Discovery and Testimony of Unretained Experts: Creating a Clear and Equitable Standard to Govern Compliance With Subpoenas

Hearing impairment is known to be one of the most frequent sensory impairments. This condition is known to be a hidden disorder which is under recognised and under treated all around the world. The World Health Organisation (WHO) estimates suggest that there are over 275 million people with hearing impairment and 80% of them living in low and middle income countries. Moreover, the estimates suggest that incidence and prevalence of hearing loss and also the number of people with hearing loss accessing services varies considerably across countries. This rises the need for health promotion (or public awareness campaigns) directed to increase awareness and education of hearing loss and hearing healthcare. This paper provides brief discussion on ‘Stories and storytelling’, ‘Cross-culture and cross-cultural communication’ and ‘Health promotion and cultural sensitivity’. The central focus of this paper is to highlight the applications of storytelling in different cultural context in health promotion, particularly to hearing loss public awareness campaigns

The Development and Failure of Social Norms in Second Life

This Note analyzes the development and efficacy of social norms in maximizing the welfare of participants in the virtual community of Second Life. Although some of these norms developed appropriately in response to the objectives and purposes of this virtual world, Second Life is so thoroughly steeped in conditions that have impeded the development of successful social norms in other communities that any system of social norms in Second Life will ultimately fail. Because social norms will likely,fail to successfully maximize resident welfare, regulatory schemes imposed both by the operators of the virtual world and by real-world governing institutions are needed to enhance the functioning of this particular alternative reality inhabited by millions

Representation of Hearing loss and Hearing Aid(s) in the United States Newspaper Media: Cross-sectional Analysis of Secondary Data

Purpose: News media plays an important role in formulating people's knowledge and opinions about various aspects of life, including health. The current study explored how hearing loss and hearing aids are represented in the U.S. newspaper media. Method: A cross-sectional study design was selected to analyze publicly available newspaper media data. The data sets were generated from the database, the U.S. Major Dailies by ProQuest, by searching key words for newspapers published during 1990–2017. Cluster analysis (i.e., text pattern analysis) and chi-square tests were performed using Iramuteq software. Results: The hearing loss data set had 1,527 texts (i.e., articles). The cluster analysis resulted in 7 clusters, which were named as (1) causes and consequences (26.1%), (2) early identification and diagnosis (9%), (3) health promotion and prevention (22.1%), (4) recreational noise exposure (10.4%), (5) prevalence (14.3%), (6) research and development (12.4%), and (7) cognitive hearing science (5.6%). The hearing aids data set had 2,667 texts. The cluster analysis resulted in 8 clusters, which were named as (1) signal processing (20.2%), (2) insurance (8.9%), (3) prevalence (12.4%), (4) research and development (5.4%), (5) activities and relation (16.2%), (6) features to address background noise (13.8%), (7) innovation (12%), and (8) wireless and connectivity (11.1%). Time series analysis of clusters in both “hearing loss” and “hearing aids” data sets indicated changes in the pattern of information presented in the newspaper media during 1990–2016 (e.g., Cluster 7 focuses on cognitive hearing science in a hearing loss data set emerging only since the year 2012 and growing rapidly). Conclusions: The text pattern analysis showed that the U.S. newspaper media focuses on a range of issues when considering hearing loss and hearing aids and that patterns or trends change over time. The study results can be helpful for hearing health care professionals to understand what presuppositions society in general may have as the media has the ability to influence societal perception and opinions

Utvärdera förändringsprocessen : Studier av patientprocesser, acceptans av hörselnedsättning och stadier av beteendeförändring

Person with hearing impairment (PHI) and their Communication partners (CPs) have a range of experiences and milestones before, during and after their audiological assessment and/or rehabilitation sessions. The term ‘patient journey’ refers to understanding the experiences and the processes the patient goes through during the course of the disease and the treatment regime. The aims of the current thesis were: (1) to further develop patient journey models of individuals with gradual-onset hearing impairment and CPs by taking their views into consideration; (2) to develop the patient journey model for PHI of sudden-onset; (3) to develop a self-reported measure of hearing disability acceptance and to study its construct and concurrent validity; (4) to investigate the health behaviour change characteristics of people noticing hearing difficulties using the stages-of-change model.  Papers I (n=32) and III (n=9) were aimed at further developing the journey model of PHI and their CPs proposed by the Ida Institute. Both studies employed qualitative methods (i.e., focus groups and interviews for data collection and thematic analysis for data analysis), and defined the models based on the perspectives of PHI and CPs both of which had seven main phases. These data were compared with the professionals’ perspectives of the journey as reported in the Ida Institute model which had six main phases. Our studies highlight new phases (i.e., self-evaluation in PHI journey and adaptation in CP journey) and also various commonalities and differences in the perspectives expressed by professionals and patients. Paper II included a pilot study to explore the patient journey of sudden-onset acquired hearing impairment from both professionals (n=16) and patients (n=4) perspectives. Both identified all the six main phases, which include: awareness; movement; diagnostics; rehabilitation; self-evaluation; and resolution. The pre-awareness phase may hinder the realisation of hearing loss in persons with gradual onset hearing loss, whereas it is far more straightforward in persons with sudden-onset due to its nature of onset. Papers IV and V employed a cross-sectional design (n=90). Paper IV was aimed at developing a Hearing Disability Acceptance Questionnaire (HDAQ), and to study its construct and concurrent validity. Results suggested that the HDAQ has a two factor structure which explains 75.7% of the variance and had good internal consistency (Cronbach’s alpha of 0.86). Also, the scale had good concurrent validity in relation to self-reported hearing disability, self-reported anxiety and depression and readiness to change measures. Paper V was aimed at understanding the stages-of-change in adults with hearing disability using the University of Rhode Island Change Assessment Scale.  As predicted a high percentage of participants (over 90%) were in the contemplation and preparation stages, supporting the stages-of-change model. Overall, the papers presented in this thesis may contribute to a better understanding of process of change through hearing impairment in PHI and their CPs. Personer med hörselnedsättning (eng. PHI) och deras kommunikationspartners (eng. CPs) har en uppsättning upplevelser och erfarenheter före, under och efter audiologisk bedömning och/eller hörselrehabilitering. Begreppet "patientprocess" avser förståelsen av de erfarenheter och de förändringsprocesser patienten genomgår under sjukdomsförloppet och behandlingen av denna. Syftet med avhandlingen var: (1) att ytterligare utveckla individuella modeller för patientprocessen vid gradvis debut av hörselnedsättning och att ta CPs erfarenheter under beaktande, (2) att utveckla modeller för patientprocessen vid plötslig debut av hörselnedsättning, (3) att utveckla självskattningsmått på acceptans av hörselnedsättning och att studera dess begreppsvaliditet och samtidig validitet, (4) att undersöka beteendeförändring avsende hälsa för personer som upplever hörselnedsättning. Artikel I (n = 32) och artikel III (n = 9) syftade bland annat till att vidareutveckla modell av patientprocessen som och deras kommunikationspartner som föreslagits av Ida Institutet. I båda studierna användes kvalitativa metoder (fokusgrupper och intervjuer för datainsamling och tematisk analys) för att bygga modeller av patientprocessen personen med hörselnedsättning och dess kommunikationspartner, där båda modellerna kom att inkludera sju huvudfaser av processen. Resultaten jämfördes med sjukvårdspersonalens perspektiv på patientprocessen enligt Ida Institutets modell. Studierna visar nya faser (självvärdering för PHIs process och anpassning för CPs process). Dessutom identifierades likheter och skillnader i jämförelsen mellan sjukvårdspersonalens och patientens perspektiv. Artikel II innehåller en pilotstudie för att undersöka och skapa modeller för patientprocessen vid plötslig förvärvad hörselnedsättning från både vårdgivarens (n = 16) och patientens (n = 4) perspektiv. Båda grupper identifierade alla sex huvudfaser. Dessa inkluderar: medvetenhet; rörelse; diagnos; rehabilitering; självvärdering; och lösning på problemet. Pre-awareness (för-medvetande) fasen kan eventuellt fördröja/förhindra förståelsen för hörselnedsättningen för personer med gradvis tilltagande hörselnedsättning, emedan förståelsen är mer direkt för personer med plötslig förvärvad hörselnedsättning. Artikel IV och artikel V var bägge baserade på en tvärsnittsstudie (n=90). Artikel IV syftade till att utveckla ett frågeformulär angående acceptans av hörselhandikapp (eng. Hearing Disabiliy Acceptance Questionnaire, HDAQ) och att studera dess begreppsvaliditet och samtidig validitet. Resultaten visar att HDAQ fick en två-faktor struktur som förklarde 75,7 % av variansen och uppvisade god intern konsistens (Cronbach’s alpha 0,86). Dessutom hade skalan god samtidig validitet i förhållande till självrapporterad hörselnedsättning, självrapporterad ångest och depression, samt i förhållande till beredskap för förändring. Artikel V (n = 90) syftade till att undersöka stadier av beteendeförändring för personer med tidig, förmodad hörselnedsättning, via den så kallade stages-of-change modellen. Mätinstrumentet för beteendeförändring var University of Rhode Island Change Assessment Scale. Som förväntat var en hög andel av deltagarna (över 90%) i tidiga stadier (eng. contemplation and preparation), vilket stöder stages-of-change modellen. Sammanfattningsvis, bidrar artiklarna i denna avhandling till en bättre förståelse av förändingsprocesser via hörselnedsättning för personer med hörselnedsättning och deras kommunikationspartners

Health behavior change in hearing healthcare: a discussion paper

Health behavior change (HBC) refers to facilitating changes to habits and/or behavior related to health. In healthcare practice, it is quite common that the interactions between practitioner and patient involve conversations related to HBC. This could be mainly in relation to the practitioner trying to directly persuade the patients to make some changes in their health behavior. However, the patients may not be motivated to do so as they do not see this change as important. For this reason, direct persuasion may result in a breakdown of communication. In such instances, alternative approaches and means of indirect persuasion, such as empowering the patient and their family members, could be helpful. Furthermore, there are several models and/or theories proposed which explain the health behavior and also provide a structured framework for health behavior change. Many such models/approaches have been proven effective in facilitating HBC and health promotion in areas such as cessation of smoking, weight loss and so on. This paper provides an overview of main models/theories related to HBC and some insights into how these models/approaches could be adapted to facilitate behavior change in hearing healthcare, mainly in relation to: i) hearing help-seeking and hearing-aid uptake; and ii) hearing conservation in relation to music-induced hearing loss (MIHL). In addition, elements of current research related to this area and future directions are highlighted

Storytelling in different cultural context: Applications to hearing loss public awareness campaign

Hearing impairment is known to be one of the most frequent sensory impairments. This condition is known to be a hidden disorder which is under recognised and under treated all around the world. The World Health Organisation (WHO) estimates suggest that there are over 275 million people with hearing impairment and 80% of them living in low and middle income countries. Moreover, the estimates suggest that incidence and prevalence of hearing loss and also the number of people with hearing loss accessing services varies considerably across countries. This rises the need for health promotion (or public awareness campaigns) directed to increase awareness and education of hearing loss and hearing healthcare. This paper provides brief discussion on ‘Stories and storytelling’, ‘Cross-culture and cross-cultural communication’ and ‘Health promotion and cultural sensitivity’. The central focus of this paper is to highlight the applications of storytelling in different cultural context in health promotion, particularly to hearing loss public awareness campaigns

Perspectives on defining hearing loss and its consequences

Objective: This discussion paper aims to highlight factors that may be important in defining hearing loss and its consequences and to present different perspectives based on various models of disability. Method: Relevant literature was reviewed to develop the discussion. Results: Hearing is a complex function that has both cognitive and emotional aspects. A person with hearing loss may have consequences in the physical, mental and social domains. Hearing loss in the context of clinical audiology is currently defined based on type of pathology and severity. However, evidence from both clinical findings and research suggest that this may not cover all the aspects of 'hearing loss' as a disability. Conclusion: Defining and describing hearing loss and its consequences with a holistic approach has some clinical value particularly in the context of audiological enablement/rehabilitation. © 2013 Informa Healthcare

Parental reported benefits and shortcomings of cochlear implantation: pilot study findings from Southeast Asia

Objective: the aim of the study was to understand the reported benefits and shortcomings by parents of children with cochlear implants and who contribute towards the cost of the implant.Method: thirty parents of children with cochlear implants from a hearing impaired school in Southeast Asia completed open-ended questionnaires and the data were analysed using content analysis.Results: a wide range of benefits and shortcomings were reported. However, it is notable that the single most reported shortcoming was related to cost.Discussion: the results suggest that, even though, in general, the reports about benefits and shortcomings were similar to previous results from western countries, the emphasis given to various aspects of shortcomings was different. In particular, it appears that parentally reported outcomes could be related to many factors including the hearing healthcare system with the costs involved for the implanted individuals and their families. These findings help us understand the parental perspectives of the success of cochlear implantation and will be useful during parental counselling session

Communication partners’ journey through their partner’s hearing impairment

The objective of the study was to further the Ida Institute model on communication partner’s (CPs) journey through experiences of person with hearing impairment (PHI), based on the perspectives of CPs. Qualitative approach using thematic analysis and process mapping. Nine CPs of hearing aid users participated in the study, recruited through the Swansea hearing impaired support group. Semi-structured interviews were conducted and the data were used to develop a CP journey template. The Ida Institute model (based on professionals’ perspective) was compared with the new template developed (based on CPs perspectives). Seven main phases were identified which include: (1) contemplation; (2) awareness; (3) persuasion; (4) validation; (5) rehabilitation; (6) adaptation; and (7) resolution. The results suggest some commonalities and differences between the views of professionals and CPs. A new phase ‘adaptation’ was identified from CPs’ reported experiences, which was not identified by professionals in the Ida Institute model. The CP journey model could be a useful tool during audiological enablement/rehabilitation sessions to promote discussion between the PHI and the CP. In addition, it can be used in the training of hearing healthcare professionals

Use of the ‘patient journey’ model in the internet-based pre-fitting counseling of a person with hearing disability : study protocol for a randomized controlled trial

Background Hearing impairment is one of the most frequent chronic conditions. Persons with a hearing impairment (PHI) have various experiences during their ‘journey’ through hearing loss. In our previous studies we have developed a ‘patient journey’ model of PHI and their communication partners (CPs). We suggest this model could be useful in internet-based pre-fitting counseling of a person with hearing disability (PHD). Methods/Design A randomized controlled trial (RCT) with waiting list control (WLC) design will be used in this study. One hundred and fifty eight participants with self-reported hearing disability (that is, score >20 in the Hearing Handicap Questionnaire (HHQ)) will be recruited to participate in this study. They will be assigned to one of two groups (79 participants in each group): (1) Information and counseling provision using the ‘patient journey’ model; and (2) WLC. They will participate in a 30 day (4 weeks) internet-based counseling program based on the ‘patient journey’ model. Various outcome measures which focuses on hearing disability, depression and anxiety, readiness to change and acceptance of hearing disability will be administered pre (one week before) and post (one week and six months after) intervention to evaluate the effectiveness of counseling. Discussion Internet-based counseling is being introduced as a viable option for audiological rehabilitation. We predict that the ‘patient journey’ model will have several advantages during counseling of a PHD. Such a program, if proven effective, could yield cost and time-efficient ways of managing hearing disability