Factors in the Effective Use of Hearing Aids among Subjects with Age-Related Hearing Loss: A Systematic Review

Objectives: Investigate factors contributing to the effective management of age-related hearing loss (ARHL) rehabilitation. Methods: A systematic review was conducted following PRISMA guidelines. The protocol was registered in PROSPERO (CRD42022374811). Articles were identified through systematic searches in the Scopus, PubMed, Web of Science, and Cochrane databases in May 2024. Only articles published between January 2005 and May 2024 were included. Studies were assessed for eligibility by two independent researchers and evaluated using the Crowe Critical Appraisal Tool v1.4 (CCAT). Results: Of the 278 articles identified, 54 were included. Three factors explain effective HA use. First, hearing aid signal processing, with directional microphones and noise reduction, improves user comfort and understanding regarding noise. Second, there is hearing aid fitting, with the NAL prescription rules as the gold standard, and bilateral, high-level HA performance for spatial localization and noise comprehension. Third, there is a patient-centered approach, using patient-related outcome measures (PROMs), questionnaires, counseling, and regular follow-up to involve patients in their therapeutic rehabilitation. Conclusions: Reaching a consensus on acoustic parameters is challenging due to variability in audiological results. Involving patients in their rehabilitation, addressing their needs and expectations, and offering individualized care are crucial.

Remote hearing-aid delivery and support: perspectives of patients and their hearing care providers

OBJECTIVE

To explore the perspectives of patients and hearing care providers (HCPs) about an adult remote hearing-aid delivery service implemented during the COVID-19 pandemic.

DESIGN

Service evaluation via surveys. The patient survey measured satisfaction with the service, perceived hearing-aid handling skills, and preferences for future services. The HCP survey explored the impact of teleaudiology on outcomes compared to in-person care and factors important for successful teleaudiology.

STUDY SAMPLE

378 patients and 14 HCPs.

RESULTS

Patients were highly satisfied with the service and self-reported good hearing-aid handling skills. However, 2 in 3 patients said they would prefer a future hearing-aid fitting to be in-person rather than remote. HCPs thought teleaudiology had positive impacts on convenience, accessibility, and flexibility, but negative impacts on communication, rapport, and the quality of care. HCPs considered computer literacy and individual preferences to be important for successful remote care; the age of the patient was considered less important.

CONCLUSIONS

Patients were generally highly satisfied with the service and for 1 in 3 it was their preferred mode of future hearing-aid fitting. Future services should be aware that a one-size-fits-all approach will not satisfy all patients and that teleaudiology should be offered on the basis of individual preference.

Patient-Reported Outcome Measures for Hearing Aid Benefit and Satisfaction: Content Validity and Readability

PURPOSE

Numerous patient-reported outcome measures (PROMs) are available to measure hearing aid benefit and satisfaction. It is unclear to what extent currently available PROMs on hearing aid outcomes, often developed decades ago, meet current guidelines for good content validity and readability. This study evaluated the content validity and readability of PROMs that focus on perceived hearing aid benefit and/or satisfaction.

METHOD

A literature review was conducted to identify eligible instruments. Content validity evaluation included mapping extracted questionnaire items to the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. In addition, study design in content validity methodology was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments study design checklist for PROM instruments. Readability was estimated using the Simple Measure of Gobbledygook measure.

RESULTS

Thirteen questionnaires were identified and evaluated. Item content focused primarily on the components of environmental factors as well as activity limitations and participation restrictions with less emphasis on body functions and personal factors. The content validity methodology analysis revealed an underuse or lack of reporting of a qualitative methodology in assessing patient and professional perspectives. All the included questionnaires exceeded the recommended sixth-grade reading level.

CONCLUSIONS

The categories covered by hearing aid PROMs vary considerably, with no single instrument comprehensively covering all the key ICF components. Future development of hearing aid outcome measures should consider a mixed methodology approach for improved content validity and ensure an appropriate reading level.

Hearing Aid Benefit and Satisfaction Results from the MarkeTrak 2022 Survey: Importance of Features and Hearing Care Professionals

The hearing aid market is rapidly evolving with advancements in features and potential changes in service delivery models, including the new over-the-counter device category. Data from the MarkeTrak 2022 survey indicate most hearing aid owners report regular quality-of-life benefits from hearing aids, even more than in previous surveys. The increased likelihood of hearing aid benefits might be attributable to modern hearing aid features advancements, such as wireless connectivity and rechargeable batteries. Hearing aid satisfaction rates have been relatively stable over the years, indicating that more than 80% of hearing aid owners are satisfied with their devices. Hearing aid satisfaction rates do not appreciably vary by fitting channel; hearing aid owners fitted in person, fitted remotely, or self-fit are similarly likely to report high satisfaction with their device. However, only respondents in the in-person channel gave establishment ratings (reflecting their willingness to recommend) that resulted and reflected a positive net promoter score. Given the potential for net promoter scores to be related to brand growth and customer loyalty, this finding has implications for the development of over-the-counter hearing aid service-delivery models. Additional work is warranted to explore the factors that negatively affect hearing aid owners' satisfaction with the companies delivering limited services.

Hearing aid Experiences of Adult Hearing aid Owners During and After Fitting: A Systematic Review of Qualitative Studies

There has been an increasing number of qualitative studies exploring the experiences and perceptions of adult hearing aid owners throughout their hearing aid journey. As these studies and reported experiences vary greatly, a systematic review was conducted to identify and synthesize the key concepts in adult hearing aid owners' experiences during and after fitting. A systematic search of three electronic databases was conducted, yielding 443 results. Articles were evaluated for inclusion based on pre-determined eligibility criteria, including conventional, smartphone-connected, and direct-to-consumer hearing devices. Twenty-five studies met the inclusion criteria. The quality of the included articles was evaluated using the Rating of Qualitative Research scale. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Synthesis Without Meta-Analysis (SWiM) were followed. A narrative synthesis was conducted, and studies were grouped into three main domains, namely experiences of owners related to a) hearing aid adoption and fitting (n = 3), b) hearing aid use (n = 20), and c) hearing aid sub-optimal use (n = 25). Hearing aid owners mainly reported on how their attitude towards hearing aids affected experiences during the fitting stage. Improved psychosocial functioning was the most prevalent perceived benefit of hearing aid use. Owners described sub-optimal use in terms of hearing device-related and non-device-related concepts. The COM-B (capability, opportunity, motivation-behavior) model is used to discuss specific service-delivery, hearing-device, and hearing-aid-owner related concepts and clinical implications, including behavior change techniques to enhance understanding of the concepts that hearing aid owners perceive as essential to improve hearing aid experiences.

Applying the Hearing Aid Fitting Standard to Selection for Adults

The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus on the selection of unilateral/bilateral hearing aids, hearing aid style, and coupling, in addition to feature selection. The standard emphasizes that decisions around these three aspects should be recommended for a patient in an individualized manner, based on their needs assessment. For these decisions, the needs assessment might include measures of speech-in-noise ability, social network size, patient preference, and a trial period. Additional elements could include assessments of manual dexterity, binaural interference, and attitude toward hearing aids. However, there are a multitude of ways to practice clinically and still meet the items outlined in the standard. As long as the selection decisions consider individualized patient factors and are capable of meeting validated prescriptive targets, a clinician would be meeting the adult hearing aid fitting minimum standard guidance. In addition, despite the large number of past studies supporting these standards, additional, high-quality research including randomized, controlled, clinical trials are still needed to further support appropriate minimum standard recommendations.

Hearing Aid Fitting Orientation and the APSO Standard

The Audiology Practice Standards Organization (APSO) which was formed in 2017 set out to compile basic services that audiologists within the field should adhere to in their practice. The second standard of the APSO is the Hearing Aid Fitting Standard for Adult and Geriatric Patients. Among the services outlined for an adult hearing aid fitting, orientation is discussed. A hearing aid fitting orientation needs to be device- and patient-centered while also covering various aspects of hearing aid orientation that supports patient's success during the process. This article discusses APSO Standard 12 regarding hearing aid orientation and details how this standard can be implemented in the clinic.

Targeted Re-Instruction for Hearing Aid Use and Care Skills

Purpose The purpose of this study was to determine if re-instructing a hearing aid (HA) user on the specific skill(s) they could not successfully perform on the Practical Hearing Aid Skills Test-Revised (PHAST-R) resulted in better HA use and care skills than a traditional fitting method. This is referred to as "targeted re-instruction." Also, factors that might affect HA use and care skills, including memory function, hearing handicap, and hearing aid-related attitudes, were assessed. Method This study was a randomized control trial. Twenty-six new HA users (13 experimental; 13 control) were fit with HAs and provided a standard HA orientation. HA use and care skills were measured immediately following the HA fitting and then again at 4 weeks post-HA fitting. The experimental group was administered the PHAST-R twice during the trial period to identify the HA use and care skills that participants needed re-instruction on. Results Participants in the experimental group maintained their HA use and care skills over the 4-week HA trial period, whereas participants in the control group showed a significant decline. Working memory, hearing handicap, and HA-related attitudes were not found to be correlated with HA use and care skills. Conclusions Participants who did not receive targeted re-instruction showed a decline in their HA use and care skills after only 4 weeks of HA use, whereas targeted re-instruction prevented a decline in HA use and care skills. It took an average of less than 10 min to administer the PHAST-R and provide targeted re-instruction, indicating that it would be appropriate to use in a clinical setting.

Disposable Hearing Aid Battery Management: Survey Assessment of Providers and Qualitative Interviews of Patients

Purpose The purpose of this study was to better understand the behaviors that hearing aid users engage in to manage batteries. Method Two arms of research, a survey of audiologists (n = 110) and qualitative interviews with adult hearing aid users (n = 13), were conducted. Surveys were distributed and collected both via paper and online methods. Descriptive analyses of survey results were conducted to report on common threads. Qualitative interviews were conducted with video recording for transcription purposes. These transcripts were then coded thematically to identify shared themes across participants. Results Results of this study highlight the variability in behavior between provider-recommended strategies (preemptive battery management) and the reactive/delay strategies that are implemented by users. Patient reports indicate several challenges related to changing their batteries including limited information on hearing aid batteries, physical/sensory challenges to the act, and the social impact of having to change hearing aid batteries. Concurrently, patients express a wide range of strategies to address other challenges including engaging in cost-conscious behaviors when managing batteries (both purchasing and deciding to replace) and maintaining a collection of easily accessible batteries for use. Conclusions Hearing aid batteries are a topic that reflect social and economic factors in a patient's life. While providers may report they cover these topics sufficiently, challenges related to batteries may need specific elucidation by the clinician to ensure adherence to recommendations and functioning devices.

Self-Reported Reasons for the Non-Use of Hearing Aids Among Hispanic Adults With Hearing Loss

Purpose To examine the self-reported reasons for the non-use of hearing aids among Mexican-American Hispanic adults who have hearing loss. Method A total of 122 Hispanic adults with hearing loss, who did not currently or previously use a hearing aid, participated in this study. Participants completed a comprehensive hearing health questionnaire and the Hearing Handicap Inventory Screening Questionnaire to examine the possible reasons for the non-use of hearing aids. Results Self-reported hearing loss, hearing handicap score, and health insurance status were the best predictors of an individual's willingness to use hearing aids to treat their hearing loss. The primary reasons cited for the non-use of hearing aids among Hispanics with hearing loss was the belief that their hearing impairment was not severe enough to warrant using a hearing aid and that hearing aids were unaffordable. Conclusions Greater public health education regarding the deleterious effects of untreated hearing loss and the positive impact of amplification on cognitive, social, and psychological health may be warranted to improve the usage rates of hearing aids in Hispanic adults.

Support care needs of people with hearing and vision impairment in dementia: a European cross-national perspective

PURPOSE

Aging-related sensory impairments are among the most common and disabling comorbidities in people with dementia (PwD). This study explored the unmet support care needs (SCNs) from the perspectives of people with hearing and/or vision impairment in dementia (PwD), and their care partners in Europe.

METHODS

This was a two-phase mixed methods study. We administered standardized questionnaires of SCNs and quality of life (QoL) to PwD with hearing and/or vision impairment (n = 97), and their care partners (n = 97) in the UK, France, and Cyprus. Next, a purposive sub-sample of 34 participants (PwD and care partners) participated as focus groups (FGs) or semi-structured interviews to explore their SCNs in depth.

RESULTS

Over 94% of the participants reported unmet SCNs (median, 13 (range 5-23)). Nearly three-quarters reported SCNs in the moderate to high range, with the most prevalent unmet SCNs for PwD being in the psychological (>60%) and physical domains (>56%), followed by the need for health information (>46%). Emergent qualitative themes were: (1) the need for tailored support care interventions; (2) care burden, social isolation, and loneliness arising from the combined problems; (3) the need for adequate support from professionals from the different fields, including education around the use of sensory aids. Both study phases revealed that SCNs were highly individualized.

CONCLUSIONS

This cross-national study revealed that PwD with sensory impairment and their care partners experience a wide range of unmet SCNs, the interactions between sensory impairments, SCNs and QoL are also complex. A tailored intervention could address these unmet SCNs, including additional support with sensory aids, psychological support, more information about concurrent impairments, and joined up health systems providing care.Implications for rehabilitationA majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs.The needs of care partners including the risk of loneliness and social isolation, need to be considered.Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education.

The feasibility of an m-health educational programme (m2Hear) to improve outcomes in first-time hearing aid users

OBJECTIVE

To (i) assess the delivery, accessibility, usability, acceptability, and adherence, and (ii) identify suitable outcome measures, for a mobile-enhanced multimedia educational programme (m2Hear) in first-time hearing aid users.

DESIGN

A prospective, single-centre feasibility study.

STUDY SAMPLE

First-time hearing aid users (n = 59), recruited at their initial hearing assessment. Evaluations were made at 1-week and at 10-12 weeks post-hearing aid fitting.

RESULTS

m2Hear was most commonly accessed via tablets (42.3%). Usability was high for the System Usability Scale (88.5%), and the uMARS, particularly for the Information (M = 4.7), Functionality (M = 4.5) and Aesthetics (M = 4.2) subscales (maximum score = 5). Participant feedback was positive, with a high percent agreeing that m2Hear aided understanding of hearing aids (98%), held their interest (86%), improved confidence to use hearing aids and communicate (84%), and provided additional information to audiologist's advice (82%). Learnings about practical hearing aid handling/maintenance skills and how to communicate with others were reportedly used equally in participant's everyday lives. m2Hear was convenient to use, clear, concise and comprehensive. Outcome measures of social participation resulted in large effect sizes (Cohen's d > 1.6).

CONCLUSIONS

A theoretically-driven, personalised and co-designed educational m-health intervention is feasible and beneficial for use in the self-management of hearing loss and hearing aids.

Validation of teleaudiology hearing aid rehabilitation services for adults: a systematic review of outcome measurement tools

PURPOSE

To investigate outcome measurement tools for the validation of teleaudiology hearing aid rehabilitation services for adults.

METHODS

A search strategy was developed to identify tools used to evaluate standard and teleaudiology hearing aid rehabilitation services for adults. A seven-domain hearing-health-care service model for validation was defined and used to analyse the applicability and suitability of patient- and service-centred tools. This model and the applicability and suitability criteria were based on the literature, the International Classification of Functioning (ICF) framework, and gold standard professional practice guidelines, which together formed the validation framework used in this study.

RESULTS

Eighteen tools were identified and assessed against the validation framework. These tools were found to primarily assess aspects in the patient communication domain and rarely in the domain of service provision. All the included tools had some applicable items for teleaudiology hearing aid services; three tools were judged as suitable and four partially suitable for validating these services.

CONCLUSION

Although there is a set of suitable tools available to validate teleaudiology hearing aid rehabilitation services, none of them cover all the seven domains of the validation model used by this review and few are focussed on a specific domain. Further improvement and/or development of new tools to comprehensively validate these services is still necessary. At this stage, this still limits clinical audiology practice research, especially in teleaudiology.IMPLICATIONS FOR REHABILITATIONOutcome measurement tools are crucial for assessing the validity of hearing rehabilitation services.Findings of this study inform clinicians and researchers on how and what to assess and use to evaluate teleaudiology and standard hearing aid rehabilitation services.The use of the proposed validation framework may facilitate the standardisation of validation of both face-to-face and remotely delivered audiology rehabilitation services and improve consistency of methodology and reported real-world outcomes across studies and thus, the evidence.

Assessment of Reliability and Validity of the Cochlear Implant Skills Review: A New Measure to Evaluate Cochlear Implant Users' Device Skills and Knowledge

Purpose The Cochlear Implant Skills Review (CISR) was developed as a measure of cochlear implant (CI) users' skills and knowledge regarding device use. This study aimed to determine intra- and interrater reliability and agreement and establish construct validity for the CISR. Method In this study, the CISR was developed and administered to a cohort of 30 adult CI users. Participants included new CI users with less than 1 year of CI experience and experienced CI users with greater than 1 year of CI experience. The CISR administration required participants to demonstrate skills using the various features of their CI processors. Intra- and interrater reliability were assessed using intraclass correlation coefficients, agreement was assessed using Cohen's kappa, and construct validity was assessed by relating CISR performance to duration of CI use. Results Overall reliability for the entire instrument was 92.7%. Inter- and intrarater agreement were generally substantial or higher. Duration of CI use was a significant predictor of CISR performance. Conclusions The CISR is a reliable and valid assessment measure of device skills and knowledge for adult CI users. Clinicians can use this tool to evaluate areas of needed instruction and counseling and to assess users' skills over time.

Using smartphone technology to support the adult audiologic rehabilitation journey

OBJECTIVE

Although the availability of mobile device applications (apps) to support people with hearing impairment is rapidly increasing, there are few reports of the use of such apps by the target population. The aim of this paper is to describe research that has applied apps at various stages of the adult rehabilitation journey.

DESIGN

A summary of studies utilising apps to investigate (1) the hearing difficulties and acoustic environments of adults with mild hearing impairment, (2) hearing aid benefit in this population and (3) useability of an app to guide hearing aid handling tasks.

STUDY SAMPLE

Older adults with no previous experience with hearing aids, who owned a smartphone or tablet and were confident in using apps. Participant samples ranged from 10 (hearing aid benefit pilot study, mean age = 70 years) to 30 participants (app useability study, mean age = 69 years).

RESULTS

All studies showed that smartphone apps can provide real-world insights during the early stages of the patient journey and hearing aid management support during the latter stages. App useability was rated positively by participants.

CONCLUSION

Smartphone apps may be used as a feasible complement to face-to-face interaction in audiology practice.

Evaluating a Theoretically Informed and Cocreated Mobile Health Educational Intervention for First-Time Hearing Aid Users: Qualitative Interview Study

BACKGROUND

Adults living with hearing loss have highly variable knowledge of hearing aids, resulting in suboptimal use or nonuse. This issue can be addressed by the provision of high-quality educational resources.

OBJECTIVE

This study aims to assess the everyday experiences of first-time hearing aid users when using a newly developed, theoretically informed cocreated mobile health (mHealth) educational intervention called m2Hear. This intervention aims to deliver greater opportunities for individualization and interactivity compared with our previously developed multimedia intervention, C2Hear.

METHODS

A total of 16 first-time hearing aid users trialed m2Hear for a period of 10-weeks in their everyday lives, after which individual semistructured interviews were completed. The data were analyzed using an established deductive thematic analysis procedure underpinned by the Capability, Opportunity, Motivation-Behavior model. The model stipulates that to engage in a target behavior, an individual must have physical and psychological capability, physical and social opportunity, and automatic and reflective motivation.

RESULTS

Capability-m2Hear was viewed as a concise and comprehensive resource, suitable for a range of digital literacy skills. It was stated that m2Hear could be conveniently reused to provide useful reminders that facilitate knowledge of hearing aids and communication. Opportunity-m2Hear was simple and straightforward to use, enabling greater individualization and independence. The availability of m2Hear via mobile technologies also improved accessibility. Motivation-m2Hear provided greater support and reassurance, improving confidence and empowering users to self-manage their hearing loss.

CONCLUSIONS

Overall, this qualitative study suggests that m2Hear supports first-time hearing aid users to successfully self-manage their hearing loss postfitting. Furthermore, this study demonstrates the utility of employing a combined theoretical and ecologically valid approach in the development of mHealth educational resources to meet the individual self-management needs of adults living with hearing loss.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03136718; https://clinicaltrials.gov/ct2/show/NCT03136718.

Understanding Variability in Individual Response to Hearing Aid Signal Processing in Wearable Hearing Aids

OBJECTIVES

Previous work has suggested that individual characteristics, including amount of hearing loss, age, and working memory ability, may affect response to hearing aid signal processing. The present study aims to extend work using metrics to quantify cumulative signal modifications under simulated conditions to real hearing aids worn in everyday listening environments. Specifically, the goal was to determine whether individual factors such as working memory, age, and degree of hearing loss play a role in explaining how listeners respond to signal modifications caused by signal processing in real hearing aids, worn in the listener's everyday environment, over a period of time.

DESIGN

Participants were older adults (age range 54-90 years) with symmetrical mild-to-moderate sensorineural hearing loss. We contrasted two distinct hearing aid fittings: one designated as mild signal processing and one as strong signal processing. Forty-nine older adults were enrolled in the study and 35 participants had valid outcome data for both hearing aid fittings. The difference between the two settings related to the wide dynamic range compression and frequency compression features. Order of fittings was randomly assigned for each participant. Each fitting was worn in the listener's everyday environments for approximately 5 weeks before outcome measurements. The trial was double blind, with neither the participant nor the tester aware of the specific fitting at the time of the outcome testing. Baseline measures included a full audiometric evaluation as well as working memory and spectral and temporal resolution. The outcome was aided speech recognition in noise.

RESULTS

The two hearing aid fittings resulted in different amounts of signal modification, with significantly less modification for the mild signal processing fitting. The effect of signal processing on speech intelligibility depended on an individual's age, working memory capacity, and degree of hearing loss. Speech recognition with the strong signal processing decreased with increasing age. Working memory interacted with signal processing, with individuals with lower working memory demonstrating low speech intelligibility in noise with both processing conditions, and individuals with higher working memory demonstrating better speech intelligibility in noise with the mild signal processing fitting. Amount of hearing loss interacted with signal processing, but the effects were small. Individual spectral and temporal resolution did not contribute significantly to the variance in the speech intelligibility score.

CONCLUSIONS

When the consequences of a specific set of hearing aid signal processing characteristics were quantified in terms of overall signal modification, there was a relationship between participant characteristics and recognition of speech at different levels of signal modification. Because the hearing aid fittings used were constrained to specific fitting parameters that represent the extremes of the signal modification that might occur in clinical fittings, future work should focus on similar relationships with more diverse types of signal processing parameters.

Investigating the prevalence and impact of device-related problems associated with hearing aid use

Objective: To explore the prevalence of device-related problems associated with hearing aid use, participants' help-seeking behaviours for these problems, and factors associated with hearing aid problems.Design: A prospective convenience cohort design surveying 413 adult hearing aid users (34-97 years of age) recruited from seven clinics across Australia.Results: Almost all participants (98%) indicated that they were experiencing at least one of the hearing aid problems included on the survey. The number of hearing aid related problems reported by participants ranged from 0 to 25 (of a possible 26), with a mean of 10 problems (SD = 5). The three most reported problems were related to difficulty hearing in noisy environments, hearing in windy environments, and understanding certain voices. Participants had reported less than half (46.33%) of the total problems identified to their clinic (range = 0-100%, mean = 43.40, SD = 13.92). Participants who reported experiencing a greater number of hearing aid problems also reported lower levels of hearing aid benefit, and satisfaction with their hearing aids.Conclusions: The majority of hearing aid owners experience problems with their hearing aids. Addressing these problems would likely contribute to improved hearing aid outcomes.

Evaluation Tools for Assistive Technologies: A Scoping Review

OBJECTIVE

Assistive technologies (ATs) support independence and well-being in people with cognitive, perceptual, and physical limitations. Given the increasing availability and diversity of ATs, evaluating the usefulness of current and emerging ATs is crucial for informed comparison. We aimed to chart the landscape and development of AT evaluation tools (ETs; ATETs) across disparate fields in order to improve the process of AT evaluation and development.

DATA SOURCES

We performed a scoping review of ATETs through database searching of MEDLINE, Embase, CINAHL, HaPI, PsycINFO, Cochrane Reviews, and Compendex as well as citation mining.

STUDY SELECTION

Articles explicitly referencing ATETs were retained for screening. We included ETs if they were designed to specifically evaluate ATs.

DATA EXTRACTION

We extracted 5 attributes of ATETs: AT category, construct evaluated, conceptual frameworks, type of end user input used for ATET development, and presence of validity testing.

DATA SYNTHESIS

From screening 23,434 records, we included 159 ATETs. Specificity of tools ranged from single to general ATs across 40 AT categories. Satisfaction, functional performance, and usage were the most common constructs of 103 identified. We identified 34 conceptual frameworks across 53 ETs. Finally, 36% incorporated end user input and 80% showed validation testing.

CONCLUSIONS

We characterized a wide range of AT categories with diverse approaches to their evaluation based on varied conceptual frameworks. Combining these frameworks in future ATETs may provide more holistic views of AT usefulness. ATET selection may be improved with guidelines for conceptually reconciling results of disparate ATETs. Future ATET development may benefit from more integrated approaches to end user engagement.

MarkeTrak 10 (MT10) Survey Results Demonstrate High Satisfaction with and Benefits from Hearing Aids

The purpose of this article is threefold. First, it is to evaluate current rates of hearing aid satisfaction, in addition to the examination of factors that influence satisfaction rates. A second purpose is to evaluate the effects of hearing aid use on mental health and quality of life, from the consumer perspective. The third purpose of this article is to review the current status of the market in terms of usage and ownership. The usage statistics from MarkeTrak 10 answer questions such as what is the most common type of hearing aid style. And what types of hearing aid features are popular? The results of the usage statistics provide not only insight into the satisfaction and quality-of-life metrics but also information about marketplace trends. By fulfilling these purposes, strengths and weaknesses of the current hearing aid marketplace can be determined, guiding future technological and clinical practice developments. Survey results demonstrate the continued dominance of mini-BTE (behind the ear) hearing aids and high popularity of features, including wireless capabilities. Overall satisfaction rates are encouragingly high, driven by satisfaction with BTE instruments, especially those acquired in the past 5 years. Noted areas for improvement continue to be related to listening in noise and patient understanding of their hearing aids. Given the high levels of noted satisfaction, it is not surprising that the sample revealed significant hearing aid benefits, notably in a lower risk for depression, higher satisfaction listening in almost all environments, and improved quality of life on a regular basis. Together, these data provide insights into the factors that drive satisfaction, encourage industrial and scientific advancements in the identified areas of weakness, and paint a bright picture of the hearing aid market from the consumer perspective.

Development and evaluation of a hearing aid manual in the Malay language

OBJECTIVE

This study aimed to (a) translate a hearing aid (HA) manual into Malay language and revise the translated manual based on best practice guidelines; (b) compare the effectiveness of the translated and the revised Malay HA manuals in helping individuals to perform HA management tasks.

DESIGN

Cross-sectional, randomised, single-blinded study.

STUDY SAMPLE

An Oticon-Dynamo HA manual was translated and revised based on best practice guidelines. Ninety participants aged 55 years and above participated in this study. They were randomly assigned into the control group (received translated manual) and the experimental group (received the revised translated manual). The Hearing Aid Management (HAM) test, which was developed in a previous study, was conducted to evaluate participant's ability to perform HA management tasks using the translated and the revised version of Malay HA manual.

RESULTS

The revised Malay HA manual had a lower reading grade level relative to the initial translated Malay HA manual. The ability to perform HA management tasks was better in the experimental group (mean = 12.2, SD = 1.15) versus the control group (mean = 8.7, SD = 2.11).

CONCLUSION

Further revision of existing HA manuals based on best practice guidelines is recommended to help individuals better manage their HAs.

The Effect of Memory Span and Manual Dexterity on Hearing Aid Handling Skills in New and Experienced Hearing Aid Users

Purpose The aim of the study was to determine the effect of memory function and manual dexterity on new and experienced hearing aid users' abilities to use and care for their hearing aids. Method New and experienced hearing aid users were administered the Practical Hearing Aid Skills Test-Revised (PHAST-R; Doherty & Desjardins, 2012 ), a measure of a hearing aid user's ability to use and care for their hearing aids. The test was administered during their 30-day hearing aid check or yearly hearing evaluation appointment. Participants were also administered the Digit Span Test of memory function ( Wechsler, 1997 ) and the Nine-Hole Peg Test of manual dexterity ( Mathiowetz, Weber, Kashman, & Volland,1985 ). Results Participants with poorer memory span function performed significantly poorer on the PHAST-R than participants with better memory span. However, no significant relationship between manual dexterity and PHAST-R performance was observed. Experienced hearing aid users who were recently reoriented on how to use and care for their hearing aids performed significantly better on the PHAST-R compared to new hearing aid users and experienced hearing aid users who had not received a hearing aid orientation within the last year. Cleaning the hearing aid and telephone use were the 2 PHAST-R tasks that all hearing aid clients needed the most recounseling on. Conclusion Memory span is significantly related to an individual's ability to correctly use and care for their hearing aids regardless of whether they are new or experienced hearing aid users.

Knowledge Is Power: Improving Outcomes for Patients, Partners, and Professionals in the Digital Age

Purpose

The aim of this research was to develop and evaluate methods to address poor knowledge of hearing aids, hearing loss, and communication in patients, partners, and nonaudiologic health and social care professionals.

Method

An interactive multimedia educational program (C2Hear) has been co-produced with hearing aid users and audiologists to provide high-quality information and demonstrate complex concepts relating to hearing aids and communication.

Results

A randomized controlled trial showed numerous benefits for first-time hearing aid users that included better knowledge and skill, and increased hearing aid use and satisfaction. Patients reported that C2Hear was highly useful, enjoyable, and preferable to written information. C2Hear Online is now freely available on YouTube and has global reach, well in excess of 150,000 views. Further developments include a version for communication partners, which showed that joint-working between hearing aid users and their communication partners resulted in joint responsibility for communication that facilitated communication behaviors. In addition, a behavior theory-driven version for use with mobile technologies (m2Hear) has been designed to be tailored to the needs of individual hearing aid users. m2Hear includes more activities/interaction to maximize user engagement and learning. Finally, C2Hear has been used to improve hearing-related knowledge in other health and social care professionals, such as carehome assistants.

Conclusion

This range of educational programs and tools aims to improve knowledge and skills, leading to better outcomes for patients, partners, and health care professionals.

Evidence-Based Interventions for Adult Aural Rehabilitation: That Was Then, This Is Now

More than a decade after Arthur Boothroyd published "Adult Aural Rehabilitation: What Is It and Does It Work?," the four cornerstones of adult aural rehabilitation are re-examined in terms of research that we and others in the field have undertaken. The focus is on novel advances in high-quality research relating to interventions to support self-management for hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counseling). Much of this new research has a theoretical underpinning (e.g., behavior change theory) to better guide the development and evaluation of interventions, with a focus on self-management and patient-centered approaches. New and emerging technologies that support e- and m-health delivery of interventions provide greater personalization and interactivity to promote self-management of hearing loss. Looking to the future, there remains a requirement for a set of relevant and appropriate outcome measures to evaluate the effectiveness of interventions trialed in clinical studies. There is a continuing need for high-quality evidence, underpinned by contemporary theory, to increase the likelihood that translational adult aural rehabilitation research that aims to benefit patients will be applied in future clinical practice.

Factors Associated With Self-Reported Hearing Aid Management Skills and Knowledge

PURPOSE

Hearing aid management describes the skills and knowledge required for the handling, use, care, and maintenance of the hearing aid. The importance of hearing aid management skills and knowledge is evidenced by their association with hearing aid outcomes. However, the nature of this association and the influence of participant factors on this association are unknown. Accordingly, the aims of the current study were to (a) investigate participant factors that influence hearing aid management skills and knowledge and (b) investigate the impact of hearing aid management skills and knowledge on hearing aid outcomes.

METHOD

Factors associated with hearing aid management skills and knowledge were investigated through an e-mail- and paper-based self-report survey, including the Hearing Aid Skills and Knowledge Inventory (Bennett, Meyer, Eikelboom, & Atlas, 2018b) and the International Outcomes Inventory for Hearing Aids (Cox & Alexander, 2002). The study sample included 518 adult hearing aid owners, ranging in age from 18 to 97 years (M = 71 years, SD = 14 years), 61% male and 39% female, recruited from seven hearing clinics across Australia.

RESULTS

Participant factors found to be associated with hearing aid skills and knowledge included participants' age, gender, style of hearing aid, age of current hearing aid, and total years of hearing aid ownership. Higher levels of hearing aid management skills and knowledge were found to be associated with better hearing aid outcomes, specifically higher self-reported satisfaction with hearing aids, perceived benefit from hearing aids, and overall outcome of the hearing aid fitting as evaluated by the International Outcomes Inventory for Hearing Aids.

CONCLUSIONS

Hearing aid management difficulties were greatest for older people, women, and owners of behind-the-ear style of hearing aids, suggesting that clinicians need to be cognizant of the additional needs for these three groups. The positive association between hearing aid outcomes and hearing aid skills and knowledge emphasizes the importance of education and training on hearing aid management for successful aural rehabilitation.

Evaluating Hearing Aid Management: Development of the Hearing Aid Skills and Knowledge Inventory (HASKI)

PURPOSE

Although hearing health care clinicians provide training on hearing aid handling and management as part of the rehabilitation program, clinical studies suggest that the level of management skill demonstrated by hearing aid owners is low. In the absence of a comprehensive clinical survey to identify these shortfalls in clinical training, the objective of this study was to develop and report the psychometric properties of the Hearing Aid Skills and Knowledge Inventory (HASKI: a self-administered version and a clinician-administered version). The HASKI evaluates the knowledge and skills required for hearing aid management. A secondary aim was to report the prevalence of hearing aid management difficulties in an Australian population.

METHOD

The development of the HASKI and the investigation of its psychometric properties in a prospective convenience cohort of 518 adult hearing aid owners, ranging in age from 18 to 97 years (M = 71 years, SD = 14), 60% male, 38% female, and 2% undisclosed, recruited from 7 hearing clinics across Australia, were used.

RESULTS

The HASKI (both the self-administered and clinician administered) demonstrated high internal consistency, interdimensional relationships, construct validity, test-retest reliability, interobserver reliability, and criterion validity. A range of aptitudes were observed from low to full competency, with 99% of participants indicating difficulty with at least 1 item on the survey.

CONCLUSIONS

The Hearing Aid Skills and Knowledge Inventories are valid and reliable measures of hearing aid handling and management skills with good potential for use in clinical settings. Hearing aid management is an area of difficulty for the majority of hearing aid owners, indicating the need for clinicians to improve the efficacy of hearing aid management training delivered.

Development of a multimedia educational programme for first-time hearing aid users: a participatory design

OBJECTIVE

To develop content for a series of interactive video tutorials (or reusable learning objects, RLOs) for first-time adult hearing aid users, to enhance knowledge of hearing aids and communication.

DESIGN

RLO content was based on an electronically-delivered Delphi review, workshops, and iterative peer-review and feedback using a mixed-methods participatory approach.

STUDY SAMPLE

An expert panel of 33 hearing healthcare professionals, and workshops involving 32 hearing aid users and 11 audiologists. This ensured that social, emotional and practical experiences of the end-user alongside clinical validity were captured.

RESULTS

Content for evidence-based, self-contained RLOs based on pedagogical principles was developed for delivery via DVD for television, PC or internet. Content was developed based on Delphi review statements about essential information that reached consensus (≥90%), visual representations of relevant concepts relating to hearing aids and communication, and iterative peer-review and feedback of content.

CONCLUSIONS

This participatory approach recognises and involves key stakeholders in the design process to create content for a user-friendly multimedia educational intervention, to supplement the clinical management of first-time hearing aid users. We propose participatory methodologies are used in the development of content for e-learning interventions in hearing-related research and clinical practice.

Evaluating Random Error in Clinician-Administered Surveys: Theoretical Considerations and Clinical Applications of Interobserver Reliability and Agreement

PURPOSE

The purpose of this study is to raise awareness of interobserver concordance and the differences between interobserver reliability and agreement when evaluating the responsiveness of a clinician-administered survey and, specifically, to demonstrate the clinical implications of data types (nominal/categorical, ordinal, interval, or ratio) and statistical index selection (for example, Cohen's kappa, Krippendorff's alpha, or interclass correlation).

METHODS

In this prospective cohort study, 3 clinical audiologists, who were masked to each other's scores, administered the Practical Hearing Aid Skills Test-Revised to 18 adult owners of hearing aids. Interobserver concordance was examined using a range of reliability and agreement statistical indices.

RESULTS

The importance of selecting statistical measures of concordance was demonstrated with a worked example, wherein the level of interobserver concordance achieved varied from "no agreement" to "almost perfect agreement" depending on data types and statistical index selected.

CONCLUSIONS

This study demonstrates that the methodology used to evaluate survey score concordance can influence the statistical results obtained and thus affect clinical interpretations.

Are hearing aid owners able to identify and self-report handling difficulties? A pilot study

OBJECTIVE

Although clinician administered surveys evaluating hearing aid handling skills exist, the development of a self-administered version may reduce clinical load, save consultation time, and facilitate more frequent use than face-to-face consultations allow. However, there is currently no evidence to support whether hearing aid owners can accurately self-report hearing aid handling skills via self-report survey that systematically evaluates the ability to accurately perform the individual aspects of hearing aid handling required for effective hearing aid management.

DESIGN

An explorative pilot study using a prospective research design.

STUDY SAMPLE

Nineteen adult hearing aid owners, aged between 65 and 93 years.

RESULTS

The self-administered survey demonstrated high sensitivity when compared with clinician evaluation of skills, with 93% of participants accurately self-identifying and reporting whether hearing aid handling skill training was required.

CONCLUSIONS

Hearing aid owners are able to accurately self-report hearing aid handling difficulties when provided with an itemised list of skills.

Changes in Psychosocial Measures After a 6-Week Field Trial

PURPOSE

The purpose of this study was to assess the extent to which intervention with hearing aids, namely, a 6-week hearing aid field trial, can minimize the psychosocial consequences of hearing loss in adults who have previously not sought treatment for their hearing loss.

METHOD

Twenty-four adults with mild to moderate bilateral sensorineural hearing loss, who had never worn hearing aids or sought help for their hearing loss, participated in this study. Participants were fitted with receiver-in-canal hearing aids, bilaterally, and wore them for 6 weeks. Participants completed subjective measures of hearing handicap and attitudes about hearing loss and hearing aids before, during, and after the hearing aid trial. A control group of age-matched participants followed the same experimental protocol, except they were not fitted with hearing aids.

RESULTS

Using hearing aids for 6 weeks significantly reduced participants' perceived stigma of hearing aids, personal distress and inadequacy due to hearing difficulties, and hearing handicap.

CONCLUSIONS

A hearing aid trial can have a positive effect on a person's attitudes toward wearing hearing aids and decrease hearing handicap.

Internet Competency Predicts Practical Hearing Aid Knowledge and Skills in First-Time Hearing Aid Users

PURPOSE

The purpose of the study was to assess whether Internet competency predicted practical hearing aid knowledge and handling skills in first-time hearing aid users.

METHOD

The design was a prospective, randomized controlled trial of a multimedia educational intervention consisting of interactive video tutorials (or reusable learning objects [RLOs]). RLOs were delivered through DVD for TV or PC, and online. Internet competency was measured at the hearing aid fitting appointment, whereas hearing aid knowledge and practical handling skills were assessed 6 weeks postfitting.

RESULTS

Internet competency predicted practical hearing aid knowledge and handling skills, controlling for age, hearing sensitivity, educational status, and gender for the group that received the RLOs. Internet competency was inversely related to the number of times the RLOs were watched.

CONCLUSION

Associations between Internet competency and practical hearing aid knowledge, handling skills, and watching the RLOs fewer times may have arisen because of improved self-efficacy. Therefore, first-time hearing aid users who are more competent Internet users may be better equipped to apply newly learned information to effectively manage their hearing loss.

Interventions to improve hearing aid use in adult auditory rehabilitation

BACKGROUND

Acquired adult-onset hearing loss is a common long-term condition for which the most common intervention is hearing aid fitting. However, up to 40% of people fitted with a hearing aid either fail to use it or may not gain optimal benefit from it. This is an update of a review first published in The Cochrane Library in 2014.

OBJECTIVES

To assess the long-term effectiveness of interventions to promote the use of hearing aids in adults with acquired hearing loss fitted with at least one hearing aid.

SEARCH METHODS

The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 5); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 13 June 2016.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of interventions designed to improve or promote hearing aid use in adults with acquired hearing loss compared with usual care or another intervention. We excluded interventions that compared hearing aid technology. We classified interventions according to the 'chronic care model' (CCM). The primary outcomes were hearing aid use (measured as adherence or daily hours of use) and adverse effects (inappropriate advice or clinical practice, or patient complaints). Secondary patient-reported outcomes included quality of life, hearing handicap, hearing aid benefit and communication. Outcomes were measured over the short ( 12 to < 52 weeks) and long term (one year plus).

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 37 studies involving a total of 4129 participants. Risk of bias across the included studies was variable. We judged the GRADE quality of evidence to be very low or low for the primary outcomes where data were available.The majority of participants were over 65 years of age with mild to moderate adult-onset hearing loss. There was a mix of new and experienced hearing aid users. Six of the studies (287 participants) assessed long-term outcomes.All 37 studies tested interventions that could be classified using the CCM as self-management support (ways to help someone to manage their hearing loss and hearing aid(s) better by giving information, practice and experience at listening/communicating or by asking people to practise tasks at home) and/or delivery system design interventions (just changing how the service was delivered). Self-management support interventions We found no studies that investigated the effect of these interventions on adherence, adverse effects or hearing aid benefit. Two studies reported daily hours of hearing aid use but we were unable to combine these in a meta-analysis. There was no evidence of a statistically significant effect on quality of life over the medium term. Self-management support reduced short- to medium-term hearing handicap (two studies, 87 participants; mean difference (MD) -12.80, 95% confidence interval (CI) -23.11 to -2.48 (0 to 100 scale)) and increased the use of verbal communication strategies in the short to medium term (one study, 52 participants; MD 0.72, 95% CI 0.21 to 1.23 (0 to 5 scale)). The clinical significance of these statistical findings is uncertain. It is likely that the outcomes were clinically significant for some, but not all, participants. Our confidence in the quality of this evidence was very low. No self-management support studies reported long-term outcomes. Delivery system design interventionsThese interventions did not significantly affect adherence or daily hours of hearing aid use in the short to medium term, or adverse effects in the long term. We found no studies that investigated the effect of these interventions on quality of life. There was no evidence of a statistically or clinically significant effect on hearing handicap, hearing aid benefit or the use of verbal communication strategies in the short to medium term. Our confidence in the quality of this evidence was low or very low. Long-term outcome measurement was rare. Combined self-management support/delivery system design interventionsOne combined intervention showed evidence of a statistically significant effect on adherence in the short term (one study, 167 participants, risk ratio (RR) 1.06, 95% CI 1.00 to 1.12). However, there was no evidence of a statistically or clinically significant effect on daily hours of hearing aid use over the long term, or the short to medium term. No studies of this type investigated adverse effects. There was no evidence of an effect on quality of life over the long term, or short to medium term. These combined interventions reduced hearing handicap in the short to medium term (15 studies, 728 participants; standardised mean difference (SMD) -0.26, 95% CI -0.48 to -0.04). This represents a small-moderate effect size but there is no evidence of a statistically significant effect over the long term. There was evidence of a statistically, but not clinically, significant effect on long-term hearing aid benefit (two studies, 69 participants, MD 0.30, 95% CI 0.02 to 0.58 (1 to 5 scale)), but no evidence of an effect over the short to medium term. There was evidence of a statistically, but not clinically, significant effect on the use of verbal communication strategies in the short term (four studies, 223 participants, MD 0.45, 95% CI 0.15 to 0.74 (0 to 5 scale)), but not the long term. Our confidence in the quality of this evidence was low or very low.We found no studies that assessed the effect of other CCM interventions (decision support, the clinical information system, community resources or health system changes).

AUTHORS' CONCLUSIONS

There is some low to very low quality evidence to support the use of self-management support and complex interventions combining self-management support and delivery system design in adult auditory rehabilitation. However, effect sizes are small. The range of interventions that have been tested is relatively limited. Future research should prioritise: long-term outcome assessment; development of a core outcome set for adult auditory rehabilitation; and study designs and outcome measures that are powered to detect incremental effects of rehabilitative healthcare system changes.

Analysis of Performance on Cognitive Test Measures Before, During, and After 6 Months of Hearing Aid Use: A Single-Subject Experimental Design

PURPOSE

The present study examined the effect of hearing aid use on cognitive test performance using a single-subject treatment design.

METHOD

Six participants 54 to 64 years old with sensorineural hearing loss were fitted with hearing aids. Participants used the hearing aids for approximately 8 hr each day for the duration of the study. A battery of cognitive tests was administered to participants during baseline (pre-hearing aid fitting), treatment (hearing aid use), and withdrawal (post-hearing aid use) study phases over a period of 6 months of hearing aid use.

RESULTS

All participants showed significant improvements in performance on the cognitive test measures with hearing aid use. The most significant treatment effects were evidenced at 2 to 4 weeks of hearing aid use on the Listening Span Test and an auditory selective attention task. In many cases, cognitive performance scores returned to baseline levels after the participant stopped using the hearing aids.

CONCLUSION

The findings from this study are consistent with the hypothesis that hearing aid use may improve cognitive performance by improving audibility and decreasing the cognitive load of the listening task.

Self-Fitting Hearing Aids: Status Quo and Future Predictions

A self-contained, self-fitting hearing aid (SFHA) is a device that enables the user to perform both threshold measurements leading to a prescribed hearing aid setting and fine-tuning, without the need for audiological support or access to other equipment. The SFHA has been proposed as a potential solution to address unmet hearing health care in developing countries and remote locations in the developed world and is considered a means to lower cost and increase uptake of hearing aids in developed countries. This article reviews the status of the SFHA and the evidence for its feasibility and challenges and predicts where it is heading. Devices that can be considered partly or fully self-fitting without audiological support were identified in the direct-to-consumer market. None of these devices are considered self-contained as they require access to other hardware such as a proprietary interface, computer, smartphone, or tablet for manipulation. While there is evidence that self-administered fitting processes can provide valid and reliable results, their success relies on user-friendly device designs and interfaces and easy-to-interpret instructions. Until these issues have been sufficiently addressed, optional assistance with the self-fitting process and on-going use of SFHAs is recommended. Affordability and a sustainable delivery system remain additional challenges for the SFHA in developing countries. Future predictions include a growth in self-fitting products, with most future SFHAs consisting of earpieces that connect wirelessly with a smartphone and providers offering assistance through a telehealth infrastructure, and the integration of SFHAs into the traditional hearing health-care model.

A Randomized Controlled Trial to Evaluate the Benefits of a Multimedia Educational Program for First-Time Hearing Aid Users

OBJECTIVES

The aims of this study were to (1) develop a series of short interactive videos (or reusable learning objects [RLOs]) covering a broad range of practical and psychosocial issues relevant to the auditory rehabilitation for first-time hearing aid users; (2) establish the accessibility, take-up, acceptability and adherence of the RLOs; and (3) assess the benefits and cost-effectiveness of the RLOs.

DESIGN

The study was a single-center, prospective, randomized controlled trial with two arms. The intervention group (RLO+, n = 103) received the RLOs plus standard clinical service including hearing aid(s) and counseling, and the waitlist control group (RLO-, n = 100) received standard clinical service only. The effectiveness of the RLOs was assessed 6-weeks posthearing aid fitting. Seven RLOs (total duration 1 hr) were developed using a participatory, community of practice approach involving hearing aid users and audiologists. RLOs included video clips, illustrations, animations, photos, sounds and testimonials, and all were subtitled. RLOs were delivered through DVD for TV (50.6%) and PC (15.2%), or via the internet (32.9%).

RESULTS

RLO take-up was 78%. Adherence overall was at least 67%, and 97% in those who attended the 6-week follow-up. Half the participants watched the RLOs two or more times, suggesting self-management of their hearing loss, hearing aids, and communication. The RLOs were rated as highly useful and the majority of participants agreed the RLOs were enjoyable, improved their confidence and were preferable to written information. Postfitting, there was no significant between-group difference in the primary outcome measure, overall hearing aid use. However, there was significantly greater hearing aid use in the RLO+ group for suboptimal users. Furthermore, the RLO+ group had significantly better knowledge of practical and psychosocial issues, and significantly better practical hearing aid skills than the RLO- group.

CONCLUSIONS

The RLOs were shown to be beneficial to first-time hearing aid users across a range of quantitative and qualitative measures. This study provides evidence to suggest that the RLOs may provide valuable learning and educational support for first-time hearing aid users and could be used to supplement clinical rehabilitation practice.

The Process of Developing an Internet-Based Support System for Audiologists and First-Time Hearing Aid Clients

BACKGROUND

In audiologic practice, complementary information sources and access to the clinician between appointments improve information retention and facilitate adjustment behaviors. An Internet-based support system is a novel way to support information sharing and clinician access.

PURPOSE

This research forum article describes the process of developing an Internet-based support system for audiologists and their first-time hearing aid clients.

METHOD

The iterative development process, including revisions by 4 research audiologists and 4 clinical audiologists, is described. The final system is exemplified.

CONCLUSION

An Internet-based support system was successfully developed for audiologic practice.

Paid Support Workers for Adults with Intellectual Disabilities; Their Current Knowledge of Hearing Loss and Future Training Needs

BACKGROUND

People with intellectual disabilities are more likely to have hearing loss than the general population. For those unable to self-advocate, the responsibility of detection and management falls to their caregivers.

METHODS

This is the first cycle of a project using action research methodology to improve services. Twenty care workers were interviewed to understand their knowledge of hearing loss and hearing aids. Themes were generated using thematic analysis.

FINDINGS

This group was better qualified than their peers but received minimal training in hearing loss. They were unable to accurately estimate expected prevalence and had a negative perception of hearing aids. Only 7% of service users were known to have hearing loss.

CONCLUSIONS

Current training is not sufficient to provide the skills for detection and management of hearing problems. This group had clear ideas on methods of learning. Working in collaboration is necessary to achieve long-term change to practice.