NIHR | Manchester Biomedical Research Centre

PhDs in Focus: Ethnicity and paediatric hearing health inequality in England

Sathveeka Kasthurisamy Soundararajan

Author: Sathveeka Kasthurisamy Soundararajan View Profile

PhD student

Welcome to our PhDs in Focus blog series, where our PhD students are showcasing their pioneering research projects at the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC).

In this blog, Manchester BRC PhD student Sathveeka Kasthurisamy Soundararajan outlines how their project is focused on reducing paediatric hearing inequalities within different ethnicities, with a particular focus on South Asian communities, by developing more culturally responsive interventions. This project is part of our Hearing Health theme.

My experience

I am an audiologist with specialised experience in paediatrics, particularly in cochlear implantation. A cochlear implant is a medical device which assists individuals with severe hearing loss by directly stimulating the auditory nerve and bypassing damaged portions of the ear. This implantation can completely transform the lives of children who are born deaf or with severe hearing impairment, as it provides them access to the world of sound which is crucial for their speech and language development.

I earned my bachelor’s degree and gained work experience in a government hospital in India, where I focused on paediatric cochlear implantations. This experience sparked my passion for enhancing the outcomes for children with hearing impairment. I moved to Manchester to earn a MSc degree in Audiology, and thoroughly enjoyed doing my final dissertation, which made me realise I wanted to have a career in research.

Sathveeka Kasthurisamy Soundararajan

My PhD

During my MSc, I was very keen on making new connections and expressed my intention of pursuing a PhD to potential supervisors. Through my dissertation advisor, who was incredibly helpful and supportive, I learned about an excellent PhD opportunity within the Hearing Health Theme at the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC).

My PhD research is focused on reducing paediatric hearing inequalities within different ethnic groups by developing more culturally responsive interventions. Coming from a different ethnic background myself, I am keen to achieve a successful outcome which could change the lives of these children and their families.

Do ethnic inequalities in hearing health exist in the UK?

Ethnic diversity has increased dramatically in the UK in the recent decade. In the 2021 census, approximately 15 million people identified as belonging to an ethnic group other than “White British”, which is an increase of 4 million people from the 2011 census figure (1, 2).

Research indicates that compared to those who identify as White British, men from most ethnic groups and women from Black African, Black Caribbean, and Indian ethnic groups are more likely to have hearing loss and to utilise hearing aids less frequently (3). These variations in demographics and research findings emphasise how urgently ethnic variations in hearing healthcare must be addressed.

The number of research publications focusing on ethnic variations in paediatric hearing care within the UK is limited (4, 5). A recent study using Millenium Cohort Study data, reveals that South Asian: Pakistani or Bangladeshi children have an increase in risk (12.1%) of Permanent Childhood Hearing Loss, followed by South Asian: Indian (less than 5%), Mixed (less than 5%), and Black (less than 5%) ethnic communities (6). Research which has addressed this has found multiple factors – such as structural and cultural barriers, stigma and shame, language barriers, miscommunication, and lack of information – which result in ethnic variations in paediatric hearing care (7-9). With growing diversity in the patient-practitioner partnership – where the practitioner and patient come from different countries of origin and may have different cultural beliefs, languages and health beliefs – there is an immediate need for developing, implementing and validating feasible strategies to enhance cultural competency in providers. These efforts are essential in reducing ethnic disparities and to improve health outcomes (10).

How do we improve the current situation?

My PhD project seeks to guide developing interventions and policies which will enhance the outcomes and accessibility of paediatric hearing healthcare for families of different ethnicities, with a specific emphasis on South Asian communities. These strategies will also be evaluated based on their acceptability, effectiveness and sustainability. As the first step, existing ethnic inequalities within a paediatric hearing dataset will be investigated to identify which group experiences the highest level of inequality.

Through an experience-based co-design model, the major hindrances in provision of high-quality hearing care for children from South Asian communities will be identified through qualitative data collection methods. Measuring the impact of these inequities requires active participation from the stakeholders, including community members and NHS clinicians. Therefore, Patient and Public Involvement and Engagement (PPIE) and Equality, Diversity and Inclusion (EDI), core areas of Manchester BRC, are an essential component of my research to achieve favourable outcomes. The project strives to promote equity, inclusiveness, sustainability and innovative cocreation.

Challenges

The project’s most demanding component lies in its interdisciplinary nature, requiring the integration of several perspectives, including a sociological lens, in order to address the goal of reducing inequalities and a health-psychological viewpoint to understand and modify the behaviors involved. This challenge is also an opportunity for me to learn more and gain a greater perspective.

Read more blogs in the PhDs in Focus series to find out how we’re developing a research talent pipeline.

Follow Manchester BRC on X/Twitter and LinkedIn to keep updated with the series.

References

  1. Catney G, Lloyd CD, Ellis M, Wright R, Finney N, Jivraj S, et al. Ethnic diversification and neighbourhood mixing: A rapid response analysis of the 2021 Census of England and Wales. The Geographical Journal. 2023;189(1):63-77.
  2. Taylor H, Shryane N, Kapadia D, Dawes P, Norman P. Understanding ethnic inequalities in hearing health in the UK: a cross-sectional study of the link between language proficiency and performance on the Digit Triplet Test. BMJ Open. 2020;10(12):e042571.
  3. Taylor H, Dawes P, Kapadia D, Shryane N, Norman P. Investigating ethnic inequalities in hearing aid use in England and Wales: a cross-sectional study. Int J Audiol. 2023;62(1):1-11.
  4. Claire XZ, Maria AQ, Clare B, Thomas B, Claire O, Claire C. Ethnic differences and inequities in paediatric healthcare utilisation in the UK: a scoping review. Archives of Disease in Childhood. 2023;108(7):518.
  5. Kapadia D, Zhang J, Salway S, Nazroo J, Booth A, Villarroel-Williams N, et al. Ethnic inequalities in healthcare: a rapid evidence review. 2022.
  6. Butcher E, Dezateux C, Knowles RL. Risk factors for permanent childhood hearing impairment. Archives of disease in childhood. 2020;105(2):187-9.
  7. Nicholson N, Rhoades EA, Glade RE. Analysis of Health Disparities in the Screening and Diagnosis of Hearing Loss: Early Hearing Detection and Intervention Hearing Screening Follow-Up Survey. Am J Audiol. 2022;31(3):764-88.
  8. Terry J. Enablers and barriers for hearing parents with deaf children: Experiences of parents and workers in Wales, UK. Health Expect. 2023;26(6):2666-83.
  9. Kingsbury S, Khvalabov N, Stirn J, Held C, Fleckenstein SM, Hendrickson K, et al. Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence. Perspect ASHA Spec Interest Groups. 2022;7(4):1060-71.
  10. Kiran CRP, Wasim H. Ethnic health inequalities in the NHS. BMJ. 2022;376:o607.