Randomised controlled feasibility trial of an active communication education programme plus hearing aid provision versus hearing aid provision alone (ACE To HEAR)

OBJECTIVE

To establish the acceptability and feasibility of delivering the Active Communication Education (ACE) programme to increase quality of life through improving communication and hearing aid use in the UK National Health Service.

DESIGN

Randomised controlled, open feasibility trial with embedded economic and process evaluations.

SETTING

Audiology departments in two hospitals in two UK cities.

PARTICIPANTS

Twelve hearing aid users aged 18 years or over who reported moderate or less than moderate benefit from their new hearing aid.

INTERVENTIONS

Consenting participants (along with a significant other) were to be randomised by a remote, centralised randomisation service in groups to ACE plus treatment-as-usual (intervention group) or treatment-as-usual only (control group).

PRIMARY OUTCOME MEASURES

The primary outcomes were related to feasibility: recruitment, retention, treatment adherence and acceptability to participants and fidelity of treatment delivery.

SECONDARY OUTCOME MEASURES

International Outcomes Inventory for Hearing Aids, Self-Assessment of Communication, EQ-5D-5L and Short-Form 36. Blinding of the participants and facilitator was not possible.

RESULTS

Twelve hearing aid users and six significant others consented to take part. Eight hearing aid users were randomised: four to the intervention group; and four to treatment-as-usual only. Four significant others participated alongside the randomised participants. Recruitment to the study was very low and centres only screened 466 hearing aid users over the 15-month recruitment period, compared with the approximately 3500 anticipated. Only one ACE group and one control group were formed. ACE could be delivered and appeared acceptable to participants. We were unable to robustly assess attrition and attendance rates due to the low sample size.

CONCLUSIONS

While ACE appeared acceptable to hearing aid users and feasible to deliver, it was not feasible to identify and recruit participants struggling with their hearing aids at the 3-month posthearing aid fitting point.

TRIAL REGISTRATION NUMBER

ISRCTN28090877.

Reported benefits of peer support group involvement by adults with hearing loss

OBJECTIVE

The purpose of this study was to better understand the benefits of self-help group involvement by adults with hearing loss.

DESIGN

A secondary content analysis of interview transcripts of participants from a previous study on the impact of stigma on help-seeking was carried out.

STUDY SAMPLE

Ten members (aged 55-76 years) of self-help groups for persons with hearing loss in the United States of America and Canada participated in the interviews.

RESULTS

Three themes describing the benefits of self-help group participation emerged: (1) Practical and accessible information about hearing loss; (2) Social belonging leading to personal transformation; and (3) A new and mutually beneficial direction.

CONCLUSIONS

The findings are discussed in relation to the "helper therapy principle", as well as group audiological rehabilitation.

Positive Social Interaction and Hearing Loss in Older Adults Living in Rural and Urban Communities

PURPOSE

This study explored the extent to which hearing loss affected positive social interactions in older adults living in rural and urban communities.

METHOD

Pure-tone behavioral hearing assessments were administered to 80 adults 60 years of age or older. In addition, all participants completed 2 questionnaires, the Medical Outcomes Study Social Support Survey (Sherbourne & Stewart, 1991) and the Patient Health Questionnaire-Ninth Edition (Kroenke, Spitzer, & Williams, 2001).

RESULTS

The preliminary findings suggested that adults with hearing loss living in rural towns had poorer positive social interactions compared with their urban counterparts with hearing loss. Also, adults with hearing loss living in rural towns had more symptoms of depression than adults with normal hearing who lived in these same geographical regions.

CONCLUSIONS

These preliminary findings could indicate that older adults with hearing loss living in rural communities will face more isolation than adults with hearing loss living in urban settings. Increasing our understanding of the extent of social isolation in adults with hearing loss living in rural and urban populations will be necessary.

Randomised controlled feasibility trial of the Active Communication Education programme plus hearing aid provision versus hearing aid provision alone (ACE to HEAR): a study protocol

INTRODUCTION

Up to 30% of hearing aids fitted to new adult clients are reported to be of low benefit and used intermittently or not at all. Evidence suggests that additional interventions paired with service-delivery redesign may help improve hearing aid use and benefit. The range of interventions available is limited. In particular, the efficacy of interventions like the Active Communication Education (ACE) programme that focus on improving communication success with hearing-impaired people and significant others, has not previously been assessed. We propose that improved communication outcomes associated with the ACE intervention, lead to an increased perception of hearing aid value and more realistic expectations associated with hearing aid use and ownership, which are reported to be key barriers and facilitators for successful hearing aid use. This study will assess the feasibility of delivering ACE and undertaking a definitive randomised controlled trial to evaluate whether ACE would be a cost-effective and acceptable way of increasing quality of life through improving communication and hearing aid use in a public health service such as the National Health Service.

METHODS AND ANALYSIS

This will be a randomised controlled, open feasibility trial with embedded economic and process evaluations delivered in audiology departments in two UK cities. We aim to recruit 84 patients (and up to 84 significant others) aged 18 years and over, who report moderate or less than moderate benefit from their new hearing aid. The feasibility of a large-scale study and the acceptability of the ACE intervention will be measured by recruitment rates, treatment retention, follow-up rates and qualitative interviews.

ETHICS AND DISSEMINATION

Ethical approval granted by South East Coast-Surrey Research Ethics Committee (16/LO/2012). Dissemination of results will be via peer-reviewed research publications both online and in print, conference presentations, posters, patient forums and Trust bulletins.

TRIAL REGISTRATION NUMBER

ISRCTN28090877.

Aging and Hearing Health: The Life-course Approach

Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of "hearing health," how to achieve it, and implications for policy and practice.

Listening and Learning: Cognitive Contributions to the Rehabilitation of Older Adults With and Without Audiometrically Defined Hearing Loss

Here, we describe some of the ways in which aging negatively affects the way sensory input is transduced and processed within the aging brain and how cognitive work is involved when listening to a less-than-perfect signal. We also describe how audiologic rehabilitation, including hearing aid amplification and listening training, is used to reduce the amount of cognitive resources required for effective auditory communication and conclude with an example of how listening effort is being studied in research laboratories for the purpose(s) of informing clinical practice.

Do group audiologic rehabilitation activities influence psychosocial outcomes?

PURPOSE

To attempt to determine whether group audiologic rehabilitation (AR) content affected psychosocial outcomes.

METHOD

A randomized controlled trial with at least 17 participants per group was completed. The 3 treatment groups included a communication strategies training group, a communication strategies training plus psychosocial exercise group, and an informational lecture plus psychosocial exercise group. Evaluations were conducted preclass, postclass, and 6-months postclass; they included hearing loss-related and generic quality of life scales, and a class evaluation form.

RESULTS

All treatment groups demonstrated short- and long-term improvement on the hearing loss-related quality of life scale. Minimal differences were measured across treatment groups. A significant difference was observed between the lecture plus psychosocial exercise group and the communication strategies training group for 1 hearing loss-related quality of life subscale. Better outcomes were measured for the 2 groups with psychosocial exercises versus the communication strategies training group on 1 generic quality of life subscale. The results for the class evaluation did not discriminate among the treatment groups.

CONCLUSIONS

Class content had only a minimal influence on treatment outcomes. Recommended AR class content includes a mix of interventions including information, training, and psychosocial exercises.