Parents' Preferences for Services for Children with Hearing Loss: A Conjoint Analysis Study

The effect of having a child with hearing impairment on parents

OBJECTIVE

In this study, it was aimed to compare parents of children with hearing impairment (with cochlear implant (CI) or hearing aid) and parents of children with normal hearing (NH) in terms of care burden, self-efficacy and psychological resilience levels.

METHODS

The study participants were parents of children aged 3-12 years. Zarit Care Burden Scale (ZCBS), Parental Self-Efficacy Scale (PSES) and Brief Psychological Resilience Scale (BPRS) were administered to the parents.

RESULTS

The mean BPRS score was statistically significantly higher for the NH group than for the hearing impairment groups. It was found that the mean ZCBS score was statistically significantly higher for CI group than for the other groups (p < 0.05). A statistically significant and positive correlation was found between the PSES and BPRS scores of the CI group.

CONCLUSION

It is thought that the results of this study will contribute to the creation of case-specific intervention/rehabilitation programs.

Parents' Part C Experiences in Rural Areas: Alignment With Recommended Practices

The Division for Early Childhood (DEC) clearly outlined recommended practices for the provision of Part C services. However, there may be challenges in rural areas associated with services aligning with these recommended practices. Therefore, this study focuses on how families experience Part C services and the extent to which services align with specific areas the DEC recommended practices in the large, rural state of Montana. We interviewed parents (N = 30) about their children's Part C services. Deductive qualitative content analysis was used. Parents' reports suggest that while some aspects of their Part C services align with specific recommended practices, others do not. There were some meaningful differences regarding alignment with these recommended practices depending on type of provider being described. The environments in which services take place are discussed, as these may influence aspects of collaboration and building family capacity.

Parents' views about factors facilitating their involvement in the oral early intervention services provided for their children with hearing loss in Kuwait

OBJECTIVES

Developed countries (such as the Unites States of America, the United Kingdom, and Australia) provide high-quality services to children with hearing loss and their parents, including universal newborn hearing screening, early fitting of hearing devices and access to high quality early, aural intervention. In contrast, many developing countries lack the resources to provide these services. Research evidence suggests that one way to compensate for delays in identification and rehabilitation for children with hearing loss is to involve the family in the early intervention process. However, evidence is deficient around the facilitation of parental involvement in early intervention for families from developing countries. The aim of this study was to investigate the perception of parents from a developing country who have a child with hearing loss to discover the factors that may influence their involvement in early intervention, identify facilitators/barriers for their involvement, and identify the specific needs of involved parents.

METHOD

A qualitative collective case study methodology was used in the form of semi-structured interviews with twenty-one participants.

RESULTS

Two global themes emerged. Firstly, factors influencing parental involvement. This included five subthemes: better communication as the key to building rapport and providing support; disappointment with the service; physical and human resources make a difference; consideration of life beyond the habilitation sessions; and my child matters the most. The second global theme-parental needs-included four subthemes: building trust; ensuring generalization; improving child outcomes; and managing needs of parents versus services. All the discussed themes are supported by quotations from the interviews.

CONCLUSION

The findings suggest that parents of children with hearing loss in developing countries perceive the services provided for their children to be disjointed and not well coordinated. Based on the parent perceptions a set of guidelines that provide a scaffold for service providers working with children with hearing loss in developing countries is outlined. The guidelines are designed to assist services for children with hearing loss in developing countries improve the delivery of their services and increase family involvement, which in turn; will assist in improving their child and family related outcomes.

Parent perspectives on multidisciplinary pediatric hearing healthcare

INTRODUCTION

Family-centered healthcare demands that families provide input regarding the care of their children. Very little is known, however, about how families perceive their experience in different types of multidisciplinary team models, and specifically, in the multidisciplinary setting currently utilized in many pediatric hearing clinics.

METHODS

Quantitative and qualitative parent survey responses were collected and analyzed in a tertiary care pediatric medical center after a one-day multidisciplinary assessment clinical appointment. Questions pertained to information across five domains, including overall experience, diagnosis, treatment plan formulation, additional testing, and resources. Quantitative responses were analyzed descriptively while qualitative responses were evaluated using content analysis to derive themes. Quantitative and qualitative data were evaluated separately and then compared to delineate themes for strengths and weaknesses.

RESULTS

Overall, high satisfaction was evident in both quantitative and qualitative responses. Results suggested that a one-day multidisciplinary assessment appointment may contribute to parents feeling overwhelmed by information shared and not fully understanding which disciplines are providing care. Analysis revealed a specific area of weakness in our particular setting was inadequate provision of information about functional hearing (e.g., listening socially and academically). Results contributed to a change from a multidisciplinary team model to an interdisciplinary care coordination approach to pediatric hearing healthcare.

CONCLUSIONS

Understanding parent perspectives and expectations is the corner stone of family-centered care and may ultimately influence a child's developmental outcome. A systematic way of evaluating parent perspectives on the clinical process can influence service delivery and help children with hearing loss meet their potential.

Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review

Background

One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science.

Methods

We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome.

Results

Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3).

Conclusions

The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a healthcare assessment tool, there is a wide range of applications for them in stakeholder engagement. The DCE approach could serve as a tool for engaging stakeholders in implementation science.

Electronic supplementary material

The online version of this article (10.1186/s13012-017-0675-8) contains supplementary material, which is available to authorized users.

The Role of Qualitative Research Methods in Discrete Choice Experiments

Background. The use of qualitative research (QR) methods is recommended as good practice in discrete choice experiments (DCEs). This study investigated the use and reporting of QR to inform the design and/or interpretation of healthcare-related DCEs and explored the perceived usefulness of such methods. Methods. DCEs were identified from a systematic search of the MEDLINE database. Studies were classified by the quantity of QR reported (none, basic, or extensive). Authors (n = 91) of papers reporting the use of QR were invited to complete an online survey eliciting their views about using the methods. Results. A total of 254 healthcare DCEs were included in the review; of these, 111 (44%) did not report using any qualitative methods; 114 (45%) reported “basic” information; and 29 (11%) reported or cited “extensive” use of qualitative methods. Studies reporting the use of qualitative methods used them to select attributes and/or levels (n = 95; 66%) and/or pilot the DCE survey (n = 26; 18%). Popular qualitative methods included focus groups (n = 63; 44%) and interviews (n = 109; 76%). Forty-four studies (31%) reported the analytical approach, with content (n = 10; 7%) and framework analysis (n = 5; 4%) most commonly reported. The survey identified that all responding authors (n = 50; 100%) found that qualitative methods added value to their DCE study, but many (n = 22; 44%) reported that journals were uninterested in the reporting of QR results. Conclusions. Despite recommendations that QR methods be used alongside DCEs, the use of QR methods is not consistently reported. The lack of reporting risks the inference that QR methods are of little use in DCE research, contradicting practitioners’ assessments. Explicit guidelines would enable more clarity and consistency in reporting, and journals should facilitate such reporting via online supplementary materials.

Developing a Patient-Centered Benefit-Risk Survey: A Community-Engaged Process

OBJECTIVES

To provide a community-engaged process to inform the design of a stated-preferences experiment. The process involved integrating patients and caregivers of people with Duchenne/Becker muscular dystrophy, advocates, clinicians, and the sponsor in conceptualizing and developing a benefit-risk survey on the basis of phase III trial results.

METHODS

Our community-engagement process for the development of a stated-preference survey included a set of five guiding principles with a foundation in the principles of community-engaged research. Engagement efforts were carried out through an informal network of three committees. Members of the leadership, stakeholder, and review committees comprised patients, caregivers, clinicians, advocacy leadership, and industry representatives.

RESULTS

Committee members participated in 15 hours of formal engagement including interviews and conference calls that ranged from 45 to 90 minutes, plus additional less-formal ad hoc communication. Committees comprised 20 individuals across three committees including adults with DMD (n = 6), parents of children with DMD (n = 6), clinicians (n = 3), members of research and advocacy organizations (n = 4), and an industry representative (n = 1). Community engagement informed attribute selection, survey length, word choice, and eligibility criteria. Challenges in the process included managing diverse stakeholder perspectives, time requirements, and the inherent tension between outcomes used in clinical trials versus attributes that correspond to patient- and family-relevant outcomes.

CONCLUSIONS

We demonstrated how community engagement can successfully influence study design to support the design of a relevant survey instrument that is ethical, acceptable, meaningful to the community, and enhances patient-centered benefit-risk assessment for regulatory decision making.

Developing attributes for discrete choice experiments in health: a systematic literature review and case study of alcohol misuse interventions

Discrete choice experiments (DCEs) become increasingly popular to value outcomes for health economic studies and gradually gain acceptance as an input into policy decisions. Developing attributes is a key aspect for the design of DCEs, as their results may misguide decision-makers if they are based on an inappropriate set of attributes. However, the area lacks guidance, and current health-related DCE studies vary considerably in their methods of attribute development, with the consequent danger of providing an unreliable input for policy decisions. The aim of this article is to inform the progress toward a more systematic approach to attribute development for DCE studies in health. A systematic review of the published health-related DCE literature was conducted to lay the foundations for a generic framework which was tested in a case study of alcohol misuse interventions. Four stages of a general attribute development process emerged: (i) raw data collection; (ii) data reduction; (iii) removing inappropriate attributes; and (iv) wording. The case study compared and contrasted a qualitative and mixed-methods approach for the development of attributes for DCEs in the area of alcohol misuse interventions. This article provides a reference point for the design of future DCE experiments in health.

Evidence-Based Medicine in Otolaryngology, Part 5: Patient Decision Aids

Modern medical decision making is a complex task requiring collaboration between patients and physicians. Related clinical evidence may delineate a clearly favorable path, but in other instances, uncertainty remains. Even in these circumstances, however, there are techniques that optimize decision making by blending existing evidence with individual patient values in the context of physician counseling. This installment of "Evidence-Based Medicine in Otolaryngology" focuses on the crucial issue of how practitioners may approach clinical situations where the data do not delineate a single irrefutable path. We describe decision aids-tools that can educate patients about data related to complex clinical decisions. We review their definition, quality standards, patient interface, benefits, and limitations. We also discuss the related concept of option grids and the role of decision aids in evidence-based practice.

Effectiveness of domain-based intervention for language development in Japanese hearing-impaired children: a multicenter study

OBJECTIVE

Decreasing language delay in hearing-impaired children is a key issue in the maintenance of their quality of life. Language training has been presented mainly by experience-based training; effective intervention programs are crucially important for their future. The aim of this study was to confirm the efficacy of 6-month domain-based language training of school-age, severe-to-profound hearing-impaired children.

METHODS

We conducted a controlled before-after study involving 728 severe-to-profound prelingual hearing-impaired children, including an intervention group (n = 60), control group (n = 30), and baseline study group (n = 638). Language scores of the participants and questionnaires to the caregivers/therapists were compared before and after the intervention. Average monthly increase in each language score of the control group and baseline study group were compared with those of the intervention group.

RESULTS

Language scores and the results of the questionnaire of the intervention group showed a significant improvement (P < .05). The average monthly language growth of the intervention group was twice that of the control group and 3 to 4 times that of the baseline study group (P < .05). The effect size was largest in communication (1.914), followed by syntax (0.931).

CONCLUSION

Domain-based language training improved the language development and daily communication of hearing-impaired children without any adverse effects.

Sensitivity of ABR based newborn screening with the MB11 BERAphone(®)

OBJECTIVES

The aim of this study is to evaluate the sensitivity of our hearing screening program. The evaluation was done using a questionnaire for parents of children who participated in the NHS for a targeted time frame of two years. A survey was accomplished to identify children who passed our screening protocol in the newborn period, but who were later identified to have hearing loss.

METHODS

For the survey a one-year cohort was established in 2008 which included 500 children who received a hearing screening at our Center with the ABR newborn screener, MB11 BERAphone(®), two years before. Two hearing questionnaires were chosen for the survey. The LittlEARS questionnaire (MED-EL Medical Electronics GmbH) for investigating the hearing behavior of the children during the first two years of life and a second, custom-developed questionnaire (Würzburger questionnaire) investigating some aspects which are not included in the LittlEARS tool, such as speech/language development, general development as well as pathological factors that might eventually lead to a temporary hearing loss.

RESULTS

Analysis of the Würzburger questionnaires revealed normal speech development for 92.9% of the children. For 4.7% male and 2.4% female children delayed speech development was reported. Although twice as many males were found, the statistical comparison showed no significant difference according to gender. The results of the LittlEARS questionnaire are identical to those of the Würzburger questionnaire in 98.3% of the investigated cases and in 1.7% of the cases slightly different results but on borderline: The LittlEAR scores showed normal auditory development for the childrens' age but the Würzburger questionnaire results showed delayed speech development.

CONCLUSIONS

Based on the follow-up analysis and the results from the two questionnaires, no permanent hearing loss was found in any child two years after they passed the newborn hearing screening. Thus, we conclude that the sensitivity of the screening test was 100%, based on survey results 2 years post screening.

Integrating the management of Ruaha landscape of Tanzania with local needs and preferences

Sustainable management of landscapes with multiple competing demands such as the Ruaha Landscape is complex due to the diverse preferences and needs of stakeholder groups involved. This study uses conjoint analysis to assess the preferences of representatives from three stakeholder groups-local communities, district government officials, and non-governmental organizations-toward potential solutions of conservation and development tradeoffs facing local communities in the Ruaha Landscape of Tanzania. Results demonstrate that there is little consensus among stakeholders about the best development strategies for the Ruaha region. This analysis suggests a need for incorporating issues deemed important by these various groups into a development strategy that aims to promote conservation of the Ruaha Landscape and improve the livelihood of local communities.

Critical limb ischemia and its impact on patient health preferences and quality of life-an international study

Critical limb ischemia (CLI) has a significant impact on patients' quality of life (QoL). Despite cost utility evaluations being required by different authorities, data on patient health preferences and utilities for CLI are scarce. Hence, the objective of this study was to assess the impact of CLI on health preferences and health status of affected patients, and to generate health state utilities. In the International Study, 200 patients with CLI (stages III and IV according to Fontaine scale) were interviewed by trained interviewers with a discrete choice instrument, a standard gamble (SG), and the EuroQol-five dimension (EQ-5D) questionnaires (Marten Meesweg, Rotterdam, Netherland). Conjoint analysis showed that a planned amputation (33%) was the most relevant health attribute followed by ambulatory function (25%) and chronic pain (15%). Non-dependence on caregiver impacted on patient health state preference considerably, whereas healing of ulcer/skin lesions had less impact. Preference values obtained from the SG were 0.84, for an amputation subpopulation arriving at 0.70. The EQ-5D index values as well as the EQ-5D visual analog scale for patients with CLI were 0.56. The QoL data of patients with CLI result in decreased QoL and preference values with a planned amputation.

Consumer preferences for hearing aid attributes: a comparison of rating and conjoint analysis methods

Low utilization of hearing aids has drawn increased attention to the study of consumer preferences using both simple ratings (e.g., Likert scale) and conjoint analyses, but these two approaches often produce inconsistent results. The study aims to directly compare Likert scales and conjoint analysis in identifying important attributes associated with hearing aids among those with hearing loss. Seven attributes of hearing aids were identified through qualitative research: performance in quiet settings, comfort, feedback, frequency of battery replacement, purchase price, water and sweat resistance, and performance in noisy settings. The preferences of 75 outpatients with hearing loss were measured with both a 5-point Likert scale and with 8 paired-comparison conjoint tasks (the latter being analyzed using OLS [ordinary least squares] and logistic regression). Results were compared by examining implied willingness-to-pay and Pearson's Rho. A total of 56 respondents (75%) provided complete responses. Two thirds of respondents were male, most had sensorineural hearing loss, and most were older than 50; 44% of respondents had never used a hearing aid. Both methods identified improved performance in noisy settings as the most valued attribute. Respondents were twice as likely to buy a hearing aid with better functionality in noisy environments (p < .001), and willingness to pay for this attribute ranged from US$2674 on the Likert to US$9000 in the conjoint analysis. The authors find a high level of concordance between the methods-a result that is in stark contrast with previous research. The authors conclude that their result stems from constraining the levels on the Likert scale.

Perceptions of parents and speech and language therapists on the effects of paediatric cochlear implantation and habilitation and education following it

BACKGROUND

During the process of implantation, parents may have rather heterogeneous expectations and concerns about their child's development and the functioning of habilitation and education services. Their views on habilitation and education are important for building family-centred practices.

AIMS

We explored the perceptions of parents and speech and language therapists (SLTs) on the effects of implantation on the child and the family and on the quality of services provided. Their views were also compared.

METHODS & PROCEDURES

Parents and SLTs of 18 children filled out questionnaires containing open- and closed-ended questions at 6 months and annually 1-5 years after activation of the implant. Their responses were analysed mainly using data-based inductive content analysis.

OUTCOMES & RESULTS

Positive experiences outnumbered negative ones in the responses of both the parents and the SLTs surveyed. The parents were particularly satisfied with the improvement in communication and expanded social life in the family. These were the most prevalent themes also raised by the SLTs. The parents were also satisfied with the organization and content of habilitation. Most of the negative experiences were related to arrangement of hospital visits and the usability and maintenance of speech processor technology. Some children did not receive enough speech and language therapy, and some of the parents were dissatisfied with educational services. The habilitation process had generally required parental efforts at an expected level. However, parents with a child with at least one concomitant problem experienced habilitation as more stressful than did other parents.

CONCLUSIONS & IMPLICATIONS

Parents and SLTs had more positive than negative experiences with implantation. As the usability and maintenance of speech processor technology were often compromised, we urge implant centres to ensure sufficient personnel for technical maintenance. It is also important to promote services by providing enough information and parental support.

Parents’ Needs Following Identification of Childhood Hearing Loss

Purpose

Appropriate support for families of children diagnosed with hearing impairment may have a direct impact on the success of early hearing detection and intervention programs in reducing the negative effects of permanent hearing loss. We conducted a qualitative study to explore parents’ needs after learning of their child’s hearing loss to better understand the important components of service delivery from families’ perspectives.

Method

Semistructured interviews were conducted with 17 families (21 parents) of preschool children in 4 centers in Ontario, Canada. Parents of children identified by neonatal screening as well as those identified through traditional referral routes participated. We asked parents to share their perceptions of the strengths and gaps in the care system.

Results

Although the majority of parents were satisfied with the range and quality of audiology and therapy services available, they identified gaps in the areas of service coordination, availability of information, and the integration of social service and parent support into the system. Access to audiology services appears to have been facilitated for children who were systematically screened.

Conclusions

The findings provide insights into the services most valued by families. These findings highlight the importance of eliciting parents’ perspectives in designing optimal care models for children and families.