DOI: 10.1097/aud.0000000000001908 ISSN: 0196-0202

Understanding Cultural Variations in Stigma Related to Hearing Health

Suhani Pattanshetti, Gabrielle H. Saunders, Samuel Couth, Charlotte Vercammen
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Objectives:

Adults with hearing loss (HL) may experience stigma, which can reduce help-seeking and may contribute to social isolation and psychological distress. Perceptions of HL and hearing devices vary across cultural contexts, underscoring the importance of examining cultural influences on stigma. The primary aim of this cross-sectional, online survey study was to examine differences in public stigma (negative societal beliefs regarding HL and hearing devices), self-stigma (internalization of these beliefs), and affiliate stigma (stigma experienced by individuals associated with someone with HL, such as family members, referred to as “affiliates”) across ethnic groups living in the United Kingdom. The secondary aim was to explore whether acculturation indicators (e.g., duration of stay in the United Kingdom, generational status determined using participants’ and their parents’ country of birth, and languages spoken at home) were associated with stigma perceptions. It was hypothesized that stigma perceptions would vary across (1) ethnic groups and (2) acculturation indicators.

Design:

Participants completed an online survey assessing stigma related to HL and hearing devices using validated questionnaires. The survey was designed to include individuals with and without HL, as well as affiliates. All items were rated on 5-point Likert scales ranging from “strongly disagree” to “strongly agree.” The final sample comprised 385 individuals: 256 with self-reported HL, 107 without HL, and 22 who were unsure. Participants were grouped into three ethnic categories, with 164 identifying as Black, 100 as South Asian, and 121 as White. Hierarchical regression analyses were used to examine whether ethnicity and acculturation indicators predicted public, self-, and affiliate stigma while controlling for covariates (age, gender, education level, hearing status).

Results:

Ethnicity was a significant predictor of public stigma, with South Asian ( β = 9.97, p < 0.001) and Black ( β = 4.03, p = 0.001) participants having higher stigma scores than White participants. A similar pattern was observed for self-stigma, with higher scores among Black ( β = 8.71, p < 0.001) and South Asian ( β = 6.28, p = 0.017) participants. Generational status also predicted stigma. Compared with second-generation participants, immigrants and first-generation participants reported lower public stigma ( β = −6.98, p = 0.004; β = −4.05, p = 0.039) and self-stigma ( β = −6.97, p < 0.001; β = −5.63, p = 0.011). Affiliate stigma was not associated with ethnicity or acculturation indicators (all p > 0.05).

Conclusions:

Ethnicity and generational status were key predictors of public and self-stigma, highlighting the role of sociocultural context in shaping perceptions of HL and hearing aid use. This suggests that a uniform approach to addressing stigma may be inadequate, as experiences of stigma may differ across cultural and generational contexts. Future qualitative work is needed to better understand lived experiences of stigma within and between ethnic groups to ground the development of culturally responsive stigma-reduction interventions and patient education materials, with implications for both translational research and clinical practice.

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