AN EVALUATION OF THE QUALITY OF LIFE OF HEARING IMPAIRED CHILDREN ATTENDING SPECIAL SCHOOLS IN THE SERBIAN EDUCATION SYSTEM

Abstract

Conclusion: The obtained results indicate that children with hearing impairment who are housed in the dormitories of schools for the deaf during their education have a favourable opinion of the quality of their lives, irrespective of the fact that they live in a dormitory compared to children who live with their families. Based on the analysis of literature related to the quality of life in the fields of social psychology, mental health, social integration and hiring, Hughes et al. Chirkinagic S, Bratkovic D, Repani I. Objective Quality of Life Indicators of Children With Disabilities in Regular and Specialized Foster Families, 6th International conference, Proceedings Living together, Association of special education teachers Croatia, Varazhdin, 2006; 289-300.

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Abstract

Quality of life is vague and difficult to define, since individual goals, in addition to economic, cultural, religious and educational factors, also have a dominant influence.

This study is aimed to determine the differences in the responses received on the quality of life of deaf and hard-of-hearing children and to show which of the two social protections, family or boarding school, provides better conditions for the assessment of the quality of life of these children.

The methods used in data processing included descriptive statistics and statistical analysis (Cronbach a, t-test and Pearson's correlation coefficient). All statistical analyses were performed in the statistical program SSPS 19. The sample consisted of 61 students in special schools for deaf children who were examined using a paediatric questionnaire about quality of life (Pediatric Quality of Life Inventory TM - PedsQL, version 4.0).

The results: With children who were housed in dormitories of special schools for deaf children, during their education we obtained less pronounced results ranging from 0,70 on the sub-scale of psycho-social health to 0,81 on the social scale.

Conclusion: The obtained results indicate that children with hearing impairment who are housed in the dormitories of schools for the deaf during their education have a favourable opinion of the quality of their lives, irrespective of the fact that they live in a dormitory compared to children who live with their families.

Keywords: quality of life, deaf children, family, boarding school, welfare

Introduction

Looking only at the plane of physical development, the complete absence of hearing (deafness) or severe hearing impairment does not represent an especially severe disadvantage. However, the consequences of this type of disability on psycho-social development and personality development, primarily in the field of communication and acquisition of a language/system of communication, classify deafness as one of the most difficult and severe impairments. For that reason, the problems faced by individuals with hearing impairment attract the attention of various professionals. Even today, the question of whether the child's family or the institution the child attends along with his/her hearing-impaired peers is the most stimulating environment for children with hearing impairment remains open.

The psycho-social difficulties faced by hearing-impaired individuals affect both psychological and social aspects of life. These aspects include feeling good about oneself, being comfortable in society, controlling tension and stress, as well as being able to fulfil goals in one's life. Hindley et al. (1) note the great importance of the family, especially the role of the parents in the development of children with hearing impairment, and conclude that the means of communication between deaf children and hearing parents represent the most important factor in the development of communicative skills, social development and achieving social maturity.

The concept of quality of life was first used by English economist Arthur Cecil Pigou when he spoke of welfare economics in his 1920 book, The Economics of Welfare. The term achieved mainstream popularity a few decades later when President of the United States John F. Kennedy used the term to describe the state of the nation. The term "quality of life" emerged as the potential unification of concepts that set goals for offering services, as well as the evaluation of their day-to-day influence on the people. When referring to the concept of quality of life, Felice (2) says that this definition varies and aggregates various developmental changes in the individual and his identity in nature, experience and lifestyles. He focuses on philosophical services: integration, maintaining relations and other types of connections, as well as the possibility of leading a typical and social life.

The World Health Organization (3) considers the quality of life to be the individual perception of one's own position in life, participation in the cultural context and the values of the system of life itself, as well as the relation towards one's own goal, expectations, standards and preoccupations. This represents a wide context in the fields of individual physical health, psychological status, financial independence or extent of independence, social relations and relationships. Bratkovic (4) considers that the quality of life of an individual living with someone with disabilities is determined, as it is for the population at large, through direct and indirect mutual relations in society, politics, culture, education, and thus types of support. At the same time, the quality of life of an individual with disabilities is primarily determined not only by their developmental difficulties but also by the conditions and influences of the environment that the individual is exposed to, including the attitudes of the social environment. Based on the analysis of literature related to the quality of life in the fields of social psychology, mental health, social integration and hiring, Hughes et al. (5) determined the existence of 15 basic dimensions of the quality of life: 1. A psychological sense of one's own satisfaction; 2. Social interaction; 3. Work and employment; 4. A physical sense of pleasure and material gain; 5. Self-determination, autonomy and personal choice; 6. Possession of skills, social adjustability and the skill of leading an independent life; 7. Social integration; 8. Social status and ecological awareness; 9. Personal development and a sense of fulfilment; 10. A place of residence; 11. Recreation and free time; 12. Normalization; 13. Individual and sociological demographic indicators; 14. Civic responsibility; and 15. Accepting the needed help. These cited dimensions of quality of life refer to the entire population, as well as the population of individuals with some form of impairment.

Research involving children with an impairment has indicated that their quality of life is much lower compared to that of children without an impairment, but it has also indicated that different problems influence their quality of life, both overall and in certain segments of functioning (6). The quality of life of children with an impairment decreased proportionately to the severity of the impairment but also to the presence of combined problems and other medical conditions. At the same time, the quality of life of these children decreased with their age, since older children had a lower quality of life relative to younger children. The study of the quality of life of deaf children and number of papers published on the topic have increased over the past few years. However, most papers focused on the study of the quality of life of hearing-impaired children with cochlear implants and their influence on the quality of life. The results indicated that the scores of students with disabilities were lower on all scales (7). Precisely because of that, the evaluation of the quality of life of hearing- impaired children can indicate the area of functioning and aspects of life that require additional support and the participation of experts, as well as improve understanding of the characteristics and needs of these children (8).

Many researchers have studied the differences in the quality of life between hearing and deaf schoolchildren (7,9) and found significant differences favouring the quality of life among hearing children compared to deaf children. On a scale, academic achievement-obtained estimates are worse for deaf children's quality of life compared to those with normal hearing. Significantly for the deaf population, the aforementioned study also indicates that hearing-impaired individuals who used individual hearing aids had a lower score on quality of life than the hearing-impaired who did not use any kind of hearing aid. The author links these results to the educational status of their parents, and so this study cannot be used as a reference for making any conclusions. Lin and Niparko (10) studied the quality of life of children with cochlear implants, while Borujeni, Hatamizadeh and Vameghi (11) studied the relations of the quality of life compared to the extent of hearing impairment on a sample of 255 adolescents aged 11 - 18 and compared them in relation to gender, age and success at school. Their results indicate that the quality of life was better among adolescents with smaller hearing impairment and that girls scored better results in the field of physical functioning. Shkrbic et al. (12) in Serbia in 2011 studied 52 adolescents aged 13 to 18 with hearing impairment and compared them to 122 hearing adolescents, determining that deafness does affect all aspects of the quality of their lives. Munoz-Baell and Ruiz (13) explained that the problems differ greatly between children born deaf, those who became hearing-impaired very early on in their lives, or children with late onset hearing impairment. Deafness at birth reflects a linguistic problem: a lack of communication that leads to social rejection, a humble education, difficulties in communication in lower-ranking jobs, and low income which, altogether, greatly impact the quality of life.

Hintermair (14) studied the quality of life of children with hearing impairment who attended regular schools (inclusive schools) in Germany. In his research, he found that the life of children with mild hearing impairment is almost identical to that of their hearing peers, but indicates that the quality of life of deaf children is closely linked to factors such as communicative ability, intelligence, academic achievement, etc. Umanski et al. (9) concluded that there are great differences in the evaluation of quality of life between hearing and deaf populations, primarily in terms of educational or social functioning. Heward (15) concluded that there were great problems in the psycho-social relations among deaf children, self-respect and the overall evaluation of the quality of life of deaf children. Qyewumi et al. (16) determined that there were far more problems in the behaviour and social skills of hearing-impaired schoolchildren than there were in the hearing population, which poses an important challenge to the psycho-social development of individuals with hearing impairment. The same author (16) also indicated a connection between the onset of the hearing impairment and the quality of life. However, very few studies dealt with the quality of life in deaf communities. It is possible that the evaluation of the quality of life in a hearing community, compared to that of a deaf community, led to the identification of differences. Savulesku (17) described that adult deaf individuals do not think that there is a problem with their own hearing-impaired children, since they do not consider deafness a type of disability, and instead think of it as the definition of their unique cultural identity and unique means of communication. The same author cites that many deaf parents refuse to provide their children who are also hearing-impaired with a cochlear implant, since they think they are choosing the "best direction in life" for their children. Thus, they accept the views of John Stewart Mill, a philosopher and radical reformist who claims that when our steps affect only ourselves, we should be free to build and act upon what we consider to be best in our lives.

This research aimed to study the quality of life of deaf and hearing-impaired children who are housed in boarding schools for children who are hearing impaired for the duration of their education and the quality of life of deaf and hearing-impaired children who stay with their families for the duration of their education. The paper analyses the differences in the quality of life of deaf and hearing-impaired children and should indicate which of the two social environments, one's own family or a boarding school, provides better conditions for higher quality of life among deaf and hearing-impaired children.

In accordance with the defined goal, a general hypothesis is established that the deaf and hearing-impaired schoolchildren who are being educated in special schools for the deaf and are staying with their families for the duration of their education have better quality of life than the deaf or hearing-impaired schoolchildren who are housed at the schools during their education.

Methods

The sample of participants included 61 deaf and hearing-impaired elementary school children, aged from 8 to 13, of both genders. The sample was divided into two sub-groups: the first consisted of 31 deaf and hearing-impaired individuals who were housed at their boarding school during their education, and the other of 30 school children who lived with their families during their education. The sample was made up of the school children of the Radivoj Popovic Elementary School from Zemun, 30 of whom were housed in the aforementioned school, and 31 school children from the Stefan of Dechani school for the deaf-hearing impaired from Belgrade, who come to school every day from their family homes. The sample consisted of 28 boys and 33 girls.

Table 1 shows that in the overall sample of participants, the girls comprise the majority (33 or 54.1%) when compared to the boys. The group of participants who during their education lived with their families or in the boarding school for children with hearing impairment were almost equal (50,8% in comparison to 49.2%, respectively).

Data on the extent of the hearing impairment were taken from the personal records of the school children, that is, from the school files, and the sample was homogenous in terms of hearing impairment, that is, all the school children had hearing impairment ranging from 41-60 dB and were classified as schoolchildren with moderate hearing impairment. None of the respondents had some other kind of disability, and they all experienced hearing loss at an early age (before the age of three). All subjects are ruled by the oral and sign language and during the tests used by the individual hearing aids.

The study did not infringe on the rights of the participants, and the data that were obtained were protected and available only to the researcher. The participants were informed of the study and its goals, the confidentiality of the data, and the legal guardians (the parents and school principals) of the participants gave their consent for participation in this study.

For the purpose of this study we used the Pediatrics Quality of Life Inventory TM (PedsQL(TM)) version 4.0. The questionnaire belongs to the group of generic questionnaires that serve to evaluate the quality of life of children aged 8- 13, contains 23 questions that are classified into 4 scales, and the responses are grouped from 0 - 4. The scales include: Emotional functioning (8 items); Social functioning (5 items); School functioning (5 items); and Physical functioning (5 items). The scores from the questionnaires were descriptively processed for the group of deaf and hearing-impaired schoolchildren housed in the boarding school and the group of deaf and hearing-impaired school children who lived with their families and are shown using percentages and frequencies for each area and item from each studied area. The questionnaire was translated into Serbian and has been culturally adapted. The scale contains five levels of scoring: 0 = never presents a problem; 1 = almost never presents a problem; 2 = sometimes presents a problem; 3 = often presents a problem; 4 = almost always present a problem. When processing the data, reverse scoring and a linear transformation is made into the 0 - 100 scale (0-100; 1-75; 2-50; 3-25; 4-0), so that a higher result also represents the higher quality of life. The results (scores) of the scale were counted as the sum of the items divided by the number of responses. By processing the obtained data, we obtained scores for the four sub-scales and three summary scores. The summary score of physical health responds to the sub-scale of physical functioning, while the summary of psycho-social health calculates the average responses to the sub-scales of emotional, social and functioning at school. The total scale score represents the sum of all of the items over the number of overall responses on all the scales.

Table 2 shows the Cronbach's alpha coefficient of consistency of the subscale and scale as a whole.

The reliability coefficient obtained based on the evaluation of children with hearing impairment who lived with their families during their education ranged from 0.64 on the emotional sub-scale up to 0,80 on the sub-scale of physical health. Children who stayed in the dormitory of the school for hearing-impaired children during their education scored less pronounced results, which ranged from 0.70 on the sub-scale of psycho-social health up to 0.81 on the social scale.

For our sample, the scale as a whole had a good internal consistency, since Cronbach's alpha coefficient has a value of 0.748. In addition, each of the sub-scales individually indicates a high level of reliability, and Cronbach's alpha coefficients range from 0.701 to 0.820. Based on the obtained results (Cronbach's alpha < 0.70) we can conclude that there is the possibility of adequate group comparison.

It took approximately 5 to 20 minutes to complete the questionnaire, since the completion was carried out in smaller groups, as was the reading of the questions and their interpretation via sign language on the part of a licensed interpreter, so that every question could be understood in detail by each of the participants with hearing impairment.

The statistical analysis of the obtained data included descriptive statistics and a statistical analysis (Cronbach's a, the t-test and Pearson's correlation coefficient). All of the statistical analyses were calculated in the statistical program SSPS 19.

Results

Reliability of the questionnaire was calculated by using the Cronbach's alpha coefficient in a sample of children with impaired hearing who reside in special boarding schools and with their families during their education, and the entire sample presented the following results:

Based on the self-evaluation of children with hearing impairment who lived with their families during their education, and of children with hearing impairment who lived in the dormitories of a school for children with hearing impairment during their education, the average values and the standard deviation on the scale and subscales of the questionnaire are shown in Table 3.

An evaluation of the quality of life indicated that children who lived with their families during their education provided lower scores compared to the children who stayed in the dormitory of the school for children with hearing impairment (table 4), except for the subscales physical health and social subscale.

The agreement between the evaluations of children with hearing impairment who lived with their families during their education or in the dormitory of the school for children with hearing impairment was calculated using Pearson's correlation coefficient r (Table 4.). After the results were processed, a low level of agreement was represented by any value of the correlation coefficient r < 0.40; moderate agreement 0.41 - 0.60; high agreement 0.61 - 0.80 and very high agreement 0.81 - 1 (20). The highest level of agreement in the responses of the children with hearing impairment who lived with their families and who lived in the dormitory were obtained on the sub-scale of functioning at school (r = 0.62, high) while the lowest were on the social subscale (r = 0.33, low) and the scale of physical health (r = 0.37, low). All of the remaining values were at the level of moderate agreement.

It is significant to point out that children from boarding schools achieve better results in all subscale except subscale academic achievement, where the difference of 0.11 in value of children from families

Discussion

On the scale and all the sub-scales, the children with hearing impairment who spend their time in the boarding school for the hearing-impaired during their education evaluated their quality of life as being higher compared to children with hearing impairment who lived with their families during their education. The difference between the average scores on the scale and all the sub-scales was statistically significant (p = 0.026). On two scales (Physical health 9.12 relative to the 8.33, and Social subscale 10.41 relative to the 10.13) children who live in the family have achieved better results compared to children from dormitory. The obtained results were expected since hearing-impaired children staying in the boarding school were more socially adjusted, more adjusted in general and less demanding than children who were living with their families, due to the restrictive conditions in which they spend their time during their education.

The factor analysis was also checked through the value of the Kaiser-Meyer-Olkin index, which had a value of 0.792. It exceeds the recommended minimal value of 0.6 (18) and gives a medium recommended value of the coefficient of 0.70 - 0.79. The Kaiser-Mayer-Olkin index serves to compare the magnitude of the studied correlation coefficients depending on the size of the partial correlation coefficients. Partial correlations are the net correlations between two variables where the influence of one or more additional variables has been eliminated. This index offers an evaluation of the suitability of the matrix for factor analysis, based on whether the variables in the matrix belong in psychometric studies. The obtained result (0.792) in our study indicates a satisfactory representative nature of the measured variables and a factor analysis is justified for the given variables.

At the same time, Bartlett's sphericity test (19) indicated a statistical significance, and the Bartlett Chi Score has a value of 694.389, that is, a statistical significance of 0.000. In statistical analysis, this test is used if the samples extracted from the population are approximately the same. This equal deviation over the sample represents the homogeneity of the variance, and Bartlett's test verifies this assumption.

For the participants who live with their families during their education, the average Index of the quality of life has a value of 49.35 with a standard deviation of 15.36. The theoretical range in which the values of the index can vary is from 0 to 100. The range in which the values of the index for the first group of participants (children who live in the family) ranges from 33 to 62. The Index of the quality of life for the second studied group (children who live in the dormitory of their boarding school) has a value of 51.43 with a standard deviation of 17.91. The individual values range from 50 to 61. This group has greater variability of individual values and greater range of the Index.

Conclusion

The quality of life is a complex concept, since authors from various professions use and interpret this concept in a variety of ways. However, everyone agrees that we are dealing with a concept that includes a great many objective and subjective factors for satisfying the needs and self-perception of the individual. The quality of life can be a problem in the case of children with hearing impairment, since we cannot deny the importance of communication, that is, participation of these children in daily life within the hearing environment. Hearing impairment causes problems in communication, whether as developmental delays of speech and language, or social isolation or stigma in these children, and their assessment of their quality of life cannot be considered satisfactory. Therefore, the evaluation of the quality of life today represents an integral part of monitoring the development and outcome of the rehabilitation and education of children with developmental issues, and thus children with hearing impairment and speech impairment.

The evaluation of the quality of life provided by the deaf children themselves represents an additional challenge, since it assumes that they are at a certain level of cognitive development as well as a level of development of speech and language function. This assumption was why the paper focused on a group of children with hearing impairment aged 8-13, since we considered that they possess an adequate language and cognitive component to understand the purpose of the survey and to understand what was being asked of them. Of course, during the data collection part of the study a sign language interpreter, who translated each question (and the possible responses) into sign language so that the children could understand better, was present.

The obtained results indicate that children with hearing impairment who are housed in the dormitory of the school for hearing-impaired individuals during their education have a more favourable opinion of the quality of their lives, irrespective of the fact that they live in a sheltered environment (a boarding school), compared to children who live with their families. It has been proven that in almost all the aspects, lower responses were obtained in relation to quality of life among children who live with their families, except on the scale of physical health (AS = 9,12 compared to AS = 8,33 for children from boarding school) and social subscale (M = 10.41, compared to 10.13 for children from boarding school), even though the results should be more favourable for this group of children, that is, there was an expectation of greater satisfaction of these participants compared to children attending boarding school. In the studies carried out to date on quality of life, the comparison was always carried out between a hearing population (of children) and children with hearing impairment, and these differences were always obviously in favour of the hearing population. In this paper, we tried to study two groups of children with hearing impairment who are housed in two different environments, children who lived with their families during their education and attended a school for the hearing impaired daily, and children who were housed in a boarding school that was specifically suited for deaf children during their education. The moderate agreement that was obtained in the study could influence the improvement in the quality of their lives. The results could be presented to the parents who should recognize the challenges that hearing-impaired children face, as well as experts who address the problematic structure of hearing impairment and who work with this type of disability on their rehabilitation and education.

Conflict of interests

Authors declares no conflict of interests.

Pe$epeHU,uu / References

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Radomir Branislav ARSIC1

Srboljub Vlastimir DJORDJEVIC2

1University of Pristina-Kosovska Mitrovica, Theacher Training Faculty in Prizren-Leposavic, Serbia

2University of Nis, Theacher Training Faculty in Vranje, Serbia

Recived: 25.11.2017

Accepted: 27.01.2017

Original article

Corresponding address:

Radomir Arsic Svetolika Rankovica 6, 34300 Arandjelovac, Serbia

Phone: ++381 63 77 37 078

E-mail: [email protected]