Hearing Accessibility

[Page 839]Consistent with the broader concept of accessibility for people with disabilities, the term hearing accessibility refers to the quality of an activity or place being accessible if people who are hard of hearing can participate in it as effectively as can people who have normal hearing. Furthermore, since people who have normal hearing find it difficult to hear in some situations, a more exacting and inclusive definition is that activities or places are hearing accessible if difficulty hearing does not restrict the participation of any person.

The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) provides a model in which health conditions are characterized in terms of impairments to body functions and structures, activity limitations, and participation restrictions. Importantly, the model recognizes that environmental and personal factors can modulate the effects of impairments on an individual’s activities and participation. The ICF model embodies a bio-psycho-social-environmental view of health that has largely replaced a narrower biomedical view of health. The broader view of health reflected in the ICF has had widespread implications for the delivery of health care. Over the last four decades, the current ICF model and earlier versions of it influenced a shift in clinical audiology practice from a diagnostic focus on impairment to a rehabilitative focus on disability. In parallel, the formation of national and international self-help organizations of people who are hard of hearing and the introduction of disability legislation advanced social policy and action to promote hearing accessibility. Thus, hearing accessibility in society extends clinic-based audiologic rehabilitation through social action to optimize the person–environment fit needed to enable full participation in everyday life by people who are hard of hearing.

Hearing accessibility is achieved when barriers that restrict participation are eliminated. Participation by individuals who have impaired hearing can be facilitated by environmental, technological, or behavioral interventions. Environmental solutions may involve modifying acoustics and lighting in communication settings. Technological solutions include the use of personal technologies such as hearing aids or the use of institutional assistive listening devices such as room systems in group or public settings. Therapeutic interventions can train individuals and their communication partners to successfully adapt their communication strategies and behaviors.

Rehabilitative audiologists contribute to hearing accessibility by recommending appropriate technologies and providing training and counseling for individuals and their communication partners. In addition, adopting a person-centered or family-centered approach in rehabilitation promotes hearing accessibility by fostering self-management by individuals who have hearing impairment and mutual support from and for their communication partners.

Beyond the clinic, audiologists and other professionals such as engineers and architects have joined forces with self-help organizations to advocate for policy changes and to develop standards for hearing accessibility in various settings. An excellent example of an environmental approach to hearing accessibility was the development of ANSI (American National Standards Institute) Standard S12.60 on Classroom Acoustics. Subsequent initiatives have resulted in the specification of acoustical standards for other important communication settings such as hospitals. In addition, hearing accessibility has been addressed to enhance participation in settings such as transportation, theaters, places of worship, offices delivering government services, and commercial venues such as banks and restaurants.

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