Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

Abstract

Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people's quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people's health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual's life span; tackling socioeconomic inequalities throughout the life-course could improve the population's health, maximizing the opportunity for healthy aging.

Keywords: critical interpretive synthesis; health inequalities; health literacy; healthy aging; patient safety.

Figure 1.

Health Inequalities: Theory of Causation (Molony & Duncan, 2016).

Figure 2.

Social Position and Health and Relevant Causal Mechanisms (Åberg Yngwe, 2004).

Figure 3.

Study Identification Flow Diagram, Inclusion and Exclusion Criteria. HL = hearing loss; CIS = critical interpretive synthesis.

Figure 4.

Conceptual Model for Hearing Health Inequalities (HHI Model). This work by Dialechti Tsimpida is licensed under a Creative Commons Attribution 4.0 International License. T1: Low socioeconomic position (SEP) and hearing loss form a vicious cycle, as hearing loss may be both a consequence of and a causal contributor to socioeconomic disparity. T2: Indicators of lower SEP are associated with a less healthy lifestyle, which is harmful to hearing ability. T3: Improving health literacy can mitigate hearing health inequalities and play a significant role in the adoption of beneficial hearing health behaviors, including help-seeking for hearing problems, hearing aid acquisition, and usage. T4: Hearing loss risks the quality and safety of individuals’ health and poses significant communication barriers in healthcare settings, delaying the detection and increasing the risk and impact of other long-term conditions. HLQ = Health Literacy Questionnaire.