Addressing patients' psychosocial concerns regarding hearing aids within audiology appointments for older adults

Discussing Patient Emotions in Audiology: Provider Experiences With the Implementation Process of Hearing Loss Psychological Inflexibility Screenings

PURPOSE

This study aimed to investigate barriers and facilitators experienced by clinical educators and graduate students when talking with patients about difficult emotions and thoughts related to their hearing.

METHOD

A longitudinal observational design was used and an Implementation Research Logic Model guided the process. Five clinical educators and five graduate students participated in the study. Participants completed pre- and postmeasures and attended individual debriefing sessions during the 8-month study period.

RESULTS

Four themes emerged from the debriefing sessions: (a) learning process, (b) confidence, (c) barriers, and (d) supervision. Participants described that the Acceptance and Action Questionnaire-Managing Child Hearing Loss and Acceptance and Action Questionnaire-Adult Hearing Loss served as a reminder to ask about patients' internal barriers and increased awareness of their discomfort in talking about patient emotions. Participants also described barriers and struggles related to supporting students in gaining counseling skills.

CONCLUSIONS

Screening for internal challenges helped clinicians remember to talk with patients about their difficult thoughts and emotions. Clinician hesitancy to engage in conversations with patients about their emotions can interfere with opportunities for patients to share their struggles and with training student in these skills.

Adults' recollections of discussions with their audiologist: a qualitative study of what was and was not successfully communicated about listening difficulties

OBJECTIVES

Some adults experience challenges in successfully communicating their listening difficulties to their audiologist, and report feeling that they are not always listened to or understood. This project examined adults' recollections of discussions with their audiologist to explore (1) how adults report describing their listening difficulties and (2) information that adults report they do not communicate, or do not communicate successfully, to their audiologist.

DESIGN

Individual semi-structured interviews were conducted. Interview transcripts were analysed using a template analysis approach.

STUDY SAMPLE

Fifteen adults who self-report listening difficulties, and who had previously consulted an audiologist.

RESULTS

Four themes were identified from adults' recollections of how they describe their listening difficulties: (1) situation or context of listening difficulties, (2) behavioural responses, (3) impacts of listening difficulties and (4) contributing factors. Adults report not always successfully communicating (1) emotional concerns and impacts, (2) descriptions of sound quality and (3) descriptions of changed listening experiences.

CONCLUSION

Results provide insights about the times when adults feel that communication with their audiologist is successful, or unsuccessful. The results are useful for informing interventions to help adults and audiologists communicate more effectively together. To further inform interventions, factors affecting adults' communication should be explored.

A scoping review exploring how adults self-describe and communicate about the listening difficulties they experience

Objective: It is unknown how adults communicate about their experienced listening difficulties with their audiologist. This scoping review aims to explore how adults self-describe the listening difficulties that they experience, and how they communicate about them. Design: A scoping review was conducted between December 2020 and September 2022 to identify published journal articles in which adults described and communicated about their listening difficulties. Study sample: Database searches yielded 10,224 articles initially. After abstract screening and full text review, 55 articles were included for analysis. Results: The listening difficulties that adults described were varied, highlighting the fact that each person has individual experiences. Adults discussed reasons for their listening difficulties, impacts of their listening difficulties, and behavioural responses they adopted to cope with their listening difficulties. Conclusions: This review shows the broad impacts of listening difficulties, and the varied ways in which adults discuss their listening difficulties. There is no available literature reporting how adults communicate about their listening difficulties in a clinical context.

Audiologists' attitudes and practice toward referring for psychosocial intervention with cochlear implant patients

Background

Hearing loss is associated with a range of poor psychosocial outcomes. Cochlear implants (CI) are an available treatment option for significant hearing loss and have been linked to improved quality of life in patients. Evidence suggests that audiologists lack the skills to appropriately detect, address, and refer for psychosocial needs among patients with hearing loss. The objective of this study is to examine the attitudes and practice patterns related to psychosocial care among audiologists who work with CI users.

Methods

A cross-sectional survey was administered to clinical audiologists who work with CI recipients in the United States. The survey evaluated participants' attitudes toward psychosocial services and factors that contribute to their abilities to address the psychosocial needs of their patients. Additionally, participants were surveyed about their practice patterns including the use of psychosocial screeners, clinical protocols regarding psychosocial care, and referral patterns for coordinated psychosocial services. Descriptive statistics were used to summarize survey responses.

Results

Sixty-eight audiologists completed the survey. Of these audiologists, a majority (73.6%) held the attitude that most or all CI patients would benefit from psychosocial intervention. Despite clinicians' recognition of psychosocial needs in this population, over 90% of participants reported never screening for psychosocial symptoms. Additionally, a majority of respondents indicated that they seldom refer their patients for psychosocial services, with referrals occurring less than half the time (58%) or never (27%). Additionally, few audiologists reported utilizing protocols or resources for guiding psychosocial practices. Audiologists indicated that the primary factors that influence their psychosocial practices include time available to spend with the patient and their comfort level in counseling.

Conclusion

Audiologists working with CI patients recognize the potential benefit of psychosocial intervention in this population. Nevertheless, audiologists encounter barriers in clinical practice which limit their ability to identify and address the psychosocial needs of their patients. Strategies designed to enhance audiologists' capacity to recognize the psychosocial needs of CI users, in addition to improved interprofessional practice on CI teams, implies significant opportunities to improve the provision of patient-centered hearing care.

Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL): validation with hearing aid users

OBJECTIVE

Individuals who are deaf or hard of hearing (DHH) may find adherence to their hearing devices difficult due to internal experiences related to their hearing loss such as sadness or frustration. The Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) is the only measure available to assess psychological inflexibility as it relates to hearing loss. The purpose of this study was to confirm the single latent structure of the AAQ-AHL (through confirmatory factory analysis) and test convergent and discriminant validity.

DESIGN

Cross-sectional data was used to further validate the AAQ-AHL.

STUDY SAMPLE

Participants were 146 adults who had diagnosed hearing loss and used a hearing aid.

RESULTS

Results revealed the AAQ-AHL has a single latent structure, correlated to other similar constructs (psychological flexibility and hearing aid efficacy), and not correlated to unrelated constructs (hearing loss severity). These results suggest that the AAQ-AHL is a valid instrument to assess psychological flexibility as it relates to hearing aid use.

CONCLUSION

Together, the findings imply the AAQ-AHL has strong psychometric properties and justification to use in a clinical setting.

Effect of Determinants of Health on the Hearing Care Framework: An Economic Perspective

Hearing care is expanding accessibility to consumers through new service delivery channels and methods of technology distribution (see Brice et al, this issue). This diversification has the potential to overcome longstanding consumer disparities (e.g., health, socioeconomic, psychological, environmental) in receiving care and provider constraints (e.g., accessibility, geography, direct access) to delivering care that adversely impacts quality of life (e.g., social isolation, depression, anxiety, self-esteem). In this article, the reader is provided with an overview of health outcomes factors (i.e., determinants of health)-in the context of an economic framework (i.e., supply, demand)-and their effect on consumer behavior and provider preferences toward hearing healthcare services. This overview also affords readers with strategic business insights to assess and integrate future hearing care services and technology to consumers in their local markets.

Centering on People: How Hearing Care Professionals Can Adapt to Consumers' Need and Outcomes

Audiology is experiencing exponential growth in technology, service, and provision options. These advancements give hearing care professionals the opportunity to revise, potentially improve, and adapt to the modern hearing care landscape to better serve the modern consumer. Consumer needs guide care planning and delivery, with the goal of achieving outcomes that are important to both the consumer and the clinician. The changes available to the hearing care industry can also enable consumers' needs to be identified and served in a more holistic and personalized manner than has previously been possible. The purpose of this article is to explain and encourage hearing care professionals to adopt a mindset of doing whatever is reasonable and clinically appropriate to meet the need and desires of the consumer by implementing choice in service, technology, and channel across whichever model of care adopted by a provider.

Use of the Behaviour Change Wheel to design an intervention to improve the provision of mental wellbeing support within the audiology setting

OBJECTIVE

This study describes the development of an intervention to increase the frequency of audiologists' asking about and providing information regarding mental wellbeing within adult audiology services.

DESIGN

The Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed.

RESULTS

A multifaceted intervention was developed to change audiologists' behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing, (2) providing general information on the mental wellbeing impacts of hearing loss, and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources.

CONCLUSION

This study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work.

Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model

OBJECTIVE

To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being.

DESIGN

A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change).

STUDY SAMPLE

Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3).

RESULTS

Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss.

CONCLUSION

Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Conversations about mental illness and health in adult audiological rehabilitation

OBJECTIVE

To understand the nature of mental health discussions in audiological rehabilitation, specifically, the types of conversations, when and how they are initiated, and the participant factors associated with discussing mental health.

DESIGN

A cross-sectional descriptive survey including quantitative (multiple choice) and qualitative (free-text) questions regarding mental health discussions between audiologists and clients.

STUDY SAMPLE

A convenience sample of 118 Australian audiologists working in adult audiological rehabilitation.

RESULTS

The majority of participants (95.8%) reported having engaged in discussions with clients about mental illness and health at some point throughout their career. The frequency of these discussions varied across participants: 7% rarely discuss, 50% discuss occasionally, 30% discuss with about half their clients and 13% have discussions with most clients. Many participants (85.6%) reported that clients would initiate these conversations, most often via disclosing the impacts of hearing loss on clients' lives.

CONCLUSIONS

Most audiologists will encounter clients with mental health concerns, and many will engage in conversations about psychological symptoms, therefore, training audiologists to recognise and address verbal and non-verbal cues regarding mental health may help to promote person-centred care and potentially improve outcomes.

Using an Online Tool to Apply a Person-Centred Approach in Audiological Rehabilitation: A Pilot Study

This study aimed to explore the experiences of adult clients with hearing loss and their audiologists in using an online tool, the Living Well Tool (LWT), during initial audiology appointments. The LWT is designed to help clients identify when and where it is most important for them to communicate effectively and live well with hearing loss. A total of 24 adult clients with hearing loss and two audiologists participated in this study. Clients were invited to complete the LWT prior to their next audiology appointment, however, most clients chose to use the LWT in-session with their audiologist. Following the appointment, clients and audiologists participated in individual qualitative semi-structured interviews to explore their experiences of using the LWT, and the extent to which the LWT facilitated person-centred care. Qualitative analysis five key themes which reflected participants' experiences and perceptions of using the LWT: (1) the LWT enhances audiological care; (2) the LWT supports person-centred audiological care; (3) the use of the LWT should be individualised; (4) users value comprehensiveness; and (5) users value accessibility. This study demonstrated that the LWT supported the provision of person-centred audiological care, providing a flexible, comprehensive and accessible means for audiologists to gain an understanding of their clients' needs and preferences. However, it was also noted that the use of a tool must be individualised and accessible for all.

A Holistic Approach to Addressing Post-Fitting Needs in the Short and Long Term for New Hearing Aid Users

Helping your client adjust to being a hearing aid (HA) user and learn to manage their hearing challenges requires a combination of technical skill and psychosocial counseling in the short- and long-term periods. A key aspect of providing support in this time period is to keep the door open for psycho-social-emotional counseling that is often necessary even when the HA user was motivated to make this change, and even when, objectively, they seem to be fit successfully. Another key aspect is not to assume that once they have checked off all the HA fitting boxes, you are done. Over the long term, the user will experience changes in their own hearing abilities and in their life circumstances that will require on-going support to adapt to new communication needs. Approaching the post-fitting period from a person-/family-centered perspective and using a holistic approach to consider how this treatment fits into the HA user's broader life will result in the most success for that person.

Barriers and facilitators to asking adults with hearing loss about their emotional and psychological well-being: a COM-B analysis

OBJECTIVE

To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being.

DESIGN

This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model.

STUDY SAMPLE

Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated.

RESULTS

Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice.

CONCLUSIONS

Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being.

A qualitative study showing that a telecare tool can have benefits before and during the initial hearing assessment appointment

Objective: To examine patient and audiologist experiences and perspectives of using a patient-centred telecare tool, the Ida Institute's Why Improve My Hearing? (WIMH) Tool, before and during the initial hearing assessment appointment.Design: A qualitative study comprising individual semi-structured interviews using a maximum variation sampling strategy. The data were analysed using an established thematic analysis technique.Study sample: Fifteen participants, including ten patients (i.e. adults with hearing loss) and five audiologists, were recruited from Adult Audiology Services within the United Kingdom's publicly-funded National Health Service (NHS).Results: Three themes described the impact of using the WIMH Tool. Theme 1 (i.e. enhanced preparation before the appointment): the Tool helps patients to better understand and accept their hearing difficulties in advance of their first appointment. Theme 2 (i.e. enriched discussion during the appointment): the tool can enhance patient-centred communication, as well as the efficiency of the appointment. Theme 3 (i.e. varied impact on outcomes following the appointment): the Tool can improve patient motivation, readiness, and involvement in decision-making, though it may have limited impact on additional outcomes, such as adherence.Conclusion: The WIMH Tool can be successfully implemented in audiological practice, resulting in benefits before and during the initial hearing assessment appointment.

‘The worse my hearing got, the less sociable I got’: a qualitative study of patient and professional views of the management of social isolation and hearing loss

Background

Social isolation is a major consequence of hearing loss. It includes an objective component (e.g. small social network) and a subjective component (e.g. loneliness).

Objective

To examine the perspectives of key stakeholders regarding (i) the relationship between hearing loss and social isolation and (ii) interventions to address hearing loss and social isolation.

Design

A phenomenological qualitative study.

Setting

A UK research centre with a role to engage patients and clinicians.

Participants

Hearing healthcare professionals (n = 7) and adults with hearing loss (n = 6) were recruited via maximum variation sampling.

Methods

Individual (n = 3) and group (n = 3) semi-structured interviews were conducted. Inductive thematic analysis was performed.

Results

Five themes were identified. Theme 1 (experience of isolation and hearing loss): hearing loss can cause people to feel disconnected at social events or to cease attending them. Theme 2 (complexity of isolation and hearing loss): the various causes of isolation (e.g. hearing loss, retirement, comorbidities) are difficult to disentangle. Theme 3 (downstream effects of isolation and hearing loss): hearing loss and/or isolation can lead to mental health problems, stigmatisation, fatigue and unemployment. Theme 4 (preferred components of an isolation intervention): an isolation intervention should be patient-led and patient-centred and take place in the community. Theme 5 (challenges to implementing an isolation intervention): barriers to implementing an isolation intervention include a lack of time, training and continuity.

Conclusion

This study demonstrated that social isolation arising from hearing loss is a substantial, complex problem and provided novel insights on implementing an intervention to address this issue.

Addressing Emotional and Psychological Problems Associated With Hearing Loss: Perspective of Consumer and Community Representatives

PURPOSE

Hearing loss causes emotional distress and can contribute to the development of psychological difficulties, yet emotional and psychological issues are not addressed within current audiology services. The purpose of this study was to use focus groups with consumer and community representatives to explore how we might improve the provision of support for clients experiencing emotional and psychological issues in relation to their hearing loss.

PARTICIPANTS

Adults with hearing loss (n = 19) and their significant others (n = 9), as well as 10 hearing health care professionals (n = 4 hearing health care clinicians, n = 4 reception staff, and n = 2 clinical managers), participated in consumer and community engagement focus groups.

METHOD

Consumer and community representatives were tasked with (a) identifying the stakeholders involved in supporting adults experiencing emotional or psychological difficulties on account of their hearing loss, (b) describing the behaviors undertaken by each stakeholder group, and (c) selecting target behavior(s) that could optimally form the basis of an intervention program to improve the quality and frequency of support provided to people experiencing emotional and psychological problems in the audiology setting.

RESULTS

Participants identified 12 stakeholder groups involved in supporting adults with hearing loss experiencing emotional and psychological problems. The three behaviors voted by participants to be the most promising for a behavioral intervention included the clinician (a) asking about, (b) providing information on, and (c) delivering therapeutic intervention for emotional and psychological well-being within audiological service provision.

CONCLUSION

Consumer and community stakeholder representatives indicate a general desire for hearing health care clinicians to deliver support for the emotional and psychological issues that arise relating to hearing loss.

Experienced hearing aid users' perspectives of assessment and communication within audiology: a qualitative study using digital methods

OBJECTIVE

To explore experienced hearing aid users' perspectives of audiological assessments and the patient-audiologist communication dynamic during clinical interactions.

DESIGN

A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice.

STUDY SAMPLES

Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 - 86 years; 9 males, 11 females).

RESULTS

Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology.

CONCLUSION

To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users' value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient-audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

Smartphone-Connected Hearing Aids Enable and Empower Self-Management of Hearing Loss: A Qualitative Interview Study Underpinned by the Behavior Change Wheel

OBJECTIVES

To identify patient-reported barriers and facilitators to using smartphone-connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed.

DESIGN

A single-center, prospective, observational study. Eight hearing aid users (new = 1, existing = 7; mean age = 71.75 years, SD = 5.23, range = 65 to 81 years) were identified through convenience sampling from 44 participants who took part in a 7-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, preset, and customized programmes. Participants were assigned to one of two focus groups following trial of the app.

RESULTS

Focus group transcripts were thematically analyzed and underpinned by the COM-B (Capability, Opportunity, Motivation-Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique Taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators. Capability: The app increased participants' knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use. Opportunity: Perceived smartphone norms (i.e., acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers. Motivation: The ability to control hearing aid settings in any listening situation (e.g., to reduce noise) empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The app also reduced hearing aid-related and self-stigma, and the ability to self-adjust hearing aids benefitted both participants and communication partners. It was the adjustability and interaction afforded by the app that empowered users, rather than the hearing aid technology itself. Perceived beliefs and knowledge about digital literacy skills, and specifically abilities to use a smartphone, were perceived to be barriers in this typically older population, particularly when they compared themselves to younger generations. Using the Behavior Change Technique Taxonomy (version 1), behavior change techniques that could be used by audiologists to address these barriers included enablement, goal setting, reframing perceptions toward technology, and addressing patient educational needs.

CONCLUSIONS

Smartphone-connected hearing aids, when used in their everyday lives, were viewed positively by participants across a range of domains, empowering them and enabling hearing loss self-management. Audiologists should consider smartphone-connected hearing aid candidacy for all who have access to smartphones and are willing to use one. Use of the BCW has identified that modifiable barriers to using smartphone-connected hearing aids exist. Audiologists could use these evidence-based behavior change techniques to support patients in adopting and using these technologies to successfully self-manage hearing loss. Overall, by reframing smartphone technologies as a tool to remain connected with society, smartphone-connected hearing aids could shift the power of managing hearing loss from clinician to patient.

Exploring Current Practice, Knowledge, and Training Needs for Managing Psychosocial Concerns in the Audiology Setting: Perspectives of Audiologists, Audiology Reception Staff, and Managers

Purpose The purpose of this study was to explore the current practices and training requirements for supporting clients experiencing psychosocial concerns in the audiology setting, from the perspectives of audiology clinicians, managers, and reception staff. Method Convenience sampling was used to recruit audiologists, reception staff, and clinic managers (N = 13, M _age = 32.2 ± 8.1, range: 25-47 years, 11 female) through a large hearing services provider in Western Australia. A semistructured focus group was used to elicit participant views regarding current experiences relating to clients who express psychosocial concerns in the audiology setting, familiarity with psychosocial interventions, and training requirements for delivery of psychosocial interventions in the audiological setting. Results Twenty-four subthemes were identified across six themes: (1) awareness of psychosocial well-being, (2) the role of others, (3) identifying client's psychosocial needs, (4) managing client's psychosocial needs, (5) barriers to providing psychosocial support, and (6) broadening audiological services to include psychosocial support. Conclusions Participants reported an awareness of their clients' psychosocial challenges within the audiology setting, yet they described uncertainty in how best to respond in providing support and whether this was within their scope of practice. A majority of audiology staff expressed desire and motivation to broaden the scope of their service in order to better address their clients' hearing loss-related psychosocial needs.

Experiences With Hearing Health Care Services: What Can We Learn From Online Consumer Reviews?

Objective The aim of this study was to examine experiences of hearing health care services as described in online consumer reviews. Design This study used a cross-sectional design. Online consumer reviews about hearing health care services generated from Google.com to an open-ended question "Share details of your own experience at this place" and perceived overall experience (indicated on a 5-point rating scale: "very good" to "very poor") were extracted from 40 different cities across the United States. The open text contributed a text corpus of 9,622 unique consumer reviews. These responses were analyzed with the cluster analysis approach using an open-source automated text analysis software program, IRaMuTeQ, to identify key themes. Association between clusters and consumer experience ratings as well as consumer metadata (percentage of older adults in the city, region) were examined using the chi-square analysis. Results The majority of consumers appeared satisfied with their hearing health care services, with nearly 95% of consumers reporting "very good" and "good" on the global experience scale. The analysis of text responses resulted in seven clusters within two domains. Domain 1 (Clinical Processes) included the three clusters: administration processes, perceived benefits, and device acquisition. Domain 2 (Staff and Service Interactions) included the four clusters: clinician communications, staff professionalism, customer service, and provider satisfaction. Content relating to administration processes was associated with overall rating regarding the hearing health care service experience. Consumer's reviews relating to administration processes mostly described negative experiences, and these participants were more inclined to provide poorer overall experience ratings. In addition, city characteristics (i.e., percentage of older adults, region) had bearing toward what elements of hearing health care services are highlighted more in the consumer reviews. Conclusions Consumers comment on a variety of elements when describing their experiences with hearing health care services. Experiences reported in most clusters were generally positive, although some concerns in the "clinical process" are associated with lower satisfaction. Employing patient-centered strategies and ensuring patients have good experiences in the areas of concern may help improve both patient experience and their satisfaction. Supplemental Material https://doi.org/10.23641/asha.16455924.

How Do Audiologists Respond to Emotional and Psychological Concerns Raised in the Audiology Setting? Three Case Vignettes

OBJECTIVES

Emotional and psychological well-being are essential to overall health, but there is little research showing how to approach emotional and psychological concerns in the audiological setting. This study investigated audiologists' self-reported clinical behaviors in response to emotional and psychological concerns and/or symptoms raised by audiology clients.

DESIGN

A sample of 83 Australia-based audiologists completed a survey including vignettes presenting older adults with hearing loss and experiencing symptoms consistent with either depression or grief. Content analysis was used to explore: (1) audiologists' self-reported usual response when clients present with emotional and psychological concerns and/or symptoms in the audiological setting; (2) audiologists' ability to identify and describe psychological symptoms; and (3) audiologists' self-reported clinical behaviors relating to client referral for psychological support.

RESULTS

When asked to describe their usual clinical course of action in response to the vignettes, over one half the audiologists described actions that address the clients concerns related to psychological well-being. Where audiologists described how they would provide psychological support, they described modifications to the audiological rehabilitation program including involving significant others in the rehabilitation process, recommending additional support outside of the audiology setting (such as General Practitioner or psychologists), and providing emotional support and counseling. When prompted, the majority of participants recognized the two cases with depression as having a mental health condition; however, 48% of participants indicated the control case as also having a mental health condition. When asked directly, the majority of audiologists indicated that they would refer the three vignettes for specialist support; however, less than one third described referral to a General Practitioner and less than 5% described referral to a mental health professional as their normal course of action in the open response item. Twenty-five different professions/people were reported as potential sources for referral.

CONCLUSION

These findings support the need for further training and/or resources for audiologists to enable them to appropriately detect, describe and refer for emotional and psychological concerns and/or symptoms raised by clients' in the audiology setting.

What Influences Decision-Making for Cochlear Implantation in Adults? Exploring Barriers and Drivers From a Multistakeholder Perspective

OBJECTIVES

To explore the factors influencing the uptake of cochlear implants in adults, determine the impact of each factor, and to conceptualize the journey to implantation from a multistakeholder perspective.

DESIGN

Concept mapping was used to integrate input from multiple stakeholders, each with their own experience and expertise. This mixed participatory method collects qualitative and quantitative data collection and enables further quantitative analysis. There were two participant cohorts: clients (cochlear implant recipients, candidates, and family members) and professionals (cochlear implant audiologists, ear, nose, and throat surgeons, administration staff, managers. and manufacturer representatives). A total of 93 people participated in the study: client cohort (n = 60, M age = 66.60 years) and professional cohort (n = 33, M age = 45.24 years). Participants brainstormed statements in response to the question "What influences people's decision to get/not get a cochlear implant?" They subsequently grouped the statements and named each group. They rated each statement as to its impact on the decision and prioritized the need for each to be changed/improved using a five-point Likert scale. Multidimensional scaling was used to produce a visual representation of the ideas and their relationship in the form of concepts. Further analysis was conducted to determine the differences between the cohorts, subcohorts, and concepts.

RESULTS

One hundred ten unique statements were generated and grouped into six concepts which either directly affected the client or their environment. These concepts were: external influences (awareness and attitude of non-implant professionals about uptake, cost, logistics, the referral pathway, public awareness); uncertainties, beliefs, and fears (fears, negative effect of word of mouth, unsuccessful previous ear surgery, cosmetics of the device, misunderstanding of how a cochlear implant functions, eligibility for an implant and outcomes after implantation); health problems (mental and physical health); hearing difficulties (social, emotional, and communication impacts of hearing loss, severity of hearing loss, benefit from and experience with hearing aids); implant professionals (implant team's attitude, knowledge and relationship with clients, quality of overall service); and goals and support (clients 'hearing desires and goals, motivation, positive impact of word of mouth, family support, having a cochlear implant mentor. The six concepts fell into two overarching domains: the client-driven domain with four concepts and the external domain with two concepts. The mean rating of concepts in terms of impact on a client's decision to get an implant ranged from 2.24 (external influences, the main barrier) to 4.45 (goals and support, the main driver). Ratings significantly differed between the client and professional cohorts.

CONCLUSIONS

This study increases our understanding of the factors, which influence a client's decision choose a cochlear implant as a hearing treatment. It also provides new information on the influence of the other stakeholders on the client journey. The magnitude of the generated statements in the client-driven domain highlights the pivotal role of individualized care in clinical settings in influencing a client's decision and the need for the professionals to understand a client's needs and expectations. A client's persistent hearing difficulties, goals, and support network were identified as drivers to the uptake of cochlear implants. However, the barriers identified highlight the need for a collaborative multi- and interdisciplinary approach to raise awareness in and educate non-implant hearing professionals about the cochlear implant process, as well as providing information to empower clients to make educated decisions and consider a cochlear implant as a hearing management option.

How Can eHealth Meet the Hearing and Communication Needs of Adults With Hearing Impairment and their Significant Others? A Group Concept Mapping Study

OBJECTIVES

To seek the perspectives of key stakeholders regarding: (1) how eHealth could help meet the hearing and communication needs of adults with hearing impairment and their significant others; and (2) how helpful each aspect of eHealth would be to key stakeholders personally.

DESIGN

Group concept mapping, a mixed-methods participatory research method, was used to seek the perspectives of key stakeholders: adults with hearing impairment (n = 39), significant others (n = 28), and hearing care professionals (n = 56). All participants completed a short online survey before completing one or more of the following activities: brainstorming, sorting, and rating. Brainstorming required participants to generate ideas in response to the focus prompt, "One way I would like to use information and communication technologies to address the hearing and communication needs of adults with hearing loss and their family and friends is to…." The sorting task required participants to sort all statements into groups that made sense to them. Finally, the rating task required participants to rate each of the statements according to "How helpful would this idea be to you?" using a 5-point Likert scale. Hierarchical cluster analysis was applied to the "sorting" data to develop a cluster map using the Concept Systems software. The "rating" data were subsequently analyzed at a cluster level and an individual-item level using descriptive statistics. Differences in cluster ratings between stakeholder groups were examined using Kruskal-Wallis tests.

RESULTS

Overall, 123 statements were generated by participants in response to the focus prompt and were included in subsequent analyses. Based on the "sorting" data and hierarchical cluster analysis, a seven-cluster map was deemed to be the best representation of the data. Three key themes emerged from the data, including using eHealth to (1) Educate and Involve Others; (2) Support Aural Rehabilitation; and (3) Educate About and Demonstrate the Impacts of Hearing Impairment and Benefits of Hearing Rehabilitation. Overall median rating scores for each cluster ranged from 3.97 (educate and involve significant others) to 3.44 (empower adults with hearing impairment to manage their hearing impairment from home).

CONCLUSIONS

These research findings demonstrate the broad range of clinical applications of eHealth that have the capacity to support the implementation of patient- and family-centered hearing care, with self-directed educational tools and resources typically being rated as most helpful. Therefore, eHealth appears to be a viable option for enabling a more biopsychosocial approach to hearing healthcare and educating and involving significant others in the hearing rehabilitation process without adding more pressure on clinical time. More research is needed to inform the subsequent development of eHealth interventions, and it is recommended that health behavior change theory be adhered to for such interventions.

International survey of audiologists during the COVID-19 pandemic: effects on the workplace

OBJECTIVE

This study surveyed the effects of the COVID-19 pandemic on the audiology workplace.

DESIGN

The study used a cross-sectional survey design for audiologists across the globe (n = 337) using an online survey (June-August 2020) focussing on changes to the workplace during the pandemic.

RESULTS

Participants represented varied work settings and audiology services. Only a third (31.5%) provided psychosocial support, which may be important during the pandemic, as part of their services. Almost all (97%) audiologists reported changes to their workplace, with 76.4% reporting reduced caseloads during the COVID-19 pandemic. When rating their current and anticipated work conditions, 38.7% reported reduced working hours although only 13.8% anticipated reduced working hours in 6-months' time. Audiologists ranked services such as access to hearing assessment, hearing device adjustment and maintenance, and general audiological support as being more important during the pandemic than services such as psychosocial, emotional and tinnitus support.

CONCLUSIONS

The COVID-19 pandemic has resulted in significant disruptions to audiological practice that highlights the need to adapt and incorporate new audiological practices including telehealth, to ensure patients have continued access to care and clinics remain sustainable during the ongoing COVID-19 pandemic and recovery phase.

A dimensional approach to understanding the relationship between self-reported hearing loss and depression over 12 years: the Three-City study

Objectives: To examine the relationship between hearing loss and depression in older adults longitudinally. This paper uses a dimensional approach to conceptualising depression, with the aim of further enhancing understanding of this relationship.Method: 8344 community-dwelling adults aged 65 years and above enrolled in the Three-City prospective cohort study were included. Relationships between baseline self-reported hearing loss (HL) with the trajectory of different dimensions of depression symptoms over 12 years were examined using linear mixed models. Depression dimensions were determined using the four-factor structure of the Centre for Epidemiology Studies-Depression Scale (CESD): depressed affect, positive affect, somatic symptoms and interpersonal problems.Results: HL was associated with somatic symptoms of depression both at baseline (b = .07, p = .04) and over 12 years (b = .01, p = .04). HL was associated with poorer depressed affect and interpersonal problems at baseline (b = .05, p = .001, b = .35, p < .001; respectively), but not over follow-up. HL was associated with poorer positive affect symptoms over time (b = -.01, p = .01).Conclusion: HL had varied relationships with different dimensions of depression symptoms, and there were different patterns of adjustment for the dimensions. HL was primarily associated with somatic symptoms, suggesting that shared disease processes might partly underlie the relationship between HL and depression. Targeted assessment and treatment of somatic and positive affect symptoms in older adults with HL might facilitate better wellbeing in this population.

Changing the narrative for hearing health in the broader context of healthy living: a call to action

OBJECTIVE

To discuss the steps necessary to facilitate hearing health care in the context of well-being and healthy living.

DESIGN

Common themes among the articles in this special supplement of the International Journal of Audiology were used to identify issues that must be addressed if audiology is to move from being hearing-focussed to taking a holistic perspective of hearing care in the context of healthy aging. These are discussed within the context of other published literature.

RESULTS AND CONCLUSIONS

Three needs were identified: (i) Increased interdisciplinary education to raise awareness of the interplay between hearing and health. (ii) Increased emphasis on counselling education in audiology programs so that audiologists are equipped with the knowledge, competence and confidence to provide counselling and emotional support to their patients, beyond care. (iii) Redefinition of therapeutic goal setting and hearing outcomes to include aspects of well-being, so that audiologists can capture and patients realise that that good hearing outcomes can have a direct positive impact on a person's quality of life that extends beyond their improved ability to hear. It was emphasised that each of these needs to be considered within the context of the audiologists' scope of practice and audiologists' well-being.

Counseling Parents at the Time of Diagnosis: Moving Toward Client-Centered Practice

Purpose The purpose of this article is to present a client-centered model of counseling that integrates information and personal adjustment counseling. Research has indicated that audiologists are more comfortable with counseling that is information based than with personal adjustment counseling. The prevailing model of diagnosis appears to be the medical model in which, first, a case history is taken, then testing and, finally, counseling. This model lends itself to audiologist as expert and the counseling as a separate entity based on information and advice. Further research has indicated parents retain little of the information provided in the initial examination because of their heightened emotions. This article presents a client-centered model of diagnosis in which information is provided within an emotionally safe context, enabling the parents to express their feelings and have the ability to control the flow of information. The ultimate purpose of a client-centered model is to empower parents by making them active participants in the diagnostic process rather than passive recipients. Conclusion The client-centered model has wide implications for the diagnostic process as well as for the training of students.

Web-based discussion forums reveal the person-centered relevance and importance of tinnitus

An increasing number of health researchers are recognizing the benefits of crowdsourcing. Web-based discussion forums are well suited for collecting qualitative research data with tinnitus participants and forum posts can be evaluated using thematic analysis. The present study reports an innovative use of such qualitative data contributed by a group of 148 people with tinnitus and tinnitus professionals through the crowdsourcing platform Tinnitus Talk. While the primary research question was focused on defining symptom concepts, discussions were broad-ranging and extended far beyond this topic. Thematic analysis of the discussion conducted by two analysts identified three novel emerging themes and these were not pre-planned according to the moderator's script. These were (i) the lived experience of tinnitus, (ii) perspectives on interventions for tinnitus, and (iii) the experience of participating in a web discussion forum. These unexpected themes contribute to a richer and more in-depth understanding of tinnitus seen through the eyes of those who experience it on a daily basis. Findings are important since spontaneous themes presumably reflect issues that are of personal relevance and importance to the participants. They therefore give insights into future research directions and have implications for patient-centered counseling strategies that could be effective in clinic.

Development of a public audiology service in Southern Malawi: profile of patients across two years

OBJECTIVE

To describe the profile of patients attending the Queen Elizabeth Central Hospital (QECH) audiology clinic in Malawi, over a two-year period (2016-2017).

DESIGN

A retrospective patient record review.

STUDY SAMPLE

There were 2299 patients assessed at the QECH audiology department between January 2016 and December 2017. Adult patients' ages ranged from 18 to 94 years (M = 45.8, SD = 19.22). The mean age of children included in this study was 7.7 years (SD= 5.21). Overall, 45.4% of patients were female.

RESULTS

Of the 61.6% of adults and 41.7% of children found to have some degree of hearing loss, 28.3% and 15.4% were fitted with hearing aids, respectively. The number of patients seen in 2017 (n = 1385) was 34% higher than that of 2016 (n = 914).

CONCLUSION

This study found that demand for hearing services is increasing in this public sector Malawian audiology department but uptake of hearing aids for those in need is low. Future evaluation of service provision and treatment outcomes is needed. Results from this study can be used to inform the development of future audiology clinics in low resource settings.

Parent and Professional Perceptions and Feedback on the Content of an eHealth Hearing Aid Learning Series for Parents of Children Who Are Deaf or Hard-of-Hearing

Purpose

To qualitatively explore parent and professional perspectives regarding the content of select Hear to Learn tutorials to identify usefulness and meaningfulness of the tutorials, and to inform regarding key components to enhance usefulness of eHealth platforms.

Method

This study used a qualitative design with two stakeholder focus groups. Stakeholder groups included four parents of children who are deaf or hard-of-hearing, and six professionals serving children who are deaf or hard-of-hearing.

Results

Findings indicate that both stakeholders valued the tutorials generally as helpful; however, areas for improvement were suggested.

Conclusion

Use of visuals, step-by-step instructions, and depth of content were identified as key elements that may be considered to optimize benefits of eHealth material for parents.

Experiences of Hearing Loss and Audiological Rehabilitation for Older Adults With Comorbid Psychological Symptoms: A Qualitative Study

Purpose There is a well-established relationship between hearing loss and psychological symptoms. To ensure audiological rehabilitation is provided appropriately for older adults with comorbid psychological symptoms, a greater understanding of their preferences and experiences is needed. This study sought to understand experiences of hearing loss and audiological rehabilitation from the perspective of older adults with comorbid psychological symptoms (e.g., depression, anxiety, psychosis). Design A qualitative study using in-depth semistructured interviews was conducted with older adults who had attended audiological rehabilitation within the last year and scored above established cutoffs on measures of depression, anxiety, and psychosis. A thematic analysis generated themes that related to participants' experiences of hearing loss and audiological rehabilitation. Results Participants included 14 older adults (eight men and six women) with an average age of 70.5 years (SD = 4.45, range: 64-80) who received hearing aids or a cochlear implant. Three major themes emerged from the analysis of participant interviews. "The cumulative impact of hearing loss and psychological symptoms" theme describes the two-way, additive relationship between hearing ability and psychological symptoms. "The experience of loss throughout hearing loss and audiological rehabilitation" captures subjective losses, the impact they have, and how participants cope with them. In contrast, "The experience of gain throughout hearing loss and audiological rehabilitation" describes the participants' reported gains, their related impacts, and coping strategies. Conclusions The experiences of participants revealed that the presence of comorbid psychological symptoms can influence the experience of hearing loss and audiological rehabilitation. These findings have implications for how audiological rehabilitation is provided to ensure optimal outcomes for adults with hearing loss and comorbid psychological symptoms. Supplemental Material https://doi.org/10.23641/asha.12985955.

Psychosocial Well-Being of Adults Who Are Deaf or Hard of Hearing

BACKGROUND

 Psychosocial well-being can interfere with engagement in activities of daily life. Consideration of psychosocial domains within hearing health care can expand audiologists' ability to understand treatment barriers and provide an opportunity to jointly address challenges.

PURPOSE

 This study explored psychosocial well-being and predictors among adults who are deaf or hard of hearing (DHH).

RESEARCH DESIGN

 Cross-sectional survey.

STUDY SAMPLE

 Two-hundred and sixty-nine surveys were included in the analysis.

DATA COLLECTION AND ANALYSIS

 Data were collected online. Backward elimination regression analyses were used to identify significant predictors of psychosocial well-being.

RESULTS

 Findings indicated most (∼70-80%) of the respondents' scores were below clinical cut-off for psychological distress, self-efficacy, quality of life, overall well-being, functioning, and relationship satisfaction, with the remainder falling between mild to severe clinical cut-offs. Psychological distress was predicted by more psychological inflexibility, presence of additional disabilities, and younger age. Increased functional impairment was predicted by psychological inflexibility.

CONCLUSION

 The majority of adults who are DHH in this study had positive indicators for psychosocial well-being. Screening patients for psychological flexibility could be included in standard hearing health care practices to help clinicians identify individuals who may benefit from additional or different support.

Audiological approaches to address the psychosocial needs of adults with hearing loss: perceived benefit and likelihood of use

OBJECTIVE

To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss.

DESIGN

Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss.

STUDY SAMPLE

A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists.

RESULTS

Overall, participants rated all of the approaches highly on both benefit and likelihood of use; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales.

CONCLUSIONS

Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

Identifying the approaches used by audiologists to address the psychosocial needs of their adult clients

OBJECTIVE

To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss.

DESIGN

A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other.

STUDY SAMPLE

An international sample of 65 audiologists.

RESULTS

Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility.

CONCLUSIONS

Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Using attribution theory to explore the reasons adults with hearing loss do not use their hearing aids

Hearing aids are an effective treatment for individuals with hearing loss that have been shown to dampen (and sometime ameliorate) the negative effects of hearing loss. Despite the devices’ efficacy, many reject hearing aids as a form of treatment. In the present qualitative study, we explored the reasons for hearing aid non-use in the United States that emerged from the stories of adults with hearing loss who do not to utilize hearing aids. We specifically used thematic analysis in concert with an attribution theory framework to identify and analyze recurring themes and reasons throughout these individuals’ narratives. A total of nine themes describing reasons of hearing aid non-use emerged. Four reasons were internally motivated: (1) non-necessity, (2) stigmatization, (3) lack of integration into daily living, and (4) unreadiness due to lack of education; five reasons were externally motivated: (5) discomfort, (6) financial setback, (7) burden, (8) professional distrust, and (9) priority setting. These findings contribute to the field of hearing healthcare by providing professionals with insight into reasons that people across the provided when recounting their experiences following the diagnosis of hearing loss, prescription for hearing aids, and their hearing aid non-use. These findings are an important step toward the development of more effective, person-centered hearing healthcare that can best address these individuals’ concerns and expectations surrounding hearing loss and hearing aids.

"What's Going on With My Ears?": Some Reflections on Managing Uncertainty in the Audiology Consultation

Purpose Feedback sessions after audiology consultations predominantly involve information counseling or patient education, where the patient is informed about their hearing status and possible management options. Effective communication is vital to ensure that information about the hearing impairment, recommendations, and/or management options is appropriately provided and understood by patients and that patient needs and expectations from the session are met. This research note reports on an exploratory study that sought to describe communication in follow-up audiological consultations within a context where ototoxicity monitoring is routine practice. Method Six interactions between patients and audiologists were video-recorded at an in-patient treatment facility for drug-resistant tuberculosis in Johannesburg and analyzed using a sociolinguistic approach. Semistructured interviews were also conducted with participants and analyzed using content analysis. Results These interactions differed considerably to other audiology consultations we have analyzed in terms of aspects such as the length of the interaction and the type of information given to patients. We observed a substantial amount of mitigative, vague, and exaggerated language in these interactions. Conclusions In this research note, we offer some reflections on this data set using a lens of uncertainty management theory and explore factors within the broader context that may contribute to the interactional features observed in the current study. Overall findings suggest the need for clinicians to be trained to embrace and address uncertainty rather than avoid it within challenging clinical encounters.

Discovering the Unmet Needs of People With Difficulties Understanding Speech in Noise and a Normal or Near-Normal Audiogram

Purpose A proportion of people with a normal audiogram or mild hearing loss (NA-MHL) experience greater-than-expected difficulty hearing speech in noise. This preliminary exploratory study employed a design thinking approach to better understand the clinical pathway and treatment options experienced by this population. Method Exploratory survey data were analyzed from 233 people with NA-MHL who had consulted a clinician and 47 clinicians. Qualitative analysis was performed on interview data from 21 people with NA-MHL and seven clinicians. Results Results revealed that noisy environments, such as restaurants, were where many people experienced listening difficulties. Most people with NA-MHL were not offered a treatment option at their audiology appointment, and their satisfaction with the appointment was diverse. Many clients reported frustration at being told that their hearing was "normal." Data from clinicians showed that there is no standard test protocol for this population, and most felt that they did not have adequate training or resources to help NA-MHL clients. Conclusion This study discusses the research needs regarding the experience of those with NA-MHL, their help-seeking behaviors, and treatment options. Understanding these needs is the first step to designing projects to improve the quality of life of this population.

Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss

Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.

Knowledge, Beliefs, and Practices of Australian Audiologists in Addressing the Mental Health Needs of Adults With Hearing Loss

Purpose Emotional and mental health is essential to overall health, but there has been little research on how to approach emotional and mental health in the audiology setting. This study provides a preliminary investigation into the current knowledge, beliefs, and practices of Australian audiologists in addressing the emotional and mental health needs of adults with hearing loss. Method A 22-item survey using open- and closed-ended questions was completed by 95 Australian audiologists using a cross-sectional study design. Results Two thirds of audiologists described being underconfident and lacking the skills required to provide emotional support to people with hearing loss. Barriers to delivering emotional support included feeling out of their depth (56.6%), time/caseload pressures (55.3%), and the perception that the provision of emotional support was not within an audiologist's scope of practice (31.6%). Audiologists described a desire to refer clients to mental health professionals yet highlighted significant barriers, including not knowing who to refer to (54.7%), when to make a referral (49.3%), or how to make a referral (38.6%). Audiologists overwhelmingly (96%) indicated that they would like to develop their knowledge and skills associated with the provision of emotional and mental health support in the audiological setting. Conclusion Knowledge, skills, and time were identified as the key areas that require attention in order to allow audiologists to address the emotional and mental health needs of adults with hearing loss.

On Teaching Counseling: Getting Beyond Informational Counseling

Purpose The purpose of this article was to examine the current state of counseling education and to present examples of strategies for teaching counseling based on the author's 40 years of university teaching. Conclusion Current research suggests that students and clinicians are not getting sufficient training in personal adjustment counseling. A recent unpublished survey suggests that only a few graduate programs require a counseling course for speech-language pathology students. Additional research suggests that, although audiology students do have access to counseling coursework, these courses focus primarily on informational/educational counseling strategies and not on teaching personal adjustment counseling strategies. The American Speech-Language-Hearing Association should review current standards for including counseling training in the curriculum, and graduate programs should review how they are teaching counseling and determine if their processes are effective.

Identifying clients' readiness for hearing rehabilitation within initial audiology appointments: a pilot intervention study

Objective: The current study sought to explore audiologists' use of the Ida Institute Motivation Tools to help them identify clients' readiness for change within initial assessment appointments.Design: The study involved a mixed methods intervention design. Data were collected pre- and post-training audiologists to use the Ida Motivation tools in their appointments. Appointments were video-recorded and analysed using conversation analysis. Clients and audiologists also completed questionnaires within each appointment to measure clients' readiness-for-change.Study sample: Participants included 5 audiologists and 22 adult clients from two Audiology clinics.Results: Audiologists incorporated the Ida Motivation tools into the post-training appointments without a significant increase in appointment time. The Ida tools solicited responses from clients that displayed their ambivalence regarding hearing rehabilitation/aids within their talk. Post-training, audiologists' perceptions of clients' stage of readiness were not significantly more likely to match clients' self-reported stage on the URICA.Conclusions: The Ida Motivation tools may be useful to solicit clients' ambivalent feelings towards hearing rehabilitation/aids, however, it is important for audiologists to actively listen for ambivalence within clients' interactional responses to the tools in order judge clients' readiness.

Parents' questions to clinicians within paediatric hearing habilitation appointments for children with hearing impairment

OBJECTIVE

To examine parents' questions to clinicians and how clinicians respond in paediatric hearing healthcare appointments with children with hearing loss.

METHODS

The data consisted of 48 video-recorded hearing habilitation appointments. Participants included 22 clinicians, 41 children, and 48 parents/carers. Data were analysed using conversation analysis.

RESULTS

A total of 89 questions from parents were directed to the clinicians in the appointments. Parents' questions were mostly designed as polar (yes/no) questions. The questions covered several action and topical agendas, and in most instances functioned as something other than merely soliciting information. The most prominent action agenda of parents' questions involved questions that displayed parental concern. These questions sought reassurance as well as information from the clinician.

CONCLUSION

While parents in this study did not ask a large number of questions during the appointments their questions performed important functions. Parents' questions cannot be assumed to be only about seeking information. Often parents' questions are in pursuit of reassurance from the clinician about their child's progress.

PRACTICE IMPLICATIONS

Clinicians may need to provide encouragement to parents to ask questions during appointments. As part of delivering family-centred care, clinicians need to be aware that their responses may need to go beyond information provision.

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.

Promoting Counseling Skills in Audiology Clinical Supervisors: Considerations for Professional Development

Purpose Clinical supervision for counseling skill development can be variable and can undermine student ability to learn patient-centered care communication. The current study aimed to evaluate the effectiveness of consultation and feedback sessions on counseling behavior, in actual clinical practice, among clinical audiology supervisors. We also collected qualitative data on participants' experiences and suggestions for improving the counseling intervention to increase counseling communication in audiology graduate training programs. Method We used a noncurrent multiple baseline design and staggered the counseling intervention to control for effects of concurrent events and passage of time. Results Two participants showed small but reliable increases in counseling behavior, whereas the 3rd participant showed bigger but less stable increases in counseling. Participants reported that brief feedback sessions were helpful; however, they also mentioned barriers to counseling, such as worries with how much time counseling could take when they have back-to-back appointments. Conclusion Clinical audiology supervisors were able to improve their counseling skills in real-life sessions with regular feedback. More structure may be needed to strengthen future counseling skills.

Depression in elderly patients with hearing loss: current perspectives

Hearing loss (HL) is highly common in older adulthood, constituting the third most prevalent chronic health condition in this population. In addition to posing a substantial burden to disease and negatively impacting quality of life, an emerging literature highlights that HL is associated with unipolar depression including among older adults. This review outlines evidence examining the HL and depression relationship as well as clinical implications for assessment and treatment of comorbid depression and HL. Although prevalence estimates of comorbid depression in HL vary, as many as 1 in 5 experience clinically relevant depression symptoms. Both cross-sectional and longitudinal studies indicate that HL is related to increased unipolar depression symptoms, although the strength of the association varies between studies. A range of methodological variations, such as inclusion age, severity of HL and assessment of depression, likely underpin this heterogeneity. Overall, however, the evidence clearly points to an association of HL with clinically relevant depression symptoms. The association with the diagnosis of major depression disorder remains less clear and under-researched. HL is also associated with a range of other poor mental health outcomes in older adults, including anxiety and suicidal ideation, and predicts poorer cognitive functioning. Accordingly, assessment and treatment of comorbid depression in HL is pertinent to promote mental well-being among older adults. Currently, evidence regarding best practice for treating depression in HL remains scant. Preliminary evidence indicates that audiological rehabilitation, including use of hearing aids, as well as community-based hearing interventions can also improve mental health. Psychological intervention that enhances communication skills and addresses coping strategies might also be beneficial for this population. Additionally, evidence suggests that online interventions are feasible and may circumvent communication difficulties in therapy associated with HL. Due to poor help-seeking among this population, an enhanced focus on specific and targeted assessment and treatment is likely necessary to ensure reduced mental health burden among older adults with HL.

Counseling Competencies in Audiology: A Modified Delphi Study

Purpose Counseling practices in audiology play a critical role in helping patients and families understand, accept, and adjust to the dynamic impacts ear-related disorders have on their lives. The purpose of this study was to identify what competencies (i.e., knowledge, skills, and attitudes) are important for audiologists to possess to provide effective counseling in practice. Method A modified Delphi study design was used to survey a panel of 33 professionals with expertise in audiologic counseling from 5 different countries. In the 1st survey round, experts were asked to respond to 3 open-ended prompts. Responses were condensed and revised into items experts were asked to rate during the 2nd and 3rd survey rounds, on a 6-point Likert scale of importance. Results A total of 819 items were generated from the open-ended prompts. A total of 72 items were included in the 2nd and 3rd rounds of survey instruments. Consensus was met on 64 audiologic counseling competency items. Conclusions The competency items identified in this study reflect important knowledge, skills, and attitudes that are important to audiologic counseling. Items that met consensus in this study can inform competencies audiology students can acquire during graduate training. Practice guidelines in the field currently lack the necessary clarity and detail needed for implementation of counseling competencies in clinical education. Future research is needed to explore factors important for implementation of evidence-based counseling training in graduate audiology programs.