Parental perspectives on services, support and pathways in the early intervention and early education of children who are deaf or hard of hearing in South Africa

Early hearing detection and intervention (EHDI) frameworks aligned with international and/or local contextual guidelines are intended to facilitate early intervention (EI), but actualisation challenges remain, particularly in low-middle-income countries. This study explored parent/caregiver experiences of EI and early education (EE) South African realities for children who are Deaf/Hard-of-Hearing (D/HH). A multi-method qualitative descriptive study was applied using surveys, interviews, and preschool reports analysis. Twenty-two parents from three special schools for the Deaf in one province participated. Ten completed in-depth telephonic interviews, 19 provided access to their child’s preschool report. Data were collected between August 2023 and August 2024. Univariate descriptive statistics were applied with reflexive thematic analysis. Five themes were identified: Service Disparities as a Function of Type, Access, and Timing; EE Preference of sign-based schooling environments over mainstream; Differential Support: Schools and Families as Consistent Anchors; No Facilitated Communication between Departments/Sectors; Parent Recommendations for Change Based on Overall Journey Description. Participants described EI and EE delays, distress experienced in mainstream preschool settings, reduced support, and limited interdepartmental/sectoral collaboration. Despite South Africa’s disability legislation, EI and EE services remain fragmented, suggesting that current policy frameworks lack the detail necessary for appropriate, timely service receipt. Mandating EHDI policy with cross-sectoral operational communication details and mechanisms within a defined, tiered approach, based on grassroots stakeholder input, is imperative for adequate EI and EE for South African D/HH children. Clinical relevance: Findings highlight the urgent need for mandated, cross-sectoral EHDI policy implementation to ensure equitable, timely support for D/HH children in South Africa.