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.

Pediatric Hearing Aid Management: Experiences and Perspectives of Spanish-Speaking Parents

PURPOSE

The purpose of the study was twofold: (a) to explore hearing aid management experiences of Spanish-speaking parents who have young children using hearing aids and (b) to explore parents' access to the Internet and perceptions about remote audiology services.

METHOD

The study used a mixed methods design. Data were collected through a phone interview.

RESULTS

Eleven mothers of children aged 14-60 months participated. Most of the children (9/11) had a bilateral hearing loss, and two had an additional disability. Three themes emerged for hearing aid management experiences: audiology services, routines, and emotional challenges/supports. Parents had variable levels of confidence in their skills ranging from no confidence to complete confidence, with the greatest variability for three items: (a) using the listening tube to make sure that the sound quality of the hearing aid is good, (b) removing moisture from the earmold tubing, and (c) troubleshooting problems when your child's hearing aids are not working. All participants reported having consistent Internet access and had positive perceptions about the possibility of remote audiology services.

CONCLUSIONS

This study provided insights into hearing aid management experiences and perceptions of Spanish-speaking parents. Parents described variability for audiology services, routines for hearing aid use and care, and access to other parents of children with hearing loss. Spanish-speaking parents present additional elements in the hearing care process that need to be incorporated in planning. Remote services may be an opportunity to enhance access to support that could improve effectiveness of hearing aid management.

Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL): validation with hearing aid users

OBJECTIVE

Individuals who are deaf or hard of hearing (DHH) may find adherence to their hearing devices difficult due to internal experiences related to their hearing loss such as sadness or frustration. The Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) is the only measure available to assess psychological inflexibility as it relates to hearing loss. The purpose of this study was to confirm the single latent structure of the AAQ-AHL (through confirmatory factory analysis) and test convergent and discriminant validity.

DESIGN

Cross-sectional data was used to further validate the AAQ-AHL.

STUDY SAMPLE

Participants were 146 adults who had diagnosed hearing loss and used a hearing aid.

RESULTS

Results revealed the AAQ-AHL has a single latent structure, correlated to other similar constructs (psychological flexibility and hearing aid efficacy), and not correlated to unrelated constructs (hearing loss severity). These results suggest that the AAQ-AHL is a valid instrument to assess psychological flexibility as it relates to hearing aid use.

CONCLUSION

Together, the findings imply the AAQ-AHL has strong psychometric properties and justification to use in a clinical setting.

Increasing Pediatric Hearing Aid Use: Considerations for Clinical Practice

PURPOSE

Hearing aid use can be variable for young children, and inconsistent wear time can undermine spoken language development. This study explored the effectiveness of hearing aid data logging (DL) awareness and coaching sessions on increasing hours of hearing aid use. We also collected qualitative data on challenges participants experienced managing hearing aid use.

METHOD

We used a single-subject design that included three conditions, during a 6-week period, in the same order for each participant. Condition A was baseline, Condition B was DL monitoring alone, and Condition C was remote coaching calls plus DL monitoring.

RESULTS

Hours of hearing aid use increased for each child from baseline to the end of the study, ranging from 1.19 to 4.4 hr. Mothers reported that the coaching calls were beneficial and helped them identify and problem-solve issues.

CONCLUSIONS

Parents were able to increase hours of hearing aid use with DL awareness and coaching support. Tele-audiology offers an opportunity to provide parents with more frequent support that can be individualized based on their situation, challenges, and family needs.

Phase 2 of collaborative action around the implementation of virtual hearing aid care: Evaluation of a clinical practice guideline

RATIONALE

Following the onset of the COVID-19 pandemic, a clinical practice guideline (CPG) around virtual hearing aid practices was developed to fill a knowledge gap within the field of audiology. Details outlining the development and mobilization of this draft guideline were outlined as Phase 1 (described in a paired paper).

AIMS AND OBJECTIVES

This study describes Phase 2 of this project as part of the Knowledge-to-Action Framework, including an evaluation of the methodological quality of the guideline and the resulting tailored version of the document (v2.0).

METHOD

The Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality and to guide revisions. Twenty-two clinicians, from a variety of clinical backgrounds, participated in the evaluation.

RESULTS AND CONCLUSION

Findings reported across six domains suggest high mean scores, ranging from 78% to 81%, in order of scope and purpose (highest rated), stakeholder involvement, rigour of development, applicability, clarity of presentation, and editorial independence. Specific recommendations made by in international co-creation team during the evaluation informed the final version of the CPG. Future development and evaluation efforts should aim to include greater representation from nontraditional practice contexts to strengthen global applicability.

Phase 1 of collaborative action around the implementation of virtual hearing aid care: Development of a clinical practice guideline

RATIONALE

There is a growing demand for comprehensive, evidence-based, and accessible clinical practice guidelines (CPGs) to address virtual service delivery. This demand was particularly evident within the field of hearing healthcare during the COVID-19 pandemic, when providers were faced with an immediate need to offer services at a distance. Considering the recent advancement in information and communication technologies, the slow uptake of virtual care, and the lack of knowledge tools to support clinical integration in hearing healthcare, a Knowledge-to-Action Framework was used to address the virtual care delivery research-to-practice gap.

AIMS AND OBJECTIVES

This paper outlines the development of a CPG specific to provider-directed virtual hearing aid care. Clinical integration of the guideline took place during the COVID-19 pandemic and in alignment with an umbrella project aimed at implementing and evaluating virtual hearing aid care incorporating many different stakeholders.

METHOD

Evidence from two systematic literature reviews guided the CPG development. Collaborative actions around knowledge creation resulted in the development of a draft CPG (v1.9) and the mobilisation of the guideline into participating clinical sites.

RESULTS AND CONCLUSION

Literature review findings are discussed along with the co-creation process that included 13 team members, from various research and clinical backgrounds, who participated in the writing, revising, and finalising of the draft version of the guideline.

Intervention Research to Increase Pediatric Hearing Device Use: A Scoping Review

PURPOSE

This study is a scoping review examining interventions to increase hearing device use for children.

METHOD

Online databases were used to identify peer-reviewed journal articles published prior to November 1, 2021, yielding 1,288 after duplications were removed. Four articles met the inclusion criteria after articles were screened by title name and abstract and subsequent full-text screening of six articles. A qualitative analysis was conducted to identify features of the intervention studies related to the participants, design, intervention, key findings, and limitations.

RESULTS

The included studies were published between 1982 and 2021, and in all four studies, the children used hearing aids. All four of the studies used a longitudinal design to address hearing aid use problems, with the timeframe ranging from approximately 1 month to 6 months and had variable success in increasing use time. None of the studies included a protocol, such as counseling skills, for addressing internal challenges that interfere with hearing aid use.

CONCLUSIONS

Review of the limited research in this area found variable effectiveness for the interventions studied. There is an urgent need for research in this area to inform clinical practice and provide evidence-based interventions to address malleable factors that interfere with audibility for children who use hearing devices.

Moderators and predictors in a parent hearing aid management eHealth program

Objective: Consistent hearing aid use is essential for spoken language development of children who are hard of hearing. A recent randomised controlled trial of an eHealth hearing aid management education program found the intervention increased knowledge, perceptions, confidence, and device monitoring among parents of young children. Yet, it is not known which variables can be a point of emphasis to improve treatment outcomes. The purpose of this study was to investigate potential moderators and predictors in the eHealth program.Design: Randomised controlled trialStudy Sample: Parents (N = 78) of children (42 months or younger) were randomised to the intervention or treatment-as-usual (TAU) group.Results: Results revealed that high psychological inflexibility, low parent activation, and low hours of hearing aid use may moderate device monitoring frequency and knowledge; parents in the intervention improved over time compared to the TAU group. Psychological inflexibility and parent activation also predicted treatment outcomes.Conclusion: The findings suggest the need to address parent psychological inflexibility related to hearing loss management, parents' role in their child's hearing aid management, and reported hours of hearing aid use as part of hearing aid service delivery. Identification of barriers to hearing aid management can assist audiologists in adjusting support to improve outcomes.

eHealth Education and Support for Pediatric Hearing Aid Management: Parent Goals, Questions, and Challenges

PURPOSE

The purpose of this study was to investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management.

METHOD

Coaching phone calls were audio-recorded, transcribed, and qualitatively analyzed for emergent themes within the categories of goals, questions, and challenges.

RESULTS

Emergent themes revealed that parent goals were focused on self-efficacy, routines, device care, and child development. Emergent themes for questions revealed that parents asked questions related to the device care, audiology appointments, confirmation of learning, and child development. For challenges, emergent themes revealed parents' own struggles (e.g., with emotions), issues related to working with their audiologist, child factors, and anticipated challenges.

CONCLUSIONS

The eHealth intervention allowed parents to raise questions and discuss their challenges in a supportive environment. Supportive accountability helped participants identify and address barriers to hearing aid management based on their priorities and current challenges. Providing supplemental learning support, in addition to routine audiology visits, can help parents develop more effective hearing aid management routines.

eHealth parent education for hearing aid management: a pilot randomized controlled trial

OBJECTIVE

Parents frequently experience challenges implementing daily routines important for consistent hearing aid management. Education that supports parents in learning new information and gaining confidence is essential for intervention success. We conducted a pilot study to test an eHealth program to determine if we could implement the program with adherence and affect important behavioural outcomes compared to treatment as usual.

DESIGN

Randomised controlled trial.

STUDY SAMPLE

Parents of children birth to 42 months who use hearing aids. Eighty-two parents were randomly assigned to the intervention or treatment-as-usual group. Four parents assigned to the intervention group did not continue after baseline testing.

RESULTS

The intervention was delivered successfully with low drop out (10%), high session completion (97%), and high program adherence. The intervention conditions showed significantly greater gains over time for knowledge, confidence, perceptions, and monitoring related to hearing aid management. Significant differences between groups were not observed for hearing aid use time.

CONCLUSION

We found that we could successfully implement this eHealth program and that it benefitted the participants in terms of knowledge and confidence with skills important for hearing aid management. Future research is needed to determine how to roll programs like this out on a larger scale.

The Long-Term Stability of the Electrical Stapedial Reflex Threshold

OBJECTIVES

To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness.

STUDY DESIGN

Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time.

SETTING

Secondary care center.

PATIENTS

Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period.

INTERVENTION(S)

Cochlear implantation, eSRT testing, and, electrical upper limits of loudness.

MAIN OUTCOME MEASURE(S)

The eSRT over multiple appointments and the cochlear implant recipients' final upper limits of loudness.

RESULTS

Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = -0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3.

CONCLUSION

Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.

Parent and Professional Perceptions and Feedback on the Content of an eHealth Hearing Aid Learning Series for Parents of Children Who Are Deaf or Hard-of-Hearing

Purpose

To qualitatively explore parent and professional perspectives regarding the content of select Hear to Learn tutorials to identify usefulness and meaningfulness of the tutorials, and to inform regarding key components to enhance usefulness of eHealth platforms.

Method

This study used a qualitative design with two stakeholder focus groups. Stakeholder groups included four parents of children who are deaf or hard-of-hearing, and six professionals serving children who are deaf or hard-of-hearing.

Results

Findings indicate that both stakeholders valued the tutorials generally as helpful; however, areas for improvement were suggested.

Conclusion

Use of visuals, step-by-step instructions, and depth of content were identified as key elements that may be considered to optimize benefits of eHealth material for parents.

The Relationship Between Psychological Processes and Indices of Well-Being Among Adults With Hearing Loss

Purpose The purpose of this study was to explore the role of psychological processes (i.e., internalized shame, self-efficacy, psychological inflexibility) regarding hearing loss in the well-being of adults who have hearing loss. Method This study used a cross-sectional survey design. Two hundred sixty-four surveys were submitted for analysis. Data were collected using a survey posted to online social media support, in audiology clinics across the country, and through national organizations supporting individuals who have hearing loss. Regressions were used to determine whether internalized shame, self-efficacy, or psychological inflexibility held any predictive value over subjects' well-being. Results Shame, self-efficacy, and psychological inflexibility significantly predicted different aspects of well-being. Conclusion Audiologists should consider the role of internalized thoughts and emotions regarding patients' hearing loss on how patients understand and manage their hearing health.

Psychosocial Well-Being of Adults Who Are Deaf or Hard of Hearing

BACKGROUND

 Psychosocial well-being can interfere with engagement in activities of daily life. Consideration of psychosocial domains within hearing health care can expand audiologists' ability to understand treatment barriers and provide an opportunity to jointly address challenges.

PURPOSE

 This study explored psychosocial well-being and predictors among adults who are deaf or hard of hearing (DHH).

RESEARCH DESIGN

 Cross-sectional survey.

STUDY SAMPLE

 Two-hundred and sixty-nine surveys were included in the analysis.

DATA COLLECTION AND ANALYSIS

 Data were collected online. Backward elimination regression analyses were used to identify significant predictors of psychosocial well-being.

RESULTS

 Findings indicated most (∼70-80%) of the respondents' scores were below clinical cut-off for psychological distress, self-efficacy, quality of life, overall well-being, functioning, and relationship satisfaction, with the remainder falling between mild to severe clinical cut-offs. Psychological distress was predicted by more psychological inflexibility, presence of additional disabilities, and younger age. Increased functional impairment was predicted by psychological inflexibility.

CONCLUSION

 The majority of adults who are DHH in this study had positive indicators for psychosocial well-being. Screening patients for psychological flexibility could be included in standard hearing health care practices to help clinicians identify individuals who may benefit from additional or different support.

Hearing care and management priority among parents of children with Down syndrome: a grounded theory

OBJECTIVE

This study qualitatively explored the factors that influence how parents of children who are Deaf or hard-of-hearing with Down syndrome prioritise hearing care and management and developed an associated theory to explain that priority.

DESIGN

Grounded theory was used for the purposes of this qualitative study. Data were collected using in-depth interviews which were analysed using a three-tiered qualitative coding process.

STUDY SAMPLE

Eighteen mothers of children who are Deaf or hard-of-hearing with Down syndrome participated in this study.

RESULTS

The higher the extent of engaged professional support, perception of benefit for child, parent activation, and family engagement, the higher the priority for hearing care and management will likely be among parents of children who are Deaf or hard-of-hearing with Down syndrome.

CONCLUSIONS

Understanding how parents of children who are Deaf or hard-of-hearing with Down syndrome decide to prioritise hearing care and management has implications for how hearing health providers and others provide care to parents to enhance priority for hearing-related needs.

Applied tele-audiology research in clinical practice during the past decade: a scoping review

OBJECTIVE

The purpose of this scoping review was two-fold, (1) to provide information about the characteristics, type of service delivery, participant information and outcomes related to tele-audiology in clinical popluations, and (2) to describe documented facilitators and barriers to tele-audiology delivery from the perspectives of practitioners and service recipients. Knowledge of these findings can assist audiologists in considering remote service delivery options for their practices.

DESIGN

A scoping review was conducted in November 2019 to identify English-language peer-reviewed journal articles published from 1 January 2010 to 30 October 2019 related to remote clinical service delivery in audiology.

RESULTS

Thirty-six published research articles were included. Research studies were classified into four broad areas with some articles including more than one area within the scope of their article: Screening (n = 5), Diagnostic (n = 5), Intervention (n = 18), and Perspectives (n = 22).

CONCLUSION

Hearing healthcare service delivery is expanding with the changing technological landscape, providing greater opportunities and flexibility for audiologists and patients. There are clear opportunities for interdisciplinary collaboration and for collaboration with on-site local facilitators. Local facilitators, with training, can assist in connecting individuals to follow-up care, provide educational support, and needed hands-on assistance for specialised testing.

Audiologist Practices: Parent Hearing Aid Education and Support

Background: Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits.

Purpose: The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents.

Research Design: A cross-sectional, population-based survey was used.

Study Sample: Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States.

Data Collection and Analysis: Responses were collected through the mail and online. Descriptive statistics were used to analyze the information.

Results: More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53–79%), regardless of their previous training experience.

Conclusions: For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Pediatric Hearing Aid Use: How Can Audiologists Support Parents to Increase Consistency?

Background: Children need consistent access to the full range of speech sounds for spoken language development, making daily hearing aid management a fundamental component of effective intervention. In addition to receiving services from professionals with expertise in childhood hearing loss, parents play a central role in the intervention process. However, parents can experience an array of barriers and challenges in learning to cope with the demands of daily management. Feedback about hearing aid use time might offer parents insight into challenges and lead to the identification of strategies to increase use, optimizing child outcomes.

Purpose: This exploratory study had 2 primary purposes: (1) to examine hearing aid use time for a cohort of children 7 mo to 6 yr of age and (2) to examine whether hearing aid use time increased when parents were given periodic objective feedback (i.e., data-logging results) about average daily use time.

Research Design: A retrospective chart review was used to collect data on eligible participants.

Results: Findings for 29 children (7 mo to 6 yr of age) revealed variability in hours of hearing aid use and an increase in hours of use with age and severity of hearing loss. Reports of typical hearing aid use from seven parents revealed that parents overestimated use by an average of 3.36 hr. Review of challenges reported revealed issues with retention, awareness of the effect of nonuse on average daily access to sound, and lack of perceived benefit of hearing aid use. Hearing aid use increased with communication about data logging for some, but not all, parents.

Conclusions: For effective integration of essential hearing aid management skills into the daily lives of primary caregivers, audiologists must consider caregiver needs in the overall child management and monitoring plan. The ability to optimize child outcomes might depend in part on the extent audiologists embrace family-centered services, engage in collaborative problem solving, and support parents in applying individualized strategies.

Parent Hearing Aid Experiences in the United States

Background: Children born with permanent hearing loss have the opportunity to receive services earlier as a result of newborn hearing screening (NHS). We conducted a survey to address three aspects within the early hearing detection and intervention (EHDI) process: (1) timeliness of service delivery, (2) hearing device access, and (3) hearing aid management. Parent experiences provide valuable information in identifying existing challenges for these components of the EHDI system.

Purpose: The aim was to investigate parent experiences as they access and manage hearing aids for their child.

Research Design: A cross-sectional, population-based survey was used.

Study Sample: Three hundred fifty-two completed surveys from parents of children born between 1977 and 2010 were returned from 45 states in the United States.

Data Collection and Analysis: Responses were obtained online and through the mail, and were analyzed using descriptive statistics.

Results: Over time, the age of hearing loss identification has decreased to a median of 2 mo, age of first hearing aid fitting has decreased to a median of 5 mo, and the delay between hearing loss identification and hearing aid fitting has remained the same with a median of 2 mo. For children born between 2007 and 2010, the top three challenges parents reported in obtaining hearing aids were (1) paying for hearing aids, (2) accepting the need for hearing aids, and (3) wait time for an appointment. Almost one-half (48%) of the parents reported that they did not receive adequate support from their audiologist in how to check the function of their child's hearing aids.

Conclusions: Significant progress has been made over the past two decades in reducing the age of hearing loss identification and hearing aid fitting for children who do not pass the NHS. However, many children continue to experience delays between hearing loss diagnosis and hearing aid fitting that exceed Joint Committee on Infant Hearing recommendations. The experiences parents reported provide valuable information about areas that need further investigation to improve the process for children with hearing loss.

Classroom Listening Experiences of Students Who Are Deaf or Hard of Hearing Using Listening Inventory For Education-Revised

Purpose This study examined classroom listening experiences reported by students who are deaf or hard of hearing using the Listening Inventory For Education-Revised (LIFE-R). Method Retrospective electronic survey responses from 3,584 school-age participants were analyzed using descriptive statistics to report student perceptions of listening difficulty in various classroom scenarios, including the strategies students used when they did not hear or understand. Stratified data were used to explore potential differences between grades and across degree of hearing loss or type of hearing technology. Results Average student listening appraisal ratings for 15 classroom, school, and social scenarios was 5.7 based on a 10-point Likert scale (0 = difficult, 10 = easy), highlighting listening difficulties encountered during the school day. This finding can be considered in context with the average rating of 7.2 reported from a previous study of students with typical hearing using the LIFE-R. The greatest difficulties were reported when trying to listen when other students in the class were making noise and in hearing the comments of other classmates. Average listening difficulty was greater for respondents in Grades 3-6 than those in Grades 7-12. Listening difficulty also generally increased relative to degree of hearing loss. When unable to hear, some students took proactive steps to improve their listening access; some reported they did nothing. Conclusions Students who are deaf or hard of hearing can face challenges in hearing and understanding throughout the school day. A functional tool to evaluate and monitor student experiences, such as the LIFE-R, can provide information to make necessary and effective adjustments to classroom instruction and the listening environment.

Pediatric Hearing Aid Management: Challenges among Hispanic Families

Hearing aid fitting in infancy has become more common in the United States as a result of earlier identification of hearing loss. Consistency of hearing aid use is an area of concern for young children, as well as other hearing aid management challenges parents encounter that may contribute to less-than-optimal speech and language outcomes. Research that describes parent hearing aid management experiences of Spanish-speaking Hispanic families, or the extent of their needs, is not available. To effectively support parent learning, in a culturally sensitive manner, providers may benefit from having a better understanding of the needs and challenges Hispanic families experience with hearing aid management.

The purpose of the current study was to describe challenges with hearing aid management and use for children from birth to 5 yr of age, as reported by Spanish-speaking parents in the United States, and factors that may influence hearing aid use.

This study used a cross-sectional survey design.

Forty-two Spanish-speaking parents of children up to 5 yr of age who had been fitted with hearing aids.

Responses were obtained from surveys mailed to parents through early intervention programs and audiology clinics. Descriptive statistics were used to describe frequencies and variance in responses.

Forty-seven percent of the parents reported the need for help from an interpreter during audiology appointments. Even though parents received information and were taught skills by their audiologist, many wanted to receive more information. For example, 59% wanted to know how to meet other parents of children who have hearing loss, although 88% had previously received this information; 56% wanted to know how to do basic hearing aid maintenance, although 71% had previously received instruction. The two most frequently reported hearing aid use challenges were fear of losing the hearing aids, and not seeing benefit from the hearing aids. Hearing aid use during all waking hours was reported by more parents (66%) when their child had a good day than when their child had a bad day (37%); during the previous two weeks, 35% of the parents indicated their child had all good days.

Hispanic parents wanted more comprehensive information, concrete resources, and emotional support from the audiologist to overcome hearing aid management challenges. Understanding parents’ perspectives, experiences, and challenges is critical for audiologists to provide appropriate support in a culturally sensitive manner and to effectively address families’ needs.

Teaching Counseling Skills in Audiology Graduate Programs: Clinical Supervisors’ Perceptions and Practices

Counseling is a critical component within audiological service delivery. Partnering with patients to support them in learning to effectively cope with their hearing challenges is a key component in achieving desired outcomes. Even though there is agreement on the foundational role counseling plays in audiology service delivery, counseling instruction varies among audiology training programs.

The purpose of this study was to investigate the perspectives and practices of supervisors in audiology graduate training programs related to mentoring students in the acquisition of counseling skills.

A cross-sectional design was used; participants completed a self-report survey.

The survey was sent to 323 clinical supervisors in AuD graduate programs in the United States.

Completed surveys were received from 205 supervisors. Responses were analyzed using descriptive statistics to identify practice trends.

Participants reported their perceptions about importance of teaching counseling skills to audiology students, their confidence in teaching skills, their self-efficacy for supporting student learning, how they provide feedback to students, and challenges they encounter. Most participants reported their program requires a counseling course (88%; n = 176). Most of the participants reported confidence in teaching counseling skills; however, fewer reported being very or extremely confident in teaching students how to talk with clients about their emotions (53%; n = 109) and explaining the rationale behind specific counseling strategies (47%; n = 97). Participants with more years of supervisory experience had statistically significantly higher self-ratings for teaching confidence and self-efficacy for supporting student learning in counseling than those with fewer years of experience.

Audiology supervisors in AuD programs believe counseling is important to teach to students; however, they report variability in use of methods for providing feedback, evaluating student performance, and in their self-efficacy for supporting student learning. Future audiologists would benefit from a more systematic approach within graduate training for teaching counseling skills.

Counseling in Pediatric Audiology: Audiologists’ Perceptions, Confidence, and Training

Pediatric audiologists are an important source of support for parents when a child is identified with hearing loss. As parents learn how to manage their child’s hearing loss they often need help navigating challenges that arise; however, audiologists may experience a variety of barriers implementing effective counseling strategies. Many internal and external barriers experienced by parents can be appropriately supported and navigated within audiology services.

To investigate audiologists’ perceptions, training, and confidence related to counseling and to explore the influence of years practicing audiology and taking a counseling course on perceptions and confidence.

A cross-sectional, population-based survey.

Three hundred and fifty surveys were analyzed from pediatric audiologists across the U.S. Responses were received from 26 states and one U.S. territory.

Data were collected through the mail and online. Descriptive and comparative statistics were used to analyze the information. Content analysis was performed to identify emergent themes from the responses to open-ended questions.

Pediatric audiologists reported their perceptions about importance of counseling skills, challenges they encounter, their confidence in counseling, and how often they use the skills when needed in practice. Most audiologists (≥75%) felt it was very or extremely important to talk with parents about nine of the ten items (e.g., their [parents’] expectations). Three-fourth of the audiologists reported experiencing a moderate challenge or greater in knowing how to assess the presence of psychosocial challenges and in having enough time to address emotional needs. Many of the audiologists felt very or extremely confident in guiding parents in the development of an action plan (62%) and determining if parents have external barriers (60%). Approximately one-third or less of the participants reported performing any of the skills (e.g., determining if parent has external or internal barriers) ≥75% of the time, and a statistically significant difference was found with participants practicing ≤10 yr using the skills more frequently than participants practicing for ≥11 yr. In addition, there was a statistically significant difference between participants who had taken an audiology-specific counseling course and those who had not; those who had reported being more confident and using counseling skills more often than audiologists did not have a counseling course.

This study found strong support for audiologist perceived importance of counseling; however, fewer audiologists reported confidence in their counseling skills and in using counseling skills. Counseling training was variable; audiologists would benefit from a more systematic approach to counseling instruction within graduate training.

Promoting Counseling Skills in Audiology Clinical Supervisors: Considerations for Professional Development

Purpose Clinical supervision for counseling skill development can be variable and can undermine student ability to learn patient-centered care communication. The current study aimed to evaluate the effectiveness of consultation and feedback sessions on counseling behavior, in actual clinical practice, among clinical audiology supervisors. We also collected qualitative data on participants' experiences and suggestions for improving the counseling intervention to increase counseling communication in audiology graduate training programs. Method We used a noncurrent multiple baseline design and staggered the counseling intervention to control for effects of concurrent events and passage of time. Results Two participants showed small but reliable increases in counseling behavior, whereas the 3rd participant showed bigger but less stable increases in counseling. Participants reported that brief feedback sessions were helpful; however, they also mentioned barriers to counseling, such as worries with how much time counseling could take when they have back-to-back appointments. Conclusion Clinical audiology supervisors were able to improve their counseling skills in real-life sessions with regular feedback. More structure may be needed to strengthen future counseling skills.

Family Involvement in Adult Hearing Evaluation Appointments: Patient Perspectives

Background Many adults suffer from an array of consequences due to their hearing loss (e.g., self-efficacy, mastery, psychosocial challenges). Family involvement can help improve their outcomes. Purpose This study aimed to determine audiology adult patients hearing experiences and inquired about their perspectives on family involvement in appointments. Research Design A cross-sectional survey was completed. Descriptive statistics, item analyses, and quantitative analyses were used to examine patient's characteristics and perspectives. Study Sample Three hundred eighty-two adult audiology patients participated in the study. Data Collection and Analysis A 15-item survey was created with 4 sections, including patient demographic information, general hearing questions, hearing experiences, and family interactions and involvement. Descriptive statistics were used to examine patient's characteristics and perspectives on family involvement in audiology appointments. Chronbach's alpha was used to reveal good internal consistency of difficult feelings related to hearing and perceived negative family member reactions. Quantitative analyses were used to determine patient perspectives on family involvement. Results Though patients reported difficulties due to their hearing loss, more than half reported that they did not want family involvement or they were unsure of the benefit that the involvement would provide. Patients who were interested in having family involved reported benefits such as educational opportunities and support. Few barriers of family involvement were reported by patients. Conclusions Patients had a mixed desire about family involvement in their adult audiology appointments. Education of patients about the benefits of family involvement may need to happen for this shift in audiologic practice.

The immune response of the scallop Argopecten purpuratus is associated with changes in the host microbiota structure and diversity

All organisms live in close association with a variety of microorganisms called microbiota. Furthermore, several studies support a fundamental role of the microbiota on the host health and homeostasis. In this context, the aim of this work was to determine the structure and diversity of the microbiota associated with the scallop Argopecten purpuratus, and to assess changes in community composition and diversity during the host immune response. To do this, adult scallops were immune challenged and sampled after 24 and 48 h. Activation of the immune response was established by transcript overexpression of several scallop immune response genes in hemocytes and gills, and confirmed by protein detection of the antimicrobial peptide big defensin in gills of Vibrio-injected scallops at 24 h post-challenge. Then, the major bacterial community profile present in individual scallops was assessed by denaturing gradient gel electrophoresis (DGGE) of 16S rDNA genes and dendrogram analyses, which indicated a clear clade differentiation of the bacterial communities noticeable at 48 h post-challenge. Finally, the microbiota structure and diversity from pools of scallops were characterized using 16S deep amplicon sequencing. The results revealed an overall modulation of the microbiota abundance and diversity according to scallop immune status, allowing for prediction of some changes in the functional potential of the microbial community. Overall, the present study showed that changes in the structure and diversity of bacterial communities associated with the scallop A. purpuratus are detected after the activation of the host immune response. Now, the relevance of microbial balance disruption in the immune capacity of the scallop remains to be elucidated.

Counseling Competencies in Audiology: A Modified Delphi Study

Purpose Counseling practices in audiology play a critical role in helping patients and families understand, accept, and adjust to the dynamic impacts ear-related disorders have on their lives. The purpose of this study was to identify what competencies (i.e., knowledge, skills, and attitudes) are important for audiologists to possess to provide effective counseling in practice. Method A modified Delphi study design was used to survey a panel of 33 professionals with expertise in audiologic counseling from 5 different countries. In the 1st survey round, experts were asked to respond to 3 open-ended prompts. Responses were condensed and revised into items experts were asked to rate during the 2nd and 3rd survey rounds, on a 6-point Likert scale of importance. Results A total of 819 items were generated from the open-ended prompts. A total of 72 items were included in the 2nd and 3rd rounds of survey instruments. Consensus was met on 64 audiologic counseling competency items. Conclusions The competency items identified in this study reflect important knowledge, skills, and attitudes that are important to audiologic counseling. Items that met consensus in this study can inform competencies audiology students can acquire during graduate training. Practice guidelines in the field currently lack the necessary clarity and detail needed for implementation of counseling competencies in clinical education. Future research is needed to explore factors important for implementation of evidence-based counseling training in graduate audiology programs.

[Expansion of family medicine in Latin America: challenges and lines of actionExpansão da medicina familiar na América Latina: desafios e linhas de ação]

Este documento tiene por objetivos resumir los desafíos actuales de la medicina familiar en América Latina y proponer posibles líneas de acción para consolidar su desarrollo. En los últimos 40 años, los sistemas de salud de la Región de las Américas han encarado reformas cuyos resultados fueron negativos en términos de equidad, y la atención primaria de la salud, lejos de ser aquella estrategia destinada a reducirla, se restringió a una política focal y selectiva. En este contexto, las propuestas técnicas de expansión de las plazas de formación en medicina familiar y su inserción en las carreras de Medicina, han carecido de coherencia y de una dirección política clara, por lo que su falta de eficacia puede leerse como un síntoma de estas reformas incompletas. Al respecto, la Confederación Iberoamericana de Medicina Familiar realizó recomendaciones sobre el compromiso político de los gobiernos para asegurar la estructura y el financiamiento necesarios, consolidar el modelo de medicina familiar como mecanismo de instrumentación de la atención primaria de la salud, la jerarquización de los programas de formación, las condiciones laborales de los médicos de familia y la certificación profesional, entre otras. Estas recomendaciones técnicas, sin acción política coherente y oportuna, no serán más exitosas que los intentos previos.

El relato de la historia que nadie conocía: programa de medicina familiar para la transformación social

Objetivo: conocer el desarrollo del programa de medicina familiar de la Fundación Universitaria de Ciencias de la Salud (FUCS) de Bogotá DC, Colombia, diez años [2007- 2017] Método: mediante la sistematización de experiencias se compilaron las voces de quienes han hecho parte en la formación y evolución del programa, como egresados, docentes y personal administrativo. Resultados: se logró develar los momentos históricos más relevantes en la estructuración y organización, identificando los enfoques epistémicoclínico y comunitario que durante años han matizado la formación de residentes, los procesos administrativos, los convenios institucionales, así como los aciertos, desaciertos y tensiones. Discusión: el programa de ha estado permeado por los cambios en las tendencias teóricas dadas por el ámbito internacional. También ha demostrado su valioso aporte a la medicina familiar como disciplina dentro del  contexto colombiano.  Conclusión: el programa ha logrado consolidarse  a nivel nacional y ha mantenido un espíritu innovador, buscando siempre ser el primero en implementar nuevas estrategias y formas de aplicar la medicina familiar.

Counseling Skill Development in Audiology: Clinical Instruction Considerations

Audiologists play a critical role in supporting patients as they provide diagnostic information about their hearing and in the delivery of treatment services. Graduate training related to counseling, however, varies among programs in the extent students are prepared to engage effectively and intentionally with patients. Instruction is needed to provide students with a framework that supports their ability to learn and implement evidence-based counseling services. This article addresses the impact patients can experience when counseling gaps exist, shares clinical instruction strategies that can support students' acquisition of counseling skills, and discusses considerations for integration of counseling education into graduate training programs.

Performance Feedback to Increase Use of Counseling Skills

Counseling is a critical component of audiological care and when implemented purposefully can yield multiple benefits for patients. Professional guidelines indicate that counseling is within the scope of practice for audiologists, yet research has shown that audiologists feel unprepared and are not comfortable providing adjustment counseling. This may be due to inadequate counseling training in audiology graduate programs. To identify ways to address this counseling training gap, this study examined the use of performance feedback to increase counseling skills among audiology graduate students. In this study, participants ( n  = 5) were recorded during clinical session encounters, and recordings were coded for time spent counseling. A licensed clinical psychologist reviewed the recordings and provided individual performance feedback to participants over the course of the study. Time spent counseling increased by the end of the study, although improvement varied across participants. Results suggest that performance feedback can be used as a method to increase counseling skills in audiology students. However, factors, such as participant motivation, feedback timing, and prerequisite counseling skills, may influence response to feedback. More research is needed on ways to maximize gains from feedback, as well as other methods to improve counseling skills in audiology students.

Opportunities for Audiologists to Use Patient-Centered Communication during Hearing Device Monitoring Encounters

Patient-centered care incorporates patient's priorities, values, and goals. Audiologists can increase patient engagement when they use patient-centered principles during communication. Recent research, however, has revealed counseling gaps in audiology that could be detrimental to the intervention process. The present study sought to understand the extent patient-centered communication strategies were used during hearing device monitoring visits by analyzing audio recordings. Counseling portions of the appointments were transcribed using conversation analysis. Missed opportunities were observed, including not validating patients' emotional concerns, providing technical responses to emotional concerns, providing information without determining patient desire for the information, and not engaging the patient in a shared planning process. Training opportunities to enhance audiological services will be discussed.

Counseling in Audiology: Au.D. Students' Perspectives and Experiences

Counseling in audiology is an important aspect of service delivery. How audiologists interact with patients and foster counseling relationships to help patients and families understand and live with hearing loss can impact outcomes of audiological interventions. Currently, variability exists in how graduate training programs are teaching counseling skills, and the extent to which counseling skills development is supported in clinical experiences is unclear. This article seeks to explore the perspectives related to the importance of counseling and counseling training experiences received through clinical instruction of Au.D. students beginning their final year of study, to identify where counseling training might be limited, and to examine how counseling skills might be better supported. Findings revealed that students generally appreciate the importance of counseling in audiology. Data suggest that how students are supported in developing counseling skills appears to be variable and unstructured.

Improving support for parents of children with hearing loss: provider training on use of targeted communication strategies

BACKGROUND

When proper protocols are followed, children who are identified with a permanent hearing loss early in life have opportunities to develop language on par with their typical hearing peers. Young children with hearing loss are dependent on their parents to manage intervention during early years critical to their development, and parents' ability to effectively integrate recommendations in daily life is foundational for intervention success. Audiologists and early intervention professionals not only need to provide current evidence-based services, but also must address parents' emotional and learning needs related to their child's hearing loss.

PURPOSE

This study explored practice patterns related to education and support provided to parents of children with hearing loss and the influence of an in-service training on provider attitudes.

RESEARCH DESIGN

This study used a prepost design with a self-report questionnaire to identify practice patterns related to communication skills and support used by providers when working with parents of children with hearing loss.

STUDY SAMPLE

A total of 45 participants (21 professionals and 24 graduate students) currently working with children completed the pretraining questionnaire, and 29 participants (13 professionals and 16 graduate students) completed the postquestionnaire.

DATA COLLECTION AND ANALYSIS

Data were collected using an online questionnaire before the training and 1 mo after training. Descriptive analyses were done to identify trends, and paired-samples t-tests were used to determine changes pretraining to posttraining.

RESULTS

Findings revealed that professionals most frequently teach skills to mothers (91%) and infrequently teach skills to fathers (19%) and other caregivers (10%). Professionals reported frequently collaborating with other intervention providers (76%) and infrequently collaborating with primary care physicians (19%). One-third of the professionals reported addressing symptoms of depression and anxiety as an interfering factor with the ability to implement management recommendations. For providers who completed both the prequestionnaires and postquestionnaires, an increase in confidence was reported for several areas of communication; however, as expected, practices remained similar, and all of the practicing professionals and 94% of the graduate students indicated a desire for more training on how to be effective in supporting parents with implementing intervention recommendations.

CONCLUSIONS

Providers do not necessarily use effective methods of communication, needed to adequately help parents, requiring additional focused training to change how providers interact with parents and how support is provided.

Daily uptake of mycotoxins - TDI might not be protective for nursed infants

Exclusive breast feeding is recommended by international bodies for the first six months of life. Because of the presence of contaminants, breast feeding might lead to toxicologically relevant exposure of the nursed child. Exposure towards mycotoxins is of specific interest because of their widespread occurrence in food and of their toxicological profile. We calculated the relationship between maternal intake at the level of the existing TDIs and the exposure in the nursed infants of several mycotoxins to evaluate whether maternal exposure at the TDI is also safe for the nursed infant. If published information was not available we used in silico methods for estimating toxicokinetic parameters and the lactational transfer. A single dose and a continuous daily intake scenario were considered. Maternal intake at the TDI exceeds the age-adjusted TDI (TDI/3) values for infants in case of deoxynivalenol and patulin in the single dose scenario. Exceedance is particularly pronounced for ochratoxin A in the continuous daily intake scenario (29.2 fold above the child adjusted TDI). According to published data in infants impaired kidney function may result from this exceedance. When setting a TDI, the safety of the exclusively nursed infant should be considered in the continuous daily intake scenario.

Evidences of Polymorphism Associated with Circadian System and Risk of Pathologies: A Review of the Literature

The circadian system is a supraphysiological system that modulates different biological functions such as metabolism, sleep-wake, cellular proliferation, and body temperature. Different chronodisruptors have been identified, such as shift work, feeding time, long days, and stress. The environmental changes and our modern lifestyle can alter the circadian system and increase the risk of developing pathologies such as cancer, preeclampsia, diabetes, and mood disorder. This system is organized by transcriptional/tranductional feedback loops of clock genes Clock, Bmal1, Per1-3, and Cry1-2. How molecular components of the clock are able to influence the development of diseases and their risk relation with genetic components of polymorphism of clock genes is unknown. This research describes different genetic variations in the population and how these are associated with risk of cancer, metabolic diseases such as diabetes, obesity, and dyslipidemias, and also mood disorders such as depression, bipolar disease, excessive alcohol intake, and infertility. Finally, these findings will need to be implemented and evaluated at the level of genetic interaction and how the environment factors trigger the expression of these pathologies will be examined.

Hearing Aid Use for Children With Hearing Loss: A Literature Review

Purpose

The purpose of this study was to complete a comprehensive literature review related to hearing aid use during early childhood.

Method

A rapid evidence assessment was completed to provide a summary of information published or presented between 1980 and 2012. A qualitative assessment was completed for all eligible material, emergent themes related to hearing aid use were synthesized, and a narrative summary was generated.

Results

Eight publications, one conference proceeding, and one presentation were identified. Three themes emerged from the review: hours of hearing aid use, factors influencing use, and suggestions about how to increase use from parents and professionals.

Conclusion

Minimal research has been done related to hearing aid use for young children with hearing loss. Further research is needed to address influences such as quality of fit, parent factors, multiple disabilities, and cultural differences and to investigate effective strategies for increasing hearing aid use.

Evaluation of a hearing screening questionnaire for use with Ecuadorian school-aged children

OBJECTIVE

The purpose of this study was to evaluate the accuracy of a teacher-administered hearing screening questionnaire to detect hearing loss among first-grade Ecuadorian children in public schools.

DESIGN

A cross-sectional design was used to compare screening results from the teacher-administered questionnaire and pure-tone audiometry.

STUDY SAMPLE

Children were randomly selected from 117 schools. The study was conducted in two phases to accommodate different school calendars in the country. Data for both screening methods were available for 4616 children.

RESULTS

For Phase 1, almost 90% who failed the questionnaire passed audiometry; and, 85% who failed audiometry passed the questionnaire. A revised questionnaire was used for Phase 2 and 70% who failed the questionnaire passed audiometry; and 85% who failed audiometry, passed the questionnaire. Of the 27 children identified in Phase 2 as having hearing loss at the time screening was done, 88.9% failed audiometry, but only 22.2% failed the questionnaire.

CONCLUSIONS

Because there was little agreement between the questionnaire and the audiometry, it was recommended that the questionnaire not be used to screen Ecuadorian children for hearing loss. The results of this evaluation of the school hearing screening program provided the Ecuadorian government with important information to guide policy decisions.