboriginal and Torres Strait Islander children in urban and remote settings in Australia

Many Aboriginal and Torres Strait Islander children are affected by chronic middle ear infection or otitis media from infancy that has a negative impact on development of listening and communication skills. Deficits in these skills are often not detected until school-age when the opportunity for early intervention is lost. Primary health and early childhood workers need screening tools to assist them with detecting the problem early, but there is a scarcity of tools. This study reports the development and validation of a screening tool for detecting communication problems in young Aboriginal and Torres Strait Islander children. The tool, called the Hearing and Talking Scale (HATS), relies on a systematic use of parent observations of communication behaviours of their children in everyday situations. Developed by using a co-design approach, the HATS is culturally and linguistically appropriate for use with parents/carers of young children by front-line workers not trained in speech-language pathology. We validated the HATS by comparing the HATS score of 68 children (46 Indigenous and 22 non-Indigenous children) with their performance in standardised assessments. The accuracy of the HATS was 80% and 81% when compared to the ASQ-TRAK and the Expressive Vocabulary Test respectively. The HATS takes 5 minutes to administer, and is easy to score and interpret. It can be used as part of a standard ear and hearing health check for young children to support early detection so that those with problems can be referred for specialist diagnosis and treatment at a young age

Examining relationships between parent-reported factors and recurring ear symptoms among Aboriginal and Torres Strait Islander children

Issue addressed Aboriginal and Torres Strait Islander child ear health is complex and multiple. We examined relationships between parent-reported sociodemographic, child health, health service access factors and ear symptoms among Aboriginal and Torres Strait Islander children aged 3 to 7 years. Methods The Longitudinal Study of Indigenous Children is a large child cohort study with annual parent-reported data collection. Generalised linear mixed model analyses examined Wave 1 (1309 children 0-5 years; 2008) predictors of being free of parent-reported ear symptoms in both Waves 2 and 3. Results A total of 1030 (78.7%) had no reported ear symptoms in either Wave 2 or 3. In the fully adjusted model, children who had been hospitalised in the past year (aOR = 2.16; 95% CI 1.19-3.93) and those with no ear symptoms (aOR = 2.94; 95% CI, 1.59-5.46) at Wave 1 had higher odds of no ear symptoms in both the subsequent waves. There were also relationships between parent main source of income–government pension or allowance as well as parents who reported no history of their own ear symptoms and higher odds of no ear symptoms in Waves 2 and 3 after partial adjustment for sociodemographic factors. Conclusion These findings suggest relationships between different sociodemographic and health factors and parent-reported ear symptoms among Aboriginal and Torres Strait Islander children that warrant further investigation. So what? Children with parent-reported ear symptoms during the early years need holistic support to prevent future ear symptoms that impact health, social and educational life trajectories

Parent Perspectives of Ear Health and the Relationship with Children’s Speech and Language in the Longitudinal Study of Indigenous Children

Health and well-being are holistic concepts that are perceived to be inseparable for Aboriginal and Torres Strait Islander peoples. We examined relationships between parent-reported ear symptoms for 787 Indigenous children at two time points (age 2–3 years, age 4–5 years) and two parent-reported speech and language outcomes one year later (age 5–6 years). Most parents (80.2%) reported no concern about their child’s expressive language and (93.8%) receptive language. Binary logistic regression models examined ear health as a predictor of children’s expressive and receptive speech and language adjusting for sociodemographic and health covariates. For children without parent-reported ear symptoms, there were lower odds of parental concern about expressive speech and language (aOR = 0.45; 95% CI 0.21–0.99) and receptive language (aOR = 0.24; 95% CI 0.09–0.62). Parents were less likely to have concerns about the child’s expressive speech and language if their child was female, lived in urban or regional areas, had excellent or very good global health, or had no disability when aged 2–5 years. Since parent-reported ear health and speech and language concerns were related, Aboriginal and Torres Strait Islander children could benefit from culturally safe, strength-based, and family-centered integrated speech, language, and ear health services