The Effect of Phonological Educational Program on Reading Skill and Phonological Awareness of Hearing Aid Users

Introduction
Reading is not only a fundamental skill for learning, but also an important factor in interacting with the outside world. Hearing loss affects language development, including speaking, reading, and academic achievement. In general, weaknesses in reading skills are evident in many educational failures. The constant lack of auditory stimulation disrupts accurate representations of spoken words, including the development of awareness of the phonological structure of those words. This deficit in phonological processing of written words prevents hearing-impaired individuals from fully acquiring reading and writing. Phonological awareness skills develop less in hearing-impaired children than in normal children, and phonological awareness in hearing-impaired students develops limitedly due to their inability to perceive phonetic distinctions (Saedi-Manesh et al, 2018). Reading depends on phonological processing skills and oral language knowledge. In a longitudinal study to investigate the role of phonological awareness (PA) and morphological awareness (MA) on reading comprehension skills and vocabulary knowledge of hearing-impaired individuals, Chan (2022) studied 28 hearing-impaired Chinese children from the beginning of first grade to the end of second grade. The results of his study showed that both PA and MA significantly affect reading comprehension of hearing-impaired children through their effects on vocabulary knowledge.
 
Materials & Methods
A review of past research indicates that so far, phonological instruction and its integration with suprasegmental features have not been provided to strengthen reading skills and phonological awareness in hearing-impaired individuals, and on the other hand, previous educational programs have been implemented in the cochlear implant group. Therefore, the researchers decided to provide basic phonological instruction along with suprasegmental features in the form of an educational program to hearing-impaired students who use hearing aids and to examine its effectiveness in their reading skills and phonological awareness. The research method is experimental and in the form of single-subject designs, using the A-B method, with a one-month follow-up phase. The statistical population of the present study included all hearing-impaired students using hearing aids in regular elementary schools in Birjand in the academic year 1401-1402. After examining the entry conditions and obtaining consent from the family, finally four hearing aid users in the second grade were selected as research subjects. The “Nama” reading test (2008) and the “Phonological Awareness” test (Soleimani and Dastjerdi Kazemi, 2010) were the instruments of this study. In this study, the effect size was calculated using the Blanchard and Squares percentage improvement formula, and the PND tool was used for visual analysis. It should be noted that according to this formula, a score of 50 percent (reduction or increase in symptoms) is considered as success, scores between 25 and 49 percent as slight improvement, and finally less than 25 percent as failure of the intervention or treatment (Pooladi et al, 1401).
Improvement Percentage= ×100
 
Results & Discussion
The findings from the two tools, "Nama" and "Phonological Awareness", are presented and analyzed separately.
Examining the effectiveness whit the "Nama" reading test
The score of the "Nama" test is the sum of the scores of its three subtests, which were calculated nine times during the study, and then the percentage of improvement of each subject in three stages (end of intervention, end of follow-up, and overall percentage of improvement) was calculated based on the Blanchard and Squares formula. In the analysis of the "Nama" subtests, the highest effectiveness was related to the "Text Comprehension" subtest and the lowest effectiveness was related to the "Letter Symbol" subtest. The percentage of improvement in different stages is presented in Table 1.
 
Table (1)
Percentage of improvement of the "Nama" test




 


Subject 1


Subject 2


Subject 3


Subject 4




Improvement End of Intervention


31/9


36/9


33/3


30/8




Improvement End of Follow-Up


13/2


28/4


32/4


16/1




Overall Percentage of Improvement


34/7


41/8


43/2


39/4




 
According to Table (1), the effectiveness of the program in all subjects in the Nama test was successful, considering the overall improvement percentage above 25%. Their effectiveness is considered low considering the overall improvement percentage (between 25 and 49%).
Visual analysis of the "Nama" test in three evaluable situations showed that in all of those situations, POD was minimal, and PND reached 100. So the intervention and follow-up can be considered effective with a high probability.
Examining the effectiveness with the "Phonological awareness" test
The score of the "phonological awareness" test is the sum of the scores of its ten subtests, which were calculated 9 times during the study, and then the percentage of improvement of each subject in three stages (end of intervention, end of follow-up, and overall percentage of improvement) was calculated based on the Blanchard and Squares formula. In the analysis of the phonological awareness test, the highest effectiveness was in the "intermediate phoneme deletion" subtest and the lowest effectiveness was in the "phoneme combination" subtest. The percentage of improvement in different stages is presented in Table 2.
 
Table (2)
Percentage of improvement in the "Phonological Awareness" test




 


Subject 1


Subject 2


Subject 3


Subject 4




Improvement End of Intervention


30/8


33/3


36/9


31/9




Improvement End of Follow-Up


16/1


32/4


28/4


13/2




Overall Percentage of Improvement


39/4


43/2


41/8


34/7




 
According to Table (2), the effectiveness of the program in all subjects in the phonological awareness test was successful, with an overall improvement percentage of over 25%. The effectiveness in the second subject (50%) was considered good and in the other subjects (between 25 and 49%) was considered low.
Visual analysis of the "phonological awareness" test in three evaluable situations showed that in all of those situations, POD is at its lowest and PND is 100. So the intervention and follow-up can be considered effective with a high probability.
 
Conclusion
This study aimed to investigate the effectiveness of a phonological educational program on reading skills and phonological awareness of hearing-impaired students who use hearing aids. The results of this study showed that the use of this educational program, which is based on phonological teachings and the training of suprasegmental features, has improved the reading skills and phonological awareness of hearing-impaired students, especially their reading comprehension.
Phonological awareness has been identified as an important predictor of reading and writing development. Some phonological awareness skills such as “syllabic segmentation” or “rhyme awareness” which are acquired earlier tend to have lower predictive power, and another group of phonological awareness skills such as “phonemic segmentation” and “phonological manipulation” that are acquired later have higher predictive power. In a long-term study of rhyme awareness and its relationship to reading and writing development, it was observed that “rhyme sensitivity and awareness” is a necessary prerequisite for the skill of “phonological segmentation.” The skill of “phonological segmentation” also plays the most important role in learning to read (Dastajerdi Kazemi and Soleimani, 2006). In the present study, the scores obtained by all subjects at the baseline stages and before the intervention in the “phonological segmentation” subtest were low, and after receiving the training program, an upward trend in scores was observed.