Data from: Reasons for low uptake of referrals to ear and hearing services for children in Malawi

Background: Early detection and appropriate intervention for children with hearing impairment is important for maximizing functioning and quality of life. The lack of ear and hearing services in low income countries is a significant challenge, however, evidence suggests that even where such services are available, and children are referred to them, uptake is low. The aim of this study was to assess uptake of and barriers to referrals to ear and hearing services for children in Thyolo District, Malawi.

Methods: This was a mixed methods study. A survey was conducted with 170 caregivers of children who were referred for ear and hearing services during community-based screening camps to assess whether they had attended their referral and reasons for non-attendance. Semi-structured interviews were conducted with 23 caregivers of children who did not take up their referral to explore in-depth the reasons for non-uptake. In addition, 15 stakeholders were interviewed. Thematic analysis of the interview data was conducted and emerging trends were analysed.

Results: Referral uptake was very low with only 5 out of 150 (3%) children attending. Seven main interacting themes for non-uptake of referral were identified in the semi-structured interviews: location of the hospital, lack of transport, other indirect costs of seeking care, fear and uncertainty about the referral hospital, procedural problems within the camps, awareness and understanding of hearing loss, and lack of visibility and availability of services.

Conclusion: This study has highlighted a range of interacting challenges faced by families in accessing ear and hearing services in this setting. Understanding these context specific barriers to non-uptake of ear and hearing services is important for designing appropriate interventions to increase uptake.

研究背景：对听力障碍儿童开展早期筛查与恰当干预，对最大化其机能水平与生活质量具有重要意义。低收入国家普遍缺乏耳部与听力医疗服务，这是一项严峻挑战；然而有证据表明，即便此类服务已可及且儿童已被转诊至相关机构，就诊率依然偏低。本研究旨在评估马拉维蒂约洛区儿童耳部与听力服务转诊的就诊率及其阻碍因素。

研究方法：本研究为混合方法研究。针对在社区筛查活动中被转诊至耳部与听力服务机构的170名儿童照护者开展问卷调查，以评估其是否已完成转诊就诊，并了解未就诊的原因。另对23名未完成转诊的儿童照护者进行半结构化访谈，以深入探究其未就诊的原因。此外，还访谈了15名利益相关方。对访谈数据开展主题分析，并对浮现出的研究趋势进行解析。

研究结果：转诊就诊率极低，150名转诊儿童中仅有5名（3%）完成了就诊。半结构化访谈共识别出7个相互关联的未就诊核心主题：医院地理位置偏远、交通不便、就医相关的其他间接成本、对转诊医院的恐惧与不确定感、社区筛查活动中的流程问题、对听力损失的认知与了解不足，以及服务可及性与曝光度缺失。

研究结论：本研究揭示了该地区家庭在获取耳部与听力医疗服务过程中面临的一系列相互关联的挑战。明确这些针对特定场景的耳部与听力服务未就诊阻碍因素，对于设计恰当的干预方案以提升就诊率具有重要意义。