Towards Context-Specific EHDI Services: Understanding Caregivers' Priorities and Preferences in South Africa Through a Conjoint Analysis

Background: Early Hearing Detection and Intervention (EHDI) programmes are critical for addressing hearing impairment in children by ensuring timely diagnosis and intervention. However, systemic barriers such as linguistic diversity, financial constraints and geographic accessibility challenges hinder equitable access to EHDI services in South Africa. This study explores caregivers' preferences for key attributes of EHDI services to inform the development of context-specific and family-centred programmes. Methods: A cross-sectional survey utilizing conjoint analysis was conducted with 31 caregivers of children with hearing impairment enrolled in early intervention preschools in Gauteng, South Africa. Participants evaluated five key attributes of EHDI services: language of service provision, location of diagnostic evaluations, mode of early intervention delivery, integration of support services and cost reduction strategies. Data were analysed using the conditional logit model to determine attribute preferences. Results: Caregivers preferred services provided in their home language, diagnostic evaluations conducted at the nearest healthcare facility, home-based early intervention sessions, regular integration of support services and reductions in the cost of EHDI services. Reluctance to adopt telehealth was also noted, highlighting concerns about technological literacy, internet access and trust in virtual care delivery. These preferences emphasize the need for accessible, linguistically congruent and affordable EHDI services tailored to the South African context. Conclusions: This study provides valuable insights into caregivers' preferences for EHDI services, offering actionable recommendations to address systemic barriers such as designing EHDI services that address systemic barriers to ensure equity in healthcare access. Policymakers and stakeholders should prioritize linguistically diverse service delivery, improve healthcare facility accessibility, incorporate continuous informational counselling and reduce financial burdens to ensure equitable and family-centred EHDI programmes. Future research should explore preferences among a more geographically and socio-economically diverse population to further refine these recommendations. While grounded in South Africa, the results provide insights applicable to other low- and middle-income countries (LMICs) with similar challenges.