Caregiver Challenges and Opportunities for Accessing Early Hearing Detection and Intervention: A Narrative Inquiry from South Africa.

Background: Early Hearing Detection and Intervention (EHDI) is essential for minimising the negative impact of childhood hearing loss on speech, language, and cognitive development. However, in low- and middle-income countries such as South Africa, various challenges hinder the implementation of EHDI services, leading to delayed diagnosis and intervention.

Aim: This study explores caregivers' experiences with EHDI services, identifying key challenges and facilitators affecting access and timely intervention.

Methods: A narrative inquiry approach was used as part of a broader research initiative on family-centred EHDI. Nine caregivers of children who are deaf or hard of hearing (DHH) were purposively sampled, and data were collected through semi-structured interviews.

Results: Thematic analysis revealed systemic and structural challenges, logistical and financial constraints, and caregiver-related factors that hindered access to EHDI services. Key facilitators included caregiver knowledge and advocacy, family support services such as counselling and South African Sign Language training, and high-quality audiological and educational services.

Conclusions: Findings emphasise the need for policy-driven reforms, including expanding newborn hearing screening programmes, improving financial assistance mechanisms, and increasing public awareness. Addressing these challenges and leveraging facilitators can help South Africa align with global EHDI benchmarks and improve outcomes for DHH children.