MM405 - Inclusion and Diversity in Hearing Care: Meeting the Needs of the Hmong Community

Abstract:
There is increasing demand to recognize and meet the needs for culturally and linguistically appropriate speech audiometry test materials for non-native English speakers. Incorporating speech audiometry materials across different languages ensures that we can meet best practice standards for diagnosis and treatment. Use of these materials will aid in the reduction of disparities across hearing healthcare among minoritized populations. Recognizing this gap in diagnostic materials, a multi-disciplinary team from the University of Wisconsin created four professionally recorded, phonetically balanced and statistically validated monosyllabic word lists in the White Hmong dialect.

Summary:
The need for innovation is often inspired at the clinical level. Comprehensive diagnostic audiometry, measuring hearing thresholds and assessing word recognition performance, is our standard of care to diagnose hearing loss, to quantify the type and configuration and to make recommendations for further care. Effective word recognition testing relies on language-specific materials yet is most commonly offered in English. When testing non-English speakers or patients with limited English proficiency (LEP), our clinical resources are often limited or non-existent. Scoring speech audiometry results outside of the audiologist’s primary language can be a challenging barrier preventing use of non-English speech materials.

For languages with smaller speaker populations, such as Hmong, word recognition materials often do not exist. Within these populations, diagnosis and treatment of hearing loss are often determined solely by pure-tone thresholds. This greatly hampers an audiologist’s insight to determine outcomes from medical treatment and limits best-practice recommendations for candidacy and effectiveness of devices such as hearing aids and cochlear implants.

The Hmong are an ethnic group that have traditionally lived in parts of Laos, Vietnam, Thailand and China. Hmong people began immigrating to the United States in the 1970s. There are over 4.5 million Hmong speakers worldwide, with an estimated 327,000 in the US as of 2019 US census. The majority of the Hmong in the US reside in California, Minnesota and Wisconsin. The Hmong language is based on the oral tradition. Although a written Romanized language system was developed for the Hmong, it is not understood by the majority of the population. This makes hearing loss a further detriment to effective communication within this population.

Recognizing these gaps in diagnostic materials, a multi-disciplinary team from the University of Wisconsin created four professionally recorded, phonetically balanced and statistically validated monosyllabic word lists in the White Hmong dialect. Each lists contains 50 unique words; two lists are presented by a Hmong male speaker and two lists are presented by a Hmong female speaker. These word lists were validated on 70 bilingual Hmong/English individuals with normal hearing thresholds and unremarkable otologic histories. This study confirmed equivalency between recorded English word lists and the four recorded Hmong word lists. Testing with 48 Hmong individuals with varying degrees of hearing loss showed word recognition performance ranging from 60-95% correct, following our expectation for the degree and configuration of hearing loss as typically seen in English-speaking patients.

Addressing the challenge of scoring speech audiometry performance outside of the audiologist’s primary language and the low Hmong literacy of interpreters, a training protocol program was developed for use with medical interpreters.

In conclusion, this study demonstrated that the four Hmong word lists were effective in assessing word recognition ability in Hmong individuals with normal hearing and hearing loss. Thoughtfully incorporating these Hmong word lists in clinical settings is the next step of best practice and has the potential to reduce disparities across hearing healthcare.