Barriers to and facilitators of paediatric early hearing detection and intervention: protocol for a systematic review and meta-synthesis of qualitative evidence

INTRODUCTION: Early hearing detection and intervention (EHDI) is a crucial public health initiative focused on the prompt identification and management of hearing impairments in children, significantly impacting their communication abilities, cognitive development and overall well-being. Although the global acceptance of EHDI programmes is gradually expanding, delay in diagnosis and enrolment in early intervention continues to challenge optimal outcomes. Qualitative studies examining the barriers and facilitators within EHDI remain limited, particularly regarding the experiences of caregivers, healthcare providers and policymakers across various contexts. This systematic review and meta-synthesis of qualitative evidence aims to comprehensively identify and synthesise these barriers and facilitators from multiple stakeholder perspectives aiming to inform policies and strategies that improve EHDI programme effectiveness. METHODS AND ANALYSIS: A comprehensive search will be conducted in PubMed/MEDLINE, Web of Science, Scopus, Scientific Information Database and MagIran, from database inception to December 2025, with no language restrictions. The SPIDER framework will guide the inclusion of qualitative studies on barriers to and facilitators of EHDI (sample: children, parents and providers; phenomenon of interest: EHDI barriers/facilitators; design: qualitative; evaluation: experiences/perspectives; research type: qualitative). Quantitative-only studies, non-peer-reviewed sources and studies without accessible full texts will be excluded. Two reviewers will independently screen titles/abstracts/full texts, resolving disagreements via discussion or a third reviewer. Quality appraisal will be done using the Critical Appraisal Skills Programme checklist. Data synthesis will employ thematic content analysis. ETHICS AND DISSEMINATION: This systematic review and meta-synthesis was approved by the Resarch Ethics Committee of Tabriz University of Medical Sciences (approval number: IR.TBZMED.VCR.REC.1404.331). The committee determind that the study adheres to established etical standards, as it involes only the synthesis and analysis of previously published literature, with no direct interaction with human participants, n collection of primary data, and no involvement in clinical interventions. Therefore, the review dose not require informed of consent or ethical clearance beyond the institutional approval obtainad. Findings will be shared via peer-reviewed publication, conference presentations and targeted summaries for policymakers and clinicians.