Service Preferences of Parents of Children With Mild Bilateral or Unilateral Hearing Loss: A Conjoint Analysis Study

Objective: Universal newborn hearing screening results in substantially more children with mild bilateral and unilateral hearing loss identified in the early years of life. While intervention services for children with moderate loss and greater are generally well-established, considerable uncertainty and variation surrounds the need for intervention services for children with milder losses. This study was undertaken with parents of young children with permanent mild bilateral and unilateral hearing loss to examine their preferences for characteristics associated with intervention services. Design: Conjoint analysis, a preference-based technique, was employed to study parents’ strength of preferences. Using a cross-sectional survey that consisted of eight hypothetical clinic scenarios, we invited parents to make a discrete choice (to select one of two or more different services) between available services with different characteristics. The survey was informed by qualitative interviews conducted for this purpose. The questionnaire was administered to parents receiving intervention services in the province of Ontario, Canada, who were enrolled in a mixed-methods longitudinal study examining outcomes in early-identified children with mild bilateral/unilateral hearing loss. Data were analyzed using a generalized linear model (probit link) to identify attributes of interest for the respondents. Characteristics of the children were entered into the model to control for differences in age of diagnosis, sex, laterality of hearing loss, and hearing aid use. Results: A total of 51 of 62 invited parents completed the questionnaire. All four attributes of care that were included in the survey were found to be statistically significant, that is, parents valued support for amplification, support for speech-language development, emotional support, and communication from professionals. Analysis showed greater preference for enhanced levels relating to support for speech-language development than for support for amplification. Preference for attributes relating to emotional support and communication were also greater than for support for amplification use. Conclusions: Conjoint analysis was used to quantify parents’ preferences for service attributes. Parents’ values provide insights into the aspects of a service model that should receive consideration in the development of intervention programs for young children with mild bilateral or unilateral hearing loss and their families. Although parents of young children with mild bilateral or unilateral hearing loss valued several components of care, they indicated a clear preference for speech-language support compared with support for amplification use. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors are grateful to the families who participated in this research and to the many providers in early intervention and education programs in Ontario who informed parents about the study and assisted with institutional ethics requirements. The authors also thank the clinicians at the Children’s Hospital of Eastern Ontario for their input into the conjoint analysis questionnaire. E.M.F. designed the study, guided the questionnaire development, and wrote the first draft of the manuscript; D.C. assisted with the questionnaire an provided interpretive analysis and critical revision. I.G. carried out the statistical analyses and provided interpretive analysis. A.D.-S. provided guidance in the study design and critical revision. J.W. managed data collection and descriptive statistical analyses. V.G., E.N., and M.S. managed the development and piloting of the questionnaire. All authors commented on the final manuscript. This study was funded through a Canadian Institutes of Health Research (CIHR, grant number 93705) and was supplemented by a CIHR New Investigator Award (2009–14) and Canadian Child Health Clinician Scientist Award (2009-4) to E.M.F. The authors declare no conflicts of interest. Address for correspondence: Elizabeth M. Fitzpatrick, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5. E-mail: elizabeth.fitzpatrick@uottawa.ca Received November 23, 2017; accepted June 30, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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