Identifying a context-effective school hearing screening test: An emic/etic framework

Objective: To identify a context-effective hearing screening test for primary schools in the Western Cape, South Africa using an emic-etic framework for test selection. Design: A sequential mixed methods design was used to: (1) Identify test properties needed to successfully screen hearing in primary school children in the Western Cape, (2) select the hearing screening test most likely to succeed in this context, and (3) assess the use of the test in context. Study sample: Three nurses, two nursing assistants, two paediatric audiologists, and 100 grade-one children participated. Results: Distortion product otoacoustic emissions (DPOAEs) were identified as the test most likely to succeed as a hearing screening test in primary school children in the Western Cape. While school nurses were able to successfully apply OAE testing in this context, its sensitivity to hearing loss in these children was 57.14%. Conclusions: The sensitivity would need to be improved before OAE testing could be used as a context-effective screening test for primary school children in the Western Cape. The study demonstrated the value of collaborative program planning using an emic-etic framework to ensure that screening tests are contextually appropriate.