Deborah Rhodes, is 1an International Aid strategist, consultant , author and academic.  Most recently she has published3 August 2023

Rotary International Action Group on Hearing connects people who are passionate about contributing to services for children and adults with hearing loss globally. In this blog, links are made to contemporary ideas about international development for the important work of the Action Group, encouraging more culturally-savvy and strengths-based approaches.

In every country, diverse factors influence whether people seek hearing assessments and access hearing aids.  These factors must be understood as part of any collaborative efforts or campaigns to improve access.  The demand for services is culturally informed, which means cultural values shape people’s understanding about their place in the world and how they interact with others, including through speech and hearing.  Organisations seeking to enhance access to hearing services, need to understand the cultural values that prevail in each country.  For example, in individualist cultures, like the US, Australia and most of Europe, individuals largely make their own decisions, such as whether to seek assistance in situations such as hearing loss.  In collectivist cultures, such as most countries in Asia, Africa, South and Latin America, and Pacific regions, decisions are more likely to be taken in the interests of the broader group, however defined (e.g. extended family, village community, language group), rather than by individuals.  This distinction inevitably affects the nature of help-seeking and hearing-aid uptake in different cultures (Zhao et al, 2015)[1] and the proportion of those with hearing impairment who seek professional help and take up rehabilitation services in different cultures.

The supply of services is also culturally-based.  For example, in more egalitarian cultures, there is a general interest in everyone having access to services through national systems, with minimal discrimination.  In cultures which are relatively more hierarchical, there are lower expectations that those without power and resources can access services.  Similarly, in cultures which are more task-oriented, services are expected to operate according to agreed standards, while in more relationship-oriented cultures, access to and quality of services are more likely to be associated with obligatory relationships and networks.

When the cultural aspects of help-seeking and of service delivery are understood, it helps explain why so few people in many countries seek or use such services. Organisations such as Rotary International which support increased demand for and access to hearing services, therefore require understanding of the cultural factors that shape both demand for and supply of hearing services, in order to bring about shifts in both.

Traditionally, organisations such as Rotary International have approached their support for services in low-resource settings by analysing gaps or identifying problems in service delivery, and offering solutions, as the basis for planning projects and campaigns.  A new book calls for a shift from a problem-based approach to a strengths-based approach: this shift could assist Rotary International to substantially enhance its global contributions.  A strengths-based approach starts with what already exists in each place as the basis for determining the preferred future of services such as hearing services.  This approach changes the power dynamics, increases motivation and stimulates locally-led ownership of change agendas.  The approach offers Rotary International ways of working that are more culturally respectful, motivational and effective, thus enhancing our contributions to global hearing services. The book ‘A Strengths-based Approach for International Development: Reframing Aid’ by Australians Dr Keren Winterford, Deborah Rhodes and Christopher Dureau, was published in the UK in July 2023, by Practical Action Publishing and is available from

Elaine Saunders and Deborah Rhodes…..

[1] Zhao, F.,  Manchaiah, V., St Claire, L., Danermark, B., Jones, L., Brandreth, M., Krishna, R., and Goodwin, R. 2015 Exploring the influence of culture on hearing help-seeking and hearing-aid uptake