Coulson, Neil S.

Ferguson, Melanie A.

Heffernan, Eithne

Henshaw, Helen

Repository@Nottingham

Full Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=iija20Download by: [University of Nottingham] Date: 29 November 2016, At: 04:27International Journal of AudiologyISSN: 1499-2027 (Print) 1708-8186 (Online) Journal homepage: http://www.tandfonline.com/loi/iija20Application of health behaviour theory to hearinghealthcare research: The state of play and beyondMelanie A. Ferguson, Neil S. Coulson, Helen Henshaw & Eithne HeffernanTo cite this article: Melanie A. Ferguson, Neil S. Coulson, Helen Henshaw & EithneHeffernan (2016) Application of health behaviour theory to hearing healthcare research:The state of play and beyond, International Journal of Audiology, 55:sup3, S1-S2, DOI:10.1080/14992027.2016.1206215To link to this article:  http://dx.doi.org/10.1080/14992027.2016.1206215© 2016 The Author(s). Published by InformaUK Limited, trading as Taylor & FrancisGroup.Published online: 15 Jul 2016.Submit your article to this journal Article views: 152View related articles View Crossmark dataInternational Journal of Audiology 2016; 55: S1–S2EditorialApplication of health behaviour theory to hearing healthcareresearch: The state of play and beyondMelanie A. Ferguson1,2, Neil S. Coulson3, Helen Henshaw1,4 & Eithne Heffernan1,41National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Nottingham, UK, 2Nottingham University HospitalsNHS Trust, Nottingham, UK, 3Division of Rehabilitation and Aging, School of Medicine, University of Nottingham, Nottingham, UK, and4Division of Clinical Neuroscience, School of Medicine, University of Nottingham Nottingham, UKForewordOver recent years, there has been an increasing use of theories ofhealth and illness behaviour from health psychology that has helpedguide hearing healthcare research. In particular, these models havebeen used to improve our understanding of response to hearing lossas a long-term condition, help-seeking, decision-making andintervention uptake in adults with hearing loss. This supplementbrings together a range of theories and models that have beenapplied across other health disciplines, namely the TranstheoreticalModel (TM), the Health Belief Model (HBM), the Self-regulatoryModel (SRM), and the Self-determination Model (SDM). Withinaudiology, the TM and HBM have received the most attention, withan initial focus on help-seeking for hearing loss and hearing aiduptake. This supplement includes not only the TM and HBM butalso theories and models that are new in the field of audiology, butwhich have been widely used with other health conditions: the SRMand SDM. Finally, a newly developed model, the COM-B(capability, opportunity and motivation – behaviour) that incorpor-ates the key components of existing models has been gainingincreasing recognition within health psychology and is just startingto gain ground in audiological research.The inspiration for this supplement in the International Journalof Audiology arose during an ‘Audiology meets Health BehaviourPsychology’ workshop that we (hearing and health psychologyresearchers) held in Nottingham in November 2014, where weinvited UK audiologists and health psychologists to join us indiscussing different health-related theories and models. Followingthe workshop, we invited some of our international colleagues whoare at the forefront of investigating these theories and models inaudiological research, and promoting their use in clinical practice,to contribute to this supplement. As with all papers submitted to theIJA, the submissions to this supplement were subjected to thestandard peer-review process by external reviewers before beingaccepted for publication.The first two papers use the Self-regulatory and Self-determin-ation Theory models. The first paper (Heffernan, Coulson, Henshaw,Barry & Ferguson) sets the scene with a qualitative study that usedLeventhal’s SRM to explore the psychosocial experiences arisingfrom hearing loss through interviews with adults with hearing lossand hearing healthcare professionals. It was found that adults withhearing loss used engaged coping (i.e. directly addressing hearingloss) and disengaged coping, which involved withdrawing fromsituations (e.g. declining an invitation) and withdrawing withinsituations (e.g. sitting quietly whilst others speak). Both copingresponses were perceived to have advantages and disadvantages,depending on the circumstances. The second paper (Ridgway,Hickson & Lind) reports on a quantitative, longitudinal cohort studythat investigated the explanatory power of Deci and Ryan’s SDTmodel in relation to hearing aid adoption decisions and fittingoutcomes. Autonomous motivation was associated with increasedhearing aid adoption and hearing aid satisfaction, while autonomysupport was associated with increased perceived competence andsatisfaction with hearing aids, and reduced activity limitations.The next four papers are based on Prochaska and DiClemente’sTranstheoretical model, which has probably been the most widelyused behaviour change model in audiology to date. The first twopapers (Ferguson, Maidment, Russell, Gregory & Nicholson;Ferguson, Woolley & Munro) report on the TM in the context offirst-time hearing aid users. The first seeks to assess the feasibilityand benefits of the Ida Institute’s Motivational Tools when used in aUK audiology clinic. The audiologists were very positive about theuse of the tools in clinic, and the patient group who engaged withthe motivational tools reported greater self-efficacy, reducedanxiety and greater engagement with the audiologist than thecontrol group, early in the patient journey. The second paper seeksto understand more about the impact of self-efficacy, readiness toimprove hearing, and patient expectations on hearing aid outcomes.Although there was no robust effect of self-efficacy, the studyshowed greater readiness and expectations predicted improvedCorrespondence: Melanie Ferguson, Nottingham Hearing Biomedical Research Unit, 113 The Ropewalk, Nottingham, Nottingham, NG1 5DU, UK. E-mail:melanie.ferguson@nottingham.ac.uk(Received 20 June 2016; accepted 22 June 2016)ISSN 1499-2027 print/ISSN 1708-8186 online  2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access articledistributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permitsnon-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.DOI: 10.1080/14992027.2016.1206215hearing aid benefits and satisfaction. Both papers suggested thatqualitative methodologies might better tap into the role of the TM toexplore psychosocial aspects of hearing loss, and this was theapproach taken in the third paper (Ekberg, Grenness & Hickson).Conversation analysis was used to examine video-recorded inter-actions between adults with hearing loss and their audiologist at theinitial appointment. The way patients described their hearing lossduring history-taking affected the way in which they responded tothe audiologist’s recommendations for rehabilitation, particularlyhearing aids, later on in the appointment. The final paper (Ingo,Bra¨nnstro¨m, Andersson, Lunner & Laplante-Le´vesque) followed upadults who had failed an online hearing screening test. Using theTM, they examined whether a range of measures of ‘stages ofchange’ could predict later help-seeking behaviour and hearing-aiduptake. Their findings indicate that there was good predictivevalidity of a single-item measure of stage of change.The Health Belief Model is examined in the next two papers.The first (Saunders, Frederick, Silverman, Nielsen & Laplante-Le´vesque) investigated both a stage (i.e. TM) and non-stage (i.e.HBM) model in their study that considered the relationshipsbetween attitudes and beliefs relative to hearing-aid uptake andoutcomes six months later. Their findings demonstrated thepredictive ability of both attitudes and beliefs and suggest strategieswhich could be used to increase uptake of hearing health care. Thesecond paper (Schulz, Modeste, Lee, Roberts, Saunders & Witsell)introduced the role of communication partners and considered theirperceived burden as a result of suspected hearing loss in others.Including this perceived burden as an additional component withinthe HBM improved the fit of the model to predict those who wouldseek hearing evaluation.The final set of papers use a new theoretical approach developedby Michie and colleagues. The first paper (Greenwell, Sereda,Coulson, El Refaie & Hoare) applied two health psychologytaxonomies to a systematic review of the techniques and effects ofself-help interventions for tinnitus. It was found that the currentevidence base for tinnitus self-help interventions is limited, as thereis a lack of high-quality, homogeneous randomized controlled trialsin this area. The findings of the available studies were mixed asregards the efficacy of tinnitus self-help interventions. The penul-timate paper (Barker, Atkins & de Lusignan) introduces the COM-Bmodel, which posits that ‘Capability’, ‘Opportunity’ and‘Motivation’ are the key drivers of behaviour. They discuss howthe COM-B model has been used in conjunction with the relatedBehaviour Change Wheel to develop an intervention aimed atpromoting regular, long-term use of hearing aids. Qualitativeinterviews with audiologists suggested that collaborative behav-ioural planning for hearing aid use is more likely to occur if theirpsychological capability, physical and social opportunity, andreflective and automatic motivation were addressed.In the final paper (Coulson, Ferguson, Henshaw & Heffernan)we review the current evidence for a range of popular healthpsychology models and theories. This paper acknowledges thevaluable work that has taken place within health psychology, whilstalso pointing to a number of limitations within these models,which affect their ability to form the basis of behaviourchange interventions. Our paper discusses how the recentlydeveloped COM-B model and Behaviour Change Wheel, inconjunction with the Theoretical Domains Framework, may holdpromise for developing and evaluating hearing health interventions.As the field of audiology progresses, the reporting of interventionsneeds to become standardized in order to accurately consider andreview the efficacy of such interventions.We hope that this special issue provides a ‘go-to’ summary ofsome of the most commonly used health psychology modelsand their application in hearing health research, and serves as aspringboard for future theoretically-driven research.Guest Foreword: On the links between healthpsychology and audiology researchHearing impairment is currently ranked higher in disease burdenthan diabetes and is projected to be in the top ten disease burdens inthe UK by 2030. Despite this, health psychologists (and the medicalprofession in general) have been slow in recognizing hearingimpairment as an important public health issue. For example, a briefsearch of the leading journal Health Psychology (audiol* ORhear*), revealed zero hits in Health Psychology’s 35-year history(cf. ‘‘diabet*’’¼ 131 hits). This is surprising given that a lot of theproblems in hearing research (e.g. uptake of hearing screening,patient reactions to impaired hearing diagnosis, uptake andsustained use of hearing aids) are common to many problems thatoccupy sizeable column inches in Health Psychology (e.g. diabetes,cancer, cardiovascular disease, obesity).It is therefore timely that the International Journal of Audiologyshould dedicate a special issue to the role of health psychology inaudiology as a welcoming gesture to health psychologists in generalwho have, relatively speaking, neglected hearing health issues. Theword ‘‘relatively’’ is operational because this special issue (andindeed previous issues of the International Journal of Audiology)provides clear evidence that audiologists and health psychologistshave been, and continue to, work productively together. The authorswho have contributed to this special issue are at the vanguardand I anticipate rapid strides in improving hearing care andpatient outcomes through enhanced audiology-health psychologycollaborations.The papers in this special issue report genuinely novel applica-tions of sometimes decades-old theories in health psychology toaudiological outcomes. These studies are important because theybroaden the domains and samples to which health psychologytheories have been applied and offer new insights into what ismissing from psychological accounts of behaviour as applied toproblems in audiology. In return, an enduring problem for healthpsychologists is the objective measurement of health behaviours inways that are unobtrusive, valid and meaningful. For audiologists,data are routinely downloaded directly from hearing aids and can beanalysed to assess uptake and adherence to a fine degree of accuracythat should be the envy of health psychologists interested inmeasuring behaviours such as cigarette smoking or dietary intake.In sum, the present impressive body of work shows that healthpsychologists and audiologists have a lot to learn from one anotherbut that we can be optimistic about more concerted efforts totackle hearing health from perspectives outside audiology, includinghealth psychology and beyond.Chris ArmitageSchool of Psychological Sciences,University of Manchester,Manchester, UKS2 M. Ferguson et al.

Application of health behaviour theory to hearing healthcare research: The state of play and beyond

Melanie A. Ferguson

Neil S. Coulson

Helen Henshaw

Eithne Heffernan

Crossref

International Journal of Audiology

Name not available

Nottingham eTheses

Nottingham ePrints

Ferguson, Melanie A. and Coulson, Neil S. and Henshaw, Helen and Heffernan, Eithne (2016) Application of health behaviour theory to hearing healthcare research: The state of play and beyond. International Journal of Audiology, 55 (sup3). S1-S2. ISSN 1708-8186 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/39057/1/Application%20of%20health%20behaviour%20theory%20to%20hearing%20healthcare%20research%20The%20state%20of%20play%20and%20beyond.pdfCopyright and reuse: The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions.This article is made available under the Creative Commons Attribution Non-commercial No Derivatives licence and may be reused according to the conditions of the licence.  For more details see: http://creativecommons.org/licenses/by-nc-nd/2.5/A note on versions: The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher’s version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.For more information, please contact eprints@nottingham.ac.ukFull Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=iija20Download by: [University of Nottingham] Date: 29 November 2016, At: 04:27International Journal of AudiologyISSN: 1499-2027 (Print) 1708-8186 (Online) Journal homepage: http://www.tandfonline.com/loi/iija20Application of health behaviour theory to hearinghealthcare research: The state of play and beyondMelanie A. Ferguson, Neil S. Coulson, Helen Henshaw & Eithne HeffernanTo cite this article: Melanie A. Ferguson, Neil S. Coulson, Helen Henshaw & EithneHeffernan (2016) Application of health behaviour theory to hearing healthcare research:The state of play and beyond, International Journal of Audiology, 55:sup3, S1-S2, DOI:10.1080/14992027.2016.1206215To link to this article:  http://dx.doi.org/10.1080/14992027.2016.1206215© 2016 The Author(s). Published by InformaUK Limited, trading as Taylor & FrancisGroup.Published online: 15 Jul 2016.Submit your article to this journal Article views: 152View related articles View Crossmark dataInternational Journal of Audiology 2016; 55: S1–S2EditorialApplication of health behaviour theory to hearing healthcareresearch: The state of play and beyondMelanie A. Ferguson1,2, Neil S. Coulson3, Helen Henshaw1,4 & Eithne Heffernan1,41National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Nottingham, UK, 2Nottingham University HospitalsNHS Trust, Nottingham, UK, 3Division of Rehabilitation and Aging, School of Medicine, University of Nottingham, Nottingham, UK, and4Division of Clinical Neuroscience, School of Medicine, University of Nottingham Nottingham, UKForewordOver recent years, there has been an increasing use of theories ofhealth and illness behaviour from health psychology that has helpedguide hearing healthcare research. In particular, these models havebeen used to improve our understanding of response to hearing lossas a long-term condition, help-seeking, decision-making andintervention uptake in adults with hearing loss. This supplementbrings together a range of theories and models that have beenapplied across other health disciplines, namely the TranstheoreticalModel (TM), the Health Belief Model (HBM), the Self-regulatoryModel (SRM), and the Self-determination Model (SDM). Withinaudiology, the TM and HBM have received the most attention, withan initial focus on help-seeking for hearing loss and hearing aiduptake. This supplement includes not only the TM and HBM butalso theories and models that are new in the field of audiology, butwhich have been widely used with other health conditions: the SRMand SDM. Finally, a newly developed model, the COM-B(capability, opportunity and motivation – behaviour) that incorpor-ates the key components of existing models has been gainingincreasing recognition within health psychology and is just startingto gain ground in audiological research.The inspiration for this supplement in the International Journalof Audiology arose during an ‘Audiology meets Health BehaviourPsychology’ workshop that we (hearing and health psychologyresearchers) held in Nottingham in November 2014, where weinvited UK audiologists and health psychologists to join us indiscussing different health-related theories and models. Followingthe workshop, we invited some of our international colleagues whoare at the forefront of investigating these theories and models inaudiological research, and promoting their use in clinical practice,to contribute to this supplement. As with all papers submitted to theIJA, the submissions to this supplement were subjected to thestandard peer-review process by external reviewers before beingaccepted for publication.The first two papers use the Self-regulatory and Self-determin-ation Theory models. The first paper (Heffernan, Coulson, Henshaw,Barry & Ferguson) sets the scene with a qualitative study that usedLeventhal’s SRM to explore the psychosocial experiences arisingfrom hearing loss through interviews with adults with hearing lossand hearing healthcare professionals. It was found that adults withhearing loss used engaged coping (i.e. directly addressing hearingloss) and disengaged coping, which involved withdrawing fromsituations (e.g. declining an invitation) and withdrawing withinsituations (e.g. sitting quietly whilst others speak). Both copingresponses were perceived to have advantages and disadvantages,depending on the circumstances. The second paper (Ridgway,Hickson & Lind) reports on a quantitative, longitudinal cohort studythat investigated the explanatory power of Deci and Ryan’s SDTmodel in relation to hearing aid adoption decisions and fittingoutcomes. Autonomous motivation was associated with increasedhearing aid adoption and hearing aid satisfaction, while autonomysupport was associated with increased perceived competence andsatisfaction with hearing aids, and reduced activity limitations.The next four papers are based on Prochaska and DiClemente’sTranstheoretical model, which has probably been the most widelyused behaviour change model in audiology to date. The first twopapers (Ferguson, Maidment, Russell, Gregory & Nicholson;Ferguson, Woolley & Munro) report on the TM in the context offirst-time hearing aid users. The first seeks to assess the feasibilityand benefits of the Ida Institute’s Motivational Tools when used in aUK audiology clinic. The audiologists were very positive about theuse of the tools in clinic, and the patient group who engaged withthe motivational tools reported greater self-efficacy, reducedanxiety and greater engagement with the audiologist than thecontrol group, early in the patient journey. The second paper seeksto understand more about the impact of self-efficacy, readiness toimprove hearing, and patient expectations on hearing aid outcomes.Although there was no robust effect of self-efficacy, the studyshowed greater readiness and expectations predicted improvedCorrespondence: Melanie Ferguson, Nottingham Hearing Biomedical Research Unit, 113 The Ropewalk, Nottingham, Nottingham, NG1 5DU, UK. E-mail:melanie.ferguson@nottingham.ac.uk(Received 20 June 2016; accepted 22 June 2016)ISSN 1499-2027 print/ISSN 1708-8186 online  2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access articledistributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permitsnon-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.DOI: 10.1080/14992027.2016.1206215hearing aid benefits and satisfaction. Both papers suggested thatqualitative methodologies might better tap into the role of the TM toexplore psychosocial aspects of hearing loss, and this was theapproach taken in the third paper (Ekberg, Grenness & Hickson).Conversation analysis was used to examine video-recorded inter-actions between adults with hearing loss and their audiologist at theinitial appointment. The way patients described their hearing lossduring history-taking affected the way in which they responded tothe audiologist’s recommendations for rehabilitation, particularlyhearing aids, later on in the appointment. The final paper (Ingo,Bra¨nnstro¨m, Andersson, Lunner & Laplante-Le´vesque) followed upadults who had failed an online hearing screening test. Using theTM, they examined whether a range of measures of ‘stages ofchange’ could predict later help-seeking behaviour and hearing-aiduptake. Their findings indicate that there was good predictivevalidity of a single-item measure of stage of change.The Health Belief Model is examined in the next two papers.The first (Saunders, Frederick, Silverman, Nielsen & Laplante-Le´vesque) investigated both a stage (i.e. TM) and non-stage (i.e.HBM) model in their study that considered the relationshipsbetween attitudes and beliefs relative to hearing-aid uptake andoutcomes six months later. Their findings demonstrated thepredictive ability of both attitudes and beliefs and suggest strategieswhich could be used to increase uptake of hearing health care. Thesecond paper (Schulz, Modeste, Lee, Roberts, Saunders & Witsell)introduced the role of communication partners and considered theirperceived burden as a result of suspected hearing loss in others.Including this perceived burden as an additional component withinthe HBM improved the fit of the model to predict those who wouldseek hearing evaluation.The final set of papers use a new theoretical approach developedby Michie and colleagues. The first paper (Greenwell, Sereda,Coulson, El Refaie & Hoare) applied two health psychologytaxonomies to a systematic review of the techniques and effects ofself-help interventions for tinnitus. It was found that the currentevidence base for tinnitus self-help interventions is limited, as thereis a lack of high-quality, homogeneous randomized controlled trialsin this area. The findings of the available studies were mixed asregards the efficacy of tinnitus self-help interventions. The penul-timate paper (Barker, Atkins & de Lusignan) introduces the COM-Bmodel, which posits that ‘Capability’, ‘Opportunity’ and‘Motivation’ are the key drivers of behaviour. They discuss howthe COM-B model has been used in conjunction with the relatedBehaviour Change Wheel to develop an intervention aimed atpromoting regular, long-term use of hearing aids. Qualitativeinterviews with audiologists suggested that collaborative behav-ioural planning for hearing aid use is more likely to occur if theirpsychological capability, physical and social opportunity, andreflective and automatic motivation were addressed.In the final paper (Coulson, Ferguson, Henshaw & Heffernan)we review the current evidence for a range of popular healthpsychology models and theories. This paper acknowledges thevaluable work that has taken place within health psychology, whilstalso pointing to a number of limitations within these models,which affect their ability to form the basis of behaviourchange interventions. Our paper discusses how the recentlydeveloped COM-B model and Behaviour Change Wheel, inconjunction with the Theoretical Domains Framework, may holdpromise for developing and evaluating hearing health interventions.As the field of audiology progresses, the reporting of interventionsneeds to become standardized in order to accurately consider andreview the efficacy of such interventions.We hope that this special issue provides a ‘go-to’ summary ofsome of the most commonly used health psychology modelsand their application in hearing health research, and serves as aspringboard for future theoretically-driven research.Guest Foreword: On the links between healthpsychology and audiology researchHearing impairment is currently ranked higher in disease burdenthan diabetes and is projected to be in the top ten disease burdens inthe UK by 2030. Despite this, health psychologists (and the medicalprofession in general) have been slow in recognizing hearingimpairment as an important public health issue. For example, a briefsearch of the leading journal Health Psychology (audiol* ORhear*), revealed zero hits in Health Psychology’s 35-year history(cf. ‘‘diabet*’’¼ 131 hits). This is surprising given that a lot of theproblems in hearing research (e.g. uptake of hearing screening,patient reactions to impaired hearing diagnosis, uptake andsustained use of hearing aids) are common to many problems thatoccupy sizeable column inches in Health Psychology (e.g. diabetes,cancer, cardiovascular disease, obesity).It is therefore timely that the International Journal of Audiologyshould dedicate a special issue to the role of health psychology inaudiology as a welcoming gesture to health psychologists in generalwho have, relatively speaking, neglected hearing health issues. Theword ‘‘relatively’’ is operational because this special issue (andindeed previous issues of the International Journal of Audiology)provides clear evidence that audiologists and health psychologistshave been, and continue to, work productively together. The authorswho have contributed to this special issue are at the vanguardand I anticipate rapid strides in improving hearing care andpatient outcomes through enhanced audiology-health psychologycollaborations.The papers in this special issue report genuinely novel applica-tions of sometimes decades-old theories in health psychology toaudiological outcomes. These studies are important because theybroaden the domains and samples to which health psychologytheories have been applied and offer new insights into what ismissing from psychological accounts of behaviour as applied toproblems in audiology. In return, an enduring problem for healthpsychologists is the objective measurement of health behaviours inways that are unobtrusive, valid and meaningful. For audiologists,data are routinely downloaded directly from hearing aids and can beanalysed to assess uptake and adherence to a fine degree of accuracythat should be the envy of health psychologists interested inmeasuring behaviours such as cigarette smoking or dietary intake.In sum, the present impressive body of work shows that healthpsychologists and audiologists have a lot to learn from one anotherbut that we can be optimistic about more concerted efforts totackle hearing health from perspectives outside audiology, includinghealth psychology and beyond.Chris ArmitageSchool of Psychological Sciences,University of Manchester,Manchester, UKS2 M. Ferguson et al.

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