Smartphone-Connected Hearing Aids Enable and Empower Self-Management of Hearing Loss: A Qualitative Interview Study Underpinned by the Behavior Change Wheel

Exploring adult hearing aid user experiences: meaning extraction methods, content patterns, and associations with demographic and outcome variables

OBJECTIVE

Employing automated language analysis, specifically Meaning Extraction Method (MEM) and Principal Component Analysis (PCA), to identify key factors in open-text responses about hearing aid experiences.

DESIGN

Exploratory, cross-sectional design, using an online questionnaire. Responses to a single open-ended question were analysed using MEM, PCA, regression, and correlation analyses.

STUDY SAMPLE

Participants (n = 538) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States.

RESULTS

The MEM-derived items revealed six factors related to hearing aid experiences: (1) life change, (2) social situation, (3) quality of life, (4) impact and speech understanding, (5) communication and interaction, and (6) music and environmental sounds. IOI-HA item 3 had the most statistically significant correlations with PCA factors. Quantile regression revealed that factors one and two significantly predicted the IOI-HA total score. Positive correlations were observed between self-reported hearing difficulty and factors one, four, and five, as well as between factor one and general health and factor two and physical activity.

CONCLUSION

Natural language analysis of open-ended textual responses can offer valuable insights into hearing aid users' experiences. Future studies should aim to refine this methodology to enhance clinical relevance and generalisability.

Consumer Perspectives on Improving Hearing Aids: A Qualitative Study

PURPOSE

Hearing aids play a pivotal role in mitigating the impact of hearing loss, yet their adoption and consistent usage remains suboptimal. Understanding the hearing aid needs of individuals with hearing loss is important to support uptake, use, and outcomes. The current study describes users' perspectives on how hearing aids can be improved.

METHOD

A cross-sectional, qualitative, content analysis design was used for an open-ended question from an online survey, exploring user perspectives on hearing aid improvements. Participants were adult hearing aid users in the United States, surveyed from the HearingTracker and Lexie Hearing user database.

RESULTS

A total of 628 participants (Mage = 66 years) were surveyed. The majority of participants used bilateral, behind-the-ear hearing aids that were obtained either through a hearing health care professional or online. Three domains, highlighting areas for hearing aid improvement, were identified. (a) The hearing aid features domain described user issues surrounding physical appearance and fit, general features, streaming, battery functionality, adjustments, smartphone applications, and hearing aid-related accessories. There was dissatisfaction with aesthetics and functionality, with a notable desire for improvements in physical appearance and fit (n = 161), and features to improve self-efficacy. (b) The sound quality domain described user issues surrounding sound perception and difficult situations. Participants highlighted unmet needs for clarity, especially in noisy environments (n = 143). (c) The service-delivery domain described user issues surrounding audiology services and general satisfaction, with criticisms centered on the high cost of hearing aids (n = 193) and the credibility of hearing health care professionals.

CONCLUSIONS

Hearing aid users appreciated current technological advances but expressed a need for improvements, to better align devices with their requirements. Key areas included physical aesthetics, user control over device adjustments, sound clarity, cost accessibility, and trust between the user and hearing health care professional. Future designs should focus on features enhancing user autonomy and self-efficacy.

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.

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 Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial

BACKGROUND

The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension.

OBJECTIVE

The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence.

METHODS

A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant.

RESULTS

The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (-7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes.

CONCLUSIONS

The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/46883.

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).

A qualitative study assessing the barriers and facilitators to physical activity in adults with hearing loss

OBJECTIVES

Growing epidemiological evidence has shown hearing loss is associated with physical inactivity. Currently, there is a dearth in evidence investigating why this occurs. This study aimed to investigate the barriers and facilitators to physical activity in middle-aged and older adults with hearing loss.

DESIGN

Individual semi-structured qualitative interviews.

METHODS

A phenomenological approach was taken. Ten adults (≥40 years) were interviewed via videoconferencing. The interview schedule was underpinned by the capability, opportunity, motivation and behaviour (COM-B) model. Reflexive thematic analysis was used to generate themes, which were subsequently mapped onto the COM-B model and behaviour change wheel.

RESULTS

Nine hearing loss specific themes were generated, which included the following barriers to physical activity: mental fatigue, interaction with the environment (acoustically challenging environments, difficulties with hearing aids when physically active) and social interactions (perceived stigma). Environmental modifications (digital capabilities of hearing aids), social support (hearing loss-only groups) and hearing loss self-efficacy were reported to facilitate physical activity.

CONCLUSIONS

Middle-aged and older adults with hearing loss experience hearing-specific barriers to physical activity, which has a deleterious impact on their overall health and well-being. Interventions and public health programmes need to be tailored to account for these additional barriers. Further research is necessary to test potential behaviour change techniques.

Change in the Characteristics of Patients Qualified for Hearing Aids over the Last 25 Years in Poland

Hearing loss is one of the most common causes of disability worldwide. The aim of the study was to compare the demographic structure and the results of hearing tests in people qualified for hearing aids over the last 25 years. The material covered 1246 patients qualified for hearing aids in the years 1996-2001 and 2016-2021. Patients were divided into two groups according to the time of qualifying for hearing aids. Group 1 (G1) consisted of 759 people qualified in the years 1996-2001, and Group 2 (G2) comprised 487 people qualified in the years 2016-2021. Statistical analysis was performed on the results of pure tone threshold audiometry and the demographic structure in both groups. Patients in G1 had statistically significantly elevated hearing thresholds (HT) in the air conduction range at frequencies from 2000 to 8000 Hz in relation to G2 patients. The opposite situation was observed for the bone conduction threshold. G2 patients had significantly elevated bone conduction HT at frequencies from 250 to 1000 Hz compared to G1 patients. The age structure in both groups was similar; however, the gender distribution was statistically significantly different. In G1 women accounted for 40%, and in G2, they became the dominant gender (53%). Over the last twenty years, there has been a change in the structure of patients qualified for hearing aids. Although the age has remained similar, today, patients decide to use hearing aids at an earlier stage of hearing loss than 25 years ago. Modern women began to use hearing aids much more often.

The Modern Hearing Care Landscape: Toward the Provision of Personalized, Dynamic, and Adaptive Care

New technologies and developments in hearing healthcare are rapidly transforming service models, delivery channels, and available solutions. These advances are reshaping the ways in which care is provided, leading to greater personalization, service efficiencies, and improved access to care, to name a few benefits. Connected hearing care is one model with the potential to embrace this "customized" hearing experience by forging a hybrid of health-technology connections, as well as traditional face-to-face interactions between clients, providers, and persons integral to the care journey. This article will discuss the many components of connected care, encompassing variations of traditional and teleaudiology-focused services, clinic-based and direct-to-consumer channels, in addition to the varying levels of engagement and readiness defining the touch points for clients to access a continuum of connected hearing care. The emerging hearing healthcare system is one that is dynamic and adaptive, allowing for personalized care, but also shifting the focus to the client's needs and preferences. This shift in the care model, largely driven by innovation and the growing opportunities for clients to engage with hearing technology, brings forth new, exciting, and sometimes uncomfortable discussion points for both the provider and client. The modern hearing care landscape benefits clients to better meet their needs and preferences in a more personalized style, and providers to better support and address those needs and preferences.

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.

Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies

BACKGROUND

Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies.

OBJECTIVE

This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies.

METHODS

A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design.

RESULTS

We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features.

CONCLUSIONS

Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies.

Real-life and real-time hearing aid experiences: Insights from self-initiated ecological momentary assessments and natural language analysis

Introduction

Smartphone technology can provide an effective means to bring real-life and (near-)real-time feedback from hearing aid wearers into the clinic. Ecological Momentary Assessment (EMA) encourages listeners to report on their experiences during or shortly after they take place in order to minimize recall bias, e.g., guided by surveys in a mobile application. Allowing listeners to describe experiences in their own words, further, ensures that answers are independent of predefined jargon or of how survey questions are formulated. Through these means, one can obtain ecologically valid sets of data, for instance during a hearing aid trial, which can support clinicians to assess the needs of their clients, provide directions for fine-tuning, and counselling. At a larger scale, such datasets would facilitate training of machine learning algorithms that could help hearing technology to anticipate user needs.

Methods

In this retrospective, exploratory analysis of a clinical data set, we performed a cluster analysis on 8,793 open-text statements, which were collected through self-initiated EMAs, provided by 2,301 hearing aid wearers as part of their hearing care. Our aim was to explore how listeners describe their daily life experiences with hearing technology in (near-)real-time, in their own words, by identifying emerging themes in the reports. We also explored whether identified themes correlated with the nature of the experiences, i.e., self-reported satisfaction ratings indicating a positive or negative experience.

Results

Results showed that close to 60% of listeners' reports related to speech intelligibility in challenging situations and sound quality dimensions, and tended to be valued as positive experiences. In comparison, close to 40% of reports related to hearing aid management, and tended to be valued as negative experiences.

Discussion

This first report of open-text statements, collected through self-initiated EMAs as part of clinical practice, shows that, while EMA can come with a participant burden, at least a subsample of motivated hearing aid wearers could use these novel tools to provide feedback to inform more responsive, personalized, and family-centered hearing care.

Hearing aid Experiences of Adult Hearing aid Owners During and After Fitting: A Systematic Review of Qualitative Studies

There has been an increasing number of qualitative studies exploring the experiences and perceptions of adult hearing aid owners throughout their hearing aid journey. As these studies and reported experiences vary greatly, a systematic review was conducted to identify and synthesize the key concepts in adult hearing aid owners' experiences during and after fitting. A systematic search of three electronic databases was conducted, yielding 443 results. Articles were evaluated for inclusion based on pre-determined eligibility criteria, including conventional, smartphone-connected, and direct-to-consumer hearing devices. Twenty-five studies met the inclusion criteria. The quality of the included articles was evaluated using the Rating of Qualitative Research scale. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Synthesis Without Meta-Analysis (SWiM) were followed. A narrative synthesis was conducted, and studies were grouped into three main domains, namely experiences of owners related to a) hearing aid adoption and fitting (n = 3), b) hearing aid use (n = 20), and c) hearing aid sub-optimal use (n = 25). Hearing aid owners mainly reported on how their attitude towards hearing aids affected experiences during the fitting stage. Improved psychosocial functioning was the most prevalent perceived benefit of hearing aid use. Owners described sub-optimal use in terms of hearing device-related and non-device-related concepts. The COM-B (capability, opportunity, motivation-behavior) model is used to discuss specific service-delivery, hearing-device, and hearing-aid-owner related concepts and clinical implications, including behavior change techniques to enhance understanding of the concepts that hearing aid owners perceive as essential to improve hearing aid experiences.

Health Behavior and Motivational Engagement Models Can Explain and Modify Teleaudiology Uptake

PURPOSE

The remote delivery of health care services (i.e., telehealth) has steadily increased across the health care landscape over the past decade with a dramatic increase following the onset of the COVID-19 pandemic. Remote audiology delivery (i.e., teleaudiology), by contrast, has traditionally been characterized by relatively low utilization. While teleaudiology services increased during the COVID-19 lockdown period, most of those services were generally limited to follow-up care and postfitting consultations to existing patients. Furthermore, there is reason to believe that, despite the benefits that remote care provides, the use of teleaudiology services has decreased as in-person care has increased following the lifting of mandatory COVID-related lockdowns. The purpose of this viewpoint article is to posit that existing theories of health behavior, usually applied to patient-specific behaviors (e.g., hearing aid uptake) may explain the reluctance of audiologists to "uptake" a teleaudiology model of care. We also explore the potential of motivational engagement strategies as a means to allow audiologists to examine their sources of ambivalence as they consider adopting a remote service-delivery model.

CONCLUSIONS

Health behavior models such as the Health Belief, Transtheoretical, and capability, opportunity, motivation, and behavior (COM-B) models represent theories that may help to explain audiologists' resistance to adopting remote delivery services. Motivational engagement strategies, such as decisional balance, can provide useful tools for audiologists to examine their attitudes toward the adoption of teleaudiology.

Hearing Aid Fitting Orientation and the APSO Standard

The Audiology Practice Standards Organization (APSO) which was formed in 2017 set out to compile basic services that audiologists within the field should adhere to in their practice. The second standard of the APSO is the Hearing Aid Fitting Standard for Adult and Geriatric Patients. Among the services outlined for an adult hearing aid fitting, orientation is discussed. A hearing aid fitting orientation needs to be device- and patient-centered while also covering various aspects of hearing aid orientation that supports patient's success during the process. This article discusses APSO Standard 12 regarding hearing aid orientation and details how this standard can be implemented in the clinic.