Self-efficacy, communication difficulties and readiness predict outcomes in new hearing aid users

Self-efficacy, communication difficulties and readiness predict outcomes in new hearing aid user

Applying the COM-B model to assess the usability of smartphone-connected listening devices in adults with hearing loss

Background: Unlike conventional hearing aids, smartphone-connected listening devices may require limited or no input from a trained audiologist in terms of device programming and adjustment. However, there is a lack of peer-reviewed evidence assessing the real-world perspectives of people living with hearing loss toward such technological innovations. Purpose: This study assessed the everyday experiences of adults living with hearing loss toward a range of smartphone-connected listening devices using the COM-B model as a theoretical framework. Research Design: A qualitative study whereby participants trialled one of the following smartphone-connected listening devices for two-weeks in their everyday lives: made-for-smartphone hearing aids, personal sound amplification product, smartphone ‘hearing aid’ app with wired earphones or wireless hearable. Individual semi-structured interviews were conducted. Study Sample: Twenty adults (13 male, 7 female; mean age = 62.25 years, SD = 11.59) with mild-moderate hearing loss (mean better ear pure-tone average = 30.49 dB HL, SD = 17.51) were recruited using a convenience sampling strategy. All participants owned conventional hearing aids. Results: The data were analysed using an established deductive thematic analysis procedure within the context of the COM-B model. The model stipulates that for individuals to engage in a particular behaviour (B), they must have sufficient capability (C), opportunity (O), and motivation (M). Capability: One of the key advantages facilitating use and adherence of smartphone-connected listening devices was the ability for participants to make fine-tune adjustments in any listening situation. Opportunity: Participants commented that these devices could address issues surrounding stigma, as smartphones are ubiquitous in everyday life. Motivation: Participants consistently reported that the ability to make adjustments via a smartphone provided them with a greater sense of autonomy and empowerment. As a result, they felt more in control of their hearing loss. Conclusions: This study lays the foundation for further high-quality research to explore whether smartphone-connected technologies have the potential to yield optimum benefits for people living with hearing loss

Knowledge is power: improving outcomes for patients, partners, and professionals in the digital age

Purpose The aim of this research was to develop and evaluate methods to address poor knowledge of hearing aids, hearing loss, and communication in patients, partners, and nonaudiologic health and social care professionals. Method An interactive multimedia educational program (C2Hear) has been co-produced with hearing aid users and audiologists to provide high-quality information and demonstrate complex concepts relating to hearing aids and communication. Results A randomized controlled trial showed numerous benefits for first-time hearing aid users that included better knowledge and skill, and increased hearing aid use and satisfaction. Patients reported that C2Hear was highly useful, enjoyable, and preferable to written information. C2Hear Online is now freely available on YouTube and has global reach, well in excess of 150,000 views. Further developments include a version for communication partners, which showed that joint-working between hearing aid users and their communication partners resulted in joint responsibility for communication that facilitated communication behaviors. In addition, a behavior theory-driven version for use with mobile technologies (m2Hear) has been designed to be tailored to the needs of individual hearing aid users. m2Hear includes more activities/interaction to maximize user engagement and learning. Finally, C2Hear has been used to improve hearing-related knowledge in other health and social care professionals, such as carehome assistants. Conclusion This range of educational programs and tools aims to improve knowledge and skills, leading to better outcomes for patients, partners, and health care professionals

Consensus on connected hearing health technologies and service delivery models in the UK: a Delphi review

Objective: To develop a consensus among hearing healthcare professionals in the UK on connected hearing health technologies and service delivery models.Design: A three-round, electronic Delphi review was developed using a participatory-design approach. This included ten open-ended questions (round one) that informed 69 Likert-scaled statements (rounds two and three).Study Sample: An expert panel of 34 hearing health professionals representing all geographic regions of the UK from either the publicly-funded National Health Service (n=22) or independent sector (n=12).Results: The majority of statements (61%) showed ≥80% consensus, highlighting that there was broad agreement amongst professionals on connected hearing health technologies. For example, there was consensus that adults who report communication difficulties and have no medical contraindications would be ideal candidates. Furthermore, it was unanimously agreed that connected technologies could result in delays in diagnosis of treatable medical conditions, as well as result in inadequate amplification. Overall, the expert panel concurred that connected technologies could serve as “gateway products” that lead to earlier hearing aid uptake.Conclusions: This Delphi review identified overarching areas of agreement that may serve as a blueprint for future implementation of connected hearing health technologies through either conventional or new service delivery models in the UK.</div

Smartphone-connected hearing aids enable and empower self-management of hearing loss: a qualitative interview study underpinned by the behavior change wheel

Objectives: To identify patient-reported barriers and facilitators to using smartphone connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed.Design: A single-center, prospective, observational study. Eight hearing aid users (new=1, existing=7; mean age= 71.75 years, SD= 5.23, range= 65-81 years) were identified through convenience sampling from 44 participants who took part in a seven-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, pre-set and customized programmes. Participants were assigned to one of two focus groups following trial of the app.Results: Focus group transcripts were thematically analysed and underpinned by the COM-B (Capability, Opportunity, Motivation – Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators. Capability: The app increased participants’ knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use. Opportunity: Perceived smartphone norms (i.e. acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers. Motivation: The ability to control hearing aid settings in any listening situation (e.g. to reduce noise), empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The app also reduced hearing aid-related and self-stigma, and the ability to self-adjust hearing aids benefitted both participants and communication partners. It was the adjustability and interaction afforded by the app that empowered users, rather than the hearing aid technology itself. Perceived beliefs and knowledge about digital literacy skills, and specifically abilities to use a smartphone, were perceived to be barriers in this typically older population, particularly when they compared themselves to younger generations. Using the Behavior Change Technique Taxonomy (version 1), behavior change techniques that could be used by audiologists to address these barriers included enablement, goal setting, re-framing perceptions towards technology, and addressing patient educational needs.Conclusions: Smartphone-connected hearing aids, when used in their everyday lives, were viewed positively by participants across a range of domains, empowering them and enabling hearing loss self-management. Audiologists should consider smartphone-connected hearing aid candidacy for all who have access to smartphones and are willing to use one. Use of the BCW has identified that modifiable barriers to using smartphone-connected hearing aids exist. Audiologists could use these evidence-based behavior change techniques to support patients in adopting and using these technologies to successfully self-manage hearing loss. Overall, by re-framing smartphone technologies as a tool to remain connected with society, smartphone-connected hearing aids could shift the power of managing hearing loss from clinician to patient. </div

Refinement and validation of the social participation restrictions questionnaire: An application of Rasch analysis and traditional psychometric analysis techniques

OBJECTIVES: The primary aim of this research was to refine and validate the Social Participation Restrictions Questionnaire (SPaRQ). The SPaRQ is a hearing-specific, patient-reported outcome measure that was originally developed through consultation with adults with hearing loss, clinicians, and researchers. This research comprised two studies. Study 1 aimed to assess the psychometric properties of the SPaRQ and to improve these properties by amending the questionnaire (e.g., removing items) as required. Study 2 aimed to validate the refined SPaRQ. DESIGN: In study 1, 279 adults with hearing loss completed a long-form, 53-item SPaRQ. Rasch analysis, a modern psychometric analysis technique, was used to assess a range of psychometric properties for the questionnaire (e.g., unidimensionality, fit to the Rasch model). The properties of the individual items were also assessed (e.g., response dependency, differential item functioning). In study 2, 102 adults with hearing loss completed the refined SPaRQ. In addition, they completed three questionnaires that had been designed to measure related constructs. These were a hearing-specific questionnaire (Hearing Handicap Inventory for the Elderly), a generic health and disability questionnaire (shortened World Health Organization Disability Assessment Schedule 2.0), and a brief depression and anxiety screening questionnaire (Patient Health Questionnaire-4). Traditional psychometric analysis techniques (e.g., Cronbach's alpha) were used to assess the construct validity and internal consistency of the refined SPaRQ. RESULTS: Rasch analysis was used to refine the SPaRQ. The result was a 19-item measure divided into two subscales. The 9-item Social Behaviors subscale measured difficulties with performing actions in a social context due to hearing loss. The 10-item Social Perceptions subscale measured negative thoughts and feelings experienced in a social context due to hearing loss. Both Rasch analysis and the traditional psychometric analysis techniques demonstrated that each subscale had strong psychometric properties. In particular, each subscale passed the test of unidimensionality, displayed good fit to the Rasch model, and had high internal consistency. In addition, it was found that, as predicted, each subscale had strong, positive correlations with the hearing-specific questionnaire and moderate, positive correlations with the generic health and disability questionnaire and the depression and anxiety screening questionnaire. Taken together, these findings support the construct validity of the 19-item SPaRQ. CONCLUSIONS: This was one of the first studies to devise a new hearing-specific outcome measure using Rasch analysis. Rasch analysis proved to be a powerful technique for supporting decisions regarding which items to retain in order to achieve a psychometrically robust questionnaire. Additional support for the robustness of this questionnaire came from the utilization of traditional psychometric analysis techniques. Therefore, this questionnaire has the potential to be used in research and clinical practice to evaluate whether auditory rehabilitation interventions improve social participation in adults with hearing loss. The next stage of this research will be to further validate this questionnaire by assessing its responsiveness in a clinical population. The combined use of modern and traditional psychometric analysis techniques should be considered in future questionnaire development and validation research

The development of an mHealth educational intervention for first-time hearing aid users: combining theoretical and ecologically valid approaches

Objective. This paper describes the development of a novel mobile health (mHealth) educational intervention designed for first-time hearing aid users based on previously developed educational multimedia videos, or reusable learning objects (RLOs), branded C2Hear. Design. The development of m2Hear used theoretical and ecologically valid approaches. The COM-B model and associated Theoretical Domains Framework were employed to identify specific components (or “active ingredients”) of the original RLOs that facilitate hearing aid use. An mHealth platform was then developed following an iterative, user-centred and participatory design approach.Study sample. Fifteen existing hearing aid users completed synchronous, real-time Think Aloud interviews. A sub-group of these participants (n=5), along with patient and public involvement panel members (n=4), subsequently reviewed the usability of the mHealth platform.Results. While factors associated with Capability featured strongly across all RLOs, topics relating to Opportunity and Motivation were also incorporated. The RLOs were broken-down into 42 shorter mobile-enhanced RLOs (or mRLOs). Each mRLO was labelled with a specific user-centred question generated from the Think Aloud interviews. The final mHealth platform was developed following four separate usability iterations.Conclusions. Overall, m2Hear provides greater opportunities for individualised learning and encourages greater interaction to facilitate self-management in first-time hearing aid users.</div

What’s in a name? A systematic review and meta-analysis to assess the effectiveness of non-medical amplification devices in adults with mild and moderate hearing losses

Objective: To assess non-medical amplification devices in adults with mild-to-moderate hearing loss, and the impact of device features on outcomes.Design: A prospectively registered systematic review.Study sample: Ten studies evaluating personal sound amplification products (PSAPs), and four evaluating smartphone amplification applications (or apps). Devices were classified as “premium” or “basic” based on the number of compression channels (≥16 or Results: Meta-analyses showed that premium PSAPs improved speech intelligibility in noise performance compared to unaided, whereas basic PSAPs and smartphone apps did not. Premium PSAPs performed better than basic hearing aids. Premium hearing aids performed better than premium and basic PSAPs, smartphone apps, and basic hearing aids. Although data could not be pooled, similar findings were also found for quality of life, listening ability, cognition, feasibility, and adverse effects.Conclusions: Premium PSAPs appear to be an effective non-medical amplification device for adults with mild-to-moderate hearing loss. Given the overlap in features available, it may be that this is a key consideration when drawing comparisons between devices, rather than the device being named a PSAP or hearing aid. Nevertheless, the extent to which PSAPs are effective without audiological input remains to be determined.</p

What’s in a name? A systematic review and meta-analysis to assess the effectiveness of non-medical amplification devices in adults with mild and moderate hearing losses

Objective: To assess non-medical amplification devices in adults with mild-to-moderate hearing loss, and the impact of device features on outcomes.Design: A prospectively registered systematic review.Study sample: Ten studies evaluating personal sound amplification products (PSAPs), and four evaluating smartphone amplification applications (or apps). Devices were classified as “premium” or “basic” based on the number of compression channels (≥16 or Results: Meta-analyses showed that premium PSAPs improved speech intelligibility in noise performance compared to unaided, whereas basic PSAPs and smartphone apps did not. Premium PSAPs performed better than basic hearing aids. Premium hearing aids performed better than premium and basic PSAPs, smartphone apps, and basic hearing aids. Although data could not be pooled, similar findings were also found for quality of life, listening ability, cognition, feasibility, and adverse effects.Conclusions: Premium PSAPs appear to be an effective non-medical amplification device for adults with mild-to-moderate hearing loss. Given the overlap in features available, it may be that this is a key consideration when drawing comparisons between devices, rather than the device being named a PSAP or hearing aid. Nevertheless, the extent to which PSAPs are effective without audiological input remains to be determined.</p