Eithne Heffernan

Academic environment in a newly established dental school with an enquiry‐based curriculum: perceptions of students from the inaugural cohorts

INTRODUCTION Established in 2007, Peninsula Dental School offers a highly innovative, enquiry-based, student-led, patient-centred curriculum. It is one of the first dental schools in UK to be based exclusively in a primary care setting. This study was carried out to evaluate the academic environment at Peninsula Dental School and to identify differences between expectations of new entrants and perceptions of senior cohorts. METHODS This was a cross-sectional survey utilising an online questionnaire based on Dundee Ready Educational Environment Measure (DREEM). The subjects were 234 dental students from all years in this enquiry-based Bachelor of Dental Surgery programme. RESULTS The response rate to the questionnaire was 56.42% with an equal gender distribution of the participants. The overall mean DREEM score of the four cohorts was 143.58 (SD ± 20.84), and the mean score for individual items was 2.87 (SD ± 0.41). The reliability of the DREEM data as a whole was strong (α = 0.93). The difference in questionnaire means for the new entrants and the senior cohorts was not significant (P > 0.05). The ANOVA results showed that there were no significant effects of age, gender or ethnicity on the mean DREEM scores. The MANOVA results showed a significant effect of ethnicity with regard to perceptions of teachers and atmosphere. CONCLUSIONS An enquiry-based, student-centred curriculum at the Peninsula Dental School provides a positive academic environment for the students.

Understanding the psychosocial experiences of adults with mild-moderate hearing loss: An application of Leventhal's self-regulatory model.

Abstract Objective: This study explored the psychosocial experiences of adults with hearing loss using the self-regulatory model as a theoretical framework. The primary components of the model, namely cognitive representations, emotional representations, and coping responses, were examined. Design: Individual semi-structured interviews were conducted. The data were analysed using an established thematic analysis procedure. Study sample: Twenty-five adults with mild-moderate hearing loss from the UK and nine hearing healthcare professionals from the UK, USA, and Canada were recruited via maximum variation sampling. Results: Cognitive representations: Most participants described their hearing loss as having negative connotations and consequences, although they were not particularly concerned about the progression or controllability/curability of the condition. Opinions differed regarding the benefits of understanding the causes of one’s hearing loss in detail. Emotional representations: negative emotions dominated, although some experienced positive emotions or muted emotions. Coping responses: engaged coping (e.g. hearing aids, communication tactics) and disengaged coping (e.g. withdrawal from situations, withdrawal within situations): both had perceived advantages and disadvantages. Conclusions: This novel application of the self-regulatory model demonstrates that it can be used to capture the key psychosocial experiences (i.e. perceptions, emotions, and coping responses) of adults with mild-moderate hearing loss within a single, unifying framework.

Careers and talents not to be wasted

Purpose – In many cases, immigrants work in jobs that are incommensurate with their qualifications and work experience. The aim of this study is to examine the experience of this “talent waste” in Polish immigrants working in the Irish labour market.Design/methodology/approach – The study used a mixed method approach. First, 309 Polish immigrants were surveyed about their employment experiences since moving to Ireland. Second, 12 skilled Polish immigrants – those with third level qualifications – were interviewed. Interviews were semi‐structured and focused on the factors leading to their underemployment and how they responded to it psychologically.Findings – The interviews revealed that immigrants to Ireland reported fewer barriers to skilled employment than immigrants in other research. Also, most had not sought employment that would utilise their qualifications when they first moved to Ireland. A typology of four psychological responses to employment status was put forth based on immigrant sense of pro...

Applying theories of health behaviour and change to hearing health research: Time for a new approach

Abstract Objective: In recent years, there has been an increase in the application of behavioural models, such as social cognition models, to the promotion of hearing health. Despite this, there exists a well-developed body of literature that suggests such models may fail to consistently explain reliable amounts of variability in human behaviours. Design: This paper provides a summary of this research across selected models of health-related behaviour, outlining the current state of the evidence. Results: Recent work in the field of behaviour change is presented together with commentary on the design and reporting of behaviour change interventions. Conclusions: We propose that attempts to use unreliable models to explain and predict hearing health behaviours should now be replaced by work which integrates the latest in behaviour change science, such as the Behaviour Change Wheel and Theoretical Domains Framework.

The development of a measure of participation in adults with hearing loss: a qualitative study of expert views

The results show that hearing loss can lead to participation difficulties in various social domains, including work, friendship and family. Most of the interviewees with hearing loss successfully participated in some social domains, but struggled in other social domains. This was particularly problematic when they struggled in the social domains they most valued, such as family life. Some reported that, although they had many social interactions, they felt isolated during those interactions. Hearing loss can cause participation difficulties by leading to fatigue, embarrassment and diminished self-confidence in social interactions.

Recruiting and retaining participants in e-Delphi surveys for core outcome set development: Evaluating the COMiT'ID study

Background A Core Outcome Set (COS) is an agreed list of outcomes that are measured and reported in all clinical trials for a particular health condition. An ‘e-Delphi’ is an increasingly popular method for developing a COS whereby stakeholders are consulted via a multi-round online survey to reach agreement regarding the most important outcomes. Many COS studies seek diverse, international input that includes professionals and healthcare users. However, the recruitment and retention of participants can be deterred by various factors (e.g. language barriers and iterative, time-consuming rounds). This report evaluates the effectiveness of recruitment and retention methods used in the Core Outcome Measures in Tinnitus International Delphi (COMiT’ID) study using participant feedback from healthcare users, healthcare practitioners, researchers, commercial representatives and funders. Methods A range of methods were applied to recruit participants to the study and maintain engagement over the three rounds. Feedback on recruitment and retention methods was collected using a twenty-item online questionnaire, with free text comments. Results A personalised email invitation was the most frequent recruitment route, and 719 professionals and healthcare users consented to take part. Retention of each stakeholder group ranged from 76 to 91% completing all three e-Delphi rounds. Feedback was given by 379 respondents. A majority of respondents were satisfied with the study methods that were implemented to promote retention. Over 55% indicated that their overall experience closely matched their expectations at the start of the study, and over 90% felt that their contribution was appreciated. Conclusions This report highlights study methods that worked well with respect to recruitment and retention, and those that did not. Findings provide a unique contribution to the growing evidence base of good practice in COS development by demonstrating the relative effectiveness of recruitment and retention methods for an e-Delphi survey. Trial registration This project was registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative. The protocol is published in Trials (doi:10.1186/s13063-017-2123-0).

Development of the Social Participation Restrictions Questionnaire (SPaRQ) through consultation with adults with hearing loss, researchers, and clinicians: a content evaluation study

Abstract Objective: This research aimed to evaluate the content of the Social Participation Restrictions Questionnaire (SPaRQ) in terms of its relevance, clarity, comprehensiveness, acceptability to adults with hearing loss, and responsiveness. Design: Cognitive interviews and a subject matter expert survey were conducted. The interview data were analysed using thematic analysis and a taxonomy of questionnaire clarity problems. Descriptive statistics were calculated for the survey data. Study sample: Fourteen adults with hearing loss participated in the cognitive interviews. Twenty clinicians and academics completed the subject matter expert survey. Results: The majority of the SPaRQ content was found to be relevant, clear, comprehensive, and acceptable. However, an important clarity problem was identified: many adults with hearing loss struggled to switch from answering positively worded items (e.g. “I can attend social gatherings”) to answering negatively-worded items (e.g. “I feel isolated”). Several subject matter experts found responsiveness difficult to assess. The SPaRQ was amended where necessary. Conclusion: Few hearing-specific questionnaires have undergone content evaluation. This study highlights the value of content evaluation as a means of identifying important flaws and improving the quality of a measure. The next stage of this research is a psychometric evaluation of the measure.

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

Over recent years, there has been an increasing use of theories of health and illness behaviour from health psychology that has helped guide hearing healthcare research. In particular, these models have been used to improve our understanding of response to hearing loss as a long-term condition, help-seeking, decision-making and intervention uptake in adults with hearing loss. This supplement brings together a range of theories and models that have been applied across other health disciplines, namely the Transtheoretical Model (TM), the Health Belief Model (HBM), the Self-regulatory Model (SRM), and the Self-determination Model (SDM). Within audiology, the TM and HBM have received the most attention, with an initial focus on help-seeking for hearing loss and hearing aid uptake. This supplement includes not only the TM and HBM but also theories and models that are new in the field of audiology, but which have been widely used with other health conditions: the SRM and SDM. Finally, a newly developed model, the COM-B (capability, opportunity and motivation – behaviour) that incorporates the key components of existing models has been gaining increasing recognition within health psychology and is just starting to gain ground in audiological research. The inspiration for this supplement in the International Journal of Audiology arose during an ‘Audiology meets Health Behaviour Psychology’ workshop that we (hearing and health psychology researchers) held in Nottingham in November 2014, where we invited UK audiologists and health psychologists to join us in discussing different health-related theories and models. Following the workshop, we invited some of our international colleagues who are at the forefront of investigating these theories and models in audiological research, and promoting their use in clinical practice, to contribute to this supplement. As with all papers submitted to the IJA, the submissions to this supplement were subjected to the standard peer-review process by external reviewers before being accepted for publication. The first two papers use the Self-regulatory and Self-determination Theory models. The first paper (Heffernan, Coulson, Henshaw, Barry & Ferguson) sets the scene with a qualitative study that used Leventhal’s SRM to explore the psychosocial experiences arising from hearing loss through interviews with adults with hearing loss and hearing healthcare professionals. It was found that adults with hearing loss used engaged coping (i.e. directly addressing hearing loss) and disengaged coping, which involved withdrawing from situations (e.g. declining an invitation) and withdrawing within situations (e.g. sitting quietly whilst others speak). Both coping responses were perceived to have advantages and disadvantages, depending on the circumstances. The second paper (Ridgway, Hickson & Lind) reports on a quantitative, longitudinal cohort study that investigated the explanatory power of Deci and Ryan’s SDT model in relation to hearing aid adoption decisions and fitting outcomes. Autonomous motivation was associated with increased hearing aid adoption and hearing aid satisfaction, while autonomy support was associated with increased perceived competence and satisfaction with hearing aids, and reduced activity limitations. The next four papers are based on Prochaska and DiClemente’s Transtheoretical model, which has probably been the most widely used behaviour change model in audiology to date. The first two papers (Ferguson, Maidment, Russell, Gregory & Nicholson; Ferguson, Woolley & Munro) report on the TM in the context of first-time hearing aid users. The first seeks to assess the feasibility and benefits of the Ida Institute’s Motivational Tools when used in a UK audiology clinic. The audiologists were very positive about the use of the tools in clinic, and the patient group who engaged with the motivational tools reported greater self-efficacy, reduced anxiety and greater engagement with the audiologist than the control group, early in the patient journey. The second paper seeks to understand more about the impact of self-efficacy, readiness to improve hearing, and patient expectations on hearing aid outcomes. Although there was no robust effect of self-efficacy, the study showed greater readiness and expectations predicted improved

Teaching and learning the mental state exam in an integrated medical school. Part II: Student performance

Aims and method To investigate medical students’ performance at and perceptions of the mental state examination (MSE) at a medical school with a modern integrated curriculum. We undertook an evaluative case study comprising a survey and analysis of performance data. The study is presented in two parts: part 2 reports the students’ performance data as assessed by integrated structured clinical examination (ISCE). Results About a third of students (32.7%) thought that the MSE ISCE was more difficult than the non-MSE ISCE from the questionnaire data. The evidence from the ISCE performance data indicates that there are no significant differences between the scores of students in the MSE station and the non-MSE stations. Clinical implications Most studnets do not find the MSE ISCE station more difficult than other ISCE stations. Perhaps therefore students should be reassured that assessments in psychiatry are just like other assessments in medicine. For some students, however, performing at the MSE ISCE station is a more complex challenge.