Factors in client-clinician interaction that influence hearing aid adoption

Discussing Patient Emotions in Audiology: Provider Experiences With the Implementation Process of Hearing Loss Psychological Inflexibility Screenings

PURPOSE

This study aimed to investigate barriers and facilitators experienced by clinical educators and graduate students when talking with patients about difficult emotions and thoughts related to their hearing.

METHOD

A longitudinal observational design was used and an Implementation Research Logic Model guided the process. Five clinical educators and five graduate students participated in the study. Participants completed pre- and postmeasures and attended individual debriefing sessions during the 8-month study period.

RESULTS

Four themes emerged from the debriefing sessions: (a) learning process, (b) confidence, (c) barriers, and (d) supervision. Participants described that the Acceptance and Action Questionnaire-Managing Child Hearing Loss and Acceptance and Action Questionnaire-Adult Hearing Loss served as a reminder to ask about patients' internal barriers and increased awareness of their discomfort in talking about patient emotions. Participants also described barriers and struggles related to supporting students in gaining counseling skills.

CONCLUSIONS

Screening for internal challenges helped clinicians remember to talk with patients about their difficult thoughts and emotions. Clinician hesitancy to engage in conversations with patients about their emotions can interfere with opportunities for patients to share their struggles and with training student in these skills.

Adults' recollections of discussions with their audiologist: a qualitative study of what was and was not successfully communicated about listening difficulties

OBJECTIVES

Some adults experience challenges in successfully communicating their listening difficulties to their audiologist, and report feeling that they are not always listened to or understood. This project examined adults' recollections of discussions with their audiologist to explore (1) how adults report describing their listening difficulties and (2) information that adults report they do not communicate, or do not communicate successfully, to their audiologist.

DESIGN

Individual semi-structured interviews were conducted. Interview transcripts were analysed using a template analysis approach.

STUDY SAMPLE

Fifteen adults who self-report listening difficulties, and who had previously consulted an audiologist.

RESULTS

Four themes were identified from adults' recollections of how they describe their listening difficulties: (1) situation or context of listening difficulties, (2) behavioural responses, (3) impacts of listening difficulties and (4) contributing factors. Adults report not always successfully communicating (1) emotional concerns and impacts, (2) descriptions of sound quality and (3) descriptions of changed listening experiences.

CONCLUSION

Results provide insights about the times when adults feel that communication with their audiologist is successful, or unsuccessful. The results are useful for informing interventions to help adults and audiologists communicate more effectively together. To further inform interventions, factors affecting adults' communication should be explored.

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.

Consumer and audiologist perspectives on hearables: a qualitative study

OBJECTIVE

We aimed to explore (i) what adults with hearing difficulties want and need from hearables, which we defined as any non-medical personal sound amplification product, and (ii) what hearing care professionals think about hearables.

DESIGN

This was an exploratory, qualitative study conducted using separate focus groups with adults with hearing difficulties and audiologists. Data were analysed inductively using reflexive thematic analysis.

STUDY SAMPLE

Participants were 12 adults with hearing difficulties and 6 audiologists.

RESULTS

Adults with hearing difficulties expressed desire for trustworthy information and support, described evaluating hearables and other devices according to diverse personal criteria, and expressed willingness to vary their budget according to product quality. Audiologists expressed views that hearables are an inferior product but useful tool, that it is not necessarily their role to assist with hearables, that hearables are a source of uncertainty, and that the provision of hearables by audiologists is not currently practical.

CONCLUSION

Adults with hearing difficulties may have complex reasons for considering hearables and may desire a high level of clinical support in this area. Ongoing research into the efficacy and effectiveness of hearables is needed together with research into effective strategies to incorporate hearables into clinical practice.

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 scoping review exploring how adults self-describe and communicate about the listening difficulties they experience

Objective: It is unknown how adults communicate about their experienced listening difficulties with their audiologist. This scoping review aims to explore how adults self-describe the listening difficulties that they experience, and how they communicate about them. Design: A scoping review was conducted between December 2020 and September 2022 to identify published journal articles in which adults described and communicated about their listening difficulties. Study sample: Database searches yielded 10,224 articles initially. After abstract screening and full text review, 55 articles were included for analysis. Results: The listening difficulties that adults described were varied, highlighting the fact that each person has individual experiences. Adults discussed reasons for their listening difficulties, impacts of their listening difficulties, and behavioural responses they adopted to cope with their listening difficulties. Conclusions: This review shows the broad impacts of listening difficulties, and the varied ways in which adults discuss their listening difficulties. There is no available literature reporting how adults communicate about their listening difficulties in a clinical context.

Implementation science challenges: hearing care professionals identify barriers to clinical research

OBJECTIVES

Conducting research in clinical settings is challenging. The aim of this study was to increase our understanding of hearing care professionals' perceptions of barriers to participating in such research.

DESIGN

A modified group concept mapping approach was used to gain anonymous responses from 124 hearing care professionals to the statement: "One reason why it is hard to conduct intervention research studies in my centre/practice is….". Participants were asked for reasons other than 'time' as this is universally reported as a barrier to clinical research.

RESULTS

A total of 107 distinct reasons were provided by participants and these were sorted into 5 clusters: "Competing demands/pressures" (18 statements), "Not a priority for management/organisation" (14 statements), "Lack of opportunity/support" (19 statements), "Clinician's knowledge, confidence, and beliefs" (24 statements), and "Recruitment/adherence to protocols is challenging" (32 statements). Identified barriers were generally similar to those reported in other healthcare settings, with unique barriers being those associated with a fear of scrutiny and lack of trust in the "academic elite".

CONCLUSION

Findings highlight the importance of researchers, clinicians, and clinic managers working together at all stages of the research process in order for clinical research to be successful.

Reasons for hearing aid uptake in the United States: a qualitative analysis of open-text responses from a large-scale survey of user-perspectives

OBJECTIVE

This study aimed to explore the main reasons for hearing aid uptake from a user perspective and recommendations to others with hearing difficulties.

DESIGN

A cross-sectional survey design was used. Responses to a single open-ended question were analysed using qualitative content analysis.

STUDY SAMPLE

Participants (n = 642) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States.

RESULTS

Participants had a mean age of 65.4 years (13.7 SD) and included 61.8% males, 37.7% females, 0.3% non-binary, and 0.2% preferred not to say. Reasons for hearing aid uptake were categorised into three domains (personal impact, social difficulties, and auditory difficulties), containing 11 main categories and 48 sub-categories. User recommendations to others with hearing difficulties constituted eight main categories (timely help, trial period, support, affordability, technology, direct-to-consumer hearing aids, adjustments, and advocacy) and 32 sub-categories.

CONCLUSIONS

The decision to take up hearing aids included intrinsic factors like readiness to change and extrinsic factors such as the availability of finances. The most frequent recommendation to others was not to delay seeking hearing help and to get hearing aids. Our findings may support strategies to facilitate behaviour change for improved hearing aid uptake.

Development and initial evaluation of the Hearing Aid Attribute and Feature Importance Evaluation (HAFIE) questionnaire

OBJECTIVES

To develop and validate a novel questionnaire aimed at providing a structured, evidence-based methodology for hearing aid recommendation and selection using self-reported importance ratings for different modern hearing aid features.

DESIGN

The initial questionnaire items were created through a concept mapping approach that involved input from hearing aid users. Hearing care professional focus groups (n = 10) were conducted to assess questionnaire content and design, and to guide modifications. Validation of this initial 34-item version of the questionnaire was conducted using an anonymous online survey tool (Qualtrics). Exploratory factor analysis was used to assess the factor structure of the dataset, using principal axis factoring. Questionnaire reliability and inter-item correlation were assessed. Items with low factor loading and high cross-loading were removed.

STUDY SAMPLE

Two hundred and eighteen adult participants with a self-reported hearing loss (median age = 48 years, range = 18-95 years) completed the questionnaire.

RESULTS

Analysis and item removal resulted in a 28-item questionnaire. Three factors were identified, dividing the hearing aid features into the subscales: "Advanced connectivity & streaming", "Physical attributes & usability", and "Sound quality & intelligibility".

CONCLUSION

This study has resulted in a patient-oriented questionnaire that allows clinicians to gather patient input in a structured manner.

Conversation success in one-to-one and group conversation: a group concept mapping study of adults with normal and impaired hearing

OBJECTIVE

The concept of conversation success is undefined, although prior work has variously related it to accurate exchange of information, alignment between interlocutors, and good management of misunderstandings. This study aimed (1) to identify factors of conversation success and (2) to explore the importance of these factors in one-to-one versus group conversations.

DESIGN

Group concept mapping method was applied. Participants responded to two brainstorming prompts ("What does 'successful conversation' look like?" and "Think about a successful conversation you have taken part in. What aspects of that conversation contributed to its success?"). The resulting statements were sorted into related clusters and rated in importance for one-to-one and group conversation.

STUDY SAMPLE

Thirty-five adults with normal and impaired hearing.

RESULTS

Seven clusters were identified: (1) Being able to listen easily; (2) Being spoken to in a helpful way; (3) Being engaged and accepted; (4) Sharing information as desired; (5) Perceiving flowing and balanced interaction; (6) Feeling positive emotions; (7) Not having to engage coping mechanisms. Three clusters (1, 2, and 4) were more important in group than in one-to-one conversation. There were no differences by hearing group.

CONCLUSIONS

These findings emphasise that conversation success is a multifaceted concept.

Exploring the relationship between planned behavior and self-determination theory on health-seeking behavior among older adults with hearing impairment

This study aimed to examine the relationship between planned behavior and self-determination theory in predicting health-seeking behavior among older adults with hearing impairment. A total of 103 participants aged 60 years and above completed a self-administered questionnaire that measured variables related to health-seeking intention, knowledge competence, relatedness, attitudes, stigma, and perceived competence and autonomy. The results of the study indicated that both the planned behavior and self-determination theory models significantly predicted health-seeking intention and behavior among older adults with hearing impairment. Higher knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy were found to be significant predictors of health-seeking intention and behavior. The findings of this study suggest that interventions aimed at increasing knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy may be effective in promoting hearing health-seeking behavior among older adults with hearing impairment. Future research may further explore the role of these variables in predicting health-seeking behavior and the effectiveness of interventions in promoting hearing health in this population. Clinical practitioners and healthcare professionals may benefit from these findings in designing targeted interventions for this population.

American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults With Hearing Loss

BACKGROUND

Hearing loss poses a significant public health challenge as a common chronic condition with many known side effects that are often worse when left untreated. Aural rehabilitation (AR) is an umbrella term that encompasses a range of interventions (e.g., informational counseling and perceptual training) designed to reduce deficits related to hearing loss that may stand alone or be used in combination as part of a holistic plan.

PURPOSE

This evidence-based clinical practice guideline is intended to inform the implementation of person-centered AR to adults with hearing loss. Given the well-known benefits of sensory management, it was not included within the scope of this guideline. The recommendations aim to help clinicians, individuals with hearing loss, and other stakeholders make evidence-informed treatment decisions and improve clinical outcomes, as well as provide payers and policymakers with information detailing a comprehensive approach to AR.

METHOD

The American Speech-Language-Hearing Association (ASHA) and a multidisciplinary panel of subject matter experts prioritized key clinical questions and outcomes that served as the foundation of the guideline. The clinical recommendations were based on a comprehensive systematic review and a meta-analysis of 85 studies published between 1978 and 2021.

RECOMMENDATIONS

Given the current state of the evidence, resource considerations, patient acceptability, clinical feasibility, and the overall balance of benefits and harms, ASHA developed several evidence-based recommendations for the provision of AR to adults with hearing loss. Each recommendation is accompanied by a series of key practice points to support its implementation within a person-centered framework.

Conversations about mental illness and health in adult audiological rehabilitation

OBJECTIVE

To understand the nature of mental health discussions in audiological rehabilitation, specifically, the types of conversations, when and how they are initiated, and the participant factors associated with discussing mental health.

DESIGN

A cross-sectional descriptive survey including quantitative (multiple choice) and qualitative (free-text) questions regarding mental health discussions between audiologists and clients.

STUDY SAMPLE

A convenience sample of 118 Australian audiologists working in adult audiological rehabilitation.

RESULTS

The majority of participants (95.8%) reported having engaged in discussions with clients about mental illness and health at some point throughout their career. The frequency of these discussions varied across participants: 7% rarely discuss, 50% discuss occasionally, 30% discuss with about half their clients and 13% have discussions with most clients. Many participants (85.6%) reported that clients would initiate these conversations, most often via disclosing the impacts of hearing loss on clients' lives.

CONCLUSIONS

Most audiologists will encounter clients with mental health concerns, and many will engage in conversations about psychological symptoms, therefore, training audiologists to recognise and address verbal and non-verbal cues regarding mental health may help to promote person-centred care and potentially improve outcomes.

Factors Influencing Postoperative Experiences in Adult Cochlear Implant Recipients: A Multistakeholder Perspective

OBJECTIVE

To explore factors influencing postoperative experiences of adult cochlear implant (CI) recipients, determine the impact of each factor, and conceptualize recipients' postoperative journey.

STUDY DESIGN

Participatory mixed methods; concept mapping.

SETTING

Tertiary care (private and public).

PATIENTS

Ninety-three participated in the brainstorming activity. Eighty-nine completed the sorting tasks (96% retention rate): CI recipients (n = 44), significant others (n = 13), CI audiologists (n = 14) and surgeons (n = 5), CI clinics' administration staff (n = 5) and managers (n = 3), and CI manufactures' clinical support staff (n = 5).

INTERVENTIONS

Rehabilitative (CIs).

MAIN OUTCOME MEASURES

Statements were generated and rated by participants. Similarity of grouping of the statements informed the matrices used for cluster analysis to form concepts.

RESULTS

Eighty-seven unique statements described the factors influencing adapting to, use, and maintenance of CIs after implantation. These were grouped, and five concepts were identified: financial considerations, complications, device usability and durability, device programming and adaptation, and patient motivation and supports. Although statements within the concepts financial considerations and complications were negatively rated, statements within the concepts device programming and adaptation, and patient motivation and supports were mostly rated as having positive influence in patients' postoperative journey. The concept device usability and durability contained both negatively and positively rated statements.

CONCLUSIONS

Postoperative experience of adult CI recipients is a multifaceted journey with several challenges to address to improve services. Although support from and connection with family and clinicians, and simplicity of using a CI device facilitated the experience, medical and surgical complications, durability, and cost of maintaining the device challenged the postoperative experience.

Guidance on Providing Patient-Centered Care

This article explores the clinical applications of Audiology Practice Standards Organization (APSO) Standards 2 and 13, both of which keep us fully focused on the patient-as-person. The topics within Standard 2 include audiologists' interpersonal communication skills, specifically clarity (ensuring patient comprehension) and empathy (understanding the patient's experiences). Standard 2 also addresses the topic of health literacy, which has been recently expanded to consider not only the degree to which individuals are able to find, understand, and use information and services to inform health-related decisions but also how organizations equitably support those necessary skills. The characteristics and benefits of services provided in patient- and family-centered care contexts are also described. Standard 13 addresses audiologists' support toward overall successful adjustment as defined by the patient, including both technical and personal adjustment to amplification, nontechnical communication issues, and rehabilitation support using readily available technologies. A new assessment protocol that includes goal setting and intervention is described, as well as a patient-centered intervention strategy involving discussion of personally meaningful photographs. Both standards provide a necessary balance to our technology-reliant profession.

Premium versus entry-level hearing aids: using group concept mapping to investigate the drivers of preference

OBJECTIVES

To investigate the difference in outcome measures and drivers of user preference between premium and entry-level hearing aids using group concept mapping.

DESIGN

A single-blind crossover trial was conducted. Aided behavioural outcomes measured were loudness rating, speech/consonant recognition, and speech quality. Preference between hearing aids was measured with a 7-point Likert scale. Group concept mapping was utilised to investigate preference results. Participants generated statements based on what influenced their preferences. These were sorted into categories with underlying themes. Participants rated each statement on a 5-point Likert scale of importance.

STUDY SAMPLE

Twenty-three adult participants (mean: 62.4 years; range: 24-78) with mild to moderately severe bilateral SNHL (PTA_{500-4000 Hz} > 20 dB HL).

RESULTS

A total of 83 unique statements and nine distinct clusters, with underlying themes driving preference, were generated. Clusters that differed significantly in importance between entry-level and premium hearing aid choosers were: Having access to smartphone application-based user-controlled settings, the ability to stream calls and music, and convenience features such as accessory compatibility.

CONCLUSION

This study has identified non-signal-processing factors which significantly influenced preference for a premium hearing aid over an entry-level hearing aid, indicating the importance of these features as drivers of user preference.

Experienced hearing aid users' perspectives of assessment and communication within audiology: a qualitative study using digital methods

OBJECTIVE

To explore experienced hearing aid users' perspectives of audiological assessments and the patient-audiologist communication dynamic during clinical interactions.

DESIGN

A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice.

STUDY SAMPLES

Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 - 86 years; 9 males, 11 females).

RESULTS

Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology.

CONCLUSION

To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users' value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient-audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

Process Evaluation of an Online SUpport PRogram for Older Hearing Aid Users Delivered in a Cluster Randomized Controlled Trial

Objectives: To evaluate the process of implementing a web-based support program (SUPR) for hearing aid users in the Dutch dispensing setting in order to allow interpretation of the randomized controlled trial's results (positive effects on hearing-aid related outcomes; no effects on psychosocial outcomes).

Design: Measures: context of implementation, recruitment, SUPR's: reach, implementation fidelity, dose delivered, dose received, satisfaction, and benefit. Data collection: quantitative and qualitative.

Study Sample: One hundred thirty-eight clients (mean age 68.1 years; 60% male) and 44 dispensers completed questionnaires. Five clients and 6 dispensers participated in interviews and focus groups.

Results: Clients and dispensers were generally satisfied with SUPR's usefulness. SUPR-videos were watched by 7–37% of the clients. Around half of the dispensers encouraged clients to watch them or informed them about SUPR. Some clients found the SUPR-materials suboptimal, and changes in personnel and limited dispenser-training were barriers acting on a contextual level.

Conclusions: This study identified several factors that contributed to the success of SUPR. Others factors, acting on various levels (e.g., intervention material, dispensers, and implementation context), were suboptimal and may explain the absent psychosocial effects. The identified factors are important to consider in further development of SUPR, and in other web-based support programs.

Reflections on How Tinnitus Impacts the Lives of Children and Adolescents

Objectives The aim of this study was to generate a conceptual framework describing which aspects of children and adolescents' lives are affected by chronic tinnitus. Design Views and experiences of 32 participants from two participant groups informed this study: (a) a tinnitus group, consisting of adults who had experienced tinnitus during childhood and/or adolescence and primary carers of children/adolescents with tinnitus, and (b) a clinicians' group, consisting of clinicians who provided care for children/adolescents with tinnitus. Participants produced statements describing aspects of children/adolescents' lives that may be affected by chronic tinnitus. Key concepts were identified through the processes of sorting the statements and rating them for degree of associated impact. Result Participants identified 118 unique aspects of the lives of children/adolescents who may be affected by chronic tinnitus. These were clustered into four concepts: (a) emotional well-being, (b) academic performances, (c) social/relationa, and (d) auditory/cognitive processing. At a group level, participants rated the impact of tinnitus as above a slight degree but below a moderate degree of impact. However, individual participant's ratings indicated a range of perceived impact for each statement. Conclusions The experience of chronic tinnitus during childhood and adolescence extends beyond the mere perception of sound. The perception of tinnitus may impact a child's emotional well-being, academic performances, social/relational, and auditory/cognitive processing. The impact of tinnitus in one aspect of a child's life may influence other aspects of their life. While at a group level, participants regarded the impact of tinnitus as "somewhat more than mild" to "less than moderate"; individual participant's ratings indicate that the impact from chronic tinnitus may be highly individual and highlighted the importance of individual assessment and management. Clinically, tinnitus management during childhood and adolescence may be improved if clinicians consider the impact and manifestation of tinnitus within each child's daily life and tailor tinnitus education and management strategies accordingly.

Online Consumer Reviews on Hearing Health Care Services: A Textual Analysis Approach to Examine Psychologically Meaningful Language Dimensions

Purpose The study examined psychologically meaningful language dimensions (i.e., social and emotional dimensions, health dimensions, and personal concerns) within online consumer reviews on hearing health care services using an automated textual analysis approach. Method Nine thousand six hundred twenty-two consumer reviews of hearing health care services, including an open-ended question (i.e., free text response to the prompt "share details of your own experience at this place") and an overall rating (on a 5-point scale ranging from "very good" to "very poor") were extracted from Google.com from 40 different cities across the United States. In addition, some metadata about the cities (i.e., region, population size, median age, percentage of older adults) were also recorded. Text responses were analyzed using the automated Linguistic Inquiry and Word Count software for selected language dimensions. The language dimensions of online hearing health care reviews were descriptively compared with language dimensions observed in the natural language of typical bloggers. Language dimensions from free text responses were correlated with quantitative overall experience ratings. Results Automated linguistic analysis showed that consumer reviews on hearing health care services had higher social processes, positive emotions, hearing, health, money, and work, and lower negative emotions and time-awareness when compared to typical bloggers. Examining the association between overall experience rating and the language dimensions revealed two broad findings. First, higher engagement of consumers in terms of social processes, positive emotions, hearing, and work dimensions was related to higher experience ratings. Second, higher engagement of consumers in terms of negative emotions, time awareness, and money was related to lower experience ratings. Conclusions Online reviews contain information about various dimensions (i.e., social and emotional dimensions as well as personal concerns) that have bearing toward the way in that they rate their health care experiences. Automated linguistic analysis of consumer reviews appears helpful in identifying gaps in service delivery that may influence consumer experience.

How do patients decide on interventions for single sided deafness? A qualitative investigation of patient views

BACKGROUND

Single-sided deafness presents communication challenges for adults. There are a range of care options, including CROS hearing aids, available but little is known about patient preferences for these interventions.

OBJECTIVE

The objective of this study was to understand the viewpoints of patients making decisions about audiological interventions they use.

METHODS

A constructivist worldview using thematic analysis to undertake a constant comparative analysis of 8 semi-structured interviews.

SAMPLING

Participants were recruited from Portsmouth Hospitals University NHS Trust audiology service in England.

FINDINGS

The results of the study describe ongoing iterative judgements being made by participants, informed by their access to information, effectiveness of audiological interventions, stigma, barriers to accessing care, and constant cost-benefit analyses being made. The key factors involved in decision-making by individuals with Single-sided deafness (SSD) are discussed.

CONCLUSIONS

This study represents the first in-depth exploration of the individual's lifeworld related to which factors influence use of different audiological interventions by individuals with SSD. It highlights the complex and ongoing nature of how decisions are made by these individuals and identifies the need for greater information provision by clinicians, such as through use of a decision aid tool.

What Influences Decision-Making for Cochlear Implantation in Adults? Exploring Barriers and Drivers From a Multistakeholder Perspective

OBJECTIVES

To explore the factors influencing the uptake of cochlear implants in adults, determine the impact of each factor, and to conceptualize the journey to implantation from a multistakeholder perspective.

DESIGN

Concept mapping was used to integrate input from multiple stakeholders, each with their own experience and expertise. This mixed participatory method collects qualitative and quantitative data collection and enables further quantitative analysis. There were two participant cohorts: clients (cochlear implant recipients, candidates, and family members) and professionals (cochlear implant audiologists, ear, nose, and throat surgeons, administration staff, managers. and manufacturer representatives). A total of 93 people participated in the study: client cohort (n = 60, M age = 66.60 years) and professional cohort (n = 33, M age = 45.24 years). Participants brainstormed statements in response to the question "What influences people's decision to get/not get a cochlear implant?" They subsequently grouped the statements and named each group. They rated each statement as to its impact on the decision and prioritized the need for each to be changed/improved using a five-point Likert scale. Multidimensional scaling was used to produce a visual representation of the ideas and their relationship in the form of concepts. Further analysis was conducted to determine the differences between the cohorts, subcohorts, and concepts.

RESULTS

One hundred ten unique statements were generated and grouped into six concepts which either directly affected the client or their environment. These concepts were: external influences (awareness and attitude of non-implant professionals about uptake, cost, logistics, the referral pathway, public awareness); uncertainties, beliefs, and fears (fears, negative effect of word of mouth, unsuccessful previous ear surgery, cosmetics of the device, misunderstanding of how a cochlear implant functions, eligibility for an implant and outcomes after implantation); health problems (mental and physical health); hearing difficulties (social, emotional, and communication impacts of hearing loss, severity of hearing loss, benefit from and experience with hearing aids); implant professionals (implant team's attitude, knowledge and relationship with clients, quality of overall service); and goals and support (clients 'hearing desires and goals, motivation, positive impact of word of mouth, family support, having a cochlear implant mentor. The six concepts fell into two overarching domains: the client-driven domain with four concepts and the external domain with two concepts. The mean rating of concepts in terms of impact on a client's decision to get an implant ranged from 2.24 (external influences, the main barrier) to 4.45 (goals and support, the main driver). Ratings significantly differed between the client and professional cohorts.

CONCLUSIONS

This study increases our understanding of the factors, which influence a client's decision choose a cochlear implant as a hearing treatment. It also provides new information on the influence of the other stakeholders on the client journey. The magnitude of the generated statements in the client-driven domain highlights the pivotal role of individualized care in clinical settings in influencing a client's decision and the need for the professionals to understand a client's needs and expectations. A client's persistent hearing difficulties, goals, and support network were identified as drivers to the uptake of cochlear implants. However, the barriers identified highlight the need for a collaborative multi- and interdisciplinary approach to raise awareness in and educate non-implant hearing professionals about the cochlear implant process, as well as providing information to empower clients to make educated decisions and consider a cochlear implant as a hearing management option.

How Can eHealth Meet the Hearing and Communication Needs of Adults With Hearing Impairment and their Significant Others? A Group Concept Mapping Study

OBJECTIVES

To seek the perspectives of key stakeholders regarding: (1) how eHealth could help meet the hearing and communication needs of adults with hearing impairment and their significant others; and (2) how helpful each aspect of eHealth would be to key stakeholders personally.

DESIGN

Group concept mapping, a mixed-methods participatory research method, was used to seek the perspectives of key stakeholders: adults with hearing impairment (n = 39), significant others (n = 28), and hearing care professionals (n = 56). All participants completed a short online survey before completing one or more of the following activities: brainstorming, sorting, and rating. Brainstorming required participants to generate ideas in response to the focus prompt, "One way I would like to use information and communication technologies to address the hearing and communication needs of adults with hearing loss and their family and friends is to…." The sorting task required participants to sort all statements into groups that made sense to them. Finally, the rating task required participants to rate each of the statements according to "How helpful would this idea be to you?" using a 5-point Likert scale. Hierarchical cluster analysis was applied to the "sorting" data to develop a cluster map using the Concept Systems software. The "rating" data were subsequently analyzed at a cluster level and an individual-item level using descriptive statistics. Differences in cluster ratings between stakeholder groups were examined using Kruskal-Wallis tests.

RESULTS

Overall, 123 statements were generated by participants in response to the focus prompt and were included in subsequent analyses. Based on the "sorting" data and hierarchical cluster analysis, a seven-cluster map was deemed to be the best representation of the data. Three key themes emerged from the data, including using eHealth to (1) Educate and Involve Others; (2) Support Aural Rehabilitation; and (3) Educate About and Demonstrate the Impacts of Hearing Impairment and Benefits of Hearing Rehabilitation. Overall median rating scores for each cluster ranged from 3.97 (educate and involve significant others) to 3.44 (empower adults with hearing impairment to manage their hearing impairment from home).

CONCLUSIONS

These research findings demonstrate the broad range of clinical applications of eHealth that have the capacity to support the implementation of patient- and family-centered hearing care, with self-directed educational tools and resources typically being rated as most helpful. Therefore, eHealth appears to be a viable option for enabling a more biopsychosocial approach to hearing healthcare and educating and involving significant others in the hearing rehabilitation process without adding more pressure on clinical time. More research is needed to inform the subsequent development of eHealth interventions, and it is recommended that health behavior change theory be adhered to for such interventions.

Development of a protocol and a clinical tool to assess the audiological needs of younger and older adults with hearing loss

OBJECTIVE

To develop a protocol and a clinical tool to assess the audiological needs of younger and older adults with hearing loss.

DESIGN

A needs assessment protocol was developed based on recommendations of an expert panel, existing literature, the International Classification of Functioning, Disability and Health, client-centered care and goal setting. The protocol was reviewed by the expert panel. Semi-structured interviews were conducted with clinical audiologists to validate its content and explore its clinical applicability. A clinical tool was developed to make the administration of the protocol more uniform.

STUDY SAMPLE

15 experts and 14 clinical audiologists.

RESULTS

Feedback received from the participants (experts and clinicians) supported the content validity of the needs assessment protocol and clinical tool. The topics covered within the protocol and tool include: Audiological needs (activity limitations, participation restrictions, environmental factors), Living conditions (social networks, living environment), Personal factors, Discussion with the client to define the intervention plan, and Recommendations.

CONCLUSIONS

A protocol and a clinical tool were developed to help audiologists and clients undertake a comprehensive audiological needs assessment. The content validity of the protocol and tool were demonstrated. Their use can facilitate the delivery of a client-centered assessment using a uniform and comprehensive approach.

Hearing aid acquisition and ownership: what can we learn from online consumer reviews?

OBJECTIVE

To explore the publicised opinions of consumers actively participating in online hearing aid reviews.

DESIGN

A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership).

STUDY SAMPLE

1378 online consumer hearing aid reviews.

RESULTS

Six clusters within two domains were identified. The domain Device Acquisition included three clusters: Finding the right provider, device and price-point; Selecting a hearing aid to suit the hearing loss; Attaining physical fit and device management skills. The domain Device Use included three clusters: Smartphone streaming to hearing aids; Hearing aid adjustment using smartphone; and Hearing in noise.

CONCLUSIONS

Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.

Does the Speech Cue Profile Affect Response to Amplitude Envelope Distortion?

Purpose A broad area of interest to our group is to understand the consequences of the "cue profile" (a measure of how well a listener can utilize audible temporal and/or spectral cues for listening scenarios in which a subset of cues is distorted. The study goal was to determine if listeners whose cue profile indicated that they primarily used temporal cues for recognition would respond differently to speech-envelope distortion than listeners who utilized both spectral and temporal cues. Method Twenty-five adults with sensorineural hearing loss participated in the study. The listener's cue profile was measured by analyzing identification patterns for a set of synthetic syllables in which envelope rise time and formant transitions were varied. A linear discriminant analysis quantified the relative contributions of spectral and temporal cues to identification patterns. Low-context sentences in noise were processed with time compression, wide-dynamic range compression, or a combination of time compression and wide-dynamic range compression to create a range of speech-envelope distortions. An acoustic metric, a modified version of the Spectral Correlation Index, was calculated to quantify envelope distortion. Results A binomial generalized linear mixed-effects model indicated that envelope distortion, the cue profile, the interaction between envelope distortion and the cue profile, and the pure-tone average were significant predictors of sentence recognition. Conclusions The listeners with good perception of spectro-temporal contrasts were more resilient to the detrimental effects of envelope compression than listeners who used temporal cues to a greater extent. The cue profile may provide information about individual listening that can direct choice of hearing aid parameters, especially those parameters that affect the speech envelope.

What does a family who is "engaged" in early intervention look like? Perspectives of Australian speech-language pathologists

PURPOSE

To build a description of what engagement in early speech-language pathology intervention looks like, by exploring speech-language pathologists' (SLPs) perceptions of (1) what characteristics best describe families who are "engaged" in early speech-language pathology intervention and (2) which characteristics are most important for engagement.

METHOD

Group concept mapping, a participatory mixed-methods research approach, was used to represent the perspectives of Australian SLPs working with children aged 0-8 years and their families in early intervention. Using Concept Systems software, participants: (1) brainstormed responses to a focus question (n = 58); (2) grouped statements into categories (n = 34); and (3) rated the importance of each statement (n = 29).

RESULT

SLPs identified 108 characteristics of engagement in early speech-language pathology intervention, which were grouped into seven key concepts: (1) the family is reliable and ready for therapy; (2) the family has an open, honest relationship with the SLP; (3) the family actively participates and takes initiative; (4) the family works in partnership to plan and set goals together; (5) the family sees and celebrates progress; (6) the family invests in intervention at home; and (7) the family understands intervention and advocates for their child. All aspects of engagement were considered important by participants, with the family-SLP relationship and families continuing to invest in intervention at home being rated most highly.

CONCLUSION

Results present a picture of engagement which has been informed by stakeholders, and which goes beyond aspects of engagement which have previously been identified in the literature. Families who are engaged in early speech-language pathology intervention are actively invested and involved in intervention in various ways, both inside and outside the clinic room.

Understanding patient empowerment along the hearing health journey

OBJECTIVE

Related to the hearing health journey, this study aimed to: (i) explore how empowerment manifests itself from individuals' first awareness of hearing loss through to hearing aid fitting and then to becoming an active hearing aid user, (ii) identify points when the different dimensions of empowerment are most relevant, and (iii) conceptualise empowerment.

DESIGN

A semi-structured interview study was conducted, followed by a template analysis of the data.

STUDY SAMPLE

Adult hearing aid users from Sweden (n = 8) and Australia (n = 10) who had worn hearing aids for between 6 and 36 months.

RESULTS

The themes that emerged from the transcripts were knowledge, skills and strategies, participation, self-efficacy, and control.

CONCLUSIONS

This study conceptualises empowerment along the hearing health journey as the process through which individuals with hearing-related challenges acquire and use knowledge, skills, and strategies, and increase self-efficacy, participation, and the feeling of control of their hearing health care, hearing solutions, and everyday lives. There are not specific points along the hearing health journey where any dimension is uniquely relevant, instead, each dimension is a dynamic component at all stages.

Web-based discussion forums reveal the person-centered relevance and importance of tinnitus

An increasing number of health researchers are recognizing the benefits of crowdsourcing. Web-based discussion forums are well suited for collecting qualitative research data with tinnitus participants and forum posts can be evaluated using thematic analysis. The present study reports an innovative use of such qualitative data contributed by a group of 148 people with tinnitus and tinnitus professionals through the crowdsourcing platform Tinnitus Talk. While the primary research question was focused on defining symptom concepts, discussions were broad-ranging and extended far beyond this topic. Thematic analysis of the discussion conducted by two analysts identified three novel emerging themes and these were not pre-planned according to the moderator's script. These were (i) the lived experience of tinnitus, (ii) perspectives on interventions for tinnitus, and (iii) the experience of participating in a web discussion forum. These unexpected themes contribute to a richer and more in-depth understanding of tinnitus seen through the eyes of those who experience it on a daily basis. Findings are important since spontaneous themes presumably reflect issues that are of personal relevance and importance to the participants. They therefore give insights into future research directions and have implications for patient-centered counseling strategies that could be effective in clinic.

Using smartphone technology to support the adult audiologic rehabilitation journey

OBJECTIVE

Although the availability of mobile device applications (apps) to support people with hearing impairment is rapidly increasing, there are few reports of the use of such apps by the target population. The aim of this paper is to describe research that has applied apps at various stages of the adult rehabilitation journey.

DESIGN

A summary of studies utilising apps to investigate (1) the hearing difficulties and acoustic environments of adults with mild hearing impairment, (2) hearing aid benefit in this population and (3) useability of an app to guide hearing aid handling tasks.

STUDY SAMPLE

Older adults with no previous experience with hearing aids, who owned a smartphone or tablet and were confident in using apps. Participant samples ranged from 10 (hearing aid benefit pilot study, mean age = 70 years) to 30 participants (app useability study, mean age = 69 years).

RESULTS

All studies showed that smartphone apps can provide real-world insights during the early stages of the patient journey and hearing aid management support during the latter stages. App useability was rated positively by participants.

CONCLUSION

Smartphone apps may be used as a feasible complement to face-to-face interaction in audiology practice.

Audiological approaches to address the psychosocial needs of adults with hearing loss: perceived benefit and likelihood of use

OBJECTIVE

To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss.

DESIGN

Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss.

STUDY SAMPLE

A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists.

RESULTS

Overall, participants rated all of the approaches highly on both benefit and likelihood of use; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales.

CONCLUSIONS

Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

Reflections and perceptions of chronic tinnitus during childhood and adolescence

OBJECTIVES

To enhance understanding of the lived experience of tinnitus during childhood/adolescence from the reflections of adults who experienced tinnitus during childhood/adolescence and the perceptions of primary carers and clinicians who care for children/adolescents who experience it. Secondly to develop a conceptual framework to better describe the experience of chronic tinnitus during childhood/adolescence and to guide approaches to assessment and management.

DESIGN

Using a concept mapping approach, participants from two stakeholder groups generated statements describing what chronic tinnitus sounds and feels like to children/adolescents who experience it. Participants subsequently grouped and rated the statements to reveal key concepts. The first stakeholder group consisted of adults who had experienced chronic tinnitus as a child/adolescent and parents of children or adolescents who are experience chronic tinnitus. The second stakeholder group consisted of clinical professionals who provide care for children/adolescents experiencing chronic tinnitus.

RESULTS

Participants identified 102 different descriptions of what chronic tinnitus sounds and feels like to children/adolescents, across five concepts: 1) Sounds of tinnitus; 2) Descriptions of tinnitus; 3) Perceptions of tinnitus; 4) Emotional responses to tinnitus and 5) Physical responses to tinnitus.

CONCLUSIONS

The experience of chronic tinnitus during childhood/adolescence is heterogenous and multifaceted. It may involve the perception of sound, emotions and physiological sequalae. How a child/adolescent experiences their tinnitus will be influenced by the interplay between the sound they perceive, the number of accompanying senses involved and their interpretation of the sound. As well as the emotions and physical effects they experience.

Identifying the approaches used by audiologists to address the psychosocial needs of their adult clients

OBJECTIVE

To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss.

DESIGN

A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other.

STUDY SAMPLE

An international sample of 65 audiologists.

RESULTS

Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility.

CONCLUSIONS

Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Discovering the Unmet Needs of People With Difficulties Understanding Speech in Noise and a Normal or Near-Normal Audiogram

Purpose A proportion of people with a normal audiogram or mild hearing loss (NA-MHL) experience greater-than-expected difficulty hearing speech in noise. This preliminary exploratory study employed a design thinking approach to better understand the clinical pathway and treatment options experienced by this population. Method Exploratory survey data were analyzed from 233 people with NA-MHL who had consulted a clinician and 47 clinicians. Qualitative analysis was performed on interview data from 21 people with NA-MHL and seven clinicians. Results Results revealed that noisy environments, such as restaurants, were where many people experienced listening difficulties. Most people with NA-MHL were not offered a treatment option at their audiology appointment, and their satisfaction with the appointment was diverse. Many clients reported frustration at being told that their hearing was "normal." Data from clinicians showed that there is no standard test protocol for this population, and most felt that they did not have adequate training or resources to help NA-MHL clients. Conclusion This study discusses the research needs regarding the experience of those with NA-MHL, their help-seeking behaviors, and treatment options. Understanding these needs is the first step to designing projects to improve the quality of life of this population.

Knowledge, Beliefs, and Practices of Australian Audiologists in Addressing the Mental Health Needs of Adults With Hearing Loss

Purpose Emotional and mental health is essential to overall health, but there has been little research on how to approach emotional and mental health in the audiology setting. This study provides a preliminary investigation into the current knowledge, beliefs, and practices of Australian audiologists in addressing the emotional and mental health needs of adults with hearing loss. Method A 22-item survey using open- and closed-ended questions was completed by 95 Australian audiologists using a cross-sectional study design. Results Two thirds of audiologists described being underconfident and lacking the skills required to provide emotional support to people with hearing loss. Barriers to delivering emotional support included feeling out of their depth (56.6%), time/caseload pressures (55.3%), and the perception that the provision of emotional support was not within an audiologist's scope of practice (31.6%). Audiologists described a desire to refer clients to mental health professionals yet highlighted significant barriers, including not knowing who to refer to (54.7%), when to make a referral (49.3%), or how to make a referral (38.6%). Audiologists overwhelmingly (96%) indicated that they would like to develop their knowledge and skills associated with the provision of emotional and mental health support in the audiological setting. Conclusion Knowledge, skills, and time were identified as the key areas that require attention in order to allow audiologists to address the emotional and mental health needs of adults with hearing loss.

Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study

BACKGROUND

Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey.

OBJECTIVE

This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss.

METHODS

A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic's Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services.

RESULTS

Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family.

CONCLUSIONS

This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally.

Identifying clients' readiness for hearing rehabilitation within initial audiology appointments: a pilot intervention study

Objective: The current study sought to explore audiologists' use of the Ida Institute Motivation Tools to help them identify clients' readiness for change within initial assessment appointments.Design: The study involved a mixed methods intervention design. Data were collected pre- and post-training audiologists to use the Ida Motivation tools in their appointments. Appointments were video-recorded and analysed using conversation analysis. Clients and audiologists also completed questionnaires within each appointment to measure clients' readiness-for-change.Study sample: Participants included 5 audiologists and 22 adult clients from two Audiology clinics.Results: Audiologists incorporated the Ida Motivation tools into the post-training appointments without a significant increase in appointment time. The Ida tools solicited responses from clients that displayed their ambivalence regarding hearing rehabilitation/aids within their talk. Post-training, audiologists' perceptions of clients' stage of readiness were not significantly more likely to match clients' self-reported stage on the URICA.Conclusions: The Ida Motivation tools may be useful to solicit clients' ambivalent feelings towards hearing rehabilitation/aids, however, it is important for audiologists to actively listen for ambivalence within clients' interactional responses to the tools in order judge clients' readiness.

Investigating the prevalence and impact of device-related problems associated with hearing aid use

Objective: To explore the prevalence of device-related problems associated with hearing aid use, participants' help-seeking behaviours for these problems, and factors associated with hearing aid problems.Design: A prospective convenience cohort design surveying 413 adult hearing aid users (34-97 years of age) recruited from seven clinics across Australia.Results: Almost all participants (98%) indicated that they were experiencing at least one of the hearing aid problems included on the survey. The number of hearing aid related problems reported by participants ranged from 0 to 25 (of a possible 26), with a mean of 10 problems (SD = 5). The three most reported problems were related to difficulty hearing in noisy environments, hearing in windy environments, and understanding certain voices. Participants had reported less than half (46.33%) of the total problems identified to their clinic (range = 0-100%, mean = 43.40, SD = 13.92). Participants who reported experiencing a greater number of hearing aid problems also reported lower levels of hearing aid benefit, and satisfaction with their hearing aids.Conclusions: The majority of hearing aid owners experience problems with their hearing aids. Addressing these problems would likely contribute to improved hearing aid outcomes.

Ototoxicity: Visualized in Concept Maps

Ototoxicity refers to the damage to structures and function of the auditory-vestibular system caused by exogenous agents such as pharmaceuticals, chemicals, and ionizing radiation. There are many potentially ototoxic substances. For example, depending on how ototoxicity is defined, there are 200 to 600 medications that can cause damage to hearing and/or balance. Ototoxicity encompasses cochleotoxicity, vestibulotoxicity, and neurotoxicity. A variety of professional disciplines are involved in determining causation, prevention, and management of ototoxic effects. Research to identify and develop otoprotectants and otorescue agents is emerging and will translate basic scientific discovery into applications for use in hearing conservation programs, safety operations, and clinical care. Original concept maps are presented here to visually represent knowledge pathways, domains, and relationships essential to the understanding of ototoxicity.

Time of Day and Hearing Aid Adoption

To date, there is little understanding of how contextual factors may influence the decisions individuals make regarding the adoption of options for hearing rehabilitation. This explorative retrospective study investigated whether hearing aid adoption and return rates are associated with the time of the day at which an appointment takes place. The study sample consisted of 24,842 patients experiencing their first audiology appointment. It was observed that hearing aid adoption was significantly associated with appointment times whereby lower hearing aid adoption rates were observed at noon and 4 p.m. It was also observed that hearing aid return rates were significantly associated with appointment times whereby lower return rates were observed at noon and 4 p.m. In light of the methodology employed in the study, it is not possible to unequivocally determine why time of day is associated with hearing aid adoption and return rates. Several possible explanations for the patterns of associations are discussed. In light of previous research observing that hunger lowers risk tolerance and glucose consumption increases risk tolerance, the results are consistent with an interpretation based on risk-aversion resulting from hunger. To establish causality between hunger and decision-making in audiology, additional research employing experimental methodologies are necessary.

The Chronic Care Model and Chronic Condition Self-Management: An Introduction for Audiologists

Hearing health care is biomedically focused, device-centered, and clinician-led. There is emerging evidence that these characteristics-all of which are hallmarks of a health care system designed to address acute, rather than chronic, conditions-may contribute to low rates of help-seeking and hearing rehabilitation uptake among adults with hearing loss. In this review, we introduce audiologists to the Chronic Care Model, an organizational framework that describes best-practice clinical care for chronic conditions, and suggest that it may be a viable model for hearing health care to adopt. We further introduce the concept of chronic condition self-management, a key component of chronic care that refers to the knowledge and skills patients use to manage the effects of a chronic condition on all aspects of daily life. Drawing on the chronic condition evidence base, we demonstrate a link between the provision of effective self-management support and improved clinical outcomes and discuss validated methods with which clinicians can support the acquisition and application of self-management skills in their patients. We examine the extent to which elements of chronic condition self-management have been integrated into clinical practice in audiology and suggest directions for further research in this area.

eHealth and the hearing aid adult patient journey: a state-of-the-art review

The number and variety of eHealth services for adults and older adults who use hearing aids (HAs) are growing rapidly. This area holds promise to increase cost-efficiency, enable better access to care, and improve patient outcomes and satisfaction. Despite the increasing interest in this field, an up-to-date picture of recent research in the area of eHealth for adults with HAs is lacking. In this state-of-the-art review we assessed the literature from the past decade about eHealth use in the HA adult patient journey. Systematic searches were conducted in CINAHL, PubMed, Scopus, and Web of Science. A total of 34 peer-reviewed empirical records were identified from the searches and from the reference lists of searched records. Records were characterized based on: eHealth platform (i.e.: offline, Internet-based, or mobile-based), service [i.e.: education and information, screening and assessment, hearing rehabilitation, or general (tele-audiology)], and phase of the patient journey (i.e.: pre-fitting, fitting, or post-fitting). The review highlighted a growing interest in the field, as revealed by an increasing trend over the search period, from 2 records in 2009-2010 up to 17 records in 2015-2016. Internet-based platforms were the most frequently used (present in more than half of the included records), with a stable trend in the period. About one-third of the records introduced services over offline platforms, whereas mobile-based platforms were used only in 6 out of 34 records, suggesting that the clinical uptake of mobile services is still limited compared to more mature offline and Internet-based platforms. Most of the eHealth services observed were related to the areas of education and information (42.5%) and hearing rehabilitation (40.4%), whereas 10.7% were related to screening and assessment, and 6.4% to general tele-audiology services. Many services covered different phases of the patient journey, especially the fitting and post-fitting phases. Overall, this review showed that the field of eHealth in the context of HA rehabilitation in adults has grown in the recent past. Research is still needed to increase the uptake and efficacy of eHealth in clinical practice, especially in terms of technology developments, technical and clinical validation, and optimization of strategies for service delivery.

Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

PURPOSE

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

METHOD

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

RESULTS

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

CONCLUSIONS

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.

Investigating the Knowledge, Skills, and Tasks Required for Hearing Aid Management: Perspectives of Clinicians and Hearing Aid Owners

PURPOSE

The purpose of this study is to identify hearing aid owners' and clinicians' opinions of the knowledge, skills, and tasks required for hearing aid management and the importance of each of these to overall success with hearing aids.

METHOD

Concept mapping techniques were used to identify key themes, wherein participants generated, sorted, and rated the importance of statements in response to the question "What must hearing aid owners do in order to use, handle, manage, maintain, and care for their hearing aids?" Twenty-four hearing aid owners (56 to 91 years of age; 54.2% men, 45.8% women) and 22 clinicians (32 to 69 years of age; 9.1% men, 90.9% women) participated.

RESULT

Participants identified 111 unique items describing hearing aid management within 6 concepts: (a) "Daily Hearing Aid Use," (b) "Hearing Aid Maintenance and Repairs," (c) "Learning to Come to Terms with Hearing Aids," (d) "Communication Strategies," (e) "Working With Your Clinician," and (f) "Advanced Hearing Aid Knowledge." Clinicians' opinions of the importance of each statement varied only slightly from the opinions of the hearing aid owner group. Hearing aid owners indicated that all 6 concepts were of similar importance, whereas clinicians indicated that the concept "Advanced Hearing Aid Knowledge" was significantly less important than the other 5 concepts.

CONCLUSION

The results highlight the magnitude of information and skill required to optimally manage hearing aids. Clinical recommendations are made to improve hearing aid handling education and skill acquisition.