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Clin Interv Aging. 2015 Nov 19;10:1857-72. doi: 10.2147/CIA.S91076. eCollection 2015.

Social representation of "hearing loss": cross-cultural exploratory study in India, Iran, Portugal, and the UK.

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Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.
Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Department of Audiology, School of Allied Health Sciences, Polytechnic Institute of Porto, Vila Nova de Gaia, Portugal.
Centre for Speech Language Therapy and Hearing, Cardiff Metropolitan University, Cardiff, UK.
Department of Social Science and Law, Tianjin University of Technology, Tianjin, People's Republic of China.
All India Institute of Speech and Hearing, University of Mysore, Mysore, India.
Department of Health and Welfare Studies, Malmö University, Malmö, Sweden.



Hearing loss is one of the most common chronic conditions in older adults. In audiology literature, several studies have examined the attitudes and behavior of people with hearing loss; however, not much is known about the manner in which society in general views and perceives hearing loss. This exploratory study was aimed at understanding the social representation of hearing loss (among the general public) in the countries of India, Iran, Portugal, and the UK. We also compared these social representations.


The study involved a cross-sectional design, and participants were recruited using the snowball sampling method. A total of 404 people from four countries participated in the study. Data were collected using a free-association task where participants were asked to produce up to five words or phrases that came to mind while thinking about hearing loss. In addition, they were also asked to indicate if each word they presented had positive, neutral, or negative associations in their view. Data were analyzed using various qualitative and quantitative methods.


The most frequently occurring categories were: assessment and management; causes of hearing loss; communication difficulties; disability; hearing ability or disability; hearing instruments; negative mental state; the attitudes of others; and sound and acoustics of the environment. Some categories were reported with similar frequency in most countries (eg, causes of hearing loss, communication difficulties, and negative mental state), whereas others differed among countries. Participants in India reported significantly more positive and fewer negative associations when compared to participants from Iran, Portugal, and the UK. However, there was no statistical difference among neutral responses reported among these countries. Also, more differences were noted among these countries than similarities.


These findings provide useful insights into the public perception of hearing loss that may prove useful in public education and counseling.


cross-culture; hearing impairment; hearing loss; perception of disability; social representation; societal attitude

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