Opportunities for Audiologists to Use Patient-Centered Communication during Hearing Device Monitoring Encounters

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.

The lived experience of hearing loss - an individualised responsibility

OBJECTIVE

This study aimed to provide a conceptual model to understand what typifies the lived experience of hearing loss.

DESIGN

A grounded theory informed study of adults with hearing loss (n = 46) who participated in individual interviews. The data were analysed in line with the constant comparative approach of grounded theory. A substantial patient and public engagement (PPIE) strategy underpinned decisions and processes throughout.

STUDY SAMPLE

Adults were recruited from age bands (16-29; 30-49;50-79 and 80 upwards) to provide different lived experience. We recruited individuals from across the UK including urban, sub-urban and rural communities and included a typical constituency of each location including black and minority ethnic participants. Our PPIE groups included adults often marginalised in research including South Asian community groups, adults in residential care and those with additional disabilities.

RESULTS

We identified the consistent features of the lived experience with hearing loss, as the individualised responsibility that hearing loss confers. These are an individual auditory lifeworld; social comparison and social support; individual and patient-centred care and individual agency and capability.

CONCLUSIONS

This work provides new insights for those practising audiology and highlights the importance of building social support systems through implementation of family and peer support approaches.

The audiological rehabilitation of workers with hearing loss in the UK: a qualitative study of workers' perspectives

PURPOSE

Unaddressed hearing loss can adversely affect employment and day-to-day work-life. Efficient and effective audiology support can help optimise hearing in the workplace. This study explores the audiological rehabilitation experiences of workers with hearing loss (WHL).

MATERIALS AND METHODS

Twenty-four WHL with experience of a wide range of audiology services across the UK participated in semi-structured interviews. Interviews were analysed using inductive thematic analysis.

RESULTS

Three main themes were generated: Theme 1: mixed experiences with audiology services (subdivided into two subthemes and four sub-subthemes). Theme 2: audiology role in work support (subdivided into three subthemes). Theme 3: "I think support could be improved if…" (subdivided into two subthemes).

CONCLUSION

The audiological rehabilitation for working-age adults with hearing loss needs improvements to deliver sufficient support and quality care. Some of the barriers to having better-functioning hearing healthcare require fundamental standards in healthcare quality, such as access to services, staff (including audiologists) deaf awareness, information and technology support, and personalised care that considers work-life needs. Further research is required to evaluate the feasibility and cost-effectiveness of improvements, such as support that extends beyond hearing aid care, whether from audiology or non-audiology services.

Hearing healthcare for workers with hearing loss: audiologists' experiences and views

PURPOSE

This study explored audiologists' perspectives regarding their interactions with workers with hearing loss (WHL).

MATERIALS AND METHODS

Semi-structured interviews were conducted with twenty-five audiologists working in the National Health Service (NHS) and independent companies (IC) in the UK and were thematically analysed.

RESULTS

The developed themes and sub-themes (shown in parenthesis) are (1) Current practices and routines (Same approach for most patients; Variations between hearing care services; Audiologists' personal experience of hearing loss) (2) Perceived challenges (Non-routine and challenging cases; The role of hearing technology; Concerns about lack of awareness and knowledge; Communication difficulties between services, Limited funding and resources) (3) Scope for better support (Would like to be informed; Other potential service improvements).

CONCLUSIONS

This study revealed that audiologists' perceived deficiencies in the hearing rehabilitation for WHL and identified ways to improve it. Key priorities for improvement were found to include addressing audiologists' informational and training needs, facilitating WHLs' access to appointments, improving communication between services, raising awareness in the workplace, developing relevant resources and extending funding for provision of longer appointments and hearing technologies. This is the first time this information has been reported in the literature. Opportunities for conducting further research in this area are suggested.Implications for rehabilitationWorkers with hearing loss face many challenges in work life and have the option of audiologic rehabilitation to alleviate their difficulties and improve their wellbeing; however, this study suggests that workers' audiological care needs improvements.Audiologists should assess and consider patients' work needs and psychosocial concerns in consultations to provide personalised care.Audiology educational programmes, services, and the healthcare system can assist audiologists in helping workers with hearing loss by providing updated knowledge, continuous training and improved interprofessional communication and patients' access to useful resources.

Intervention Research to Increase Pediatric Hearing Device Use: A Scoping Review

PURPOSE

This study is a scoping review examining interventions to increase hearing device use for children.

METHOD

Online databases were used to identify peer-reviewed journal articles published prior to November 1, 2021, yielding 1,288 after duplications were removed. Four articles met the inclusion criteria after articles were screened by title name and abstract and subsequent full-text screening of six articles. A qualitative analysis was conducted to identify features of the intervention studies related to the participants, design, intervention, key findings, and limitations.

RESULTS

The included studies were published between 1982 and 2021, and in all four studies, the children used hearing aids. All four of the studies used a longitudinal design to address hearing aid use problems, with the timeframe ranging from approximately 1 month to 6 months and had variable success in increasing use time. None of the studies included a protocol, such as counseling skills, for addressing internal challenges that interfere with hearing aid use.

CONCLUSIONS

Review of the limited research in this area found variable effectiveness for the interventions studied. There is an urgent need for research in this area to inform clinical practice and provide evidence-based interventions to address malleable factors that interfere with audibility for children who use hearing devices.

Students' Reflections During Training Workshops on Communication and Information Exchange in Audiology Consultations: An Exploratory Qualitative Study

PURPOSE

This clinical focus article outlines various communication challenges and scenarios related to information giving encountered by a group of audiology students, as reflected on during a series of communication skills workshops.

METHOD

We held two online training workshops during which students reflected on their clinical communication experiences and asked questions related to clinical scenarios. Third-year audiology students from a South African university participated in the workshops (17 in the first, 15 in the second). We analyzed these reflections using thematic analysis.

RESULTS

Students' reflections related to four themes: (a) balancing information giving, (b) managing shared decision making, (c) managing linguistic differences, and (d) relating bad news. The first theme was heavily prioritized in students' reflections. Providing students with time to practice skills introduced in the initial communication skills workshop enabled further reflection in the subsequent workshop. We discuss these themes using specific examples raised by students.

CONCLUSIONS

Our findings suggest that students first need to master basic information giving skills before they can move on to more advanced skills such as managing shared decision making, linguistic differences, and relating bad news. This study confirms that reflective skills need to be developed with students in an explicit manner, rather than as part of a hidden curriculum. Our approach to providing communication training and encouraging reflection on clinical experiences offers a starting point for clinical educators to support students in developing these skills.

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.

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.

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.

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.

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.