The Effect of Chronological Age on the Acceptance of Internet-Based Hearing Health Care

Patients With Cardiovascular Disease Revisiting Specialist Physicians via Remote Treatment: Interview Study of Experiences

BACKGROUND

Access to health care for an aging population with growing needs presents major challenges in northern Sweden's sparsely populated regions. Few people, the lack of professionals, and long distances make it difficult to provide health care on equitable terms according to the Swedish legislation. Remote treatment (RT) using information and communication technology has been suggested to overcome these difficulties, and person-centered care (PCC) is a desired philosophy to improve the quality of health care. However, there is scarce knowledge about how patients experience RT meetings.

OBJECTIVE

This study aimed to describe the experiences of patients with cardiovascular disease revisiting specialist physicians via RT guided by a PCC perspective in northern Sweden's sparsely populated regions.

METHODS

A qualitative study was conducted based on interviews with 8 patients with cardiovascular disease revisiting their physician through RT, from a digital health room to a health care center or from a health care center to a hospital. The interviews were recorded, transcribed verbatim, and analyzed using inductive content analysis. The results are discussed from a PCC perspective.

RESULTS

The analysis resulted in 6 categories: good accessibility, safety with good relationships, proximity and distance with technology, habit and quality of the technology facilitating the meeting, cherishing personal integrity, and participation in own care. These categories were interpreted as the theme, participation and relationships are important for good and close care via RT.

CONCLUSIONS

The study shows that participation and relationships are important for good and close care via RT. To improve the quality of an RT meeting, PCC can be applied but needs to be extended to the digital domain-electronic PCC, especially the communication component, as it is the most salient difference from a face-to-face meeting. Important factors that should be considered before, during, and after the RT meeting have been identified.

Telemedicine and visit completion among people with HIV during the coronavirus disease 2019 pandemic compared with prepandemic

OBJECTIVES

Telemedicine became the primary mode of delivering care during the COVID-19 pandemic. We describe the impact of telemedicine on access to care for people with HIV (PWH) by comparing the proportion of PWH engaged in care prior to and during the COVID-19 pandemic.

DESIGN AND METHODS

We conducted an observational analysis of patients enrolled in the Johns Hopkins HIV Clinical Cohort, a single-center cohort of patients at an urban HIV subspecialty clinic affiliated with an academic center. Due to the COVID-19 pandemic, the clinic transitioned from in-person to mostly telemedicine visits. We compared patients receiving care in two time periods. The prepandemic period included 2010 people with at least one visit scheduled between 1 September 2019 and 15 March 2020. The pandemic period included 1929 people with at least one visit scheduled between 16 March 2020 and 30 September 2020. We determined the proportion of patients completing at least one of their scheduled visits during each period.

RESULTS

Visit completion increased significantly from 88% prepandemic to 91% during the pandemic (P = 0.008). Visit completion improved significantly for patients age 20-39 (82 to 92%, P < 0.001), women (86 to 93%, P < 0.001), Black patients (88 to 91%, P = 0.002) and patients with detectable viremia (77 to 85%, P = 0.06) during the pandemic. Only 29% of people who completed at least one telemedicine visit during the pandemic did so as a video (versus telephone) visit.

CONCLUSION

During the pandemic when care was widely delivered via telemedicine, visit completion improved among groups with lower prepandemic engagement but most were limited to telephone visits.

Assessing Public Health Workforce Informatics Competencies: A Study of 3 District Health Departments in Georgia

CONTEXT

Despite the increased recognition of the importance of having informatics-competent public health professionals, the competency level of the public health workforce in public health informatics (PHI) has not been examined extensively in the literature.

OBJECTIVE

The purpose of this study was to assess public health workforce informatics competencies in select Georgia health districts and determine the correlates of PHI proficiency.

METHODS

This study is based on a cross-sectional quantitative study design. We conducted an online self-administered survey of employees from 3 selected district health departments to assess proficiency in foundational PHI competency domains. Three hundred thirty-three respondents completed the survey, with a response rate of 32.5%. A gap score was calculated as a proxy to identify informatics training needs. A path analysis was conducted to assess the relationships among contextual factors and foundational PHI competency domains.

RESULTS

The public health employees participating in this study reported relatively high proficiency in foundational PHI competency. Psychometric testing of the competency assessment instrument revealed 2 foundational informatics competency domains-effective information technology (IT) use and effective use of information. The effective use of IT mediated the relationship between employee-level factors of age and past informatics training and the effective use of information.

CONCLUSION

The study highlights the importance of improving the ability of public health professionals to leverage IT and information to advance population health. Periodic assessment of staff PHI competencies can help proactively identify competency gaps and address needs for additional training. Short assessment tools, such as presented in this study, can be validated and used for such assessments.

[Systematic review of digital technology acceptance in older adults. Perspective of TAM models]

In this study, a systematic review of researches published about the determining factors in the intention of the use of devices and digital technology in older adults has been carried out. The technology acceptance model is the framework used. The main result of the analysis of 60 scientific articles published between 2010 and 2020 has been summarized after a bibliographic research and a subsequent selection process in the most important bibliographic databases: Web of Science (n=45), Scopus (n=66) and Google Scholar (n=224). It has been proved the predominance of quantitative studies with a prevalence of study factors that associate the intention to use technology with: Facilitating conditions, experience, health, social support, emotions, perceived enjoyment, perceived satisfaction in using technology, anxiety, perceived risk, motivation, cost, subjective norm and social influence. The results of the systematic review allow us to conclude the urgent need to incorporate new research on the identification and influence of these factors that stand between older adults and technology, as possible barriers or facilitators of use.

Improving the Efficiency of the Digits-in-Noise Hearing Screening Test: A Comparison Between Four Different Test Procedures

PURPOSE

This study compared the test characteristics, test-retest reliability, and test efficiency of three novel digits-in-noise (DIN) test procedures to a conventional antiphasic 23-trial adaptive DIN (D23).

METHOD

One hundred twenty participants with an average age of 42 years (SD = 19) were included. Participants were tested and retested with four different DIN procedures. Three new DIN procedures were compared to the reference D23 version: (a) a self-selected DIN (DSS) to allow participants to indicate a subjective speech recognition threshold (SRT), (b) a combination of self-selected and adaptive eight-trial DIN (DC8) that utilized a self-selected signal-to-noise ratio (SNR) followed by an eight-trial adaptive DIN procedure, and (c) a fixed SNR DIN (DF) approach using a fixed SNR value for all presentations to produce a pass/fail test result.

RESULTS

Test-retest reliability of the D23 procedure was better than that of the DSS and DC8 procedures. SRTs from DSS and DC8 were significantly higher than SRTs from D23. DSS was not accurate to discriminate between normal-hearing and hard of hearing listeners. The DF and DC8 procedures with an adapted cutoff showed good hearing screening test characteristics. All three novel DIN procedure durations were significantly shorter (< 70 s) than that of D23. DF showed a reduction of 46% in the number of presentations compared to D23 (from 23 presentations to an average of 12.5).

CONCLUSIONS

The DF and DC8 procedures had significantly lower test durations than the reference D23 and show potential to be more time-efficient screening tools to determine normal hearing or potential hearing loss. Further studies are needed to optimize the DC8 procedure. The reference D23 remains the most reliable and accurate DIN hearing screening test, but studies in which the potentially efficient new DIN procedures are compared to pure-tone thresholds are needed to validate these procedures.

Listening in 2020: A Survey of Adults' Experiences With Pandemic-Related Disruptions

PURPOSE

The COVID-19 pandemic has introduced lifestyle changes that may negatively impact communication, including the pervasive use of face masks and videoconferencing technology. Here, we examine the effects of age and self-rated hearing on subjective measures of speech understanding via a survey accessed by adults residing in the United States.

METHOD

Responses to an online survey were obtained from adults (21 years of age and older) during the summer and fall of 2020. The survey included questions about hearing and speech understanding in a variety of scenarios and different listening conditions, including when communicating with people using face masks in quiet and noisy environments and when using videoconferencing.

RESULTS

Data from 1,703 surveys were analyzed. In general, the use of face masks led to the perception of poorer speech understanding and greater need for concentration, especially in noisy environments. When responses from all participants were considered, poorer self-rated communication ability was noted as age increased. However, among people who categorized their overall hearing as "Excellent" or "Good," younger adults rated their speech understanding ability in noisy situations as poorer than middle-age or older adults. Among people who rated their overall hearing as "Fair" or "Poor," middle-age adults indicated having more difficulty communicating with people using face masks, as compared with older adults. Examination of open-ended responses suggested that the strategies individuals use when communicating with people wearing face masks vary by age and self-rated hearing. Notably, middle-age and older adults were more likely to report using strategies that could put them at risk (e.g., asking others to remove their face masks).

CONCLUSIONS

Even younger adults with self-perceived good hearing are not immune to communication challenges brought about by face masks. Among individuals with similar degrees of self-rated hearing, the expected increase in communication difficulty with age was not noted among our respondents.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.16528431.

Design Considerations for Mobile Health Applications Targeting Older Adults

Mobile technologies are becoming ubiquitous in the world, changing the way we communicate and provide patient care and services. Some of the most compelling benefits of mobile technologies are in the areas of disease prevention, health management, and care delivery. For all the advances that are occurring in mobile health, its full potential for older adults is only starting to emerge. Yet, existing mobile health applications have design flaws that may limit usability by older adults. The aim of this paper is to review barriers and identify knowledge gaps where more research is needed to improve the accessibility of mobile health use in aging populations. The same observations might apply to those who are not elderly, including individuals suffering from severe mental or medical illnesses.

Associations between absolute and relative electronic cigarette harm perceptions and information-seeking behaviours among US adult current, former and never smokers

INTRODUCTION

Electronic cigarette (e-cigarette) harm perceptions and information seeking behaviours are both important antecedents of e-cigarette use, yet the relationship between them has been rarely studied. We assessed how absolute (e-cigarettes are harmful to my health) and relative harm perceptions (e-cigarettes are more/less harmful than cigarettes) were associated with specific e-cigarette information seeking behaviours in a sample of current, former and never cigarette smokers.

METHODS

We used data from US adults in two cycles of the Health Information National Trends Survey (HINTS-FDA 2015, n = 3738; 2017, n = 1736). Analyses controlled for socio-demographics, ever e-cigarette use and survey cycle. Data were analysed between January and August 2020.

RESULTS

Higher relative harm perceptions were associated with lower odds of having sought any information on e-cigarettes [adjusted odds ratio 0.61, 95% confidence interval (0.48, 0.84)] and on how to use e-cigarettes to quit smoking specifically [adjusted odds ratio 0.59, 95% confidence interval (0.38, 0.91)]. Smoking status did not moderate associations between absolute or relative harm perceptions and information seeking behaviours, nor was it associated with specific information seeking behaviours after adjusting for covariates.

DISCUSSION AND CONCLUSIONS

The risks of e-cigarettes relative to combusted cigarettes (as opposed to the absolute risks of e-cigarettes) appear to be more important in individuals' information seeking behaviours about e-cigarettes. Public health messages could ensure that all individuals understand how one's health risk would change if they exclusively used e-cigarettes, switched to e-cigarettes completely or used both products.

Measurement of Digital Literacy Among Older Adults: Systematic Review

Background

Numerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations.

Objective

This systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission’s Digital Competence (DigComp) Framework.

Methods

Electronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use.

Results

Searches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ≥50 years (10/27) or ≥60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59%). Scores on the CCAT ranged from 34 (34/40, 85%) to 40 (40/40, 100%). Most instruments measured 1 or 2 of the DigComp Framework’s elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including “digital content creation” and “safety.”

Conclusions

The current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like “digital content creation” and “safety” that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged.

Healthcare Professionals' Acceptance of Digital Cognitive Rehabilitation

With technological possibilities in healthcare steadily increasing, more tools for digital cognitive rehabilitation become available. Acceptance of such technological advances is crucial for successful implementation. Therefore, we examined technology acceptance specifically for this form of rehabilitation in a sample of healthcare providers involved in cognitive rehabilitation. An adjusted version of the Technology Acceptance Model (TAM) questionnaire was used, including the subscales for perceived usefulness, perceived ease of use, subjective norm (toward use), and intention to use, which all contribute to actual use of a specific technology. Results indicate a generally favorable attitude toward the use of digital cognitive rehabilitation and positive responses toward the TAM constructs. Only for subjective norm, a neutral mean response was found, indicating that this could pose a potential obstacle toward implementation. Potential differences between subgroups of different age, gender, and professional background were assessed. Age and gender did not affect the attitude toward digital cognitive rehabilitation. Occupational therapists showed lower scores than healthcare psychologists and physiatrists with regard to perceived usefulness, possibly linked to a difference in operational and managerial tasks. The findings of his study stimulate further implementation of digital cognitive rehabilitation, where the role of subjective norms should be specifically considered.

Digital Proficiency Is Not a Significant Barrier for Taking Up Hearing Services With a Hybrid Online and Face-to-Face Model

Purpose The aim of this study was to determine the effect of self-perceived digital proficiency on the uptake of hearing services through a hybrid online and face-to-face hearing health care model. Method Adults were recruited via online methods to complete an online hearing screening test within the greater Durban area in South Africa. On submission of contact details after failing the screening, contact was made via telephone to assess readiness for further hearing care. If motivated and willing to continue, a face-to-face appointment for diagnostic hearing testing was confirmed, at which time an e-mail with an online mobile device and computer proficiency survey was sent. Hearing services were offered using combined online and face-to-face methods. Results Within 2 years (June 2017 to June 2019), 1,259 people from the target location submitted their details for the clinic audiologist to contact, of whom 931 participants (73.95%) failed the screening test. Of these participants, 5.69% (53/931, 57.41% men) attended a face-to-face diagnostic hearing evaluation. Mobile device and computer proficiency scores were not a predictor of acquiring hearing services. Age was the only significant predictor (p = .018) for those continuing with hearing care. Patients who continued with hearing care by acquiring hearing aids and support services were older (M = 73.63 years, SD = 11.62) and on average aware of their hearing loss for a longer time (M = 14.71 years, SD = 15.77), as compared to those who discontinued hearing health care who were younger (M = 59.21 years, SD = 14.42) and on average aware of their hearing loss for a shorter time (M = 6.37 years, SD = 9.26). Conclusions Digital proficiency is not a predictor for acquiring hearing services through a hybrid online and face-to-face hearing care model. Hybrid services could allow professionals to assist patients in a combination of face-to-face and online services tailored to meet individual needs, including convenience and personalized care.

Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

BACKGROUND

Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present.

OBJECTIVE

This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults.

METHODS

This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature.

RESULTS

Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%).

CONCLUSIONS

The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation.

TRIAL REGISTRATION

PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/15490.

Perceptions of allied health staff of the implementation of an integrated electronic medical record across regional and metropolitan settings

ObjectiveThe aim of this study was to investigate the perceptions of allied health professionals (AHPs) to implementation of an integrated electronic medical record (EMR) across both regional and metropolitan settings. MethodsThe study was conducted as a cross-sectional electronic survey. AHPs working at three hospital sites within Queensland Health were sent an electronic survey link. Participation was voluntary and recruitment via a snowball sampling technique was encouraged. Responses were analysed descriptively. ResultsIn all, 104 responders completed the survey. Responders were distributed across three sites within the selected health service, with most (75%; n=78) being at the largest site. Physiotherapy accounted for the largest number of responders (22%). Most responders were female (87%; n=90) and between 20 and 40 years of age (68%; n=71). On a scale from 0 (being anxious) to 100 (being excited), at the time EMR implementation was announced, there was a trend towards excitement (mean score 59). The most commonly reported factor hindering EMR implementation was the opportunity to practice with EMR (34%), whereas clinical ‘change champions’ were reported as the most common facilitators (61%). Overall, 60% of responders were very satisfied or satisfied with the EMR, but limited effects on efficiency and patient care were reported. ConclusionsThe results suggest an overall positive response to EMR implementation. Minimal staff reported effects such as stress or anxiety in the workplace related to EMR implementation, and a perception of ‘comfort’ was cited once EMR was part of usual practice. However, responders did not report a significant effect on speed, efficiency or quality of patient care following EMR implementation. What is known about the topic?A growing body of literature exists regarding the perceptions of staff (particularly medical officers) in moving towards EMRs, but there is limited evidence regarding the perceptions of AHPs, and the barriers and facilitators to this change. What does this paper add?This paper presents a novel perspective regarding the perceptions of AHPs regarding the implementation of an EMR and provides a perspective of the barriers and facilitators that supported a smooth transition at three sites. What are the implications for practitioners?Despite being a large-scale service change, the introduction of an EMR did not significantly increase AHPs’ subjective feelings of anxiety. Services considering EMR implementation should invest in the provision of timely information, ‘at-elbow’ support and opportunities to practice the new system.

A Smartphone National Hearing Test: Performance and Characteristics of Users

PURPOSE

The smartphone digits-in-noise hearing test, called hearZA, was made available as a self-test in South Africa in March 2016. This study determined characteristics and test performance of the listeners who took the test.

METHOD

A retrospective analysis of 24,072 persons who completed a test between March 2016 and August 2017 was conducted. User characteristics, including age, English-speaking competence, and self-reported hearing difficulty, were analyzed. Regression analyses were conducted to determine predictors of the speech reception threshold.

RESULTS

Overall referral rate of the hearZA test was 22.4%, and 37% of these reported a known hearing difficulty. Age distributions showed that 33.2% of listeners were ages 30 years and younger, 40.5% were between ages 31 and 50 years, and 26.4% were older than 50 years. Age, self-reported English-speaking competence, and self-reported hearing difficulty were significant predictors of the speech reception threshold.

CONCLUSIONS

High test uptake, particularly among younger users, and high overall referral rate indicates that the hearZA app addresses a public health need. The test also reaches target audiences, including those with self-reported hearing difficulty and those with normal hearing who should monitor their hearing ability.

Empowering Senior Cochlear Implant Users at Home via a Tablet Computer Application

PURPOSE

The introduction of connectivity technologies in hearing implants allows new ways to support cochlear implant (CI) users remotely. Some functionalities and services that are traditionally only available in an in-clinic care model can now also be accessed at home. This study explores the feasibility of a prototype of a tablet computer application (MyHearingApp [MHA]) in a group of senior experienced CI users at home, evaluating usability and user motivation.

METHOD

Based on user feedback, a tablet computer application (MHA) for the Cochlear Nucleus 6 CP910 sound processor was designed implementing six different functionalities: (a) My Hearing Tests, (b) My Environment, (c) My Hearing Journey, (d) Tip of the Day, (e) Recipient Portal, and (f) Program Use and Events. The clinical evaluation design was a prospective study of the MHA in 16 senior experienced CI users. During 4 weeks, participants could freely explore the functionalities. At the end, the usability and their motivation for uptake and adherence were measured using a baseline and follow-up questionnaire.

RESULTS

Based on the System Usability Score (as part of the follow-up questionnaire), a good level of usability was indicated (M = 75.6, range: 62.5-92.5, SD = 8.6). The ability to perform hearing tests at home is ranked as the most relevant functionality within the MHA. According to the Intrinsic Motivation Inventory (Deci, Eghrari, Patrick, & Leone, 1994) questionnaire (as part of the follow-up questionnaire), participants reported high levels of interest and enjoyment, found themselves competent, and did not experience pressure while working with the app.

CONCLUSIONS

This study evaluated a tablet computer application (MHA) for experienced senior CI users by means of a prospective design, which provided novel insights into delivering CI care into the home of the CI user. The user feedback from this small-scale study suggests that the participants are open to take more responsibility for and to become a more active actor in their own hearing care, if only this is facilitated with the right tools. This may foster the evolution from a clinic-led to a more patient-centered care model, where CI users feel more empowered in the self-management of their hearing implant device.

eHealth and the hearing aid adult patient journey: a state-of-the-art review

The number and variety of eHealth services for adults and older adults who use hearing aids (HAs) are growing rapidly. This area holds promise to increase cost-efficiency, enable better access to care, and improve patient outcomes and satisfaction. Despite the increasing interest in this field, an up-to-date picture of recent research in the area of eHealth for adults with HAs is lacking. In this state-of-the-art review we assessed the literature from the past decade about eHealth use in the HA adult patient journey. Systematic searches were conducted in CINAHL, PubMed, Scopus, and Web of Science. A total of 34 peer-reviewed empirical records were identified from the searches and from the reference lists of searched records. Records were characterized based on: eHealth platform (i.e.: offline, Internet-based, or mobile-based), service [i.e.: education and information, screening and assessment, hearing rehabilitation, or general (tele-audiology)], and phase of the patient journey (i.e.: pre-fitting, fitting, or post-fitting). The review highlighted a growing interest in the field, as revealed by an increasing trend over the search period, from 2 records in 2009-2010 up to 17 records in 2015-2016. Internet-based platforms were the most frequently used (present in more than half of the included records), with a stable trend in the period. About one-third of the records introduced services over offline platforms, whereas mobile-based platforms were used only in 6 out of 34 records, suggesting that the clinical uptake of mobile services is still limited compared to more mature offline and Internet-based platforms. Most of the eHealth services observed were related to the areas of education and information (42.5%) and hearing rehabilitation (40.4%), whereas 10.7% were related to screening and assessment, and 6.4% to general tele-audiology services. Many services covered different phases of the patient journey, especially the fitting and post-fitting phases. Overall, this review showed that the field of eHealth in the context of HA rehabilitation in adults has grown in the recent past. Research is still needed to increase the uptake and efficacy of eHealth in clinical practice, especially in terms of technology developments, technical and clinical validation, and optimization of strategies for service delivery.

Acceptance of internet-based hearing healthcare among adults who fail a hearing screening

OBJECTIVE

This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants' acceptance of IHHC (Phase 2).

STUDY SAMPLE

Twenty-seven adults (age 55+) who failed a hearing screening participated.

DESIGN

During Phase 1 participants were administered the University of Rhode Island Change Assessment (URICA) and patient technology acceptance model (PTAM) Questionnaire. During Phase 2 participants were randomly assigned to a training or control group. Training group participants attended an instructional class on existing IHHC websites. The control group received no training. The PTAM questionnaire was re-administered to both groups 4-6 weeks following the initial assessment.

RESULTS

The majority of participants were either considering or preparing to do something about their hearing loss, and were generally accepting of IHHC websites (Phase 1). The participants who underwent brief IHHC training reported increases in hearing healthcare knowledge and slight improvements in computer self-efficacy (Phase 2).

CONCLUSIONS

Older adults who fail hearing screenings may be good candidates for IHHC. The incorporation of a simple user-interface and short-term training may optimize the usability of future IHHC programs for this population.

Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial

OBJECTIVE

Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population.

OUTCOME MEASURES

The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention.

METHODS

We used a parallel group design (RCT). The data were collected in 2013-2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37).

RESULTS

Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20-59 years and 60-80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants.

CONCLUSIONS

This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention.

TRIAL REGISTRATION NUMBER

This trial is registered at ClinicalTrals.gov, NCT01837550; results.

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.