The effectiveness of an integrative therapeutic program in enhancing psychological hardiness among hard-of-hearing female adolescents in Saudi Arabia

Abstract Background Hard-of-hearing (HOH) female adolescents may experience psychological challenges that can affect their adaptation and well-being. Psychological hardiness may serve as an important psychological resource for coping with such challenges, highlighting the need for targeted therapeutic interventions for this population. Aim This study aimed to examine the effectiveness of an integrative therapeutic program in enhancing psychological hardiness among HOH female adolescents in Al-Ahsa Governorate, Saudi Arabia. Results Among the initial sample of 69 DHH female adolescents, the mean psychological hardiness score was (M = 2.87), indicating a moderate descriptive level, with statistically significant differences according to degree of hearing loss, educational level, type of hearing assistive device, preferred communication method, parents’ hearing status, and educational environment. In the intervention stage, the experimental group showed a significant improvement in psychological hardiness from pre- to post-intervention ( r = .88), whereas the control group showed no change. Post-intervention psychological hardiness was higher in the intervention group than in the control group, with a large effect size ( r = .83; η² = 0.61). Conclusion The findings provide preliminary evidence supporting the potential value of integrative therapeutic interventions for enhancing psychological hardiness among HOH female adolescents. Trial registration The intervention was conducted from January 15, 2026, to March 12, 2026. The study was subsequently registered on ClinicalTrials.gov (NCT07514468) on March 31, 2026, and was therefore retrospectively registered. The retrospective registration occurred because the researchers did not complete the ClinicalTrials.gov registration process before the intervention commenced. The trial record is currently publicly available. Importantly, the study protocol, eligibility criteria, intervention procedures, outcome measures, and data collection procedures had been established before the start of the intervention and were not modified as a result of the retrospective registration. The information reported in the ClinicalTrials.gov record was reviewed to ensure consistency with the corresponding study details reported in the manuscript. Methodology The study was conducted in two stages. In the first stage, a researchers-developed Psychological Hardiness Scale was administered to 69 DHH female adolescents recruited from middle and secondary schools in Al-Ahsa Governorate, Saudi Arabia to assess their level of psychological hardiness and examine differences according to selected demographic characteristics. In the second stage, 25 HOH female adolescents with relatively low psychological hardiness scores who met the eligibility criteria were purposively selected. Of these, 15 who agreed to receive the therapeutic program constituted the intervention group, while 10 who did not receive the program but agreed to complete the pre- and post-intervention assessments constituted the control group.