The purpose of this study was to discover the views of hearing impaired children and their parents to the use of coloured hearing aids. Although much emphasis has been placed on the need for the acceptability of hearing aids by adult wearers, children have rarely been asked for their opinions on their aids. The accepted belief has been that if the hearing aid has been correctly prescribed and the child gets significant benefit from it, then he or she will wear it. The psychological and social aspects have rarely been addressed. Hearing aid manufacturers have produced little if any research to support their production of multi-coloured hearing aids which would appear to contradict the accepted belief that the smaller and less conspicuous the aid is, the more acceptable it is to the user, his family and his peers.
For this study, it was felt that questionnaires would be the most useful and time efficient method of obtaining the views of children and their parents from different parts of the country. Existing verified questionnaires have been designed mainly for adults but they were looked at for content and question type.
The Denver Scale of Communication Function (Alpiner, Chevrette, Glascoe, Metz and Olsen. 1978) and its modified version, The Quantified Denver Scale of Communication Function (Schow and Nerbonne 1980) are attitude scales designed for hearing-impaired adults. They enable them to make a subjective judgement on the impact their hearing impairment has on relationships with family and the social and vocational aspects of life, their ability to communicate with others and their self-image. The questionnaires, however, do not ask for reactions specifically to the hearing aids either by the wearers or their families. The same applies to many of the other scales, which are concerned more with communication problems rather than acceptance or possible stigma.
A second disadvantage of these scales was felt to be their length. As they were designed for use with adults, the questions often numbered 25 or more. The Communication Profile for the Hearing Impaired (Demorest and Erdman 1978) stretched to 145 items and 25 scores! The children who would perhaps be responding to this study could range in age from 4 to 16 and would be unlikely to complete such a long questionnaire.
The age range of the children was also felt to be a probable area of concern. All adult studies presume a certain level of linguistic competence and so the questions or statements used can be quite complex e.g.
"I tend to be negative about life in general because of my hearing loss."
"I feel threatened by many communication situations due to difficulty hearing."
"Since I have trouble hearing, I hesitate to meet new people."
Quantified Denver Scale of Communication Function.
The children taking part in this study could possibly have very limited language skills due either to their youth or to severe pre-lingual hearing loss so the questions needed to be phrased in a way that matched their vocabulary. Many hospital paediatric departments have booklets for children to fill in during a stay. The language used in these is simple and age appropriate. The style was regarded as non-threatening and yet not condescending. It was also felt that the younger respondents might benefit from visual representation of some of the questions so that they could at least attempt to answer these questions without the help of an adult. The smiley faces similar to those used in pain assessment in paediatric hospital wards were considered to be appropriate in this instance.
As the questions in adult surveys did not address reactions by the wearers or their families to actual hearing instruments, new questions had to be devised and care had to be taken to ensure that they did not lead the children towards specific answers. One area of interest was if children had considered whether brightly coloured aids would make them "stand out" in the playground and possibly cause them to become the target for bullying. As the idea could not be planted in their minds the question had to be phrased in a very open form – "Do you like to wear your aids on the playground?"
A pilot study was carried out by distributing questionnaire packs among 4 families with hearing impaired children known to the author. Alterations were made to the questionnaires on the basis of their replies.
The questionnaire packs consisted of a covering letter to the parents and children requesting their co-operation, one questionnaire for the child and one to be completed by either or both parents. A photographic example of some coloured hearing aids was included so that respondents were aware of what was currently available. (see Appendices). Each pack also included a stamped, addressed return envelope.
Several Education Authorities were contacted and their permission requested to distribute the questionnaire packs to families through the peripatetic service as well as general ethical permission to carry out the research. Permission was granted by the Education Authorities in Buckinghamshire, Liverpool, Oxfordshire, Staffordshire and Wigan. 60 questionnaire packs were eventually sent out. An attempt was made to gain the views of an equal number of families whose children did or did not already wear coloured hearing aids.
The children were selected by their local teachers of the deaf mainly from units for hearing impaired pupils or from mainstream classes. The criteria used in the selection included an ability to complete at least part of the questionnaire and regular, if not all day, hearing aid use, but in general, it was left to the local teachers to decide how to select the children.
The families were advised that the child’s questionnaire could be filled in at home or at school with the help of a teacher of the deaf. It would appear from the replies that the majority of children chose to fill in their own answers or dictated them to their parents.
44 families (77.3%) replied to the questionnaire. 23 (52.3%) of the responses came from those with coloured aids and 21 (47.7%) from those with traditional beige aids.
Two questionnaires, examples of which can be seen in the appendix, were used in this study; one for the children which was designed specifically to be "child friendly", and one for their parents. The former aimed to gain insight into children’s views of the use of their own aids and of different coloured ones in school and at leisure and also asked what they thought other children thought about their aids. As the researcher was unaware of the ages or the linguistic abilities of the children who would reply to the questionnaires, graphics were used in the opening questions to encourage younger and less able children to attempt to complete the task. Help with the later questions could be obtained from teachers or parents. Many of the children’s questions required only "yes" or "no" or definite answers rather than opinions which were regarded, by the researcher, as possibly too complex for many of the children. A final section was included for those who wished to say what other children’s attitudes were to their aids.
The children were asked their gender and their age and if they liked their hearing aids. They were asked the colour of their aids and which 2 colours (from the example sheet) they would like best. Again, more simple language , "like best" rather than "prefer" was used to clarify the question for the younger children.
They were then asked to give a reason for their choice.
An attempt was made to discover whether the children enjoyed wearing their aids in different social situations, both within and outside school. They were then asked to say whether bright coloured aids would be "better"
a) at school
b) at home
and what sort of school they attended. The final question required the children to consider how their peer group felt about their hearing aids.
The parental questionnaire was divided into three sections.
The first section, "About You and Your Child", addressed the child’s position within the family and the age at which the deafness was identified. Questions on what type of school the child attended and the parents’ perception of their child’s hearing aid use both at school and at home aimed to clarify some of the answers given by the children in their questionnaires.
The second section dealt with whether the child already had coloured hearing aids, why and when they were issued and the parents’ attitudes to them.
In the final section parents were asked to comment on statements relating to the effect coloured aids may have on the child and his peer group; teenagers and their views on coloured aids as a fashion statement; the age at which children might prefer them and the possible logistical problems of spares and repairs.
Both parents and children were given the opportunity to ignore any question should they so wish and were assured of the anonymity and confidentiality of their replies.