Carly Meyer

What factors influence help-seeking for hearing impairment and hearing aid adoption in older adults?

Abstract Objective: The purpose of this review paper was to identify factors that influence older adults’ decisions to seek help for hearing impairment and to adopt hearing aids. Design: A literature search of abstracts within peer-reviewed journal articles published in English between 1990 and 2010 was conducted in online bibliographic databases using the keywords: hearing; impair* or loss; seek* or candidate* or applicant* or acquir*; and hearing aid* or help or advice. Results: Twenty-two articles that were directly relevant to this topic were included in this review. Conclusions: The evidence suggests that individuals are more likely to seek help for hearing impairment and/or adopt hearing aids if they: (1) have a moderate to severe hearing impairment and self-reported hearing-related activity limitations or participation restrictions; (2) are older; (3) perceive their hearing as poor; (4) consider there to be more benefits than barriers to amplification; and (5) perceive their significant other/s as supportive of hearing rehabilitation. A barrier to help-seeking for hearing impairment and hearing aid adoption appears to be general practitioners’ management of age-related hearing impairment.

Factors associated with success with hearing aids in older adults

Abstract Objective: To examine associations between audiological and non-audiological factors and successful hearing aid use in older adults. Design: In a retrospective study, audiological factors, attitudinal beliefs (as derived from the health belief model), client demographics, psychological factors, and age-related factors were evaluated. Study sample: Participants included 160 individuals, 60 years or older, with unilateral or bilateral hearing impairment (HI), fitted with hearing aids for the first time in the previous two years. Participants were assigned to either an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85) based on their self-reported hearing aid use and benefit. Results: A multivariate, binomial logistic regression model indicated five factors associated with group membership: participants who had greater support from significant others; more difficulties with hearing and communication in everyday life before getting hearing aids; more positive attitudes to hearing aids; coupled with greater perceived self-efficacy for advanced handling of hearing aids; or who were receiving more gain from their devices; were more likely to be successful hearing aid owners. Conclusions: These findings highlight the importance of addressing non-audiological factors in order to assist older adults achieve success with hearing aids.

An investigation of factors that influence help-seeking for hearing impairment in older adults

Abstract Objective: To examine the influence of audiological and non-audiological factors on help-seeking for hearing impairment (HI) in older adults. Design: A retrospective research design was employed. Participants completed 14 measures, after which two multivariate, multinomial logistic regression models were fitted to the data to determine which factors were associated with consultation for HI and hearing aid uptake. Study sample: Three-hundred-and-seven individuals who were 60 years or older and who presented with a unilateral or bilateral HI participated in the study. Non-hearing aid owners were assigned to a non-consulter group (n = 55) or a consulter group (n = 92); hearing aid owners were assigned to an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85). Results: A similar combination of factors was associated with the decisions to consult a health professional about HI and/or to adopt hearing aids. The most important factors related to attitudinal beliefs (e.g. perceived benefits of hearing aids) and external cues to action (e.g. support from significant others). Greater HI also influenced consultation and adoption of hearing aids. Conclusions: Findings highlight the importance of non-audiological factors in hearing rehabilitation to improve consultation for HI and hearing aid adoption.

Investigation of the actions taken by adults who failed a telephone-based hearing screen.

Objectives: Hearing impairment constitutes a highly prevalent chronic health condition among older adults worldwide which negatively impacts on communication and health-related quality of life. Irrespective of this, the majority of older adults do not seek professional help for hearing impairment and/or do not obtain hearing aids. Therefore, a new approach for detecting and promoting help-seeking for hearing impairment is needed. The purpose of this study was to investigate the actions taken by those who failed Telscreen, a telephone-based screening tool for hearing loss, and to increase our understanding of factors that influence taking action. Design: A cohort of 193 participants (112 females, 81 males; age range 24–93 yr) who had failed Telscreen participated in a follow-up telephone interview 4 to 5 mo later. Participants were asked why they called Telscreen, about their hearing ability, their Telscreen result, and what action they had taken toward hearing rehabilitation. One outcome measure was identified: decision to seek professional help for hearing impairment (yes/no). Given that the outcome measure was dichotomized, a logistic regression model for binary outcomes was fitted to the data. Results: Of the 193 participants who failed Telscreen, only 36% sought help from a range of sources (e.g., audiologist, hearing service or hearing aid provider, and family doctor). Results of the logistic regression analysis indicated that individuals who had considered hearing aids before calling Telscreen and/or who recalled their Telscreen result were significantly more likely to seek professional help for their hearing impairment. Nineteen participants who sought help for their hearing impairment had hearing aid fitting recommended to them. Eight participants had aid/s fitted, and of these, six reported a successful outcome. Conclusions: For every 100 individuals who fail a hearing screening, only 36 seek help. Of these 36 individuals who take some action, 13 are recommended hearing aids, approximately half of whom follow this advice and obtain hearing aids. Approximately three-quarters of these individuals use and value their hearing aids. Provided that the screening is automated and low cost, hearing screening via telephone has proven to change the lives of 5% of individuals who decided to seek professional help for hearing impairment at little cost to the other 95% of individuals. Suggestions for future research based on the present research findings are discussed.

Communication Patterns in Audiologic Rehabilitation History-Taking: Audiologists, Patients, and Their Companions

Objectives: The nature of communication between patient and practitioner influences patient outcomes. Specifically, the history-taking phase of a consultation plays a role in the development of a relationship and in the success of subsequent shared decision making. There is limited research investigating patient-centered communication in audiology, and this study may be the first to investigate verbal communication in an adult audiologic rehabilitation context. This research aimed, first, to describe the nature of verbal communication involving audiologists, patients, and companions in the history-taking phase of initial audiology consultations and, second, to determine factors associated with communication dynamics. Design: Sixty-three initial audiology consultations involving patients over the age of 55, their companions when present, and audiologists were audio–video recorded. Consultations were coded using the Roter Interaction Analysis System and divided into three consultation phases: history, examination, and counseling. This study analyzed only the history-taking phase in terms of opening structure, communication profiles of each speaker, and communication dynamics. Associations between communication dynamics (verbal dominance, content balance, and communication control) and 11 variables were evaluated using Linear Mixed Model methods. Results: The mean length of the history-taking phase was 8.8 min (range 1.7 to 22.6). A companion was present in 27% of consultations. Results were grouped into three areas of communication: opening structure, information exchange, and relationship building. Examination of the history opening structure revealed audiologists’ tendency to control the agenda by initiating consultations with a closed-ended question 62% of the time, followed by interruption of patient talk after 21.3 sec, on average. The aforementioned behaviors were associated with increased verbal dominance throughout the history and increased control over the content of questions. For the remainder of the history, audiologists asked 97% of the questions and did so primarily in closed-ended form. This resulted in the audiologist talking as much as the patient and much more than the companions when they were present. Questions asked by the audiologist were balanced in topic: biomedical and psychosocial/lifestyle; however, few emotionally focused utterances were observed from any speaker (less than 5% of utter ances). Conclusions: Analysis of verbal communication involving audiologists, patients, and companions in the history-taking phase in 63 initial audiology consultations revealed a communicative exchange that was audiologist-controlled and structured, but covered both medical and lifestyle content. Audiologists often attempted to create a relationship with their patients; however, little emotional relationship building occurred, which may have implications later in the consultation when management decisions are being made. These results are not in line with patient-centered communication principles. Further research and changes to clinical practice are warranted to transform patient-centered communication from an ideal to a reality.

Identifying the barriers and facilitators to optimal hearing aid self-efficacy

Abstract Objective: Many older adults with hearing impairment are not confident in their ability to use hearing aids (i.e. experience low hearing aid self-efficacy), which has been found to be a barrier to hearing help-seeking and hearing aid use. This study aimed to determine what factors were associated with achieving adequate hearing aid self-efficacy. Design: A retrospective research design was employed wherein hearing aid self-efficacy was the primary outcome. Explanatory variables included personal demographics, visual disability, and experiences related to participants’ hearing ability and hearing aids. Study sample: A total of 307 older adults with hearing impairment participated in the study (147 non hearing aid owners and 160 hearing aid owners). Results: Non-hearing aid owners were more likely to report adequate hearing aid self-efficacy if they reported no visual disability, had experienced hearing loss for longer, reported more positive support from a significant other, and were not anxious about wearing hearing aids. Hearing aid owners were more likely to report adequate hearing aid self-efficacy if they had had a positive hearing aid experience and no visual disability. Conclusions: More research is needed to develop and evaluate intervention approaches that promote optimal levels of hearing aid self-efficacy among older adults with hearing impairment.

Hearing aid user guides: suitability for older adults.

Abstract Objective: The aim of this study was to analyse the content, design, and readability of printed hearing aid user guides to determine their suitability for older adults, who are the main users of hearing aids. Design: Hearing aid user guides were assessed using four readability formulae and a standardized tool to assess content and design (SAM - Suitability Assessment of Materials). Study sample: A sample of 36 hearing aid user guides (four user guides from nine different hearing aid manufacturers) were analysed. Results: Sixty nine percent of user guides were rated ʽnot suitable’ and 31% were rated ʽadequate’ for their suitability. Many scored poorly for scope, vocabulary, aspects of layout and typography, and learning stimulation and motivation. The mean reading grade level for all user guides was grade 9.6 which is too high for older adults. Conclusion: The content, design, and readability of hearing aid user guides are not optimal for older adults and thus may serve as a barrier to successful hearing aid outcomes for this population.

Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials.

A self-fitting hearing aid has been proposed as a viable option to meet the need for rehabilitation in areas where audiology services are unreliable. A successful outcome with a self-fitting hearing aid pivots in part on the clarity of the instructions accompanying the device. The aims of this article are (a) to review the literature to determine features that should be incorporated into written health-care materials and factors to consider in the design process when developing written instructions for a target audience of older adults and (b) to apply this information to the development of a set of written instructions as the first step in self-fitting of a hearing aid, assembling four parts and inserting the aid into the ear. The method involved a literature review of published peer reviewed research. The literature revealed four steps in the development of written health-care materials: planning, design, assessment of suitability, and pilot testing. Best practice design principles for each step were applied in the development of instructions for how to assemble and insert a hearing aid. Separate booklets were developed for the left and right aids and the content of each consisted of simple line drawings accompanied by captions. The reading level was Grade 3.5 equivalent and the Flesch Reading Ease Score was 91.1 indicating that the materials were “very easy” to read. It is essential to follow best practice design principles when developing written health-care materials to motivate the reader, maximize comprehension, and increase the likelihood of successful application of the content.

Management of Hearing Aid Assembly by Urban-Dwelling Hearing-Impaired Adults in a Developed Country Implications for a Self-Fitting Hearing Aid

A self-fitting hearing aid, designed to be assembled and programmed without audiological or computer support, could bring amplification to millions of people in developing countries, who remain unaided due to the lack of a local, professional, audiological infrastructure. The ability to assemble and insert a hearing aid is fundamental to the successful use of a self-fitting device. In this study, the management of such tasks was investigated. Eighty older, urban-dwelling, hearing-impaired adults in a developed country were asked to follow a set of written, illustrated instructions to assemble two slim-fit behind-the-ear hearing aids. Participants were allowed to access assistance with the task from an accompanying partner. A range of personal and audiometric variables was measured through the use of structured questionnaires and standardized tests of health literacy, cognitive function, and manual dexterity. The results showed that 99% of participants were able to complete the hearing aid assembly task, either on their own or with assistance. Health literacy, or the ability to read and understand health-related text, and gender most strongly influenced participants’ ability to complete the assembly task independently and accurately. Higher levels of health literacy were associated with an increased likelihood of independent and successful task completion. Male participants were more likely to complete the task on their own, while female participants were more likely to assemble the device without errors. The results of this study will inform future work regarding development of educational material for the self-fitting hearing aid as well as candidacy for such a device.

Family member involvement in audiology appointments with older people with hearing impairment

Abstract Objective: This study aimed to investigate family members’ involvement in audiology rehabilitation appointments. Design: Audiology appointments were video-recorded and analysed using quantitative coding and conversation analysis (CA). Study sample: The study sample included 13 audiologists, 17 older adults with hearing impairment, and 17 family members. Results: Initial coding showed that family members participated in 12% of the total talk time during audiology appointments. The CA results demonstrated that family members were not typically invited to join the conversation. However, family members would self-select to speak by: (1) responding to questions from the audiologist which were directed at the client; (2) self-initiating expansions on clients’ turns; and (3) self-initiating questions. When family members did participate in the interaction, audiologists typically responded by shifting the conversation back to the client. Conclusion: While family members currently have minimal participation in audiology appointments, they display a strong interest in being involved and sharing their experiences of the clients hearing impairment. The findings suggest support for implementing family-centred care principles in audiology practice.