Bustos Rubilar, Mario Andres; (2024) Factors affecting outcomes in children with cochlear implants in Chile considering the Latin American Context. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

In Chile, one of the most developed countries in Latin America, the incidence of congenital deafness in children is approximately 2.8 per 1000 newborns. This represents a significant challenge for the public health system in terms of intervention. Deaf children with permanent, severe, or profound hearing loss face multiple communication challenges, which can be addressed through the use of sign language, spoken language, or a mixed communication. When it comes to spoken language development, equipping deaf children with cochlear implants (CI) has proven to be beneficial, especially when the implantation occurs at an early age. Rehabilitative interventions for deaf children in Chile are implemented within the framework of the Explicit Healthcare Guarantees (GES) policy. However, up to the present time, no study has been published to evaluate the effectiveness of the national policies incorporated in this plan. Furthermore, there is a need for local measures of expected outcomes with CI and the factors influencing these outcomes in Chile and Latin America. This is particularly important given the shared challenges in the region, such as inequalities and social determinants of health. Thus, the aim of this thesis was to determine the factors affecting spoken language outcomes in children with CI in Chile, taking into account the Latin American context. The project involved multiple investigations, including the transcultural adaptation of instruments into Chilean Spanish, the characterisation of the national population of children and adults with CI (n=107), and a longitudinal follow-up study on the progress of spoken language in a sub-sample of children with CI in Chile (n=49). The results of these studies were consistent with previous research, highlighting that influencing factors depend on the child, the family, and the local context. These factors encompass early identification, additional challenges, social determinants of health, the daily CI use, family involvement, and the use of spoken language in educational environments. The thesis also offers significant insights into the underdevelopment of spoken language skills among our sample of children with CI in Chile and the role of social inequalities in hindering their progress. Additionally, they shed light on the lack of policies directed toward minority groups, such as children with disabilities, which are issues specific to Chile and the Latin American region.

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