Jill E. Preminger

Hearing help-seeking and rehabilitation Perspectives of adults with hearing impairment

Abstract Objective: This study investigated the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Design: Individual semi-structured interviews were completed. Study sample: In total, 34 adults with hearing impairment in four countries (Australia, Denmark, UK, and USA) participated. Participants had a range of experience with hearing help-seeking and rehabilitation, from never having sought help to being satisfied hearing-aid users. Results: Qualitative content analysis identified four main categories (‘perceiving my hearing impairment’, ‘seeking hearing help’, ‘using my hearing aids’, and ‘perspectives and knowledge’) and, at the next level, 25 categories. This article reports on the densest categories: they are described, exemplified with interview quotes, and discussed. Conclusions: People largely described hearing help-seeking and rehabilitation in the context of their daily lives. Adults with hearing impairment rarely described clinical encounters towards hearing help-seeking and rehabilitation as a connected process. They portrayed interactions with clinicians as isolated events rather than chronologically-ordered steps relating to a common goal. Clinical implications of the findings are discussed.

Conducting qualitative research in audiology: A tutorial

Abstract Objective: Qualitative research methodologies are being used more frequently in audiology as it allows for a better understanding of the perspectives of people with hearing impairment. This article describes why and how international interdisciplinary qualitative research can be conducted. Design: This paper is based on a literature review and our recent experience with the conduction of an international interdisciplinary qualitative study in audiology. Results: We describe some available qualitative methods for sampling, data collection, and analysis and we discuss the rationale for choosing particular methods. The focus is on four approaches which have all previously been applied to audiologic research: grounded theory, interpretative phenomenological analysis, conversational analysis, and qualitative content analysis. Conclusions: This article provides a review of methodological issues useful for those designing qualitative research projects in audiology or needing assistance in the interpretation of qualitative literature.

Preliminary evaluation of the speech perception assessment and training system (SPATS) with hearing‐aid and cochlear‐implant users

SPATS is evaluated as a testing and training system for hearing‐aid (HA) users and cochlear‐implant (CI) users. Criterion measures include the HINT, CNC tests, W22 tests, and Coxs CDT, parts of Gatehouses SSQ and a special SPATS inventory. SPATS measures include the identification of syllable constituents (onsets, nuclei, and codas) and measures of top‐down and combined top‐down and bottom‐up recognizing spoken sentences. Control subjects were measured on criterion and SPATS tests, and then retested after a pause of several weeks. Trained subjects took all of the same tests, but in the time between first and second testing underwent either 12 or 24 hours of systematic training using special SPATS algorithms that focus training on items of intermediate difficulty in quiet and noise. Trained subjects show gains on speech‐perception measures in quiet and noise, and in look‐and‐listen tasks, even though there was no training of visual speech perception. Subjects report that SPATS training and testing gave them a much clearer understanding of the severity of their hearing impairments and led to improved speech perception in everyday life through greater attention to detail, and to differences between talkers. [Supported by Grant No. R44DC006338 from NIH/NIDCD.]

The influence of mood on the perception of hearing-loss related quality of life in people with hearing loss and their significant others

Abstract The purpose of this research was to investigate the congruent/incongruent perceptions of hearing-loss related quality of life between members of couples and to determine how incongruence was affected by individual psychosocial characteristics, specifically measures of mood (negative affect and positive affect), stress, and communication in the marriage. An exploratory correlational analysis was performed on data for 52 couples in which only one member had a hearing loss. In the regression analyses the independent variables were hearing-loss related quality of life scores measured in people with hearing loss, measured in significant others, and differences in hearing-loss related quality of life among members of a couple. The results demonstrate that both in people with hearing loss and their significant others, perceptions of hearing-loss related quality of life is highly correlated with negative mood scores. Incongruence in hearing-loss related quality of life scores reported by members of a couple were highly correlated with negative affect measured within each individual. Future research evaluating the effectiveness of audiologic rehabilitation can use measures of mood as an outcome variable. Sumario El objetivo de este trabajo fue investigar las percepciones congruentes e incongruentes sobre la calidad de vida relacionada con la hipoacusia entre los miembros de una pareja y determinar la forma en que las características psico-sociales, específicamente la medición del estado de ánimo (efectos positivos y negativos), el stress y la comunicación en el matrimonio afectaron las incongruencias. Se llevó a cabo un análisis exploratorio y de correlación en los datos de 52 parejas en las que uno de sus miembros tenía una hipoacusia. En el análisis de regresión las variables independientes fueron: las puntuaciones de calidad de vida relacionadas con la hipoacusia, medidas en las personas con hipoacusia, en sus seres queridos; y las diferencias en la calidad de vida relacionada con la hipoacusia entre los miembros de la pareja. Los resultados demostraron que tanto en las personas con hipoacusia como en sus parejas, las percepciones sobre la calidad de vida relacionada con la hipoacusia tienen una alta correlación con las puntuaciones de estado de ánimo negativo. Las puntuaciones sobre incongruencia en la calidad de vida relacionada con la hipoacusia reportada por los miembros de la pareja estuvieron altamente correlacionadas con la afección negativa por el estado de ánimo. La incongruencia en las puntuaciones de la calidad de vida relacionada con la hipoacusia reportadas por los miembros de la pareja se correlacionaron altamente con el efecto negativo medido en cada individuo. Investigaciones futuras evaluando la efectividad de la rehabilitación audiológica pueden utilizar las mediciones del estado de ánimo como variable resultante.

The Hearing Impairment Impact-Significant Other Profile (HII-SOP): a tool to measure hearing loss-related quality of life in spouses of people with hearing loss.

BACKGROUND Third-party hearing loss-related quality of life (HLQoL) reports measure the third-party disability as a result of communicating regularly with someone with hearing loss. Scales with known psychometric characteristics validated on a diverse subject population are needed in order to describe the activity limitations and participation restrictions experienced by spouses as a result of living with an individual with hearing loss. PURPOSE The purpose of the present study was to develop a scale to measure third-party HLQoL in spouses of people with hearing loss with acceptable psychometric characteristics. This scale is known as the Hearing Impairment Impact-Significant Other Profile (HII-SOP). RESEARCH DESIGN In Study 1, the initial test items were developed and evaluated with a factor analysis for adequate construct validity. In Study 2, the internal consistency reliability, the validity, and the test-retest reliability of the revised test were evaluated. STUDY SAMPLE In Study 1, 120 people between 34 and 87 yr of age participated and in Study 2, 164 people between 23 and 88 yr of age participated. DATA COLLECTION AND ANALYSIS In Study 1, a 41-item questionnaire was developed based on five content areas: physical adjustment, social activities, emotional reaction, intimate relationship, and change in roles. The scale was submitted to a factor analysis to analyze interrelationships among items, determine the underlying dimensions, and select items for the final scale. In Study 2, the internal consistency reliability, construct validity, and test-retest reliability were evaluated in the revised 20-item questionnaire. The internal-consistency reliability was measured using Cronbachs alpha. Validity was assessed by observing the correlations of the new scale with well-established scales measuring related constructs: overall health-related quality of life, marital communication, HLQoL, and negative affect, in both the person with hearing loss and the spouse. Test-retest reliability was measured in a subset of the spouses who completed the HII-SOP between 2 and 4 wk after the initial scale was completed. RESULTS The HII-SOP is a 20-item scale with three subscales which measure: (1) the emotions that arise when having a spouse with hearing loss as well as the impact of the hearing loss on the marital relationship, (2) the impact of the hearing loss on the social life of the spouse, and (3) the communication strategies used by the spouse. The scale and its subscales have adequate internal-consistency reliability suggesting that the 20 items do measure a single construct and the subscales do measure distinct subconstructs. The HII-SOP scale was significantly correlated with measures expected to relate to the construct of third-party disability associated with hearing loss. Finally, the HII-SOP scale has adequate test-retest reliability (r = 0.90) and the 95% critical differences is 19.7 points. CONCLUSIONS The HII-SOP is a scale to measure third-party HLQoL in spouses of individuals with hearing loss. Scores of 20-39 reflect mild third-party disability, scores of 40-59 reflect moderate third-party disability, and scores >60 reflect severe third-party disability associated with hearing loss.

Training listeners to identify the sounds of speech: II. Using SPATS software.

In the first section of this two-part article, several lines of research on auditory perceptual learning were shown to support the proposition that users of hearing aids and cochlear implants would benefit from systematic training on the new “speech code” represented by the modified sounds they experience through those devices. Research also suggests that improved abilities to use the speech code can improve the recognition of meaningful sentences. We proposed several criteria for training systems designed to take advantage of what has been learned over the past half century about auditory perceptual learning of both speech and other complex sounds. In this second part we describe such a system and summarize the results of a validation study conducted with it. The Speech Perception Assessment and Training System (SPATS)* is designed to improve a listener’s perception of natural everyday speech. It consists of two independent speech-recognition testing and training programs, one for the constituents of speech, referred to earlier as “the code,” and the other for sentences. The purpose of the constituent training program is to sharpen the listener’s attentional focus on those spectral-temporal properties that specify the elements of syllables, onsets (single consonants and clusters), nuclei (vowels and vowel-like sounds), and codas (final consonants and clusters). A sentence module trains a combination of bottom-up and top-down processing in a novel auto-scoring identification task in which listeners are encouraged to make strong use of linguistic context.

Perceptions of age and brain in relation to hearing help-seeking and rehabilitation.

Objectives: This study used a qualitative approach to explore the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Two superordinate themes, Age and Brain, emerged from prior analyses and are investigated in the present article. Design: In-depth semistructured interviews were completed in four countries with 34 adults (aged 26 to 96 years) with hearing impairment. Participants were asked to “Tell the story of your hearing.” Participants included individuals with different levels of experiences in hearing help-seeking and rehabilitation. The themes of Age and Brain emerged from the data based on qualitative content analysis. These major themes were analyzed further using interpretative phenomenology to create models of themes and subthemes as they related to hearing help-seeking and rehabilitation expectations and experience. Results: Age was discussed by 68% of the 34 participants. The data were sorted into three themes: Expectations, Self-Image, and Ways of Coping. Brain was discussed by 50% of the participants. The data were sorted into three themes: Cognitive Operations, Plasticity, and Mental Effort. Conclusions: Adults with hearing impairment think of their age and their brain as contributing to their hearing impairment, disability, help-seeking, and rehabilitation. Although hearing impairment associated with older age was typically construed as a stigma, not all perceptions of aging and hearing impairment were negative. Some participants viewed older age and its influence on relationships or priorities as a reason for seeking out hearing health care or as the determining factor in deciding to wear hearing aids (HAs). Some expected hearing impairment with older age, thus they found it easier to accept wearing HAs than they may have at a younger age. They discussed the brain in terms of the cognitive operations that may either inhibit or improve speech communication. Participants believed that they could train their brains to improve their communication (and sometimes avoid the need for HAs) or to increase their HA benefit. Age and Brain interconnected in a number of ways. Participants believed that older age led to cognitive decline, which resulted in decreased speech understanding. Participants also believed that the cognitive decline that accompanies older age may limit HA benefit. Hearing healthcare providers may wish to clarify negative messages about age and brain with their patients and provide information about how older brains are capable of changing and benefiting from HA use and comprehensive audiologic rehabilitation programs.

Perceptions of adults with hearing impairment regarding the promotion of trust in hearing healthcare service delivery

Abstract Objective: This paper describes how trust is promoted in adults with hearing impairment within the context of hearing healthcare (HHC) service delivery. Design: Data were analysed from a previously published descriptive qualitative study that explored perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Study sample: Interview transcripts from 29 adults from four countries with different levels of hearing impairment and different experience with the HHC system were analysed thematically. Results: Patients enter into the HHC system with service expectations resulting in a preconceived level of trust that can vary from low to high. Relational competence, technical competence, commercialized approach, and clinical environment (relevant to both the clinician and the clinic) influence a patients resulting level of trust. Conclusions: Trust is evolving rather than static in HHC: Both clinicians and clinics can promote trust. The characteristics of HHC that engender trust are: practicing good communication, supporting shared decision making, displaying technical competence, offering comprehensive hearing rehabilitation, promoting self-management, avoiding a focus on hearing-aid sales, and offering a professional clinic setting.

The selection and validation of output sound pressure level in multichannel hearing aids.

Objective To validate the Australian National Acoustic Laboratories’ (NAL) procedure for prescribing output sound pressure level (OSPL) for multichannel hearing aids (Dillon & Storey, 1998) Design The NAL OSPL prescriptive procedure for multichannel hearing aids was used to calculate Predicted OSPL, Predicted Maximum Acceptable OSPL and Predicted Minimum Acceptable OSPL for 20 subjects with sensorineural hearing loss fitted with a 2-channel linear hearing aid. Subjects rated the speech clarity and quality of average (65 dBA) and loud (80 dBA) speech, in quiet and in noise, with the hearing aid set to a number of OSPL settings. These data were used to evaluate the validity of the Predicted OSPL. Frequency-specific loudness discomfort levels (LDLs) were measured to determine whether use of measured LDLs would improve the accuracy of the prediction. Results The Predicted Minimum Acceptable OSPL was in good agreement with the measured minimum acceptable OSPL for both the low- and high-frequency channels. The Predicted Maximum Acceptable OSPL was in good agreement with the measured maximum acceptable OSPL for the low-frequency channel, but was only a fair predictor for the high-frequency channel. The use of measured LDLs rather than predicted LDLs did little to improve the accuracy of the fitting. A direct comparison between the NAL single-channel and multichannel prescribed OSPL settings showed that most listeners rated speech clarity higher for the multichannel settings. Conclusions In two channel hearing aids, the NAL Predicted Minimum Acceptable OSPL and Predicted Maximum Acceptable OSPL are reasonable predictors of minimum and maximum OSPL levels measured using sound clarity and quality ratings. The results of this study support the use of the NAL prescriptive formula for setting OSPL in multichannel hearing aids. Such settings should be verified by having the listener rate the loudness of an intense speech signal. If tolerance problems are evident, the OSPL in the high-frequency channel(s) should be reduced first.

The Effect of Chronological Age on the Acceptance of Internet-Based Hearing Health Care

PURPOSE The purpose of this article is to offer design considerations in developing Internet-based hearing health care for older adults by analyzing and discussing the relationship between chronological age, computer skills, and the acceptance of Internet-based hearing health care. METHOD This article reports baseline data from a training study measuring the acceptance of Internet-based hearing health care. Participants (n = 26; 20 men, 6 women) were aged 55–95 years. All passed a cognitive screen and failed a hearing screen. Participants completed the Patient- Technology Acceptance questionnaire (Or, 2008). Computer literacy was measured using the Northstar Digital Literacy Assessment (Cytron-Hysom, Hadley, Vanek, Graif, & Asp, 2012). RESULTS Computer literacy was negatively correlated with increasing age. Additional negative relationships were seen between computer literacy and computer anxiety and between computer literacy and computer self-efficacy. Finally, there was a negative relationship between computer self-efficacy and computer anxiety. CONCLUSION These results suggest computer literacy is lower in adults of advanced age than in those who are a few years younger. Indirect relationships were observed between age and computer self-efficacy and between age and computer anxiety. Consideration should be given to addressing discrepancies in self-efficacy and computer literacy in older adults to increase the likelihood of acceptance of Internet-based hearing health care.