Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis

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dc.contributor.advisorGilson, Lucy
dc.contributor.authorDe Kock, Carmen
dc.date.accessioned2025-08-13T07:35:27Z
dc.date.available2025-08-13T07:35:27Z
dc.date.issued2025
dc.date.updated2025-08-07T10:38:44Z
dc.description.abstractHearing loss is a global public health burden and mostly affects those living in low and middle-income countries (LMICs). Hearing loss is expected to significantly increase without public health interventions. One approach to address ongoing challenges is the World Health Organisation's recommendation for the integration of ear and hearing care (EHC) services into healthcare packages. However, little is known about EHC integration approaches particularly in LMICs additionally, these approaches have not been investigated through a health systems lens. This qualitative review aimed to describe the various approaches to the EHC service integration in LMICs and to identify enabling and constraining factors. We conducted a qualitative synthesis to describe the factors influencing EHC service integration experiences. We reviewed 850 records and included 17 studies, with a focus on LMICs, using adaptations of the Valentijn integration and World Health Organization EHC frameworks. Our investigation showed that most integration approaches in LMICs were at micro or individual level. Enabling factors for integration of EHC services were training, mentorship, collaboration, technology, inclusion of EHC in healthcare packages and investment in EHC services. Barriers were challenges with training, facilities and equipment, policy implementation and resourcing of EHC services. We further described factors influencing healthcare seeking behaviour and the use of integrated EHC services such as access and ability to pay, referrals systems, and communication and awareness. This study describes the complex nature of EHC integration and ways to support integration. Key considerations are the level of integration, training to address workforce issues and factors influencing service utilisation as we work towards health system strengthening.
dc.identifier.apacitationDe Kock, C. (2025). <i>Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/41570en_ZA
dc.identifier.chicagocitationDe Kock, Carmen. <i>"Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025. http://hdl.handle.net/11427/41570en_ZA
dc.identifier.citationDe Kock, C. 2025. Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis. . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/41570en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - De Kock, Carmen AB - Hearing loss is a global public health burden and mostly affects those living in low and middle-income countries (LMICs). Hearing loss is expected to significantly increase without public health interventions. One approach to address ongoing challenges is the World Health Organisation's recommendation for the integration of ear and hearing care (EHC) services into healthcare packages. However, little is known about EHC integration approaches particularly in LMICs additionally, these approaches have not been investigated through a health systems lens. This qualitative review aimed to describe the various approaches to the EHC service integration in LMICs and to identify enabling and constraining factors. We conducted a qualitative synthesis to describe the factors influencing EHC service integration experiences. We reviewed 850 records and included 17 studies, with a focus on LMICs, using adaptations of the Valentijn integration and World Health Organization EHC frameworks. Our investigation showed that most integration approaches in LMICs were at micro or individual level. Enabling factors for integration of EHC services were training, mentorship, collaboration, technology, inclusion of EHC in healthcare packages and investment in EHC services. Barriers were challenges with training, facilities and equipment, policy implementation and resourcing of EHC services. We further described factors influencing healthcare seeking behaviour and the use of integrated EHC services such as access and ability to pay, referrals systems, and communication and awareness. This study describes the complex nature of EHC integration and ways to support integration. Key considerations are the level of integration, training to address workforce issues and factors influencing service utilisation as we work towards health system strengthening. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - Ear and hearing care, integration, low-and middle-income countries LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis TI - Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis UR - http://hdl.handle.net/11427/41570 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/41570
dc.identifier.vancouvercitationDe Kock C. Integration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis. []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/41570en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectEar and hearing care, integration, low-and middle-income countries
dc.titleIntegration of ear and hearing care services in low and middle-income health systems: a systematic review and qualitative synthesis
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPH
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