Gender differences in coping strategies and self-rated disability and handicap were explored in individuals with noise-induced hearing loss. The study group consisted of 60 male and 33 female patients, consecutively presenting at the hearing clinics in two hospitals in the western part of Sweden. The females were older and had worse average hearing thresholds over the low frequencies (0.5, 1 and 2 kHz) in the better ear than the males. However, all subjects rated their hearing loss as "moderate" to "severe". The patients responded to the Communication Strategies Scale, CSS, measuring "maladaptive behaviour", "verbal strategies" and "nonverbal strategies" and the Hearing Disability and Handicaps Scale, HDHS, which is composed of four factorially derived subscales: "speech perception", "non-speech sounds", "interpersonal distress" and "threat to the self-image". Pure-tone audiometry and sociodemographic data was also assessed. Despite differences in pure-tone audiometry, there were no significant differences between gender in perceived disability or handicap. Significant gender differences in coping were found. The women used "maladaptive behaviour" and "verbal strategies" significantly more often than the men. This is in agreement with results of an interview-study of women with NIHL, showing that the perceived emotional temperature in a specific situation guided the choice of coping strategy. The gender difference in coping could also be related to, and explained by, the conversational goal (transactional or interactional).
Keywords: Gender difference, coping, disability, handicap, noise-induced hearing loss
|How to cite this article:|
Hallberg L. Is there a gender difference in coping, perceived disability and handicap in patients with noise-induced hearing loss?. Noise Health 1999;1:66-72
|How to cite this URL:|
Hallberg L. Is there a gender difference in coping, perceived disability and handicap in patients with noise-induced hearing loss?. Noise Health [serial online] 1999 [cited 2014 Sep 2];1:66-72. Available from: http://www.noiseandhealth.org/text.asp?1999/1/2/66/31703
| Introduction|| |
Regardless of age, auditory problems will render parts of the speech signal inaudible and thereby affect communication. Accordingly, a hearing disability strikes at the very heart of human life: social interactions (Jones, 1987). The environment also contributes to hearing impaired listener´s difficulties in understanding speech, for example by the acoustical conditions and the talker´s articulation. Individuals with hearing loss develop strategies to cope with their situation. Probably, some coping strategies have a moderating effect on the auditory demanding situation and are thereby preventing feelings of handicap. Other coping strategies might result in the opposite: increased feelings of handicap. It is very common for people to use a variety of strategies, both emotion-focused and problemfocused coping. Most research on coping with hearing loss has been conducted on males. An interesting question is to investigate if there is a gender difference in coping with a hearing loss.
| Aims|| |
The purposes of this study were to describe coping strategies, used by individuals with noise-induced hearing loss (NIHL) and, also, to assess self-rated disability and handicap in these subjects. An additional aim was to explore gender differences in coping, in perceived disability and in handicap in subjects with NIHL
| Materials & Methods|| |
The study sample consisted of 93 subjects, 60 men and 33 women. The mean-age of the women was 71 years (SD = 11 years) and for the males the mean-age was 55 years (SD = 11). This difference in age between gender was significant: the women were older (t = -6.95; df = 91; p< 0.001). All individuals had a hearing loss of a sensori-neural type and were consecutive patients at the hearing clinics at two hospitals in the western part of Sweden. The criteria for inclusion in the study were a puretone average (PTA) of more than 45 dBHL over the high frequencies (3, 4 and 6 kHz) and a history of noise-exposure (Heijbel & Liden, 1974). There was no significant gender difference in PTA over the high frequencies: PTA was 61 dBHL in both groups with standard deviations of 8 and 9 dBHL, respectively. PTA over the low frequencies (0.5, 1 and 2 kHz) was 22 dBHL (SD=11) in the male group and 37 dBHL (SD = 10) in the female group, which was a significant difference (t = -6.44; df = 91; p< 0.001). Accordingly, the females were older and had worse hearing on the low frequencies compared to the males. However, all subjects rated their hearing loss as "moderate" to "severe" on a four-point scale, ranging from "mild" (1) to "very severe" (4). Ten men (17%) and 23 women (70%) had hearing aids.
Two well-known and standardised questionnaires were used: the Communication Strategies Scale (CSS) and the Hearing Disability and Handicaps Scale (HDHS) intended to measure coping and perceived disability and handicap, respectively. The patients were requested to respond to these two questionnaires during their visit at the hearing clinic. The CSS was developed by Demorest and Erdman (1986) and was translated into Swedish by Hallberg and co-workers (1992). The questionnaire intends to measure three types of coping strategies: "maladaptive behaviour", "verbal strategies" and "nonverbal strategies". The CSS consists of 25 items on a five-point rating scale ranging from "almost never" (1) to "almost always" (5). Scores on the maladaptive behaviour scale were reversed before the statistical analysis, which means that low scores on all three subscales indicate potential problems. Some examples of items are "One way I get people to repeat what they said is by ignoring them" (maladaptive behaviour). "When I don´t understand what someone has said, I ask them to repeat it " (verbal strategy) and "When I must listen in a group, I try to sit where I´ll be able to hear better" (non-verbal strategy).
The HDHS was developed by Hetu and coworkers (1994) and was psychometrically evaluated for Swedish conditions by Hallberg (1998). The HDHS consists of 25 items on a four-point rating scale ranging from "seldom" (1) to "always" (4). The Swedish version of the scale contains four factorially derived subscales, labelled "speech perception" (factor 1), "nonspeech sounds" (factor 2), "interpersonal distress" (factor 3) and "threat to the self-image" (factor 4). Some examples of items included in the subscales are: "Do you have difficulty following a conversation normally in any of the following situations: at work, in a bus or a car, or when shopping?" (speech perception), "Do you have difficulties hearing the footsteps of someone coming into the room without seeing them?" (non-speech sounds), "Do you feel that your hearing condition has an influence on the relationship you have with your spouse or a person close to you?" (interpersonal distress) and "Do you ever get the feeling of being cut off from things because of your hearing difficulty?" (threat to the self-image). The summed scores of the first two factors, "speech perception" and "non-speech sounds", intends to measure "perceived disability", whereas the sum of the other two factors, "interpersonal distress" and "threat to the self-image", captures aspects of the handicap creation process.
| Results|| |
In the total sample (n = 93), non-verbal strategies were most often used in coping with demanding auditory situations: more often than "half of the time" (mean = 3.4; SD = 0.8) women and men used these coping strategies. Verbal strategies were used somewhat less often than "half of the time" (mean = 2.7; SD = 0.8) by the total study sample. Maladaptive behaviour was used "sometimes" in the total study sample.
No significant gender difference in the use of non-verbal strategies was found. In the male group, the mean value was 3.3 (SD = 0.9) and in the female group the mean was 3. 5 (SD = 0.5). Examples of non-verbal strategies are to listen carefully and catch the main points and to pay close attention to the speaker´s face. "Verbal strategies" were more often used by the female group (mean = 3.2; SD = 0.6) than in the male group (mean = 2.5; SD = 0.8). Verbal strategies could be exemplified by asking for repetition and informing others about the hearing loss. The difference between gender was significant (t = - 4.58; df = 80.72; p<0.001). "Maladaptive behaviour" was used more often in the female group (mean = 2.9; SD = 0.3) than in the male group (mean = 4.1; SD = 0.6). The scoring of maladaptive behaviour was reversed: low score indicates a frequent use. Maladaptive behaviour includes avoiding conversation, guessing what was said and dominating conversation. This difference between gender was significant (t = 11.26; df = 85,32; p<0.001). To sum up, the women in the study used "maladaptive behaviour" and "verbal strategies" significantly more often than did the men.
Perceived disability and perceived handicap
The mean value of "speech perception" (factor 1) was 14.0 (SD = 3.0) in both groups. For factor 2, "non-speech sounds", the figures for the male and female groups were 13.3 (SD = 3.4) and 12.2 (SD = 4.3), respectively. In the male group the mean-values for "interpersonal distress" (factor 3) and "threat to the self-image" (factor 4) were 10.0 (SD = 3.2) and 7.3 (SD = 2.4), respectively. The figures of factors 3 and 4 in the female group were 10.5 (SD = 4.1) and 7.4 (SD = 2.3), respectively. Accordingly, there were no significant differences between gender in any of the four factors of the HDHS see [Table - 3].
The mean-values for "perceived disability" were 27.3 (SD = 3.5) and 26.3 (SD = 6.8) in the male and the female group, respectively. The figures of "perceived handicap" were 17.3 (SD = 5.0) and 18.0 (SD = 6.1) for the male and the female group, respectively. Although there was a significant difference in PTA low (0.5, 1 and 2 kHz) but not in PTA high (2, 3 and 6 kHz) between genders, no significant differences in "perceived disability" and "perceived handicap" were found. All subjects rated their hearing loss as "moderate" to "severe" on a four-point scale, ranging from "mild" to "very severe". The subjective duration of hearing loss was more than 5 years for the majority of subjects (n = 63).
| Discussion|| |
It has been reported in several studies that men with NIHL often are unwilling to acknowledge hearing difficulties (e.g. Hetu et al., 1990; Hallberg & Barrenas, 1993; Hallberg & Barrenas, 1995). One way to minimise hearing difficulties is to use invisible non-verbal strategies such as intensive concentrating, sitting close to the speaker and try to catch the main points. Probably, both personality and situational context guides which coping strategy is chosen. However, there is a strong tie between being able-bodied and maleness. Reluctance to acknowledge hearing difficulties might indicate a need to avoid stigmatisation and preserve a positive self-image. According to McKellin (1994), a spoiled sense of identity is due to the cultural association of hearing disability with impaired cognitive skills and loss of manliness. Non-verbal coping strategies were used somewhat more often than "half of the time" by all subjects in the present study. The females used "verbal strategies" and "maladaptive behaviour", for example interrupting others when listening to them is difficult, asking for repetition and informing others about their hearing disability, significantly more often than the males. This is in line with results from an interview-study, showing that the perceived emotional temperature in the specific situation guided the women´s choice of coping strategy (Hallberg & Jansson, 1996). In an accepting and friendly climate, "verbal strategies" (e.g. asking for repetition) were used, whereas "maladaptive strategies" (e.g. pretending to hear) were used if the emotional climate was non-accepting or unfriendly. This indicates that the environment to a great extent influences coping with demanding auditory situations. Getty and Hetu (1994) have also focused on the gender difference in responses to hearing loss: efforts are made on the part of males to cope and meet auditory demands without disclosing their hearing loss.
The gender difference in coping with hearing loss found in the present study, could also be related to, and explained by, the conversational goal. Communication has two main functions: (1) a transactional or content-oriented function and (2) an interactional or relational function (Pichora-Fuller, 1997). Most talk fulfils to some degree both of these functions. However, the transactional function of language is often stressed in our information-focused culture: conversation mainly includes people asking questions in order to get information rather than recognising that much talk fulfils social functions, such as expressing solidarity and connectedness (Johnson & Pichora-Fuller, 1994). For example, clinical encounters between clinicians and clients are mainly transactional and information-oriented. The main goal is to provide information. An interesting research question to be answered is whether there is a gender difference in the goal of communication or not? A hypothesis is that the informational goal of conversation predominates among men, whereas the interactional goal, giving priority to social relationships and small talk, predominates among women. This hypothesis assumes that women have good relational listening ability, whereas men strive to extract informational details in their more task-oriented activities. Earlier research findings have indicated such a gender difference in communication goal (e.g. Maltz & Borker, 1982).
In this study, there were no significant gender differences in self-reported disability and selfreported handicap. Obviously, increased auditory problems, as indicated by pure-tone audiometry, do not always lead to an increase in self-reported disability and/or in self-reported handicap. Research has shown weak, moderate as well as strong correlations between pure-tone audiometry and perceived handicap (e.g. Lalande, Lambert & Riverin, 1988; Hallberg & Carlsson, 1991). It has also been reported that male perceptions of hearing-related handicap were more predictive of pure-tone audiometry than were female's perceptions (Anderson, Dancer & Durand, 1990). The female group had somewhat worse hearing on the low frequencies, but did not report more problems on the disability and handicap scales than the males.
This discrepancy between objectively measured hearing impairment (PTA) and the subjectively measured handicap (HDHS) could be understood by the actual communication goal (Johnson & Pichora-Fuller, 1994) and the choice of coping strategy. Clinical assessment of puretone audiometry, i.e. pure-tone tests in a sound isolated chamber, implicitly assumes that the purpose of communication is to exchange information (i.e. a transactional goal). Pure-tone tests do not adequately reflect the real life situations met by hearing impaired individuals. Therefore, pure-tone audiometry might be of less importance in the prediction of self-reported handicap. If the goal of communication is mainly interactional, it is less likely that the perceived handicap is increasing with the degree of hearing impairment. Society and the nature of the communication demand, rather than the physiological impairment, are handicapping to the individual. According to Kathy PichoraFuller (1997), "the issue is not so much what is heard, as what has to be done with what is heard".
| Conclusion|| |
In conclusion, women and men experience and cope with hearing loss differently and might also have different conversational goals.
| References|| |
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Department of Psychology, Göteborg University & Nordic School of Public Health, Göteborg
[Table - 1], [Table - 2], [Table - 3]