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Pediatric Audiology

Evaluating Self-Efficacy in Parents of Children with Hearing Loss

Ambrose, Sophie E. PhD; Appenzeller, Margo PhD; DesJardin, Jean L. PhD

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doi: 10.1097/01.HJ.0000717176.09147.0d
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For young children with hearing loss to learn a spoken language, their parents or caregivers must ensure the child's consistent use of appropriately fit hearing devices and exposure to high levels of quality linguistic input.1-5 However, since the overwhelming majority of deaf and hard-of-hearing children are born to parents with normal hearing who may have limited knowledge about hearing devices and language skills enhancement,6 parents may need additional support to provide their children with optimal auditory access and language-rich environments.

Photo courtesy of Boys Town National Research Hospital. Audiology, advocacy, hearing loss.
Figure 1
Figure 1:
SPISE-R scores in the knowledge and confidence sections. Boxes: Twenty-fifth to 75th percentile (interquartile range); whiskers: minimum and maximum values, except where indicated by circles representing outlier scores; solid lines: medians. Audiology, advocacy, hearing loss.
Figure 2
Figure 2:
Relationship between knowledge (purple circles) and confidence (orange triangles) total scores and action total scores, hearing device use, and language outcomes. The figure shows individual variability in the data and the strong impact of two low-scoring participants on the relationships between confidence and language outcomes. Audiology, advocacy, hearing loss.

Early interventions for young children with hearing loss highlight the critical role of parents and caregivers in supporting and teaching their young child at home. As professionals working with parents of young children with hearing loss, our responsibilities include ensuring that parents understand their child's hearing and language needs and have the knowledge and confidence necessary to carry out tasks relevant to meeting those needs. Knowledge and confidence are key components of parental self-efficacy (PSE), which refers to parents’ perceptions of their competence and confidence in their ability to carry out specific parenting tasks.7,8 PSE is positively related to a variety of desirable outcomes in both children with normal hearing9–11 and children with hearing loss.2,12,13 PSE has also been shown to be malleable given appropriate interventions.9 Noting the potential impact of changes in PSE, we investigated PSE in terms of supporting a child's hearing device use and language development.


To develop a better understanding of these constructs, we recently revised the Scale of Parental Involvement and Self-Efficacy (SPISE)14 and created the SPISE-R,15,16 a parent questionnaire with five sections. The first four use a seven-point Likert scale to query parents’ perceptions of their beliefs (seven items), knowledge (10 items), confidence (10 items), and actions (15 items) relevant to supporting their child's auditory access and language development. In the sections on knowledge, confidence, and action, higher scores indicate higher levels of the construct being measured. These sections yield a total score, which is the average of all items in the section, and two additional scores: the average score for auditory access items and the average score for language development items. The final section of the SPISE-R asks how long the child typically wears his or her hearing device. Free access to the SPISE-R is available in the appendix of the study by Ambrose, et al.15

Our study involved a fairly large group of parents who were asked about their perceptions of PSE and their child's hearing device use.15 We were particularly interested in how PSE constructs (knowledge and competence) related to each other as well as to factors such as demographics (e.g., parent education level), parents’ self-reported actions, and child factors (hearing device use and language abilities).

Results indicated that overall, parental knowledge and confidence were positively and strongly related, and the majority of the parents reported relatively high levels of knowledge and confidence, both for items relevant to supporting their child's auditory access and items relevant to supporting their child's language development. Parents of children with cochlear implants reported higher knowledge levels than parents of children with hearing aids, and mothers reported higher confidence levels than fathers. However, none of the other demographic characteristics we examined (parent gender, parent education level, having an immediate family member with hearing loss, child age, degree of hearing loss, and age at hearing loss diagnosis) were significantly related to either knowledge or confidence. Inspection of individual data indicated high variability between participants, with some parents reporting substantially lower knowledge and confidence levels than others. In both sections, the item with the lowest score pertained to use of the Ling 6-Sound test, indicating either that parents may not know much about this screening tool or parents need additional support to utilize this test in checking the function of their child's device daily.


We were particularly interested in finding out whether knowledge or confidence was related to the parents’ perceptions of their own actions and their children's hearing device use and language outcomes since these relationships may point toward the benefits of high levels of PSE. Study findings indicated that both knowledge and confidence scores were significantly correlated with action scores and hearing device use, whereas only confidence scores were significantly correlated with language scores (see Fig. 2). These results imply that parents who perceive themselves as knowledgeable and confident in a particular skill, such as keeping their child's device on, believe they can successfully apply that skill at home, and that these characteristics are tied to desirable outcomes such as consistent device use. Parents’ perceived confidence levels may be particularly important in supporting language development. For example, parents who reported being highly confident in their ability to help their children communicate their wants and needs were likely to have children with strong language outcomes.


Results from several studies indicate the potential of SPISE-R for educational and clinical use to better understand the areas in which parents show strengths and areas in which parents may need additional support to meet the needs of their young child with hearing loss. When time with families is limited during appointments or early intervention sessions, the SPISE-R may prove especially useful in identifying topics and skills for which professionals should provide additional support. Further research is needed to determine how best to use the SPISE-R in clinical and educational settings with families, which intervention strategies may influence parents’ self-efficacy (e.g., use of video feedback for parent-child interactions, hands-on practice with troubleshooting hearing devices), and if the resulting changes have an impact on parents’ behaviors and children's language outcomes over time.


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