Understanding patient empowerment along the hearing health journey

Adolescent-Centered mHealth Applications in a Collaborative Care Model: A Virtual Focus Group Study With Audiologists

PURPOSE

Technology-enabled care, including the use of mobile health (mHealth), is emerging as a viable hearing health care delivery method. While the integration of mHealth with adult populations currently supports a wide array of hearing services, a better understanding of the implementation across the lifespan is needed. Literature surrounding the unique population of adolescent hearing aid users is currently lacking. Research is needed to highlight factors important to the use and clinical integration of mHealth hearing aid applications (apps) with adolescents. This study explored two primary objectives: (a) audiologists' perceptions around the use of mHealth apps to enable collaborative, child-inclusive hearing aid personalization, and (b) person-centered ideation around potential app design components to benefit users aged 12 to 17 years.

METHOD

Twelve audiologists participated in virtual synchronous focus groups, across three group sessions using Cisco Webex. Sessions were recorded, transcribed, and analyzed using an inductive, codebook thematic analysis approach.

RESULTS

Six main themes resulted from group discussion analyses: (a) client candidacy: characteristics impacting suitability for mHealth use; (b) clinical implementation: organizational, professional, or patient-level strategies for mHealth adoption; (c) collaboration: the use of two or more individuals working together; (d) empowerment: process of acquiring and using knowledge, skills, and strategies; (e) remote technology: technologies enabling remote hearing aid personalization; and (f) application functionality and design: features and characteristics important to an adolescent-focused app.

CONCLUSIONS

Findings identified the potential for clinical integration of hearing aid apps with adolescents in a collaborative care model, including consideration of child-specific use patterns, outcomes, and key design and technology components to support real-world implementation and use. Results may guide development and tailoring efforts around existing and future hearing aid apps for use with adolescent populations.

Short- and long-term effects of remote synchronous fine-tuning for first-time hearing aid users: a randomised controlled trial

OBJECTIVE

To evaluate the short- and long-term effect of remote synchronous fine-tuning and follow-up visits on hearing-related problems and hearing aid (HA) benefits for first-time HA users.

DESIGN

A randomised controlled trial.

STUDY SAMPLE

Patients at public tax-funded HA clinics in Sweden due for aural rehabilitation (AR) were randomised to either an intervention group (n = 33) or a control group (n = 36). Both groups completed the conventional AR process, but the intervention group received synchronous remote fine-tuning of HAs and online follow-up visits. Outcome measures were used before and after intervention, and 6 months and 1 year after intervention.

RESULTS

Both groups improved hearing-related problems measured with the Hearing Handicap Inventory for the Elderly/Adults over time, and no significant differences were found between the groups. Such improvements were also found for the Abbreviated Profile of Hearing Aid Benefit except for the subscale aversiveness. Both groups decreased the use of HAs in hours/day over time. The intervention group reported significant improvements in activity limitation when measured directly after the intervention, compared to the control group.

CONCLUSION

Synchronous remote fine-tuning and follow-ups for first-time HA users did not influence the outcomes of hearing-related problems and HA benefits differently from standard care at our clinic.

Synchronous remote fine-tuning and follow-up within aural rehabilitation: a randomised controlled trial

OBJECTIVE

The objective of the study was to evaluate the effect of including synchronous remote fine-tuning and follow-up as a part of the aural rehabilitation process.

DESIGN

A randomised controlled trial (RCT).

STUDY SAMPLE

Experienced hearing aid users who were due for renewed aural rehabilitation were randomised to either an intervention group (n = 46) or a control group (n = 49). Both groups underwent all stages of the conventional renewed aural rehabilitation process within our clinics, but the intervention group was also offered remote follow-up visits, including an opportunity for synchronous remote fine-tuning of hearing aids. The Hearing Handicap Inventory for the Elderly/Adults (HHIE/A), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the International Outcome Intervention for Hearing Aid Users (IOI-HA) were used as outcome measures.

RESULTS

Both groups improved in self-rated hearing difficulties and hearing aid benefits measured with HHIE/A and APHAB. No significant differences were found between the intervention and the control group.

CONCLUSION

Including synchronous remote follow-up and fine-tuning as a part of an aural rehabilitation process may effectively complement clinical visits. Additionally, the synchronous remote follow-up has the potential to further develop person-centred care by enabling hearing aid users to identify individual needs directly in an everyday environment.

Refinement and Validation of the Empowerment Audiology Questionnaire: Rasch Analysis and Traditional Psychometric Evaluation

OBJECTIVES

Empowerment is the process through which individuals with hearing-related challenges acquire and use knowledge, skills and strategies, and increase self-efficacy, participation, and control of their hearing health care, hearing solutions, and everyday lives. The aim was to refine and validate the Empowerment Audiology Questionnaire (EmpAQ), a hearing-specific measure of empowerment. This was achieved through (1) refinement via Rasch analysis (study 1), and (2) traditional psychometric analysis of the final survey structure (study 2).

DESIGN

In study 1, 307 adult hearing aid owners completed the initial empowerment measure (33 items) online. To inform an intended item reduction, Rasch analysis was used to assess a range of psychometric properties for individual items. The psychometric properties included analysis of individual items (e.g., response dependency, fit to the polytomous Rasch model, threshold ordering) and the whole EmpAQ (e.g., dimensionality). Item reduction resulted in a 15-item version (EmpAQ-15) and a short-form 5-item version (EmpAQ-5), validated using modern (Rasch), and traditional (Classical Test Theory) psychometric analysis (study 2). In study 2, 178 adult hearing aid owners completed the EmpAQ-15 and EmpAQ-5, alongside 5 questionnaires to measure related constructs. These included two hearing-specific questionnaires (Social Participation Restrictions Questionnaire and Self-Assessment of Communication), two general health-related questionnaires (Patient Activation Measure and World Health Organization Disability Assessment Schedule 2.0), and a general empowerment questionnaire (Health Care Empowerment Questionnaire). Modern (Rasch) and traditional psychometric analysis techniques (internal consistency, construct validity, and criterion validity) were used to assess the psychometric properties of the EmpAQ-15 and EmpAQ-5.

RESULTS

Rasch analysis of the initial 33-item measure of empowerment identified 18 items with high response dependency, poor fit to the Rasch model, and threshold disordering, which were removed, resulting in a long-form (EmpAQ-15) hearing-specific measure of empowerment. A short-form (EmpAQ-5) version was developed for use in the clinic setting. Validation of the two EmpAQ measures using Rasch analysis showed good item fit to the Rasch model, appropriate threshold targeting, and the existence of unidimensionality. Traditional psychometric evaluation showed that both questionnaires had high internal consistency and positive correlations with the hearing-specific questionnaires. However, in contrast with our hypotheses, correlations with general health questionnaires were stronger than with hearing-specific questionnaires; all questionnaires were correlated with the EmpAQ and in the direction hypothesized. Taken together, these findings support the construct validity of the EmpAQ-15 and EmpAQ-5.

CONCLUSIONS

The EmpAQ-15 and EmpAQ-5 are the first self-report measures to be developed specifically for the measurement of empowerment. The EmpAQ-15 and EmpAQ-5 were found to meet the Rasch model criteria for interval-level measurements. Traditional psychometric evaluation supports the construct validity of both measures. The EmpAQ measures have the potential to be used in both research and clinical practice to evaluate empowerment along the hearing journey. The next stage of this research will be to further validate these measures by assessing their responsiveness, minimal clinically important difference, and clinical interpretability in a clinical population.

Development of a self-report measure of empowerment along the hearing health journey: a content evaluation study

OBJECTIVE

To conduct the first phases in the development of a self-report measure of empowerment on the hearing health journey, specifically, item generation and content evaluation of the initial pool of items generated.

DESIGN

A content expert panel survey and cognitive interviews were conducted. Descriptive statistics were obtained for the quantitative data, and the cognitive interviews were analysed using thematic analysis.

STUDY SAMPLE

Eleven researchers and clinicians participated in the content expert surveys. Sixteen experienced hearing aid users participated in the cognitive interviews, recruited from the USA and Australia.

RESULTS

The items underwent five iterations based on feedback from the survey and interview data. This resulted in a set of 33 quality-tested potential survey items that were rated highly for relevance (mean = 3.96), clarity (mean = 3.70) and fit to dimensions of empowerment (mean = 3.92) (scale 0-4, where 4 was the maximum rating).

CONCLUSIONS

Involving stakeholders in item generation and content evaluation increased relevance, clarity, fit to dimension, comprehensiveness, and acceptability of the items. This preliminary version of the 33-item measure underwent further psychometric refinement (Rasch analysis and traditional classical test theory testing) to validate it for clinical and research use (reported separately).

Exploring Hearing Care Technology from Clinic to Capability

Healthcare systems are traditionally a clinician-led and reactive structure that does not promote clients managing their health issues or concerns from an early stage. However, when clients are proactive in starting their healthcare earlier than later, they can achieve better outcomes and quality of life. Hearing healthcare and the rehabilitation journey currently fit into this reactive and traditional model of care. With the development of service delivery models evolving to offer services to the consumer online and where they are predominately getting their healthcare information from the internet and the advancement of digital applications and hearing devices beyond traditional hearing aid structures, we are seeing a change in how consumers engage in hearing care. Similarly, as the range of hearing devices evolves with increasingly blended and standard levels of technology across consumer earbuds/headphones and medical grade hearing aids, we are seeing a convergence of consumers engaging earlier and becoming increasingly aware of hearing health needs. This article will discuss how the channels, service, and technology are coming together to reform traditionally clinician-led healthcare models to an earlier consumer-led model and the benefits and limitations associated with it. Additionally, we look to explore advances in hearing technologies and services, and if these will or can contribute to a behavioral change in the hearing healthcare journey of consumers.

Remote Technologies to Enhance Service Delivery for Adults: Clinical Research Perspectives

There are many examples of remote technologies that are clinically effective and provide numerous benefits to adults with hearing loss. Despite this, the uptake of remote technologies for hearing healthcare has been both low and slow until the onset of the COVID-19 pandemic, which has been a key driver for change globally. The time is now right to take advantage of the many benefits that remote technologies offer, through clinical, consumer, or hybrid services and channels. These include greater access and choice, better interactivity and engagement, and tailoring of technologies to individual needs, leading to clients who are better informed, enabled, and empowered to self-manage their hearing loss. This article provides an overview of the clinical research evidence-base across a range of remote technologies along the hearing health journey. This includes qualitative, as well as quantitative, methods to ensure the end-users' voice is at the core of the research, thereby promoting person-centered principles. Most of these remote technologies are available and some are already in use, albeit not widespread. Finally, whenever new technologies or processes are implemented into services, be they clinical, hybrid, or consumer, careful consideration needs to be given to the required behavior change of the key people (e.g., clients and service providers) to facilitate and optimize implementation.

"We forget about peoples' hearing loss": identifying key aspects of hearing aid and communication training in residential care homes

OBJECTIVES

The first objective was to assess the feasibility of training on hearing aids and communication strategies by support workers in residential care via a cascade training model using two different training packages. The second was to identify key elements of these packages to inform the design of a multimedia training package.

DESIGN

Quantitative and qualitative methodologies were used. A pre-post feasibility design assessed the questionnaire data from residential care support workers to measure knowledge and confidence at three stages during the training. Semi-structured interviews explored the support workers' experiences and adherence to cascading the training packages.

STUDY SAMPLE

Fourteen support workers employed by Sense (charity for deafblind people) were trained to become "Hearing Champions" and cascaded their learning to 117 support colleagues.

RESULTS

Hearing Champions gained knowledge, skills and confidence, which were subsequently enhanced by sharing their learning with others. Despite individual and organisational barriers, they reported examples of improved practice and feelings of empowerment.

CONCLUSIONS

It is feasible to deliver training to support workers in residential homes using the face-to-face "Hearing Champions" and multimedia C2Hear training methods by cascading training to their colleagues. Support workers expressed a preference for training that is portable, adaptable and interactive.

Smartphone-Guided Educational Counseling and Self-Help for Chronic Tinnitus

Tinnitus is an auditory phantom perception in the ears or head in the absence of a corresponding external stimulus. There is currently no effective treatment available that reliably reduces tinnitus. Educational counseling is a treatment approach that aims to educate patients and inform them about possible coping strategies. For this feasibility study, we implemented educational material and self-help advice in a smartphone app. Participants used the educational smartphone app unsupervised during their daily routine over a period of four months. Comparing the tinnitus outcome measures before and after smartphone-guided treatment, we measured changes in tinnitus-related distress, but not in tinnitus loudness. Improvements on the Tinnitus Severity numeric rating scale reached an effect size of 0.408, while the improvements on the Tinnitus Handicap Inventory (THI) were much smaller with an effect size of 0.168. An analysis of user behavior showed that frequent and intensive use of the app is a crucial factor for treatment success: participants that used the app more often and interacted with the app intensively reported a stronger improvement in the tinnitus. Between study allocation and final assessment, 26 of 52 participants dropped out of the study. Reasons for the dropouts and lessons for future studies are discussed in this paper.