Social exchange theory tenets and the employment of persons with disabilities in the Western Cape, South Africa.

Hearing Loss (HL) is one of the most common disabilities worldwide. Early diagnosis and intervention are therefore a clinically relevant focus of audiology research. In 2019, an estimated 1.57 billion people were affected, demonstrating the importance of improving assessment methods. Adult HL assessments typically include medical history, ear examination, and pure-tone and speech audiometry. Although informative, these measurements often fail to address broader factors related to the causes and consequences of HL. Furthermore, such measurements are typically performed in controlled laboratory settings and do not reflect real-life listening in complex environments. Unlike pure-tone audiometry, which measures thresholds using a single tone in quiet, real-life listening requires detecting sounds across frequencies in the presence of multiple distracting sounds. Therefore, pure-tone audiometry outcomes alone do not necessarily reflect daily-life hearing difficulties. Furthermore, the impact of HL on non-audiological aspects, such as social participation and cognitive functioning is often neglected in HL assessment. For instance, loneliness can result from limited communication caused by HL, which can further diminish an individual’s quality of life. Several studies have demonstrated relationships between HL and social isolation, cognitive decline, depression, and dementia. To identify all aspects needed to be included in the HL assessment, a universal reference is required. The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) framework is a globally accepted standard that defines a bio-psycho-social model relating a health condition to functioning, disability, and contextual factors. According to the ICF framework, functioning and disability refer to Body Functions (BF), Body Structures (BS), and Activities and Participation (AP). Contextual factors refer to Environmental Factors (EF) and Personal Factors (PF). These domains are further divided into more detailed concepts in a hierarchical manner. The ICF Core Sets for Hearing Loss (CSHLs) are two collections of ICF categories that include the most crucial aspects related to HL. The “Brief” CSHL includes 27 categories and is intended for use in screening, epidemiological studies, and situations requiring a concise overview of functioning. The “Comprehensive” CSHL includes 117 categories and is designed for detailed clinical assessment and research applications. Both Core Sets were developed through an international expert consensus process to standardize outcome measurement and ensure a common interdisciplinary framework for describing functioning and disability in individuals with hearing loss. The complete list of categories is provided by Danermark et al.