1
|
Smith C, Bhattacharya D, Hansjee D, Jeffries C, Richards K, Scott S. Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions. BMJ Open 2024; 14:e086184. [PMID: 39209492 PMCID: PMC11367299 DOI: 10.1136/bmjopen-2024-086184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is difficulty manipulating a food bolus from the mouth to the throat. Up to 70% of older adults develop OD; however, it is unmanaged in primary care, leading to avoidable hospitalisation. OBJECTIVE This behavioural science realist review aimed to develop programme theories to describe how interventions facilitate primary care healthcare professionals (HCPs) to proactively manage OD. METHODS We developed initial programme theories (IPTs) inductively using the expertise of stakeholders and deductively using the theoretical domains framework (TDF). Databases were searched to identify evidence regarding contexts, behavioural mechanisms and outcomes related to proactive management of OD and comparative behaviours which offer transferrable learning. IPTs were tested with the evidence to confirm, refine or refute, to produce final programme theories. RESULTS 36 sources of evidence were included. Five final programme theories were generated explaining how primary care HCPs can be facilitated to proactively manage OD: (1) OD education and training, (2) checklists with OD signs and symptoms, (3) incorporating OD identification into existing workflow, (4) making HCPs aware that older adults and carers expect them to manage OD and (5) raising awareness of the adverse outcomes of OD. CONCLUSION The five programme theories provide the behavioural mechanisms by which an intervention may facilitate primary care HCPs to proactively manage OD. Through the programme theories' linkage to the TDF, behaviour change techniques (BCTs) mapped to the relevant TDF domain can be selected for an intervention. Operationalisation of selected BCTs into a coherent intervention package should be undertaken using codesign methodology. PROSPERO REGISTRATION NUMBER CRD42022320327.
Collapse
Affiliation(s)
- Caroline Smith
- School of Healthcare, University of Leicester College of Life Sciences, Leicester, UK
| | - Debi Bhattacharya
- School of Healthcare, University of Leicester College of Life Sciences, Leicester, UK
| | | | - Charlotte Jeffries
- School of Healthcare, University of Leicester College of Life Sciences, Leicester, UK
| | - Keisha Richards
- School of Healthcare, University of Leicester College of Life Sciences, Leicester, UK
| | - Sion Scott
- School of Healthcare, University of Leicester College of Life Sciences, Leicester, UK
| |
Collapse
|
2
|
McKenna L, Vogt F. Stressful life events and tinnitus : Reflections and speculations. HNO 2024:10.1007/s00106-024-01501-3. [PMID: 39093322 DOI: 10.1007/s00106-024-01501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 08/04/2024]
Abstract
The role of life events has not been extensively studied in the context of tinnitus. There is, however, evidence about the psychological impact of tinnitus and about the influence of psychological processes as mediators of the tinnitus experience. On the basis of this evidence, the possibility that stressful life events can act as a trigger for tinnitus is discussed; although the evidence is fragmentary and indirect, the possibility cannot be discounted. It is argued that the onset of tinnitus and the associated clinical encounters can constitute an acute stressful life event, and the ongoing experience of tinnitus can be regarded as a chronic stressful life event. Interactions between ongoing tinnitus and other life events are discussed. Possible mechanisms in terms of stress influencing predictive processing and signal detection judgments are considered.
Collapse
Affiliation(s)
- Laurence McKenna
- Ear Institute, University College London, 332 Gray's Inn Road, London, UK.
| | - Florian Vogt
- Royal National ENT and Eastman Dental Hospitals, University College London, London, UK
| |
Collapse
|
3
|
Pryce H, Smith S, Burns O'Connell G, Hussain S, Straus J, Shaw R. The lived experience of hearing loss - an individualised responsibility. Int J Audiol 2024:1-9. [PMID: 38767328 DOI: 10.1080/14992027.2024.2351037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
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.
Collapse
Affiliation(s)
- Helen Pryce
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Sian Smith
- Institute of Health and Neurodevelopment and School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Georgie Burns O'Connell
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Saira Hussain
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Rachel Shaw
- Institute of Health and Neurodevelopment and School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| |
Collapse
|
4
|
Rose C, Law GU, Howard RA. The psychosocial experiences of adults diagnosed with coeliac disease: a qualitative evidence synthesis. Qual Life Res 2024; 33:1-16. [PMID: 37516676 PMCID: PMC10784387 DOI: 10.1007/s11136-023-03483-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Coeliac disease is a chronic autoimmune condition associated with intestinal and extraintestinal symptoms. Coeliac Disease is managed through strict adherence to a gluten-free diet, which, though usually effective, is challenging to maintain. This review synthesised qualitative research on the psychosocial experiences of adults living with coeliac disease. METHODS Keyword searches were conducted of the academic databases CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS and Web of Science for articles published (2005-2021), followed by forward and backward searches. Thematic synthesis of included articles was carried out on sections reporting findings or results, discussion, conclusions, and supporting data. The inductive thematic synthesis identified descriptive and analytical themes from the included studies. RESULTS Of 1284 records identified, 17 articles from 15 original studies were included in the thematic synthesis. The majority of studies were from Europe (76%), with the remainder from North America and Australia. Data represented 371 adults with coeliac disease (72% female; 17-85 years old, diagnosed < 1-42 years ago) across eight countries. Findings identified six analytical themes relating to the psychosocial experience of coeliac disease: 'Living with ongoing risk'; 'Losing more than gluten'; 'A changed identity'; 'A changed relationship with food'; 'The gluten-free diet creates a multifaceted burden'; and 'Learning how to live well with Coeliac Disease'. CONCLUSIONS Coeliac disease changes adults' psychosocial experiences. Adaptation involves ongoing learning, and development of psychological acceptance facilitates adjustment. Increased public education about coeliac disease may reduce stigma and risk. Psychosocial assessment and support could improve quality of life post-diagnosis.
Collapse
Affiliation(s)
- Catharine Rose
- School of Psychology, University of Birmingham, Birmingham, UK.
| | - Gary U Law
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Ruth A Howard
- School of Psychology, University of Birmingham, Birmingham, UK
| |
Collapse
|
5
|
Marks E, Hallsworth C, Vogt F, Klein H, McKenna L. Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: a randomised controlled trial. Cogn Behav Ther 2023; 52:91-109. [PMID: 35762946 DOI: 10.1080/16506073.2022.2084155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Insomnia is a significant difficulty and is reported by large proportion of people with tinnitus. Although cognitive behavioural therapy for insomnia (CBTi) might be an effective treatment, no controlled studies had been conducted to date. This randomised controlled trial evaluated the benefits of CBTi on a sample of 102 people with tinnitus-related insomnia. Participants were randomised to 1) CBTi, 2) Audiology-Based Care (ABC) or 3) Sleep Support Group (SSG). Primary outcomes included insomnia, sleep efficiency and total sleep time. Secondary outcomes measured sleep onset latency, sleep quality, tinnitus distress, psychological distress, functioning and quality of life. CBTi was superior at reducing insomnia and increasing sleep efficiency compared to ABC post-intervention and at 6-month follow-up. ABC was superior at reducing insomnia and increasing sleep efficiency compared to SSG. Both CBTi and ABC reported increased total sleep time compared to SSG at 6-month follow. More than 80% of participants in the CBTi group reported clinically meaningful improvements compared to 47% in ABC and 20% for those receiving social support. CBTi was more effective in reducing tinnitus distress and improving sleep quality, functioning and some aspects of mental health. CBTi and ABC offer effective treatments for tinnitus-related sleep disorder but CBTi offers a sizeable benefit.
Collapse
Affiliation(s)
| | | | - Florian Vogt
- Department of Psychology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Laurence McKenna
- Department of Psychology, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Pryce H, Dauman N, Burns-O’Connell G. What is the burden of tinnitus? Front Psychol 2023; 13:981776. [PMID: 36710784 PMCID: PMC9879209 DOI: 10.3389/fpsyg.2022.981776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Tinnitus is a complex experience that often occurs alongside other health conditions, including hearing loss. In the UK, as in other western countries, patterns of health are changing with a rise in multi-morbidity and complexity of health conditions. As we age, we can expect to live with multiple health conditions. Burden of illness has long been recognised. Less well recognised is the burden that accumulates from the treatment of health conditions. Methods This qualitative thematic analysis of patient accounts described the cumulative burdens of tinnitus, both the experience of hearing the tinnitus and from the treatments undertaken. Between 2017-8 we conducted interviews with 38 participants who were help-seekers in a range of contrasting UK clinical services (Physician led, Audiology led and Hearing Therapy led). We examined these interview data using reflexive thematic analysis methods to identify and explore the cumulative burdens for those who live with and seek help for their tinnitus. Specifically, we used six phased approach to determine and group themes. Results The themes provide a coherent description of the nature of the burden that people with tinnitus experience. Discussion In tinnitus, as with most chronic health conditions, the largest treatment workload is devolved to the patient. Patients are required to implement treatments, learn about tinnitus and find new ways of coping. Yet this work happens invisibly, without recognition from clinicians who measure outcomes but not the efforts made to achieve outcomes. Patient-centred care depends upon the recognition of the cumulative burdens that patients experience.
Collapse
Affiliation(s)
- Helen Pryce
- Department of Audiology, Aston University, Birmingham, United Kingdom
| | - Nicolas Dauman
- Université de Poitiers, Univ Rennes, Univ Angers, Univ Brest, RPPSY, Poitiers, France
| | | |
Collapse
|
7
|
Dauman N. Towards a psychological framework on time perception in patients with chronic tinnitus. Front Aging Neurosci 2023; 15:1141903. [PMID: 37139090 PMCID: PMC10149727 DOI: 10.3389/fnagi.2023.1141903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Although disabling tinnitus is a chronic auditory phantom sensation, current knowledge on time perception (i.e., subjective time) in sufferers is limited and unsystematic. This theoretical analysis provides a first approach to this topic, highlighting the heterogeneity of time perception in humans as shown in various research areas. This heterogeneity is inherently related to goal attainment. Our immediate perception of time is restricted to present moment and recent past, whereas our sense of time is mostly future-oriented and represented as our past in a mental time line. The heterogeneity of time translates into a tension between anticipated changes one wants to see happen and full commitment that is required to goal attainment. Tinnitus sufferers are intensely aware of this tension in their self-perception. Their most compelling desire is that they no longer perceive tinnitus, but they get closer to this goal only by avoiding to put all their thoughts into it. Our analysis provides new perspectives on acceptance of tinnitus in relation to this time paradox. Building on the Tolerance model and the role of self-awareness in time perception, we contend that the main way for patients to gain long-term self-confidence is to engage in the present moment. Attention to this attitude is obscured in chronic sufferers by worries and ruminations associated with the ongoing presence of tinnitus. We provide arguments that time perception is a social perception, emphasizing the role of rewarding interactions in helping sufferers to overcome the feeling of being prevented from living in the moment. In the course of improvement towards acceptance, different changes in time perception are hypothesized that promote individuals' disengagement from unattainable goal (i.e., tinnitus suppression). A framework for future research is proposed, which distinguishes individuals' behaviors and associated emotions in relation to the time paradox.
Collapse
Affiliation(s)
- Nicolas Dauman
- Université de Poitiers, Univ Rennes, Univ Angers, Univ Brest, RPPSY, Poitiers, France
- Maison des Sciences de l’Homme et de la Société, Université de Poitiers – CNRS, Poitiers, France
- *Correspondence: Nicolas Dauman,
| |
Collapse
|
8
|
Riha C, Güntensperger D, Kleinjung T, Meyer M. Recovering Hidden Responder Groups in Individuals Receiving Neurofeedback for Tinnitus. Front Neurosci 2022; 16:867704. [PMID: 35812211 PMCID: PMC9261875 DOI: 10.3389/fnins.2022.867704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
The widespread understanding that chronic tinnitus is a heterogeneous phenomenon with various neural oscillatory profiles has spurred investigations into individualized approaches in its treatment. Neurofeedback, as a non-invasive tool for altering neural activity, has become increasingly popular in the personalized treatment of a wide range of neuropsychological disorders. Despite the success of neurofeedback on the group level, the variability in the treatment efficacy on the individual level is high, and evidence from recent studies shows that only a small number of people can effectively modulate the desired aspects of neural activity. To reveal who may be more suitable, and hence benefit most from neurofeedback treatment, we classified individuals into unobserved subgroups with similar oscillatory trajectories during the treatment and investigated how subgroup membership was predicted by a series of characteristics. Growth mixture modeling was used to identify distinct latent subgroups with similar oscillatory trajectories among 50 individuals suffering from chronic subjective tinnitus (38 male, 12 female, mean age = 47.1 ± 12.84) across 15 neurofeedback training sessions. Further, the impact of characteristics and how they predicted the affiliation in the identified subgroups was evaluated by including measures of demographics, tinnitus-specific (Tinnitus Handicap Inventory) and depression variables, as well as subjective quality of life subscales (World Health Organization—Quality of Life Questionnaire), and health-related quality of life subscales (Short Form-36) in a logistic regression analysis. A latent class model could be fitted to the longitudinal data with a high probability of correctly classifying distinct oscillatory patterns into 3 different groups: non-responder (80%), responder (16%), and decliner (4%). Further, our results show that the health-related wellbeing subscale of the Short Form-36 questionnaire was differentially associated with the groups. However, due to the small sample size in the Responder group, we are not able to provide sufficient evidence for a distinct responder profile. Nevertheless, the identification of oscillatory change-rate differences across distinct groups of individuals provides the groundwork from which to tease apart the complex and heterogeneous oscillatory processes underlying tinnitus and the attempts to modify these through neurofeedback. While more research is needed, our results and the analytical approach presented may bring clarity to contradictory past findings in the field of tinnitus research, and eventually influence clinical practice.
Collapse
Affiliation(s)
- Constanze Riha
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Priority Program “ESIT—European School of Interdisciplinary Tinnitus Research,” Zurich, Switzerland
- *Correspondence: Constanze Riha, , orcid.org/0000-0002-6006-7018
| | | | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland
- Neuroscience Center Zurich (ZNZ), ETH Zürich, Zurich, Switzerland
| | - Martin Meyer
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich (ZNZ), ETH Zürich, Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Beukes EW, Manchaiah V, Andersson G, Maidment DW. Application of the Behavior Change Wheel Within the Context of Internet-Based Cognitive Behavioral Therapy for Tinnitus Management. Am J Audiol 2022; 31:433-444. [PMID: 35436419 DOI: 10.1044/2022_aja-21-00160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although experiencing tinnitus can lead to many difficulties, these can be reduced by using techniques derived from cognitive behavioral therapy. Internet-based cognitive behavioral therapy (ICBT) has been developed to provide an accessible intervention. The aim of this study was to describe how ICBT can facilitate tinnitus management by identifying the active ingredients of the intervention from the perspective of health behavior change. METHOD The ICBT intervention was evaluated using the Behavior Change Wheel in eight steps across the following three stages: (1) understanding the behavior, (2) identifying intervention options, and (3) identifying content and implementation options. RESULTS Target behaviors identified to reduce tinnitus distress, as well as additional problems associated with tinnitus, included goal setting, an increased understanding of tinnitus, encouraging deep breathing and progressive muscle relaxation, identifying and restructuring unhelpful thoughts, engaging in positive imagery, and reducing avoidance behaviors. ICBT provided the required components for individuals to be physically and psychologically capable of adapting to tinnitus, providing social and environmental opportunities to manage hearing loss through practice and training, and facilitated automatic and reflective motivation. CONCLUSION Understanding ICBT in the context of the Behavior Change Wheel has helped identify how its effectiveness can be improved and can be used for future tinnitus intervention planning. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19555213.
Collapse
Affiliation(s)
- Eldré W. Beukes
- Vision and Hearing Sciences Research Group, School of Psychology and Sports Sciences, Anglia Ruskin University, Cambridge, United Kingdom
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora
| | - Vinaya Manchaiah
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, India
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - David W. Maidment
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| |
Collapse
|
10
|
Marks E, Handscomb L, Remskar M. "I can see a path forward now": a qualitative investigation of online groups for tinnitus in the time of Covid-19. Int J Audiol 2022:1-8. [PMID: 35499467 DOI: 10.1080/14992027.2022.2063195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The Covid-19 pandemic led the British Tinnitus Association to offer more online support to people with tinnitus. The aim of this study was to understand how low-intensity group-based digital interventions could benefit people with tinnitus. DESIGN Semi-structured interviews explored participants' experiences and views on receiving support via an online group. STUDY SAMPLE Sixteen people with tinnitus who had attended a recent online tinnitus group and/or workshop were recruited using convenience sampling. RESULTS Three overarching themes were extrapolated from the data: feeling part of a community, being reliably informed, and living better with tinnitus. CONCLUSIONS Participants reported significant benefits from both types of online group. There was appreciation for the accessibility of help during lockdown, and participants felt that this type of support would continue to be valuable post-pandemic. As seen in research on face-to-face groups, benefits came from a supportive community of people with tinnitus and knowledgeable, skilled and trustworthy facilitation and information provision. Outcomes focussed on feeling less isolated, more informed and hopeful. Online groups could offer an accessible ongoing resource supporting people on their journey with tinnitus.
Collapse
Affiliation(s)
| | - Lucy Handscomb
- Faculty of Brain Sciences, UCL Ear Institute, London, UK
| | - Masha Remskar
- Department of Psychology, University of Bath, Bath, UK
| |
Collapse
|
11
|
Surrounded by Sound: The Impact of Tinnitus on Musicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179036. [PMID: 34501628 PMCID: PMC8431046 DOI: 10.3390/ijerph18179036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022]
Abstract
AIM To investigate the impact of tinnitus on professional musicians in the UK. BACKGROUND Tinnitus is the experience of sound when an external source is absent, primarily associated with the ageing process, hearing loss, and noise exposure. Amongst populations exposed to industrial noise, noise exposure and noise-induced hearing loss (NIHL) have been found to be the factors most associated with tinnitus. The risk of NIHL amongst professional musicians is greater than that amongst the general population, meaning they may be at increased risk of tinnitus. METHODS Seventy-four professional musicians completed an online survey involving closed and open-ended questions, and completed the Tinnitus fuctional Index (TFI) questionnaire. Descriptive statistics and thematic analysis of open-ended qualitative responses were used to analyse the data. RESULTS Three themes were generated from the analysis of the responses to the open-ended questions. These themes were: (1) the impact of tinnitus on the lives of professional musicians, (2) professional musician experience of tinnitus services, support, and hearing health and safety, and (3) the support professional musicians want. The mean global TFI score for professional musicians was 39.05, interpreted as tinnitus being a moderate problem. Comparisons with general population data revealed lower TFI scores for the TFI subscales of 'sense of control' and 'intrusiveness' for professional musicians and higher for auditory difficulties associated with tinnitus amongst professional musicians. CONCLUSION Tinnitus can negatively impact on professional musicians' lives. There is a need for bespoke self-help groups, awareness raising, and education to prevent tinnitus and promote hearing health among musicians.
Collapse
|
12
|
Beukes EW, Lourenco MPCG, Biot L, Andersson G, Kaldo V, Manchaiah V, Jacquemin L. Suggestions for shaping tinnitus service provision in Western Europe: Lessons from the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14196. [PMID: 33837639 PMCID: PMC8250123 DOI: 10.1111/ijcp.14196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tinnitus severity has been exacerbated because of the COVID-19 pandemic and those with tinnitus require additional support. Such support should be informed by patient preferences and needs. The objective of this study was to gather information from individuals with tinnitus living in Europe to inform stakeholders of the (a) support they needed in relation to changes associated with the COVID-19 pandemic and (b) suggestions regarding tinnitus care for the future. METHODS A cross-sectional mixed method study design was used using closed and open-ended questions via an online survey. Data were gathered from 710 adults experiencing tinnitus in Western Europe, with the majority living in The Netherlands, Belgium and Sweden. Data were analysed using qualitative content analysis and descriptive statistics. RESULTS Those with tinnitus indicated the following support needs during the pandemic (a) support for tinnitus, (b) support for hearing-related difficulties, (c) social support and (d) pandemic-related support. Five directions for future tinnitus care were provided, namely, (a) need for understanding professional support and access to multidisciplinary experts, (b) greater range of therapies and resources, (c) access to more information about tinnitus, (d) prioritising tinnitus research and (e) more support for hearing protection and hearing loss prevention. CONCLUSIONS The findings point to the need for accessible (remote), patient-centred, suitable and evidence-based tinnitus care. Insights from the current study can be used by various stakeholders including clinical practitioners and tinnitus support services to ensure those with tinnitus have access to the help and support required in order to reduce service provision insufficiencies.
Collapse
Affiliation(s)
- Eldré W. Beukes
- Department of Speech and Hearing SciencesLamar UniversityBeaumontTXUSA
- Department of Vision and Hearing SciencesAnglia Ruskin UniversityCambridgeUK
| | - Matheus P. C. G. Lourenco
- Experimental Health PsychologyMaastricht UniversityMaastrichtThe Netherlands
- Research Group Health PsychologyKU Leuven UniversityLeuvenBelgium
| | - Lana Biot
- Faculty of BiomedicalPharmaceuticals and Veterinary SciencesUniversity of AntwerpAntwerpBelgium
| | - Gerhard Andersson
- Department of Behavioral Sciences and LearningDepartment of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Viktor Kaldo
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of PsychologyFaculty of Health and Life SciencesLinnaeus UniversityVäxjöSweden
| | - Vinaya Manchaiah
- Department of Speech and Hearing SciencesLamar UniversityBeaumontTXUSA
- Department of Speech and HearingSchool of Allied Health SciencesManipal UniversityManipalKarnatakaIndia
| | - Laure Jacquemin
- Department of Translational NeurosciencesFaculty of Medicine and Health SciencesUniversity of AntwerpWilrijkBelgium
- Department of Otorhinolaryngology and Head and Neck SurgeryAntwerp University HospitalEdegemBelgium
| |
Collapse
|
13
|
Overestimation of body weight and its association with parental, teacher and peer support: evidence from the Israeli Health Behaviours in Schools survey. Public Health Nutr 2021; 24:4035-4042. [PMID: 34238401 DOI: 10.1017/s1368980021002676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the association between family, teachers and peer support patterns on gaps in adolescent's weight perceptions. DESIGN A cross-sectional, school-based survey collected information on weight and height, weight perception, socio-economic and family characteristics and social support. Principal component analysis (PCA) was performed to capture social support patterns (SSP). Multivariable logistic regression was used to model adolescent weight perception, including SSP adjusted for demographic variables. SETTING The 2014 Israeli Health Behaviours in School-Aged Children (HBSC) survey. PARTICIPANTS Adolescents aged 11-18 years (n 7563). RESULTS In total, 16·1 % of the boys and 10·7 % of the girls were overweight or obese. Most participants perceived their size accurately. Body size was underestimated by 25·6 % of the boys and 15·1 % of the girls, while 15·2 % of the boys and 27·7 % of the girls overestimated their body size. PCA generated three SSP accounting for 81·9 % of the variance in social support. Female sex and higher SES increased odds of overestimating body size. Students in the top quartile (Q4 v. Q1-Q3) of family support and teacher support were less likely to overestimate their body size. Good parental communication reduced the odds of body size overestimation in middle school students. Male sex and higher family support increased odds of underestimation. CONCLUSIONS Significant support from parents and teachers was associated with accurate weight perceptions; thus, support skills may be amenable to intervention. Efforts should be made to educate adolescents on healthy weight.
Collapse
|
14
|
Beukes EW, Onozuka J, Brazell TP, Manchaiah V. Coping With Tinnitus During the COVID-19 Pandemic. Am J Audiol 2021; 30:385-393. [PMID: 33979227 DOI: 10.1044/2021_aja-20-00188] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose The COVID-19 pandemic disrupted normal operations of health care services, broad sectors of the economy, and the ability to socialize freely. For those with tinnitus, such changes can be factors in exacerbating tinnitus. The purpose of this study was to determine tinnitus help-seeking behavior, which resources individuals utilized to cope during the pandemic, and what additional support is desired. Method An exploratory cross-sectional study design including 1,522 adults with tinnitus living in North America (Canada and the United States) was used. Data were collected through an online survey distributed by the American Tinnitus Association via e-mail. Free text from open-ended questions was analyzed using the automated content analysis. The responses to the structured questionnaire were analyzed using descriptive and nonparametric statistics. Results Significantly less tinnitus support was sought during the pandemic, and very few respondents utilized tinnitus support networks during the pandemic at the time the survey was conducted. Nonetheless, seeking support during the pandemic was significantly associated with significantly less tinnitus distress. The most frequently utilized resources for coping during the pandemic were contacting family and friends, spending time outdoors or in nature, relaxation, and exercise. Such tools for coping were associated with significantly less tinnitus distress. The support requested and advice provided by participants to health care services had overlap. The main support needs related to managing tinnitus included addressing hearing loss, providing peer support, finding cures, and accessing trained and understanding health care providers to help. The advice for professionals related to tinnitus management included the need for cures, personalized support, addressing hearing loss, targeting the tinnitus percept, and providing more information about the condition. Conclusions These findings provide suggestions on how to better support those with tinnitus at a time when health care is undergoing rapid changes. Findings can be used by stakeholders, clinical practitioners, and tinnitus support services to devise ways to work more effectively together to improve access to patient-driven, suitable, accessible, and evidence-based support. Supplemental Material https://doi.org/10.23641/asha.14558514.
Collapse
Affiliation(s)
- Eldré W. Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Joy Onozuka
- American Tinnitus Association, Washington, DC
| | | | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India
| |
Collapse
|
15
|
Van Overmeire R, Van Keer RL, Bilsen J. Impact of terrorist attacks on social relationships. Clin Psychol Psychother 2021; 28:1472-1481. [PMID: 33768615 DOI: 10.1002/cpp.2587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND People that experience a trauma might also experience problems in their social relationships. However, how witnessing a terrorist attack influences social relationships is still understudied. This is important, as currently, there is more focus on the individual's mental health and not on how this mental health can impact the individual's social relations. In this study, the impact of the experience of a terrorist attack on social relationships was studied. METHODS In-depth interviews were conducted, with 31 directly exposed people during the 22 March 2016 attacks in Belgium. Data were analysed using reflexive thematic analysis. RESULTS Three factors related to the impact on social relationships were found. First, participants felt that they had changed. This includes feeling more aggressive, guilty, distrusting or psychosomatic factors, such as migraine attacks, which can hamper social visits. Second, the reactions of others on the participant's expressing their feelings and behaviour also caused participants to not feel understood by their social relationships. Third, due the first two factors, participants coped in different ways (e.g. remaining silent and avoiding certain triggers), which in turn caused their social relationships to change. CONCLUSIONS The social relationships of witnesses of terrorist attacks can be hampered due to both themselves as well as the reaction of others. More awareness seems to be needed on the possible mental health consequences of terrorist attacks for witnesses.
Collapse
Affiliation(s)
- Roel Van Overmeire
- Mental Health and Wellbeing Research Group (MENT), Vrije Universiteit Brussel, Brussels, Belgium
| | - Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
16
|
Greenwell K, Sereda M, Coulson NS, Geraghty AWA, Bradbury K, Hoare DJ. ‘That’s just how I am’: a qualitative interview study to identify factors influencing engagement with a digital intervention for tinnitus self‐management. Br J Health Psychol 2020; 26:727-747. [DOI: 10.1111/bjhp.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology School of Psychology University of Southampton UK
- Division of Clinical Neuroscience National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Hearing Sciences Group School of Medicine University of Nottingham UK
| | - Magdalena Sereda
- Division of Clinical Neuroscience National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Hearing Sciences Group School of Medicine University of Nottingham UK
| | - Neil S. Coulson
- Division of Rehabilitation, Ageing and Wellbeing School of Medicine University of Nottingham UK
| | - Adam W. A. Geraghty
- School of Primary Care, Population Sciences and Medical Education University of Southampton UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology School of Psychology University of Southampton UK
| | - Derek J. Hoare
- Division of Clinical Neuroscience National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Hearing Sciences Group School of Medicine University of Nottingham UK
| |
Collapse
|
17
|
Abstract
OBJECTIVE This qualitative study sought to construct a model of empowerment for clinical implementation, based on the first-hand experience of a sample of individuals with chronic tinnitus. DESIGN The study was conducted in accordance with the inductive approach to data in classic grounded theory (GT). GT aims to build a model of behavior that accounts for the main concern of individuals and how they strive to resolve it. Twenty-one participants with chronic tinnitus (10 females, 11 males, age 31-85, mean: 57.6 years, mean duration of tinnitus: 12 years) were recruited through the patient association France Acouphènes and ENT consultations. Open-ended, tape-recorded interviews addressed the variation in the intrusiveness of tinnitus in daily life. A constant comparison analysis was undertaken to identify a core category and to distinguish stages in behavioral changes toward the tolerance of tinnitus. RESULTS Participants' main concern was to limit the intrusiveness of tinnitus day in, day out. They continuously had to handle tinnitus-induced frustration, which was found to be the core category of the analysis accounting for how all the participants tried to deal with the condition. The more they managed to handle their frustration, the better they coped with the condition. Three behavior patterns were identified as facilitating the ongoing management of tinnitus-induced frustration: (1) searching for perspective upon tinnitus; (2) maintaining order in perception despite its interference; and (3) alleviating conflict arising from social interactions. A model of empowerment is presented that is based on four stages toward tolerance of tinnitus. They are dominated by lack of perspective upon tinnitus (circuit 1), preservation of energy through attempts to control its intrusiveness (circuit 2), attempts to detach oneself from the interference of tinnitus through constant activities (circuit 3), and self-induced relief through the fulfillment of meaningful goals (circuit 4). CONCLUSION Tolerance of tinnitus requires finding balance between limiting one's social participation and spontaneity in carrying out meaningful activities. Tolerance can be enhanced by the preservation of one's energy and the mediating role of enjoyment through the fulfillment of gratifying goals. In patient counseling, it is essential to address the individual's desire for direct relief from tinnitus through its elimination. Individuals should be made aware that such a desire will likely be thwarted, resulting in the worsening of intrusiveness. Improvement in tolerance is accompanied by the attenuation of niggling self-awareness, a change that is typical of full commitment with valued goals and that helps in alleviating the interference of tinnitus. By understanding the role of frustration, individuals may develop a sense of responsibility in dealing with disabling tinnitus.
Collapse
|
18
|
Erlandsson SIM, Lundin L, Dauman N. The Experience of Tinnitus and Its Interaction With Unique Life Histories-Life Events, Trauma and Inner Resources Narrated by Patients With Tinnitus. Front Psychiatry 2020; 11:136. [PMID: 32256394 PMCID: PMC7093576 DOI: 10.3389/fpsyt.2020.00136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The challenges facing people with chronic tinnitus include finding relief and rebuilding quality of life. However, previous traumatic episodes may influence adjustment and prolong suffering. Recovery implies reducing aggravating reactions and improving social roles, relationships and interests. Self-narratives about living with tinnitus have not yet received the attention they deserve in the research literature. Thus, the main goal of the present study was to illustrate how tinnitus suffering interacts with the participants' unique life histories. Method: Four women and one man (ages 52-58) took part in the study after consulting a special hearing clinic for annoying tinnitus. Criteria for inclusion were that tinnitus was regarded as a problem with negative consequences for quality of life. The participants should be willing to share how the experience of tinnitus suffering interacts with their previous life story. Narrative methodology was employed in order to achieve the goals of the study. We used unstructured interviews with free conversation, which allowed for rich narratives with full contextual meaning. Results: The findings, based on the narrative analysis, revealed that three out of five participants presented a regressive form of narrative indicating ongoing struggles beyond tinnitus itself, which they were unable to bring to closure. For them, valued goals were continuously thwarted by frustrating circumstances in their lives, either past events or current unresolved issues. Progressive and stable narratives, as identified in the other two participants, demonstrated values that rely on others' attitude and understanding toward their suffering, in sharp contrast to the regressive narratives. We suggest that a central issue in tinnitus rehabilitation should be to help suffering patients to overcome unresolved conflicts and thereby extend their ability for a fuller commitment in life. Conclusion: Considering enduring tinnitus as a chronic condition, whose course is likely to vary depending on the patient's general health status, an alteration of progressive and stable narratives is likely to occur during the lifespan. A progressive narrative shows similarities to the core construct of the salutogenesis model of health promotion (1). In conclusion, a narrative approach in tinnitus rehabilitation can be health promoting by offering the patient the opportunity to engage in storytelling, which in turn can increase comprehensibility and a sense of coherence.
Collapse
Affiliation(s)
| | - Linda Lundin
- Department of Social and Behavioral Science, University West, Trollhättan, Sweden
| | - Nicolas Dauman
- Department of Psychology, CAPS-EA4050, University of Poitiers, Poitiers, France
| |
Collapse
|