Helen Pryce

An exploration of the perspectives of help-seekers prescribed hearing aids

AIM This pilot study uses qualitative methods to learn about the psycho-social needs of people who seek help with hearing loss. BACKGROUND There has been some emphasis in health policy to reduce the number of appointments required between assessment of hearing loss and fitting of hearing aids. This may respond to audiological needs but may not address the psycho-social needs. This study piloted a phenomenological approach to identify the patients perspective. METHODS A phenomenological approach was taken to provide description of patient perspectives. Findings Six patients reported that help-seeking was primarily influenced by the need to appease social partners and to improve hearing performance. Hearing aids were not regarded as acceptable treatments. CONCLUSIONS Service providers need to consider the psycho-social consequences of hearing-aid issue alongside audiological needs.

Illness perceptions and hearing difficulties in King-Kopetzky syndrome: what determines help seeking?

Abstract The present study explored illness perceptions of hearing difficulties amongst one hundred participants who reported experiencing hearing difficulties despite normal audiometric thresholds. This experience is referred to as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). Logistic regression was used to consider the associations between help-seeking and a range of audiological and illness perception measures. Results indicate that help-seekers present with poorer speech in noise thresholds than non help-seekers, and that coherent illness perceptions and a negative belief in the consequences of hearing difficulties are associated with help-seeking status, regardless of hearing sensitivity. Sumario El presente estudio exploró la percepción de la enfermedad y las dificultades auditivas entre cien participantes que reportaron experimentar dificultades auditivas a pesar de umbrales auditivos normales. Esta experiencia se refiere al Síndrome de King-Kopetzky (KKS), una disfunción auditiva oscura (OAD) o un trastorno del procesamiento auditivo (APD). Se utilizó una regresión logística para considerar las asociaciones entre la búsqueda de ayuda y un rango de medidas sobre la percepción audiológica y de la enfermedad. Los resultados indican que los que buscan ayuda se presentan con peores umbrales de lenguaje en ruido que quienes no buscan ayuda, y la coherencia en la percepción de la enfermedad asícomo la creencia negativa sobre las consecuencias de las dificultades auditivas se asocian con la condición de búsqueda de ayuda, sin importar la sensibilidad.

The process of coping in King-Kopetzky Syndrome

Our object was to describe the process of coping in King-Kopetzky syndrome and hypothesise how the process is mediated. We used a qualitative study using open-ended interviews. The data were gathered purposefully from 19 cases in the first phase of the study. Accounts were then compared deductively with six accounts from a previous interview-based study. Maximum contrast was sought in cases and in experience of clinical interventions. Participants were recruited from Hearing Therapy services in Bath and North East Somerset Primary Care Trust and The Welsh Hearing Institute. Interviews were conducted in participants’ homes or clinic setting. Coping was determined by the concept that the individual developed about their hearing difficulties. The process of conceptualizing involves reconciling the symptoms experienced with the information obtained from clinicians. The process is mediated by the context in which hearing difficulties occur and the interventions that are received. Forming a coherent concept of hearing difficulties facilitates coping. Clinicians can assist this process by giving patients with King-Kopetzky Syndrome an explanation of the condition.

A qualitative investigation of decision making during help-seeking for adult hearing loss

Abstract Objective: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. Design: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. Study sample: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. Results: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. Conclusions: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss.

The role of volunteer support in the community for adults with hearing loss and hearing aids

OBJECTIVES To explore interactions between audiology patients and volunteers, to describe encounters and define the role of volunteers. METHODS Qualitative ethnographic and interview study of volunteer-patient interactions. Ten volunteer participants from two volunteer schemes in South West England were observed and interviewed. Three patient participants were interviewed. RESULTS Analysis of observational data showed that volunteers provided support relating to local services and hearing aids, but did not engage in discussions about hearing loss. Interviews with volunteers identified gaps in audiology provision, including accessible services and clear information and highlighted a need for more support from audiology services to enable them to fulfil their role. Volunteer interactions with patients mimicked a clinician-patient encounter and volunteers employed strategies and behaviours used by professional audiologists. CONCLUSIONS Audiology volunteers could provide an accessible bridge between health services and the community but their care is limited to focus on hearing aids. PRACTICE IMPLICATIONS Volunteers enable patients to use hearing aids appropriately and are a core element of current care arrangements. However, volunteers express a need for adequate support from audiology services. Volunteers have the potential to increase service capacity and to bridge the gaps between community and audiology healthcare services.

Foundations of an intervention package to improve communication in residential care settings:a mixed methods study

Abstract Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management.

Group or individual tinnitus therapy: What matters to participants?

Abstract Objective: To explore the ‘active ingredient’ of tinnitus therapy groups. Study design: The design was an inductive qualitative study informed by grounded theory. Eight participants, four from a tinnitus group and four from individual therapy with similar content, were invited to discuss their experiences of tinnitus therapy. The interviews were transcribed and analysed using a constant comparative approach. Results: The findings revealed that group experiences facilitate information exchange and social comparison, which facilitates coping. Conclusions: The human dynamics of groups may have an additional therapeutic benefit.

Shared decision-making in tinnitus care: an exploration of clinical encounters

Objectives This study examined clinical encounters between clinicians and patients to determine current practice for the diagnosis and treatment of tinnitus. The objective was to develop an understanding of the ideal clinical encounter that would facilitate genuine shared decision‐making. Design Video ethnography was used to examine clinical encounters for the diagnosis and treatment of tinnitus. Methods Clinical encounters were video‐recorded. Patients were interviewed individually following their clinic appointment. Data were analysed using constant comparison techniques from Grounded Theory. Initial inductive analyses were then considered against theoretical conceptualizations of the clinician–patient relationship and of the clinical encounter. Results Alignment between clinician and patient was found to be essential to a collaborative consultation and to shared decision‐making. Clinician groups demonstrated variation in behaviour in the encounter; some asked closed questions and directed the majority of the consultation; others asked open questions and allowed patients to lead the consultation. Conclusions A shift away from aetiology and physiological tests is needed so that tinnitus is managed as a persistent unexplained set of symptoms. This uncertainty is challenging for the medical professionals; lessons could be learned from the use of therapeutic skills. Further research is required to test techniques, such as the use of decision aids, to determine how we might create the ideal clinical encounter. Statement of contribution What is already known on this subject? Tinnitus is a condition in which sound is heard in the absence of an external source. Current approaches to managing tinnitus vary depending on clinical site (Hoare & Hall, 2011). In most instances, tinnitus does not have a straightforward medical cause. Tinnitus care is challenging to traditional biomedical encounters because the process of diagnosis may not lead to a defined treatment. Clinicians are required to consider not only what the tinnitus sounds like but more importantly, what it means for the affected individual. This requires a careful and skilled approach to eliciting a patients current behaviour, coping, and preferences for both outcomes and treatment approaches. What does this study add? We provide the first in‐depth description of decision‐making in clinical services for tinnitus. Findings suggest a shift in focus is required to move away from the current prioritization of the biomedical treatment of tinnitus. There is variation to the extent different clinicians were able to deal with the uncertainty presented by the symptoms of tinnitus.

Causal attributions in King-Kopetzky syndrome

Abstract At least 10% of people who present for help with hearing difficulties will be found to have normal hearing thresholds. These cases are clinically categorized as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). While recent research has focussed on the possible mechanistic basis for these difficulties, the perceptions of the hearing difficulties that lead people to seek help have not hitherto been identified. This study presents findings from an observational survey of causal attributions of hearing difficulties from 100 people with KKS. The findings suggest that participants regard immunity and risk related causes of hearing difficulties as pre-dominant. Psychological factors were not considered to be causal for hearing difficulties. These factors were not affected by diagnostic classification. These findings inform audiologists about their patient beliefs for the first time. The authors suggest that clinicians take care to ensure that their counselling is responsive to these beliefs. Sumario Al menos el 10% de quienes piden ayuda por problemas auditivos tienen umbrales auditivos normales. Estos casos se caracterizan clínicamente como síndrome de King Kopetzky (KKS), Disfunción Auditiva Obscura (OAD) o Problema de Procesamiento Auditivo (APD). Mientras que la investigación reciente se ha enfocado a las posibles bases mecanicistas de estas dificultades, las percepciones sobre los problemas auditivos que impulsan a que la gente busque ayuda, no han sido identificadas hasta ahora. Este estudio presenta hallazgos de una encuesta observacional sobre la atribución de causas de problemas auditivos en 100 personas con KKS. Los hallazgos sugieren que ellos consideran como causas, la inmunidad y los riesgos de problemas auditivos, como predominantes. Los factores psicológicos no fueron tomados en cuenta como causa de problemas auditivos. Estos factores no se afectaron por la clasificación diagnóstica. Los hallazgos informan por primera vez, a los audiólogos, sobre las percepciones de sus pacientes. Los autores sugieren que los clínicos tengan cuidado en asegurar que su orientación sea sensible a esas percepciones.

The development of a decision aid for tinnitus

Abstract Objective: To develop a decision aid for tinnitus care that would meet international consensus for decision aid quality. Design: A mixed methods design that included qualitative in-depth interviews, literature review, focus groups, user testing and readability checking. Study sample: Patients and clinicians who have clinical experience of tinnitus. Results: A decision aid for tinnitus care was developed. This incorporates key evidence of efficacy for the most frequently used tinnitus care options, together with information derived from patient priorities when deciding which choice to make. Conclusion: The decision aid has potential to enable shared decision making between clinicians and patients in audiology. The decision aid meets consensus standards.