Key findings about hearing loss in the working-life: a scoping review from a well-being perspective

Abstract

Objective

This scoping review investigated key findings about hearing loss (HL) in the working life (WL) from a well-being perspective.

Design

A scoping review protocol was used to search the literature and to explore and extract key findings. A narrative analysis of key findings was used to group the data into themes. Study sample: Fifty-three articles from 29 different journals were included in the analysis.

Results

The narrative analysis identified three broad themes; individual aspects, work environment and work organisation. Individual aspects concerned problems that workers with HL experienced in their working lives, strategies they used to manage their working lives and different aspects of health in relation to WL. Work environment focussed on the physical, organisational and social work environment. Work organisation identified aspects related to division of labour and employment status.

Conclusions

Several of the included papers revealed lots of findings but did not substantially discuss the findings from a WL perspective. HL and well-being in WL is a multidimensional phenomenon due to the interplay between the individual and the environment. This interplay is rarely discussed in the included papers. Furthermore, intersectional aspects are infrequently highlighted and need to be further explored in future research.

Keywords:

• Hearing loss
• working life
• well-being
• scoping review
• health
• employment

Introduction

Health and well-being in working life (WL) have been studied extensively, and research on work-related health points towards several work environment factors that affect health in general in different ways, such as the nature of the work and the psychosocial work climate. Important factors relate to the individual experience of control, balance and social support in the work situation. Experiencing too little or too much control and receiving low social support in a work situation may lead to psychological strain, which, in turn, can result in ill-health (Swedish Council on Health Technology Assessment [SBU] 2014). The experience of justice and equality in the workplace has also been studied. Jobs that offer limited opportunities for development and stimulation can result in reduced well-being and thereby increase the risk of ill-health. Furthermore, perceived injustices in the workplace are stress factors that can also result in ill-health (Swedish Council on Health Technology Assessment [SBU] 2014; Nieuwenhuijsen et al. 2010; Jung and Bhattacharyya 2012).

Persons with hearing loss in working life

Persons with hearing loss (HL) are vulnerable in WL. Research in the area demonstrates an overrepresentation of sick leave and an increased use of social and employment benefits related to work and sick leave among workers with HL (Fischer et al. 2014; Danermark and Gellerstedt 2004; Hogan et al. 2009; Kramer et al. 2006; Pierre et al. 2012). Furthermore, persons with HL are more likely to be unemployed and earn less than the average population (Jung and Bhattacharyya 2012).

WL research on employees with HL has identified several health problems in relation to work-related health (Danermark and Gellerstedt 2004; Backenroth-Ohsako et al. 2003). Women with HL seem to be particularly affected by ill health (Danermark and Gellerstedt 2004; Coniavitis Gellerstedt and Danermark 2004; Svinndal et al. 2018), which mirrors an overall gender-related pattern in the labour market (Mastekaasa and Melsom 2014). Furthermore, scientific studies have highlighted different kinds of barriers in WL for persons with HL, such as a lack of workplace accommodations (Svinndal et al. 2018; Punch et al. 2007) and insufficient assistive technologies (Jennings and Shaw 2008; Koskela et al. 2016). Other significant barriers include the lack of support from significant others (Shaw et al. 2013b; Svinndal et al. 2020b) and employers’ attitudes and knowledge about HL in relation to the work situation (Koskela et al. 2016; Shaw et al. 2013b; Doolabh and Khan 2020; Svinndal et al. 2020a).

Some studies have focussed on facilitating factors in relation to work and HL. Accommodations in the workplace, such as flexibility in working conditions (e.g. organising the workday and the tasks), and individuals’ strategies to manage their work situation (e.g. visual support and physical positioning) have been identified as facilitating factors (Svinndal et al. 2020b). Working-life research that focuses on persons with disabilities in general concludes that facilitating conditions in the work situation interact positively with several factors, such as an inclusive work climate (Erickson et al. 2014; Nelissen et al. 2014), leadership (Kensbock and Boehm 2016; Luu 2019a; Luu 2019b), social inclusion in the workplace (Gustafsson et al. 2018), and working in a customised work situation (McLaughlin et al. 2004; Nevala et al. 2015).

A counterpart to ill-health is well-being. There is no consensus on the concept of “well-being”, and many different definitions exist depending on the domain in which it is used, such as the emotional, physical, social, societal and workplace domains (e.g. Dodge et al. 2012). Based on the purpose of creating an overview of HL in WL, this study will use the definition of workplace well-being by the International Labour Organization (2020) as a conceptual framework. The definition reads, “Workplace well-being relates to all aspects of working life, from the quality and safety of the physical environment, to how workers feel about their work, their working environment, the climate at work and work organization”.

Currently, no review of key aspects of WL in relation to HL has been identified. Punch (2016) conducted a review based on 21 included papers on workplace barriers, facilitators and accommodations for persons who are deaf or hard-of-hearing. The author found that there was a lack of awareness among employers, supervisors and other employees concerning proper accommodations to use in the workplace. Having to ask for work-place accommodations was also identified as a barrier in the WL of employees. Furthermore, the study concluded that the perspective of the employer, supervisor and human resource professionals were clearly missing in the research area, resulting in a very narrow perspective in the working-life research. A clear limitation in the study by Punch (2016) is that the author made no distinction between the two groups, which makes it impossible to tell if the results are valid for persons with HL only. In this study, the specific research questions are as follows:

• Which key findings about the target group in WL are reported?

• How do the reported findings relate to the workplace well-being definition of the ILO?

Methods

Study design

This study is a scoping review and utilises the methodology outlined by the Joanna Briggs Institute (Peters et al. 2020; Peters et al. 2015). To date, few literature reviews of WL research in relation to HL have been performed. It was decided that mapping of the literature should be executed, and key findings in relation to the specific research questions should be explored. The former outlined reason is also the most common motive to conduct a scoping review (Tricco et al. 2016).

Review protocol

Prior to the study, a study protocol was developed. The protocol consists of information regarding study objectives, study characteristics, methods and reporting.

Eligibility criteria

According to the methodology, the “PCC” mnemonic (Population, Concept and Context) is used as a guide to construct the objectives and the title for a scoping review. In this review, the population consists of the following:

• working adults (who are paid for their work), with any type and any degree of HL, acquired or congenital;

• working age (can differ between countries, approximately 18–67 years);

• oral communication as first communication mode;

• hearing aid (HA) users, cochlear implant (CI) users, as well as nonusers of HA or CI;

• known HL-related comorbidities, such as tinnitus and hyperacusis, if accompanied by HL;

• any perspective of HL in WL (i.e. client perspective, professional perspective and family perspective).

The concept

• all types of findings reported (e.g. sick leave, reported aspects [such as communication, energy level, identity and control/demand of work] related to HL in WL);

• outlined theoretical approach in the papers.

The context

• WL; paid work (employer, employee and own business);

• any country

Furthermore, some particulars were set to facilitate the search and eligibility processes. These were:

• peer-reviewed, scientific journals

• original studies

• focus in the paper on HL and WL

• published 1990–2020

• English language

The exclusion criteria were as follows:

Hearing impairment without HL (e.g. only tinnitus, hyperacusis), multiple disabilities (e.g. deaf-blindness, reported dual-sensory loss), deafness involving sign language, mixed target groups if also mixed in the results section, prevalence studies of HL in the general work force, risk factors for HL in the general work force, systematic reviews, meta-analyses, meta-syntheses, tutorials (and similar), books, book chapters, letters, columns and sounding board articles.

Information sources and search strategies

A comprehensive literature search was conducted in collaboration with a skilled librarian. A test search was performed in a variety of scientific databases used in other reviews within the HL area (e.g., Granberg et al. 2014), and final conclusions of relevant databases and adequate search strategies were made based on the test search. The selected databases were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, PubMed and Web of Science. The selected search terms and search strategies varied according to database structure. The different searches were executed in blocks that were combined in the last step. The first block consisted of search terms for the population (e.g. HL, hearing impairment, hearing aids and CIs), and the second block contained search terms for the concept and the context (e.g. work, employee, labour market, WL, return to work and job performance). The search strategies are available upon request from the corresponding author.

Study selection process

In total, the searches generated 2059 possible papers to include. After checking for duplications, 1906 records remained. All abstracts were screened by the two authors separately. Inclusion of an abstract was judged as “yes”, “maybe” or “no”. Papers for which no abstract was available were automatically judged as “yes” for inclusion. After screening the abstracts, comparisons of the assessments were made. Disagreements were solved through discussions. In total, 205 records (111 “yes”; 94 “maybe”) were retrieved in full text to be evaluated in relation to the inclusion criteria. As in the previous step, all papers were assessed for eligibility by the two authors separately followed by comparisons of the assessment. Finally, 53 papers were included in the current scoping review. The inclusion process is illustrated in Figure 1.

Figure 1. PRISMA flow-chart, the inclusion process.

Data extraction process

By using a data extraction form, data were manually extracted from the included articles by the two authors separately. Information about demographics (authors, country and year), journal, study objectives, study population, study design including methodology, theoretical aspects and key findings were extracted. From papers with multiple focus topics, only information related to the current research topic was extracted.

Data analysis

The data were mainly analysed narratively with the ILO workplace well-being definition as a starting point. A narrative analysis is a summary of the reported findings divided into subthemes to enhance the interpretation of the analysis (Pawson 2002). The key findings were organised into eight subsections depending on the content of the findings. After that, the subsections were merged into three broad themes: individual aspects, work environment and work organisation (Figure 2). Furthermore, to present an overview of the study information in the included papers, a descriptive, statistical analysis was performed where the studies were examined and presented in relation to the extracted study information (see data extracting process).

Figure 2. Narrative analysis of the key findings about hearing loss in the WL.

Results

Study characteristics

Articles included in this scoping review were published in 29 different journals, of which six journals recurred ≥3 times. Most research about HL in WL was published in the International Journal of Audiology, followed by the journal Work: a journal of prevention, assessment and rehabilitation (see Table 1).

Table 1. Overview of included journals.

Journals (n = 29)	n = 53
Acta Oto-Laryngologica	1
Acta Otorrinolaringol Espanola	1
American Annals of the Deaf	1
Annals of Otology, Rhinology & Laryngology	1
BMC Public Health	2
British Journal of Audiology	2
Cochlear Implants International	3
Disability and Rehabilitation	2
Ear and Hearing	3
Economics and Human Biology	1
European Archives of Oto-Rhino-Laryngology	1
European Journal of Public Health	1
International Journal of Audiology	8 (15%)
International Journal of Rehabilitation Research	2
Journal of Agromedicine	1
Journal of Deaf Studies and Deaf Education	3
Journal for Oto-Rhino-Laryngology, Head and Neck Surgery (ORL)	1
Journal of Rehabilitation	3
Journal of the American Academy of Audiology	1
Journal of Vocational Rehabilitation	1
Otology & Neurotology	1
Rehabilitation Counselling Bullentin (RCB)	1
Scandinavian Journal of Work Environmental Health	1
Social Behaviour and Personality	1
Swedish Journal of Disability Rehabilitation (SJDR)	1
The journal of Laryngology & Otology	1
The journal of Rural Health	1
Trends in Hearing	1
Work	6 (11%)

Almost all studies were conducted in North America or Europe (n = 47). Fifty-three percent of the papers were published during the last decade, and 42% were published between 2000 and 2010. Most included studies used other researchers’ results as a theoretical basis in their studies (level III), and approximately 2/3 of the papers applied a quantitative design, including cross-sectional, experimental and register studies. Different populations were used in the studies, including the general population (recruitment through, e.g. advertisement, hearing health organisations or social media), clinical populations (recruitment from hearing health clinics or similar) and register data (public registers or different kinds of registers typically held by hearing health clinics, research institutes, etc.). A few populations were labelled “other” and indicated that, e.g. the professional perspective of HL in WL was highlighted (Table 2).

Table 2. Study characteristics.

Characteristics	N = 53
Country:
Australia	2	4%
Canada	8	15%
Denmark	1	2%
Denmark/USA	1	2%
Finland	5	9%
Israel	1	2%
The Netherlands	6	11%
New Zealand	2	4%
Norway	4	7%
South Africa	1	2%
Spain	1	2%
Sweden	8	15%
Switzerland	1	2%
UK	1	2%
USA	11	21%
Year:
1990–1999	3	6%
2000–2010	22	42%
2011–2020	28	53%
Applied method:
Qualitative	14	27%
Quantitative	36	67%
Mixed design	3	6%
Theoretical approach^a:
Level I	1	2%
Level II	17	32%
Level III	35	66%
Population:
Clinical	17	32%
General	24	45%
Mixed	1	2%
Other	2	4%
Registers	9	17%

^aLevel I: grand theories; level II: middle-range theories; level III: background literature.

Aspects of well-being in working life

The narrative analysis will be presented according to the three themes of individual aspects, work environment and work organisation. Each of the themes is further divided into subthemes (outlined in Figure 2).

Individual aspects

This main section includes individual experiences and perspectives of the workers with HL, including how they perceive their WL and how they manage their WL and their health. One section is devoted to CIs and WL. The main reason for this section is that the included papers address the impact the CI has on WL, i.e. the papers are not addressed from a HL perspective but from a CI perspective.

Perceived problems in working life

The experienced problems were highly related to work performance and being able to contribute to work and to be an employee. These matters could include productivity issues, such as inability to complete work tasks or error in work because of misunderstandings and misinformation, reduced business quality, the loss of work time due to the need for verbal repetition or having to approach the speaker or a general reduced ability to perform in different ways (Canton and Williams 2012; Hass-Slavin et al. 2005; Morata et al. 2005; Nachtegaal et al. 2012). Furthermore, several papers disclosed specific problems from a HL perspective, such as difficulties communicating (in noise and in quiet surroundings), difficulties executing demanding work tasks in relation to sounds and communication, difficulties using telephones including tele-conferences, in meetings, distinguishing between and comprehending different voices and accents, executing work tasks in loud and noisy environments, difficulties localising sounds, distinguishing between sounds and difficulties because of nonworking hearing technology or poor access to adequate technologies (Kramer et al. 2006; Punch et al. 2007; Shaw et al. 2013b; Svinndal et al. 2020b; Morata et al. 2005; Hua et al. 2015; Tye-Murray et al. 2009; Williams et al. 2006). Employees also experienced an imbalance between work demands and experienced control in their work compared to others without HL (Danermark and Gellerstedt 2004; Kramer et al. 2006). The relation between having HL and safety risks at work was also highlighted in some papers. This aspect included worries about working in loud environments, worries about not hearing warning signals and other important environmental sounds, and general safety concerns (Canton and Williams 2012; Hass-Slavin et al. 2005; Morata et al. 2005). Other problems highly related to WL were also mentioned, such as losing “a competitive edge” (Tye-Murray et al. 2009), not being “mentally present” at work (Hua et al. 2015), social withdrawal after work hours, social isolation and the feeling of exclusion (Canton and Williams 2012; Hua et al. 2015; Grimby and Ringdahl 2000).

Strategies to manage working life

The included papers revealed several aspects of managing WL in relation to both communication and being a worker and an employee with HL. Almost all the included papers that focussed on strategies used by persons with HL reported on facilitating strategies to enhance communication, such as moving closer to the speaker, asking for repetition, or using hearing aids or other technical or assistive devices (Shaw et al. 2013b; Hass-Slavin et al. 2005; Hua et al. 2015; Tye-Murray et al. 2009; Williams et al. 2006; Grimby and Ringdahl 2000; Jennings et al. 2013; Detaille et al. 2003). Several papers discuss specific strategies that employees would use to manage WL. These strategies included so-called “buddy” systems (a person in the workplace that could assist in, e.g. “filling in” communication gaps) (Punch et al. 2007; Svinndal et al. 2020b; Tye-Murray et al. 2009; Williams et al. 2006; Grimby and Ringdahl 2000; Jennings et al. 2013; Geyer and Schroedel, 1999), avoidance of challenging or embarrassing situations (Shaw et al. 2013b; Hass-Slavin et al. 2005; Hua et al. 2015) and preparations prior to potentially challenging work situations, such as controlling the physical environment, scheduling private meetings, using e-mails over telephone and disclosing HL to colleagues and management (Shaw et al. 2013b; Hass-Slavin et al. 2005; Hua et al. 2015; Tye-Murray et al. 2009; Jennings et al. 2013; Detaille et al. 2003; Geyer and Schroedel 1999). Another important topic concerned acceptance or recognition of one’s own situation as a worker with HL. Specifically highlighted as important factors in managing WL were own knowledge, awareness of own situation, to have a positive attitude towards HL, and to have accepted the HL (Svinndal et al. 2020b; Tye-Murray et al. 2009).

Health in relation to working life

Several aspects of both psychological and physical health issues were reported among workers with HL. Psychological factors such as anxiety, negative feelings, anger, insomnia, fatigue, tiredness, irritability, concentration problems and a general lack of energy were specifically highlighted in the papers (Danermark and Gellerstedt 2004; Backenroth-Ohsako et al. 2003; Coniavitis Gellerstedt and Danermark 2004; Svinndal et al. 2018; Hass-Slavin et al. 2005; Hua et al. 2015; Tye-Murray et al. 2009; Grimby and Ringdahl 2000). The need for recovery after a working day was emphasised in some of the studies (Hass-Slavin et al. 2005; Hua et al. 2015). Furthermore, associations between hearing status and the need for recovery (the poorer someone’s hearing, the higher the need for recovery), as well as psychosocial work characteristics, such as job demands, and the need for recovery, were discovered in some of the papers (Nachtegaal et al. 2012; Nachtegaal et al. 2009). Additionally, physical health problems were commonly reported among workers with HL and included neck problems, headaches, tensions and pain (Danermark and Gellerstedt 2004; Hass-Slavin et al. 2005; Hua et al. 2015; Grimby and Ringdahl 2000). Some of the papers took a gender perspective on health. From the findings, it was clear that women seem to be particularly vulnerable to health problems related to WL. These problems concerned psychologically related health problems such as insomnia and fatigue (Danermark and Gellerstedt 2004; Coniavitis Gellerstedt and Danermark 2004; Svinndal et al. 2018), but headaches were also reported more frequently among women with HL than men with HL (Danermark and Gellerstedt 2004).

Cochlear implants and working life

Nine of the included papers concerned CIs and the impact the implants had on different aspects of the WL of the individuals. A great deal of the papers measured different variables pre- and post-implantation. Some papers reported that implantation had (self-rated) positive impacts on income, employment status, job satisfaction, professional skills, development in professional careers, employment opportunities, position in the labour market and how much the individuals were able to work (Clinkard et al. 2015; Fazel and Gray 2007; Goh et al. 2016; Kos et al. 2007; Huarte et al. 2017; Harkonen et al. 2017). Others revealed the impact CIs had on performances in WL, such as improved communication with co-workers, phone abilities, increased awareness of warning signals and other sounds in the environment, and overall increased functioning (Kos et al. 2007; Harkonen et al. 2015b; Saxon et al. 2001). Huarte et al. (2017) stated that the CIs resulted in increased motivation to go to work for the employee, increased the feeling of being more competent to perform work, and were associated with the experience of less discrimination at work. Harkonen et al. (2015a) explored the effect of sequential bilateral cochlear implantation on different work aspects and concluded that not only work performance and activity at work increased but also individual exhaustion after a working day decreased with an additional implant.

Work environment

The concept of the work environment is a broad term and includes all physical, organisational and social aspects of work. The working environment also includes the psychological aspects of how the workplace is organised as well as well-being at work as perceived by the individual.

The physical work environment

The physical conditions at the workplace, mentioned in the articles by employees with HL, are foremost problems with noise (Danermark and Gellerstedt 2004; Kramer et al. 2006; Coniavitis Gellerstedt and Danermark 2004; Hass-Slavin et al. 2005; Morata et al. 2005; Nachtegaal et al. 2012; Hua et al. 2015; Williams et al. 2006; Shaw et al. 2013a), accessibility to hearing technology (Detaille et al. 2003; Geyer and Schroedel 1999) and a “hearing-customized” workplace (Geyer and Schroedel 1999). Working in a noisy environment was considered a safety risk (Morata et al. 2005), and lack of environmental awareness of hazards, such as warning signals, gave rise to stress and tension in the workplace (Canton and Williams 2012). A decreased hearing ability in noise significantly increased the odds of sick leave, with the need for recovery as an underlying factor (Nachtegaal et al. 2012). Shaw et al. (2013b) reported the lack of hearing-friendly workspaces and contexts as well as problems with technologies as a major challenge for employees with HL. Accordingly, two of the facilitators mentioned by employees with HL in relation to the physical work environment included technologies and noise reduction (Shaw et al. 2013a).

The organisational work environment

The organisational work environment includes aspects, such as leadership and management, interactions, participation, distribution of tasks, requirements/demands, resources and responsibilities. In relation to these aspects, articles focussed on work accommodations from different perspectives (Svinndal et al. 2018; Punch et al. 2007; Koskela et al. 2016; Shaw et al. 2013b; Svinndal et al. 2020b; Doolabh and Khan 2020; Svinndal et al. 2020a; Morata et al. 2005; Tye-Murray et al. 2009; Williams et al. 2006; Geyer and Schroedel 1999; Shaw et al. 2013a). Some of the work accommodations involved redesigning the job, such as job tasks (Williams et al. 2006; Geyer and Schroedel 1999), working hours and reorganisation of resources (Svinndal et al. 2020a). Other accommodations focussed on communication, such as assistive technology, in-kind support at the workplace (e.g. support from managers and colleagues), and strategies to facilitate interaction used by those involved (Shaw et al. 2013b; Svinndal et al. 2020b; Williams et al. 2006; Geyer and Schroedel 1999). Accommodations were reported to be difficult to obtain in the workplace (Punch et al. 2007), and men were less likely to receive workplace accommodations than women (Svinndal et al. 2018). The availability of accommodations was also associated with education level and company size (Geyer and Schroedel 1999). Employees with higher educational levels were more likely to have workplace accommodations. In workplaces with fewer than 15 employees, accommodations were least often available from employers. The opportunity to make use of workplace accommodations could be facilitated by the disclosure of HL to employers, managers and colleagues (Shaw et al. 2013b; Detaille et al. 2003; Shaw et al. 2013a; Southall et al. 2011).

A few articles investigated the employer’s or manager’s perspective on the work situation and work environments for employees with HL (Koskela et al. 2016; Doolabh and Khan 2020; Svinndal et al. 2020a ; Morata et al. 2005; Shaw et al. 2013a). Employers and managers tend to have low knowledge of workplace accommodations and the needs of employees with HL (Koskela et al. 2016; Morata et al. 2005; Shaw et al. 2013a), including concerns of safety and workplace communication (Doolabh and Khan 2020; Morata et al. 2005). Svinndal (2020a) found that managers felt a great responsibility for the functioning of their employees in the workplace; however, though they expressed good possibilities to adjust the work situation, HL issues were easily forgotten. Yet, neither supervisors nor managers believed that HL had a negative effect on the ability of employees to perform their jobs efficiently and effectively (Morata et al. 2005).

The social work environment

The social work environment includes the psychosocial work climate and social interaction, collaboration and social support from managers and colleagues. Several articles found the social work environment to be both a facilitator and a barrier to work performance and job satisfaction of people with HL (Punch et al. 2007; Koskela et al. 2016; Svinndal et al. 2020a, 2020b; Nachtegaal et al. 2012; Hua et al. 2015; Tye-Murray et al. 2009; Grimby and Ringdahl, 2000; Jennings et al. 2013; Detaille et al. 2003; Shaw et al. 2013a; Backenroth 1997). Support from managers and co-workers was described as a major facilitator in almost all these articles. Disclosure of HL could, in relation to support, be viewed as a facilitating factor where managers and colleagues who knew about HL provided support in challenging situations (Jennings et al. 2013). Acceptance from colleagues, as well as accommodations in the workplace, could also influence job performance in a positive manner (Tye-Murray et al. 2009). This finding was also in line with the results of Nachtegaal et al. (2012), who demonstrated an association between low social support and low self-rated productivity. Consequently, the relation between productivity and HL may be altered by social work environmental factors and the climate at work.

Work organisation

Work organisation can be described as the division of labour, i.e. the distribution, coordination and control of work tasks, skills and authority in an organisation, and aspects related to employment status.

Division of labour

A few articles focus on work organisation, i.e. the division of labour in terms of occupational categories or sectors (Hogan et al. 2009; Kramer et al. 2006; Coniavitis Gellerstedt and Danermark 2004; Huarte et al. 2017; Christensen and Datta Gupta 2017; Boutin 2010; Schroedel and Geyer 2000). Two studies (Boutin 2010; Schroedel and Geyer 2000) compared occupational categories between a population of persons with HL and a deaf (signing and visual) population. Boutin (2010) found a significant relationship between the degree of HL and occupational category, where the odds were higher for employees with HL to be employed as management professionals and related or natural resources, construction and maintenance compared to deaf (signing and visual) employees and lower for employees to be employed in service or in production, transportation and material moving. This finding is somewhat contradictory to the results by Schroedel and Geyer (2000), who found that fewer individuals in the HL population were employed in professional, managerial and technical jobs but were more often employed in crafts, machine operation and labour occupations compared to the deaf (signing and visual) population.

Hogan et al. (2009) found that men with HL, in comparison to men without HL, were more likely to be in trades, production or transport, and women with HL were more likely to be in lower level clerical, sales or service work. Huarte et al. (2017) established that the most common occupational activities for CI users were within the service sector and that approximately 25% worked in the construction sector. However, one study identified no differences in the types of jobs or types of contracts between employees with normal hearing and those with HL (Kramer et al. 2006).

Regarding gender aspects in the division of labour, Coniavitis Gellerstedt and Danermark (2004) found that 75% of the women with HL, compared to 28% of the men with HL, had occupations related to health and caring professions, professions related to economy, administration and personnel and teaching professions, mirroring an overall gender pattern in the labour market, where occupations within the service, care and commerce industries are dominated by women. The most frequent occupations for men with HL were professions related to economy, administration and personnel, mining, construction and metal work, which was held by approximately 40% of the men, compared to 25% of the women with HL. The authors argued that women with HL, in accordance with the pattern in the population at large, comparably often have high-stress job types. Christensen and Datta Gupta (2017) also point to a segregated labour market, where men with HL are more likely to work in blue-collar jobs and in the private sector.

Aspects related to employment status

Some articles focus on aspects related to work organisation, such as employment rate, unemployment and/or sick leave (Fischer et al. 2014; Hogan et al. 2009; Kramer et al. 2006; Pierre et al. 2012; Jung and Bhattacharyya 2012; Svinndal et al. 2018; Huarte et al. 2017; Christensen and Datta Gupta 2017; Emmett and Francis 2015; Friberg et al. 2013; Helvik et al. 2013; Jarvelin et al. 1997; Stam et al. 2013). Studies on employment rate, unemployment, and sick leave for persons with HL report that HL appears to have effects on employment status. All of the studies that compared persons with HL with persons without HL found that persons with HL were more likely to be either unemployed or partly employed (Hogan et al. 2009; Jung and Bhattacharyya 2012; Svinndal et al. 2018; Emmett and Francis 2015; Jarvelin et al. 1997; Stam et al. 2013) and that HL was also associated with decreased wage income or having any form of wage income (Jung and Bhattacharyya 2012; Emmett and Francis 2015). Accordingly, Hogan et al. (2009) found that people with HL and communication difficulties were in the bottom three income groups. People with HL had, on average, longer times of unemployment and looking for work (Stam et al. 2013). Concerning sick leave, studies have demonstrated a similar pattern in which sick leave was more frequently reported among those with HL (Kramer et al. 2006; Pierre et al. 2012; Christensen and Datta Gupta 2017), especially due to stress-related complaints, such as fatigue, strain or burnout (Kramer et al. 2006; Svinndal et al. 2018). Early retirement was also reported to be more common among persons with HL (Fischer et al. 2014; Helvik et al. 2013), as were longer sick-leave spells (Friberg et al. 2013). However, in most studies, the employment status of employees with HL was associated with, or dependent on, intermediating factors, such as age, sex, socioeconomic status and health/comorbidities, which, together with HL, affected the employment rate (Hogan et al. 2009; Christensen and Datta Gupta 2017; Stam et al. 2013; Dammeyer et al. 2019) and exit from the labour market for persons with HL (Fischer et al. 2014). Studies have shown that hearing difficulties were significantly associated with unemployment for women with HL (Pierre et al. 2012), as well as part-time work in women with HL (Hogan et al. 2009; Svinndal et al. 2018). Additionally, the gender pattern seems to be similar to the patterns of early retirement and long sick-leave spells, where the associations with (long-term) sickness absence (Kramer et al. 2006; Friberg et al. 2013) and disability pension/benefits were stronger for women than for men (Pierre et al. 2012; Svinndal et al. 2018).

Discussion

This scoping review focuses on HL in WL from a well-being perspective. In sum, 53 papers from different perspectives were included. Three main themes were identified that constituted well-being in WL: individual aspects, work environment and work organisation. All these themes contain rich and valuable information about the review topic, and several interesting discussion areas have emerged from the included studies.

Intersectionality

An aspect that is only partly addressed in the articles is intersectionality, i.e. differences in the population in terms of, for example, age, ethnicity, education level and sex/gender. Intersectional aspects are foremost described in relation to the population or in the methods section but are rarely part of the results (except for the categorisation of sex) or the discussion. Sex, i.e. the categorisation man/woman, is mostly addressed in articles describing register data and most often regarding employment rate, unemployment and sick leave. Few articles address gender aspects (i.e. the socially constructed roles, behaviours, activities and attributes that a given society sees as appropriate for men and women), such as gender patterns in the division of labour (e.g. Hogan et al. 2009; Coniavitis Gellerstedt and Danermark 2004; Christensen and Datta Gupta 2017) and workplace accommodations (Svinndal et al. 2018). The lack of an intersectional perspective in articles claiming to have a work-life perspective can be viewed as problematic because WL is segregated regarding gender, age and educational level. Studies have, for example shown associations between gender segregation at work, health and sick leave (Gonäs et al. 2019) as well as gender inequality in job quality (Stier and Yaish 2014). To only have one aspect in mind (i.e. the HL) and not reflect upon other significant aspects, such as gender, age and education level, when drawing conclusions about WL conditions could result in erroneous conclusions about the influence of HL, an intersectional and contextual perspective is called for in studies about WL conditions.

The absence of a multidimensional perspective

Many of the included papers focus on a variety of aspects of WL (as can be noted in the results section) in the same publication. Furthermore, the articles report many findings but do not necessarily substantially discuss their findings. HL in the context of work can be considered a multidimensional phenomenon due to the interplay between the individual and the context and the integration of factors on individual, organisational and societal levels. Unfortunately, the results show that this complexity has only been addressed to a minor extent. Very few articles describe the context, i.e. the work situation and factors on organisational or societal levels, and the interplay between individuals with HL and their work environment from different perspectives. From a WL research point of view, descriptions of the work context (e.g. the work environment and work organisation) and use of WL theories in the articles can be considered meagre. As demonstrated in the results, two-thirds of the articles only used background literature (third-level theories, according to Merton (1967)) to frame their findings. The background literature that was used in the included papers addressed HL aspects (e.g. research on individuals with HL, relating to WL) and was infrequently connected to the work context in general. Approximately one-third of the articles used middle-ranged theories (i.e. theories within a limited area, such as WL). These theories could be classified as either theories developed/evolved in the field of WL (e.g. the demand-control model (Karasek and Theorell 1990)) or theories from the sociological or psychological field, such as social identity theory (Tajfel and Turner 1979). Only one article (Cinamon et al. 2008) used what can be considered as a grand theory, i.e. a more inclusive theory at a more abstract level (e.g. ecological system theory (Bronfenbrenner 1989)). The meagre use of theories from the field of work, when investigating work conditions for workers with HL, is problematic, as this means that we still lack knowledge of significant factors regarding work situations and conditions for people with HL, as seen from a work perspective rather than from a HL perspective. This is something that should be developed in future studies of WL for people with HL.

Vocational rehabilitation

As stated in this review, Schroedel and Geyer (2000) recognise that deaf persons were provided with, e.g. business, and vocational training, to a higher extent than their peers with HL. One important reason for this conclusion might be that it is rarely outlined which rehabilitation disciplines should focus on adults with HL in WL. Persons with HL seem to be scarcely part of vocational rehabilitation (VR) programmes. In a systematic review on VR services to persons with HL, Gussenhoven et al. (2013) identified only nine VR programmes for adults with HL, including some programmes with unclear or mixed target groups. In many countries, ordinary audiological rehabilitation services do not target adults in their working lives (i.e. where the WL as a context is in focus) but, rather, adults in WL age. Furthermore, in Sweden (as an example), WL and how to focus on work-related issues in audiological rehabilitation are not part of undergraduate training programmes completed by individuals to become audiologists. This finding might be similar in many other countries. Knowledge about WL and economic conditions is required if one wants to work in this area. For example, Shaw et al. (2013a) report that the audiologists in their study considered not knowing about the economic aspects of WL a barrier in their professional work with employees with HL. The occupational therapists in the study, conversely, lacked knowledge about HL aspects in WL. These results might call for an entirely new vocational discipline and career for audiologists, where one could add, e.g. a master’s degree in WL (or similar) to the undergraduate audiological training. An important conclusion of this review is that persons with HL need to be considered in VR services or in other rehabilitation services towards WL to come to terms with the negative consequences that many adults with HL experience.

Methodological aspects

In this review, 205 papers were read in full text, of which 53 were included in the scoping review. Consequently, 152 of the read full-text papers were excluded. A common reason for exclusion was “mixed target groups” (n = 41). Most of the papers in this group contained research in which there was a mix of people with HL and persons who were deaf (using sign-language as the first communication mode). This matter is somewhat problematic. One can argue that these groups are different primarily because of language and should not be merged because of auditory aspects. As the current review emphasises, research evidence reveals differences between the two groups. Deaf persons achieved competitive jobs and were provided with college/university training, business and vocational training and on-the-job training to a greater extent than persons with HL (Dammeyer et al. 2019). Furthermore, Schroedel and Geyer (2000) concluded that the median income and economic and occupational achievements were higher for deaf persons than for persons with HL. In previous studies, aspects of health have been reported to differ between the groups. For example Fellinger et al. (2007) established that persons with HL had worse quality of life and worse social relationships than those who were deaf (sign-language as the first communication mode). Although these are only a few examples, there are differences between the groups that need to be acknowledged in scientific studies. Consequently, when including both groups in a study, it is important to stratify the results according to language (first communication mode).

Furthermore, one might wonder how only one-quarter of the read full-text papers were included. There are two main reasons for this occurrence. Either an abstract was not available and therefore an article had to be retrieved in full text to determine whether it should be included or not, or it was impossible to decide from the article abstract if the inclusion criteria were fulfilled. From this point of view, it must be considered a weakness in the published studies that some of the abstracts contained too brief study information.

Conclusions

There are relatively few studies (n = 53) published on persons with HL and WL during the investigated period. The focus of the studies varies from an individual perspective (micro level) to a societal perspective (macro level). A great deal of the studies focuses on the individual perspective, such as the experience of problems and health issues. In addition to a few aspects, there seem to be few specific differences between the problems that individuals experience in WL and the problems they experience in other areas of life. This matter can either indicate that there are no true differences between WL and other important life areas for persons with HL or that there are substantial differences, but they are not visible to us because of the lack of an interrelated perspective on the individual in the context, a disacknowledging of the significance of the context. Furthermore, the results are rarely discussed from a working-life perspective; that is, interactional factors between the labour market and the individual are often not included in the studies, and there is often a lack of discussion on how the labour market functions. Factors associated with HL are important, but specific conditions on how the labour market and the work situation are organised might be equally important to understand HL in WL. Therefore, the results from this review call for research in the area with an extended focus, in addition to HL, to further investigate working-life conditions for adults with HL.

Acknowledgements

The authors thank Ulrika Johansson at the University library of Örebro University, Sweden, for excellent help and support with the database searches.

Disclosure statement

No potential conflict of interest was reported by the author(s).