Hearing Loss in Iraq Deteriorates Social and Environmental Quality of Life Gangguan Pendengaran di Irak Memperburuk Kualitas Hidup Sosial dan Lingkungan Alsada Sarah Abed sara.abd2206m@conursing.uobaghdad.edu.iq Ibrahim Nuha Adel nuhaa@conursing.uobaghdad.edu.iq Iraq Iraq 11 06 2024 <bold id="_bold-8">Introduction</bold>

Hearing impairment is often utilized as a substitute for hearing loss. Hearing impairment is a reduction in the ability to hear caused by failure in either the neurological or auditory system. Loss might lead to a decline in language interpretation skills and sensitivity to various frequencies [1]

Hearing impairment is the most severe and dangerous limitation that a human could have[2]

Hearing enables communication through the use of sound[3]

Quality of life refers to an individual's ability to recognize their place in society within the cultural and value frameworks they are part of, aligning with their personal goals, expectations, and standards[4] (QOL) is a holistic term[5]

It observes life satisfaction, encompassing aspects such as physical health, family, education, career, wealth, religious beliefs, finance, and the environment[6]

Health-related (QoL) is increasingly accepted as an outcome measure[7]

A high standard of life is evident when community members have the essential conditions for optimal health[8]

HL is a significant public health issue[9]. Hearing loss can result in secondary issues such as learning impairments, social isolation, reduced independence, depression, and the potential early onset of dementia, all of which impact quality of life[10].

People with hearing impairments experience challenges in communication, limited access to health information, and inadequate support and education from healthcare professionals, resulting in disparities in health outcomes and higher healthcare costs[11]

HL is one of the most prevalent work-related illnesses globally[12]

The implication of chemical-induced hearing loss on workers should not be underestimated [13]

Noise is a significant risk in occupational and environmental settings, leading to hearing impairment, The World Health Organization stated that 16% of adult debilitating hearing loss is caused by exposure to industrial noise[14] In Iraq Hearing loss has been more prevalent among Iraqi people since 2006, perhaps due to the effects of civilization and urbanization[15]

Objectives of Study

1. To evaluate the effectiveness of hearing loss on the Social and Environmental behaviors of patients with hearing loss

 <bold id="_bold-9">Method</bold> <bold id="_bold-10">A. Study Design and Setting</bold>

A descriptive study was carried out at the Otolaryngology department on 200 patients was used, which was non-randomized at Al-Diwaniya Teaching Hospital, located in Al-Diwaniyah From December 25th, 2023, to February 26th, 2024.

Study population and sampling technique

The study included a sample of 200 patients who visit Al-Diwaniyah Teaching Hospital . A nonprobability-purposive sampling technique was used to select the participants.

Patients who are eligible for study with age over 18 years with Diagnosed with hearing loss. While the exclusive criteria was Hearing-impaired individual, Incapacity to comprehend, collaborate, and respond. And Suffering from a terminal illness

 <bold id="_bold-11">B. Sample Size</bold>

The number of people who had examined in pure tone audiometry at Otolaryngology department in Al-Diwaniya teaching hospital, in Al-Diwaniyah city four months was 500.

After following the table prepared by Krejcie & Morgan for the sample size for a known population[16] , it was found that the sample size was 217, 17 questionnaires were ruled out because of the inaccuracy and clarity of the answers.

Data collection and Study instruments

Data were collected via a self-report questionnaire

utilizing the WHO Quality of Life-BREF (WHOQOL-BREF) Version in Arabic.

The WHOQOL-BREF is a 26-item questionnaire with four domains:

1.Physical health (7 items)

2.Psychological health (6 items)

3.Social relationships (3 items)

4.Environmental health (8 items).[17]

It also includes questions about quality of life and general health. Each item of the WHOQOL-BREF is rated on a five-point ordinal scale from 1 to 5.

Hearing loss measured by PTA

Pilot study

a. A pilot study was conducted for one week before beginning data collection from 2023 /12/ 20 to 2023 /12 /23 .

b. A pilot study was carried out using a sample size of 20 participants

The study results showed that the questions were simple to understand. The questionnaire can be completed in an appropriate period of 5-10 minutes. The pilot study sample has been excluded from the original study sample.

 <bold id="_bold-12">C. Ethical Consideration and Agreement </bold>

Approval from the ethics committee of Baghdad Nursing College.

Participation in the study was voluntary. The researcher clarified the study's objectives to the patients and their relatives. All patients who choose to participate in the trial provided verbal consent. All individuals were freely given the decision to participate in the study. They were permitted to withdraw whenever they felt uncomfortable. Full confidentiality was guaranteed, and all gathered data will be utilized solely for research reasons. Personal details were obtained with serial identifying numbers, ensuring anonymity.

 <bold id="bold-5c8befd7cee1ae9b5ad3f69333255f80">D. </bold> <bold id="_bold-13">Data Collection</bold>

Data were collected by a self-administered questionnaire comprising three components.

Part one was designed by the researcher and authorized by the supervisor.

The Socio-demographic data of patients includes gender, age, education level, marital status, occupation, income, and property ownership.

Part two: Medical information

Part three: Quality of life was assessed by a self-reported structured questionnaire utilizing the WHO Quality of Life-BREF (WHOQOL-BREF) Version in Arabic

The WHOQOL-BREF is a 26-item questionnaire with four domains

item of the WHOQOL-BREF is rated on a five-point ordinal scale from 1 to 5.

 <bold id="bold-ba62c9eda79272ff5ee43f1ce83508b8">E. </bold> <bold id="_bold-15">Statistical Analysis</bold>

The data were analyzed using IBM's Statistical Package for Social Science (SPSS) for Windows, version 27. The descriptive statistical measures of frequency and percent were employed. The measures of central tendency, specifically the arithmetic mean, and scattering, specifically the standard deviation, were also employed [18]. Spearman's rank correlation coefficient was employed to determine the relationship between the variables under study. Point Biserial Correlation was employed to quantify the disparity in the dependent variable when the independent variable comprises two distinct categories [19].

 <bold id="_bold-16">Results and Discussion</bold> <bold id="bold-478d90588ce8cbd7b9c228f4df7c2927">A. Results</bold>

The mean age 64.7±11.699. as gender distribution 60.5% of adults with hearing loss are females and 39.5% of them are males. The residency refers that the majority of adults with hearing loss are resident in urban (92.5%). according to causes of hearing loss 57.5% of them reported that diseases were the cause, 38.5% reported that trauma was the cause [20],

<bold id="bold-d7d082ca31c272d975941a79767ec75d">Evaluation of Quality of Life related to “Social Domain” among Adults with Hearing Loss</bold>

Social QoL F % M SD Ass.
Low 29 14.5 10.56 2.902 Moderate
Moderate 88 44
High 83 41.5
Total 200 100

f: Frequency, %: Percentage

M: Mean for total score, SD: Standard Deviation for total score, Ass: Assessment

Low= 3 – 7, Moderate= 7.1 – 11, High= 11.1 – 15

This table indicates that adults with hearing loss perceive moderate to high social quality of life in which 44% seen with a moderate level and 41.5

% of them seen with the high level.

<bold id="_bold-31">Levels of Social Quality of life among Adults with Hearing Loss (N=200)</bold>

This figure reveals that 44% of adults with hearing loss associated with moderate social quality of life while 41.5% associated with a high social quality of life.

<bold id="_bold-34">Evaluation of Social Domain among Adults with Hearing Loss (N=200) </bold>

List Social M SD Evaluation
1 How satisfied are you with your personal relationships? 3.81 1.176 High
2 How satisfied are you with your sex life? 3.44 1.197 Moderate
3 How satisfied are you with the support you get from your friends? 3.32 1.347 Moderate

M: Mean, SD: Standard Deviation

Low= 1 – 2.33, Moderate= 2.34 – 3.66, High= 3.67 - 5

This table presents the items of the quality of life related to social domain among adults with hearing loss; [21] the mean scores indicate that adults with hearing loss have moderate to high quality of life related to social aspect in which they are highly satisfied with their personal relationship and moderately satisfied with their sexual life perceiving support from family and friends [22].

<bold id="_bold-40">Evaluation of Quality of Life related to “Environmental Domain” among Adults with Hearing Loss</bold>

Environmental QoL f % M SD Ass.
Low 36 18 23.98 5.996 Moderate
Moderate 130 65
High 34 17
Total 200 100

f: Frequency, %: Percentage

M: Mean for total score, SD: Standard Deviation for total score, Ass: Assessment

Low= 8 – 18.66, Moderate= 18.67 – 29.33, High= 29.34 – 40

This table shows that adults with hearing loss have a moderate level of environmental quality of life as reported among 65% of them.

<bold id="bold-20d177ef803d7c30579a9d37ff5dbabd">Levels of Environmental Quality of life among Adults with Hearing Loss (N=200)</bold>

This figure reveals that 65% of adults with hearing loss have a moderate environmental quality of life.

<bold id="bold-e7b60ac4c4aad2d4c18315dbd3e13995">Evaluation of Environmental Domain among Adults with Hearing Loss (N=200) </bold>

List Environmental M SD Evaluation
1 How safe do you feel in your daily life? 3.28 1.195 Moderate
2 How healthy is your physical environment? 2.90 1.268 Moderate
3 Have you enough money to meet your needs? 2.73 1.260 Moderate
4 How available to you is the information that you need in your day-to-day life? 3.04 1.138 Moderate
5 To what extent do you have the opportunity for leisure activities? 2.43 1.278 Moderate
6 How satisfied are you with the conditions of your living place? 3.40 1.240 Moderate
7 How satisfied are you with your access to health services? 2.94 1.232 Moderate
8 How satisfied are you with your transport? 3.27 1.083 Moderate

M: Mean, SD: Standard Deviation

Low= 1 – 2.33, Moderate= 2.34 – 3.66, High= 3.67 - 5

This table presents the items of quality of life related to environmental domain among adults with hearing loss; the mean scores indicate that adults with hearing loss have moderate quality of life related to environmental aspect among all items [23].

<bold id="bold-9d7f766de0eef401720f5b73c8236cda">Overall Evaluation of Quality of Life related among Adults with Hearing Loss</bold>

Overall QoL f % M SD Ass.
Low 30 15 79.11 17.065 Moderate
Moderate 130 69
High 32 16
Total 200 100

f: Frequency, %: Percentage

M: Mean for total score, SD: Standard Deviation for total score, Ass: Assessment

Low= 26 – 60.66, Moderate= 60.67 – 95.33, High= 95.34 – 130

This table manifests that adults with hearing loss have a moderate quality of life as reported among 69% of them (M±SD= 79.11±17.065).

<bold id="bold-ebbf75108669f8f302d27f65873013f0">Overall Quality of life among Adults with Hearing Loss (N=200)</bold>

This figure reveals that 69% of adults with hearing loss associated with moderate quality of life.

 <bold id="bold-d2bd181e6174b6668df30167f7c359d8">B. </bold> <bold id="_bold-74">Discussion</bold>

In This tables reveals that adults with hearing loss have moderate”

Studies show that people with hearing loss are less likely to engage in social activities, experience more difficulty in relationships with family and friends, and encounter emotional challenges in the workplace [24]

Difficulties in maintaining connections and social interactions, along with the shame and difficulties associated with hearing loss[25]

A study conducted in the USA demonstrated that there were no discernible disparities in levels of social interaction between those with and without hearing impairments[26].

Women are significantly affected by social isolation due to hearing loss. [27]

The high ratings in the social dimension may be attributed to their active social engagement, influenced by cultural norms, and the support from their family and friends. [28]

Table (2): shows that adults with hearing loss have moderate level of environmental quality of life as reported among 65% of them.

This tables reveals that adults with hearing loss have moderate

Due to patient who have hearing loss may have developed effective techniques to manage their condition

Adults experiencing hearing impairment may struggle to identify environmental sounds, such as those related to safety, leading to heightened safety hazards [29] Hearing loss is linked to economic challenges such as limited learning, low wages, and lack of career opportunities [30]

Environmental elements including ambient noise, acoustics, and illumination can greatly influence people with hearing impairments, hindering their communication skills [31]

hearing problems can lead to reduced participation in leisure activities and time spent out-of-home [32]

Studies have shown different factors that affect persons' access to hearing healthcare, such as motivators, challenges, and problems with compliance. [33]

Thorslund discovered that although hearing loss can affect the selection of transportation mode, it does not have a major effect on the actual utilization of various modes. [34]

These findings indicate that people who have hearing loss may have developed effective techniques to manage their condition.

Table (3-11): manifests that adult with hearing loss have moderate quality of life

Because most of patient have a moderate Hl in the study and Hearing loss is an invisible ailment that is not visually apparent.

Unlike other disabilities, many individuals often do not view hearing loss as a disabling condition [35]

The patient with hearing impairment experiences a worse quality of life compared to individuals with normal hearing [36]

There are strong associations between HL and QOL while others find less strong [37],or no relationships at all [38].

 <bold id="_bold-75">Conclusion</bold>

Hearing loss significantly impacts the quality of life by affecting social and environmental interactions, necessitating further research to explore interventional strategies and underlying causes. This descriptive study, conducted at the Otolaryngology Department of Al-Diwaniyah Teaching Hospital, Iraq, from December 25, 2023, to March 1, 2024, involved 200 participants aged 18 and older. Using nonprobability-purposive sampling, participants underwent pure tone audiometry, and their quality of life was assessed using the Arabic version of the WHOQOL-BREF tool. Data analysis with SPSS version 27 revealed that the average age of participants was 45.5±15.5 years, with 60.5% females and 39.5% males. The results indicate a moderate impact of hearing loss on social and environmental quality of life. The study underscores the need for tailored interventions to ameliorate the adverse effects of hearing loss and enhance service provision for the hard of hearing. Future research should focus on longitudinal studies to track the progression of hearing loss and evaluate the effectiveness of targeted interventions over time.