The Role of the Listener in Communicative Accessibility for People with Hearing Loss
A Qualitative Study
Abstract
Introduction and objective: The number of deaf individuals and those with hearing loss continues to grow, as do technological advances aimed at compensating for these limitations. However, such advances will remain insufficient unless accompanied by greater communicative responsibility on the part of listeners. The main objective of this study was to identify communicative barriers, contexts, and professionals, as well as resources in the daily lives of deaf and hard-of-hearing individuals, in order to recommend and incorporate practices that promote communicative accessibility.
Method: This qualitative, descriptive, phenomenographic study is based on semi-structured interviews conducted with deaf and hard-of-hearing individuals residing in Salamanca. Purposive sampling was employed, with data collection and parallel analysis continuing until saturation was reached (n = 11). Literal transcription and inductive coding were performed using Atlas.ti software.
Results: The analysis revealed five thematic categories: barriers, environments, professionals, resources, and emotions. The main communicative barriers were associated with the physical characteristics of environments, interlocutor attitudes, and linguistic violations—factors that generated negative emotions such as anger and sadness among participants. Healthcare settings were identified as particularly challenging for communicative interaction. Ensuring accessibility emerges as an unavoidable priority for all individuals.
Discussion: Communication barriers significantly limit opportunities for participation and autonomy among deaf and hard-of-hearing individuals.
Conclusions: This study highlights communicative adjustments by the listening interlocutor as essential for achieving effective and equitable interaction.
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Andersen AH, Santurette S, Pedersen MS, Alickovic E, Fiedler L, Jensen J, et al. Creating clarity in noisy environments by using deep learning in hearing aids. Semin Hear. 2021;42(3):260-81. https://doi.org/10.1055/s-0041-1735134. PMID: 34594089.
Balling LW, Mølgaard LL, Townend O, Nielsen JBB. The collaboration between hearing aid users and artificial intelligence to optimize sound. Semin Hear. 2021;42(3):282-94. https://doi.org/10.1055/s-0041-1735135. PMID: 34594090.
Fabry DA, Bhowmik AK. Improving speech understanding and monitoring health with hearing aids using artificial intelligence and embedded sensors. Semin Hear. 2021;42(3):295-308. https://doi.org/10.1055/s-0041-1735136. PMID: 34594091.
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Amariutei AE, Jeng JY, Safieddine S, Marcotti W. Recent advances and future challenges in gene therapy for hearing loss. R Soc Open Sci. 2023;10(6):230644. https://doi.org/10.1098/rsos.230644. PMID: 37325593.
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British Deaf Association. British Deaf Association responds to gene therapy trial to treat deafness: "Deaf children are not broken; what they need most of all is access to sign language" [Internet]. London: BDA News; 2024 [citado 8 Ene 2026]. Disponible en: https://bda.org.uk/gene-therapy-response/
National Deaf Center. Effective communication [Internet]. Austin: NDC Resources; 27 Sep 2017 [citado 8 Ene 2026]. Disponible en: https://nationaldeafcenter.org/resource-items/effective-communication/
Mairson TM, Howe E. Addressing structural audism in medicine: How those who are deaf and hard of hearing are marginalized in healthcare. Psychiatry. 2024;87(1):1-5. https://doi.org/10.1080/00332747.2023.2286844. PMID: 38266212.
Masuku KP, Moroe N, Van der Merwe D. "The world is not only for hearing people - It's for all people": The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa. Afr J Disabil. 2021;10:a800. https://doi.org/10.4102/ajod.v10i0.800. PMID: 34395202.
Olsson S, Dag M, Kullberg C. Hard of hearing adults' interpersonal interactions and relationships in daily life. Disabilities. 2021;1:71-88. https://doi.org/10.3390/disabilities1020007
Parmar B, Henshaw H, Howe S, Rolfe C, Le Mere P, et al. "I always feel like I'm the first deaf person they have ever met:" Deaf awareness, accessibility and communication in the United Kingdom's National Health Service (NHS): How can we do better? PLoS One. 2025;20(5):e0322850. https://doi.org/10.1371/journal.pone.0322850. PMID: 40333900.
Torallo SL. Hearing the unheard: life adaptation struggles and coping mechanisms of the deaf. Int J Open-Access Interdiscip New Educ Discov. 2025;4(1). https://doi.org/10.63498/nxz2st247
Waters-Johnson AZ. Living in silence: an autoethnography of relating, coping, and navigating daily challenges with hearing impairment. J Autoethnogr. 2021;2(1):39-54. https://doi.org/10.1525/joae.2021.2.1.39
Jorrín-Abellán I, Fontana-Abad M, Rubia-Avi B, coordinadores. Investigar en educación. Madrid: Síntesis; 2021.
Guest G, Bunce A, Johnson L. How Many Interviews Are Enough? An Experiment with Data Saturation and Variability. Field Methods. 2006;18(1):59-82. https://doi.org/10.1177/1525822X05279903
Crenshaw K. Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989;(140):139-67.
Besser J, Stropahl M, Urry E, Launer S. Comorbilidades de la hipoacusia y consecuencias de la multimorbilidad para la asistencia audiológica. Hear Res. 2018;369:3-14. https://doi.org/10.1016/j.heares.2018.06.008. PMID: 29941312.
España. Real Decreto 193/2023, de 21 de marzo, por el que se regulan las condiciones básicas de accesibilidad y no discriminación de las personas con discapacidad para el acceso y utilización de los bienes y servicios a disposición del público. Boletín Oficial del Estado, n. º 69, (22 de marzo de 2023). [citado 8 Ene 2026]. Disponible en: https://www.boe.es/eli/es/rd/2023/03/21/193/con
Organización Mundial de la Salud (OMS). Sordera y pérdida de la audición [Internet]. Ginebra: OMS; 26 Feb 2025 [citado 8 Ene 2026]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/deafness-and-hearing-loss
Olusanya BO, Ruben RJ, Parving A. Reducing the burden of communication disorders in the developing world: an opportunity for the millennium development project. JAMA. 2006;296(4):441-4. https://doi.org/10.1001/jama.296.4.441. PMID: 16868302.
Andersen AH, Santurette S, Pedersen MS, Alickovic E, Fiedler L, Jensen J, et al. Creating clarity in noisy environments by using deep learning in hearing aids. Semin Hear. 2021;42(3):260-81. https://doi.org/10.1055/s-0041-1735134. PMID: 34594089.
Balling LW, Mølgaard LL, Townend O, Nielsen JBB. The collaboration between hearing aid users and artificial intelligence to optimize sound. Semin Hear. 2021;42(3):282-94. https://doi.org/10.1055/s-0041-1735135. PMID: 34594090.
Fabry DA, Bhowmik AK. Improving speech understanding and monitoring health with hearing aids using artificial intelligence and embedded sensors. Semin Hear. 2021;42(3):295-308. https://doi.org/10.1055/s-0041-1735136. PMID: 34594091.
Frosolini A, Franz L, Caragli V, Genovese E, De Filippis C, Marioni G. Artificial intelligence in audiology: a scoping review of current applications and future directions. Sensors (Basel). 2024;24(22):7126. https://doi.org/10.3390/s24227126. PMID: 39598904.
Umashankar A, MN A, Pachaiappan C. Applications of artificial intelligence in hearing aids and auditory implants: a short review. J Hear Sci. 2021;11(3):20-3. https://doi.org/10.17430/JHS.2021.11.3.2
Khoza-Shangase K. Setting a research agenda for speech therapy and audiology practice in South Africa. S Afr J Commun Disord. 2025;72(1):e1-e6. https://doi.org/10.4102/sajcd.v72i1.1085. PMID: 40035119.
Amariutei AE, Jeng JY, Safieddine S, Marcotti W. Recent advances and future challenges in gene therapy for hearing loss. R Soc Open Sci. 2023;10(6):230644. https://doi.org/10.1098/rsos.230644. PMID: 37325593.
Ren Y, Landegger LD, Stankovic KM. Gene therapy for human sensorineural hearing loss. Front Cell Neurosci. 2019;13:323. https://doi.org/10.3389/fncel.2019.00323. PMID: 31379508.
British Deaf Association. British Deaf Association responds to gene therapy trial to treat deafness: "Deaf children are not broken; what they need most of all is access to sign language" [Internet]. London: BDA News; 2024 [citado 8 Ene 2026]. Disponible en: https://bda.org.uk/gene-therapy-response/
National Deaf Center. Effective communication [Internet]. Austin: NDC Resources; 27 Sep 2017 [citado 8 Ene 2026]. Disponible en: https://nationaldeafcenter.org/resource-items/effective-communication/
Mairson TM, Howe E. Addressing structural audism in medicine: How those who are deaf and hard of hearing are marginalized in healthcare. Psychiatry. 2024;87(1):1-5. https://doi.org/10.1080/00332747.2023.2286844. PMID: 38266212.
Masuku KP, Moroe N, Van der Merwe D. "The world is not only for hearing people - It's for all people": The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa. Afr J Disabil. 2021;10:a800. https://doi.org/10.4102/ajod.v10i0.800. PMID: 34395202.
Olsson S, Dag M, Kullberg C. Hard of hearing adults' interpersonal interactions and relationships in daily life. Disabilities. 2021;1:71-88. https://doi.org/10.3390/disabilities1020007
Parmar B, Henshaw H, Howe S, Rolfe C, Le Mere P, et al. "I always feel like I'm the first deaf person they have ever met:" Deaf awareness, accessibility and communication in the United Kingdom's National Health Service (NHS): How can we do better? PLoS One. 2025;20(5):e0322850. https://doi.org/10.1371/journal.pone.0322850. PMID: 40333900.
Torallo SL. Hearing the unheard: life adaptation struggles and coping mechanisms of the deaf. Int J Open-Access Interdiscip New Educ Discov. 2025;4(1). https://doi.org/10.63498/nxz2st247
Waters-Johnson AZ. Living in silence: an autoethnography of relating, coping, and navigating daily challenges with hearing impairment. J Autoethnogr. 2021;2(1):39-54. https://doi.org/10.1525/joae.2021.2.1.39
Jorrín-Abellán I, Fontana-Abad M, Rubia-Avi B, coordinadores. Investigar en educación. Madrid: Síntesis; 2021.
Guest G, Bunce A, Johnson L. How Many Interviews Are Enough? An Experiment with Data Saturation and Variability. Field Methods. 2006;18(1):59-82. https://doi.org/10.1177/1525822X05279903
Crenshaw K. Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989;(140):139-67.
Besser J, Stropahl M, Urry E, Launer S. Comorbilidades de la hipoacusia y consecuencias de la multimorbilidad para la asistencia audiológica. Hear Res. 2018;369:3-14. https://doi.org/10.1016/j.heares.2018.06.008. PMID: 29941312.
España. Real Decreto 193/2023, de 21 de marzo, por el que se regulan las condiciones básicas de accesibilidad y no discriminación de las personas con discapacidad para el acceso y utilización de los bienes y servicios a disposición del público. Boletín Oficial del Estado, n. º 69, (22 de marzo de 2023). [citado 8 Ene 2026]. Disponible en: https://www.boe.es/eli/es/rd/2023/03/21/193/con
TEIRA-SERRANO, C., REGATOS-CORCHETE, G., & ARTEAGA-OLASAGASTI, O. (2026). The Role of the Listener in Communicative Accessibility for People with Hearing Loss: A Qualitative Study. Revista ORL, 17(2), e34589. https://doi.org/10.14201/orl.34589
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