The revised form of the Hearing Performance Inventory

Patient-Reported Outcome Measures for Hearing Aid Benefit and Satisfaction: Content Validity and Readability

PURPOSE

Numerous patient-reported outcome measures (PROMs) are available to measure hearing aid benefit and satisfaction. It is unclear to what extent currently available PROMs on hearing aid outcomes, often developed decades ago, meet current guidelines for good content validity and readability. This study evaluated the content validity and readability of PROMs that focus on perceived hearing aid benefit and/or satisfaction.

METHOD

A literature review was conducted to identify eligible instruments. Content validity evaluation included mapping extracted questionnaire items to the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. In addition, study design in content validity methodology was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments study design checklist for PROM instruments. Readability was estimated using the Simple Measure of Gobbledygook measure.

RESULTS

Thirteen questionnaires were identified and evaluated. Item content focused primarily on the components of environmental factors as well as activity limitations and participation restrictions with less emphasis on body functions and personal factors. The content validity methodology analysis revealed an underuse or lack of reporting of a qualitative methodology in assessing patient and professional perspectives. All the included questionnaires exceeded the recommended sixth-grade reading level.

CONCLUSIONS

The categories covered by hearing aid PROMs vary considerably, with no single instrument comprehensively covering all the key ICF components. Future development of hearing aid outcome measures should consider a mixed methodology approach for improved content validity and ensure an appropriate reading level.

Further Evaluation and Application of the Wisconsin Age-Related Hearing Impairment Classification System

Purpose The primary purpose of this report is to further evaluate the Wisconsin Age-Related Hearing Impairment Classification System (WARHICS) scheme for the classification of audiograms obtained from older adults, ages 50-89 years. Method This was a retrospective analysis of data from 11,729 older adults included in two population, one community, and two clinical data sets. To aid in the interpretation of the audiogram classifications, the functional significance of audiogram categories was evaluated using Hearing Handicap Inventory-Screen scores available for 10,330 of these same individuals. Results A WARHICS level could be obtained successfully for 99.5% of the 11,729 audiograms included in these analyses. It was applied successfully to population, community, and clinical samples. WARHICS Level 8 audiograms, corresponding to a broad profound hearing impairment (pure-tone thresholds from 500 to 8000 Hz, all > 80 dB HL), were very rare (.1% prevalence). WARHICS subtypes, designed to identify those with high-frequency notched audiograms or flat audiograms, occurred only 3%-6% of the time, depending on the data set. When compared to the current hearing-impairment grading system of the World Health Organization (WHO), several WARHICS levels fell within a given WHO hearing-impairment grade suggesting a finer grained categorization by the WARHICS. The Hearing Handicap Inventory-Screen scores provided justification for the fine-grained categorization according to the WARHICS. It is also demonstrated that the WARHICS levels could be extended to the classification of audiograms from all adults, regardless of age. Finally, a WARHICS-WHO hybrid classification scheme is proposed for future evaluation. Conclusions Although the WARHICS was developed from a population data set, it was demonstrated here to be applicable to population, community, and clinical data sets for adults aged 50-89 years. The applicability of the WARHICS or a WARHICS-WHO hybrid to population data sets that included younger adults suggests that this classification system has the potential to be applied even more broadly than just to age-related hearing loss.

Hearing loss and quality of life

OBJECTIVE

We sought to identify multidimensional factors associated with health-related quality of life (HRQoL) for use in developing an inventory in which HRQoL is a core concept in evaluating the impact of hearing loss and the efficacy of rehabilitative interventions.

METHOD

A qualitative approach was used in which we posed two major questions to a focus group consisting of eight adults with self-reported, bilateral sensorineural hearing loss of varying degrees. In essence, those questions were: (1) How do you define quality of life?, and (2) Can you describe specific incidents in your everyday life in which your hearing loss has impacted your quality of life? The discussion was embedded within a framework that utilized a modification of the Critical Incident Technique (CIT). We used well-established analytic techniques to translate the data into unitized thought units, which we coded into meaningful categories. Response frequency was used to determine the salience of responses in addressing the research questions.

RESULTS

Participants defined QoL in terms of a number of primary dimensions, most of which were directly or indirectly associated with specific recalled incidents in which those dimensions have played a notable role in contributing to their QoL.

CONCLUSIONS

The use of well-established methods to gather and analyze qualitative data generated by self-report techniques offers a promising direction for developing a standardized inventory for identifying the factors that impact QoL for persons with hearing loss and for evaluating the success of intervention strategies aimed at improving their HRQoL.

Hearing aid satisfaction: what does research from the past 20 years say?

Hearing aid satisfaction is a pleasurable emotional experience as an outcome of an evaluation of performance. Many tools have been designed to measure the degree of satisfaction overall, or along the dimensions of cost, appearance, acoustic benefit, comfort, and service. Various studies have used these tools to examine the relationships between satisfaction and other factors. Findings are not always consistent across studies, but in general, hearing aid satisfaction has been found to be related to experience, expectation, personality and attitude, usage, type of hearing aids, sound quality, listening situations, and problems in hearing aid use. Inconsistent findings across studies and difficulties in evaluating the underlying relationships are probably caused by problems with the tools (eg, lack of validity) and the methods used to evaluate relationships (eg, correlation analyses evaluate association and not causal effect). Whether satisfaction changes over time and how service satisfaction contributes to device satisfaction are unclear. It is hoped that this review will help readers understand current satisfaction measures, how various factors affect satisfaction, and how the way satisfaction is measured may be improved to yield more reliable and valid data.

Guidelines for choosing a self-report outcome measure

A table of available self-report inventories used throughout the world is provided with references for obtaining necessary psychometric data for research or clinical applications. Considerations for choosing an inventory (reliability, validity, and content appropriateness) are discussed and issues related to group versus single-subject applications examined. It is preferable that translation and revalidation of existing outcome measures be considered above developing new ones for international application.

Measuring the effects of Meniere's disease: results of the Patient-Oriented Severity Index (MD POSI) version 1

We describe the development and initial psychometric testing of a new self-report instrument for quantifying the impact of Meniere's disease (MD) on patients' lives: the Meniere's Disease Patient-Oriented Severity Index (MD POSI). Eighty-five volunteers with chronic MD took a self-administered MD POSI. The internal consistency form of reliability was determined by calculating Cronbach's alpha. The relationship between total MD POSI problem severity scores and responses to a global question concerning the degree to which his or her MD had changed the patient's life assessed construct-related validity. The total problem severity score yielded excellent reliability (Cronbach's alpha = .928). No significant age or gender effects were seen. A highly statistically significant association was noted between total problem severity scores and the degree to which the patient's life had been changed by his or her MD (Spearman rank correlation = .526, p < .0001), indicating excellent construct-related validity. The material included in the initial questionnaire provides important information that can be used clinically to quantify the impact of MD on patients' health status. A beta version of the instrument is in the process of validation and determination of its sensitivity to change in health status.

Assessing Release-Time Options in a Two-Channel AGC Hearing Aid

The purpose of this study was to determine whether different release times, as implemented in a commercial two-channel AGC hearing aid, would result in differing speech intelligibility performance, user preference, or use time. In experiment one, 14 subjects were fitted with a two-channel multi-memory AGC hearing aid. Four memories were programmed to have identical frequency responses and output limitation characteristics. Only the release times were varied, with the low channel/high channel set as follows (in ms): 20/35, 20/150, 100/35, 500/7. Results obtained from the NST (+5 S/N), magnitude estimations of intelligibility, and data-logging of use time did not show any release-time pair to be superior to any other. In experiment two, 10 subjects participated in a forced-choice, paired-comparison procedure using the same release-time pairs from experiment one. Auditory stimuli consisted of three input levels, consisting of speech, speech in noise, and music. Results indicated no release-time pair to be superior in any listening condition. Results may be explained, in part, by the use of a curvilinear compression circuit and the milder hearing loss exhibited by the subjects. Future investigation of the effect of release-time variation should be carried out on circuits with adjustable compression parameters (and fixed compression ratios) with listeners exhibiting different degrees of hearing loss.

Longitudinal study of hearing aid effectiveness. II: Subjective measures

This report is the second of two detailing a longitudinal follow-up of hearing aid users. The experimental group (N = 65) was followed closely for a 12-month period after obtaining amplification. Factors of degree of hearing loss, configuration of hearing loss, previous experience with hearing aids, daily use time, and circuit type were defined. Subjective tests included the "Understanding Speech" subsection of the Hearing Performance Inventory (HPI) (Giolas, Owens, Lamb, & Schubert, 1979; Lamb, Owens, & Schubert, 1983), an expectations checklist, a qualitative judgment task, and a satisfaction questionnaire that included items of use time, battery life, and main reason for satisfaction rating. Only those items of the HPI describing fairly quiet backgrounds showed significant change (improvement) over the year. The expectation checklist showed a mean reduction in score indicative of performance exceeding expectations. The qualitative judgment task did not significantly differentiate among the circuits used, although the linear circuit was judged as having better sound quality than those circuits considered to be noise-reduction. Correlations with the objective tests reported previously in Part I suggest a weak relationship between speech recognition performance and self-assessment of communication performance. Questions of the validity of subjective measures, the best time frame for obtaining outcome measures, and the usefulness of group data are addressed.

Qualitative analysis of the handicap associated with occupational hearing loss

Hearing difficulties among noise-exposed workers were investigated by means of an interview. A group of 61 workers from a metal product plant had their hearing tested; 66% had abnormal hearing according to their age. Interviews on hearing problems and on their consequences were conducted at home with the spouses. The interviews were recorded and transcribed, and then treated according to a procedure that combines phenomenological and content analysis. The results were classified into hearing disabilities, disadvantages and adjustments. Listening and communication problems result in extra efforts, anxiety and stress, changes in social activities, isolation in groups and a negative self-image. These problems also affect others, especially the spouse, who take an active part in the spontaneous adjustment to disabilities. A model of the structure of the handicap has been outlined illustrating how spontaneous adjustments can be in themselves sources of disadvantages. Implications for rehabilitation services are discussed in terms of the means to facilitate optimal adjustment to disabilities.