Health behavior theories as predictors of hearing-aid uptake and outcomes

Objective: To understand hearing behaviors of adults seeking help for the first time through the application of two models of health behavior change: the transtheoretical model and the health belief model. Design: The relationships between attitudes and beliefs were examined relative to hearing-aid uptake and outcomes six months later. Study sample: One hundred and sixty adults completed the University of Rhode Island change assessment (targeting the transtheoretical model), and the hearing beliefs questionnaire (targeting the health belief model), as well as the hearing handicap inventory and the psychosocial impact of hearing loss scale, within two months of an initial hearing assessment. Six months later, participants completed these same questionnaires, while those who had taken up hearing aids also completed hearing-aid outcome questionnaires. Results: (1) Attitudes and beliefs were associated with future hearing-aid uptake, and were effective at modeling this behavior; (2) attitudes and beliefs changed following behavior change, and (3) attitudes and beliefs following behavior change were better predictors of hearing-aid outcomes than pre-behavior change attitudes and beliefs. Conclusion: A counseling-based intervention targeting the attitudes and beliefs assessed by the transtheoretical model and the health belief model has the potential to increase uptake of hearing health care.Funding Agencies|Oticon Foundation; VA Rehabilitation Research and Development Center of Excellence [C9230C]</p

Use of a Frequency-Modulated System for Veterans with Blast Exposure, Perceived Hearing Problems, and Normal Hearing Sensitivity

Traumatic brain injury can impact the central auditory system leading to poor auditory recall and increased difficulties hearing in poor acoustic environments. In recent years, audiologists have increasingly encountered blast-exposed veterans who report speech understanding problems that are disproportionate to their essentially normal hearing sensitivity, and thus are thought to have an auditory processing disorder. In light of studies showing frequency-modulated (FM) systems to be effective rehabilitation for auditory processing difficulties, we examined the use of an FM system intervention for blast-exposed veterans with functional hearing problems in the presence of normal hearing sensitivity. The outcomes for three veterans who were provided with an FM system as part of a multisite randomized clinical trial are described. Data indicate that FM systems are beneficial for some patients reporting hearing problems in the presence of normal hearing sensitivity but factors other than audiometric profile and reported complaints influence outcome. These include understanding of speech in noise, patient communication demands, auditory lifestyle, and the presence of posttraumatic stress disorder or other mental health factors. Furthermore, education (and reeducation if necessary) of the patient and their spouse or family is critical to successful outcome

A Randomized Controlled Trial to Evaluate Approaches to Auditory Rehabilitation for Blast-Exposed Veterans with Normal or Near-Normal Hearing Who Report Hearing Problems in Difficult Listening Situations

Background: Blast exposure is a major source of injury among Service members in the Iraq and Afghanistan conflicts. Many of these blast-exposed veterans report hearing-related problems such as difficulties understanding speech in noise and rapid speech, and following instructions and long conversations that are disproportionate to their measured peripheral hearing sensitivity. Evidence is mounting that these complaints result from damage to the central auditory processing system. Purpose: To evaluate the effectiveness of audiological rehabilitative interventions for blast-exposed veterans with normal or near-normal peripheral hearing and functional hearing difficulties. Research Design: A randomized controlled trial with four intervention arms. Study Sample: Ninety-nine blast-exposed veterans with normal or near-normal peripheral hearing who reported functional hearing difficulties. Intervention: Four interventions were compared: compensatory communication strategies (CCS) education, CCS and use of a personal frequency modulation system (FM + CCS), CCS and use of an auditory training program (AT + CCS), and use of all three interventions combined (FM + AT + CCS). Data Collection and Analysis: All participants tested before, and immediately following an 8-week intervention period. The primary outcome measures upon which the study was powered assessed speech understanding in noise and self-reported psychosocial impacts of the intervention. In addition, auditory temporal processing, auditory working memory, allocation of attention, and hearing and cognitive self-report outcomes were assessed. Results: Use of FM + CCS resulted in significant benefit for speech understanding in noise and self-reported hearing benefits, and FM + AT + CCS provided more self-reported cognitive benefits than FM + CCS, AT + CCS, or CCS. Further, individuals liked and reported using the FM system, but there was poor adherence to and high attrition among individuals assigned to receive AT. Conclusions: It is concluded that a FM system (or remote microphone via Bluetooth system) is an effective intervention for blast-exposed veterans with normal or near-normal hearing and functional hearing difficulties and should be routinely considered as an intervention approach for this population when possible

Hearing Screening in the Community

Background: Adults typically wait 7–10 yr after noticing hearing problems before seeking help, possibly because they are unaware of the extent of their impairment. Hearing screenings, frequently conducted at health fairs, community events, and retirement centers can increase this awareness. To our knowledge, there are no published studies in which testing conditions and outcomes have been examined for multiple “typical screening events.” Purpose: The purpose of this article is to report hearing screening outcomes for pure tones and self-report screening tests and to examine their relationship with ambient noise levels in various screening environments. Study Sample: One thousand nine hundred fifty-four individuals who completed a hearing screening at one of 191 community-based screening events that took place in the Portland, OR, and Tampa, FL, metro areas. Data Collection and Analysis: The data were collected during the recruitment phase of a large multisite study. All participants received a hearing screening that consisted of otoscopy, pure-tone screening, and completion of the Hearing Handicap Inventory–Screening Version (HHI-S). In addition, ambient sound pressure levels were measured just before pure-tone testing. Results: Many more individuals failed the pure-tone screening (n = 1,238) and then failed the HHI-S (n = 796). The percentage of individuals who failed the pure-tone screening increased linearly with age from \u3c20% for ages \u3c45 yr to almost 100% for individuals aged ≥85 yr. On the other hand, the percentage of individuals who failed the HHI-S remained unchanged at approximately 40% for individuals aged ≥55 yr. Ambient noise levels varied considerably across the hearing screening locations. They impacted the pure-tone screen failure rate but not the HHI-S failure rate. Conclusions: It is important to select screening locations with a quiet space for pure-tone screening, use headphones with good passive attenuation, measure sound levels regularly during hearing screening events, halt testing if ambient noise levels are high, and/or alert individuals to the possibility of a false-positive screening failure. The data substantiate prior findings that the relationship between pure-tone sensitivity and reported hearing loss changes with age. Although it might be possible to develop age-specific HHI-S failure criteria to adjust for this, such an endeavor is not recommended because perceived difficulties are the best predictor of hearing health behaviors. Instead, it is proposed that a public health focus on education about hearing and hearing loss would be more effective

Development of a Hearing Help-seeking Questionnaire Based on the Theory of Planned Behavior

Objective: Our objective was to develop and assess a questionnaire measuring the constructs of the theory of planned behaviour (TPB) regarding older adults’ behaviours towards seeking a hearing test. Design: Older adults who failed a hearing screening completed a newly developed Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) questionnaire. A principal components analysis (PCA) examined the factor structure of the questionnaire, and a reliability analysis determined the internal consistency of the factors. An examination of six-month follow-up data determined whether the questionnaire differentiated between individuals who did and did not seek out a hearing test by comparing their TPB-HHS scores. Study Sample: Participants were 407 adults aged 50 to 89 recruited at community hearing screenings. Results: PCA and reliability analyses resulted in a 4-factor, 18 item questionnaire. Three of four factors demonstrated acceptable internal consistency. The TPB-HHS explained 60.18% of the variance and factors were interpreted to be measuring the constructs of Intentions, Perceived Behavioral Control, Attitudes, and Subjective Norms. Individuals who sought a hearing test scored significantly higher on the Intentions, Perceived Behavioral Control, and Attitudes scales than those who did not. Conclusions: The TPB-HHS provides insight into underlying psychological mechanisms that drive behaviours related to hearing help-seeking in older adults

Auditory Difficulties in Blast-exposed Veterans with Clinically Normal Hearing

Vast numbers of blast-injured Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn personnel report postconcussive symptoms that include headache, dizziness, poor memory, and difficulty concentrating. In addition, many report hearing problems, such as difficulty understanding speech in noise, yet have no measureable peripheral auditory deficits. In this article, self-report and performance-based measures were used to assess 99 blast-exposed Veterans. All participants reported auditory problems in difficult listening situations but had clinically normal hearing. Participants\u27 scores on self-report questionnaires of auditory difficulties were more similar to scores of older individuals with hearing impairment than to those of younger individuals with normal hearing. Participants showed deficits relative to published normative data on a number of performance-based tests that have demonstrated sensitivity to auditory processing deficits. There were several measures on which more than the expected number of participants (15.9%) performed one or more standard deviations below the mean. These were assessments of speech understanding in noise, binaural processing, temporal resolution, and speech segregation. Performance was not universally poor, with approximately 53% of participants performing abnormally on between 3 and 6 of the 10 measures. We concluded that participants exhibited task-specific deficits that add to the evidence suggesting that blast injury results in damage to the central auditory system

Is Measured Hearing Aid Benefit Affected by Seeing Baseline Outcome Questionnaire Responses?

PURPOSE: To determine whether hearing aid outcome measured by the Hearing Handicap Inventory (HHI) for the Elderly/Adults (Newman, Weinstein, Jacobson, & Hug, 1990; Ventry & Weinstein, 1982) is differentially affected by informed vs. blind administration of the postfitting questionnaire. METHOD: Participants completed the HHI at their hearing aid evaluation and again at their hearing aid follow-up visit. At follow-up, half received a clean HHI form (blind administration), whereas the remainder responded on their original form (informed administration) and could thus base their follow-up responses on those they gave at the hearing aid evaluation. RESULTS: The data show that for the population examined here, informed administration of the follow-up HHI did not yield a different outcome to blind administration of the follow-up HHI. This was not influenced by past hearing aid use, age of the participant, or the duration of time between baseline questionnaire completion and follow-up completion. CONCLUSION: These data suggest that completion of follow-up questionnaires in either informed or blind format will have little impact on HHI responses, most likely because of the many other factors that combined to influence hearing aid outcome