Kenneth Southall

Stigma: A negative and a positive influence on help-seeking for adults with acquired hearing loss

Abstract There are stigmas associated with many chronic health conditions that emerge in adulthood. People who present manifestations of hearing loss are often perceived by others to be cognitively diminished, less able, and socially incompetent. In order to avoid being identified as a member of a stigmatized group, individuals with hearing loss may choose not to seek health services or fail to comply with recommended treatments. The purpose of this study was to better understand how stigma impacted upon the help-seeking activities of adults with an acquired hearing loss. Ten people who had hearing loss, and were members of peer-support groups participated in audio-recorded semi-structured interviews. Verbatim transcripts were analysed using thematic analyses. Analyses revealed that lasting decisions about hearing loss management were made following ‘critical junctures’, when the negative stress found in the respondents social and physical environment far outweighed positive energy, or when the positive energy found in the respondents environment far outweighed the negative stress. The time course development of these processes is described. Sumario Existen estigmas asociados con muchas condiciones crónicas de salud que aparecen en la edad adulta. La gente que presenta manifestaciones de pérdida auditiva a menudo son percibidas por los demás como disminuidos cognitivamente, menos capaces, y socialmente incompetentes. Para evitar ser identificado como un miembro de un grupo estigmatizado, los individuos con hipoacusia escogen no buscar ayuda en los servicios de salud o fallan en cumplir con los tratamientos recomendados. El propósito de este estudio fue entender mejor cómo el estigma impacta las actividades de búsqueda de ayuda de adultos con hipoacusias adquiridas. Diez personas con pérdida auditiva, que era miembros de grupos de apoyo a iguales, participaron de entrevistas semi-estructuradas, grabadas en audio. Se analizaron las transcripciones usando un análisis temático. Los análisis revelaron las decisiones duraderas sobre el manejo de la hipoacusia se realizaban luego de “encrucijadas críticas”, cuando la tensión negativa encontrada en el ambiente social y físico del participante sobrepasaba la energía positiva, o cuando la energía positiva que se hallaba en el ambiente del participante sobrepasaba la tensión negativa. Se describe el desarrollo en el tiempo de estos procesos.

Factors that influence the use of assistance technologies by older adults who have a hearing loss.

The objective of this study was to describe and better understand the factors that influence the use of assistance technologies by older adults who have a hearing loss. We were interested in adopting a methodological approach that would provide an in-depth account of individual experiences related to the use of these technologies. A qualitative research design was therefore selected. Audio-recorded interviews were conducted with ten individuals who were 65 years of age or older and were current successful assistance technology users. Thematic analysis was used to draw meaning from the interview transcripts. The results suggest that successful use of these assistance technologies involves the recognition of hearing difficulties, an awareness that technological solutions exist, consultation for and acquisition of devices, and adapting to device use and modified behaviour. These four landmarks seem to be crucial stages when people either move toward successful assistance technology use or are discouraged from assistance technology use. Based on these results, a representative model of assistance technology awareness, acquisition and utilization is proposed.

Evaluating use and outcomes of mobility technology: A multiple stakeholder analysis

Purpose: This qualitative, multi-site study compared and contrasted the outcomes of mobility technology (MT) and the factors influencing these outcomes from the perspective of MT users, caregivers, and professionals involved in MT service delivery. Method: Qualitative focus groups were held in the USA and Canada with multiple stakeholder groups (consumer: n = 45, caregiver: n = 10, service provider: n = 10). Data were analyzed thematically. Results: MT outcomes were conceptualized by participants as a match between expectations for MT and the actual outcomes experienced. Several factors influenced the match including a) MT features, b) environmental factors (e.g. built/physical environment, societal context of acceptance, MT delivery systems/policies), and c) the ability to self-manage the interaction across person, technology and environment, which involved constant negotiation and strategizing. Stakeholders identified MT outcomes that corresponded to ICF levels including body structure and function, activity, and participation across environments; however, varied on their importance and influence on MT impact. Conclusions: The conceptual fit model and factors related to self-management of MT represent new knowledge and provide a framework for stakeholder-based evaluation of MT outcomes. Implications for MT assessment, service delivery, outcomes research, and interventions are discussed. Implications for Rehabilitation There is a need for research on mobility technology (MT) such as canes, walkers and wheelchairs that documents the experiences of people with disabilities using MT. This qualitative, multi-site study compared and contrasted the outcomes of MT and the factors influencing these outcomes from the perspective of MT users, caregivers, and professionals involved in MT service delivery. Results from this research inform our understanding of MT use, assessment and outcomes.

Factors that influence disclosure of hearing loss in the workplace

Abstract Objective: The objective of the study was to identify factors that lead individuals to conceal or disclose their hearing loss in the workplace. Design: A qualitative research paradigm called qualitative description was selected to address this issue. Study sample: Twelve people who had an adult onset hearing loss, and were gainfully employed, participated in audio-recorded semi-structured interviews designed to probe issues related to disclosure of hearing loss. A photo elicitation interview technique was employed during the interviews. Content analyses were used to extract pertinent information from verbatim transcripts. Results: Five recurring themes emerged as important considerations in relation to this topic: (1) perceived importance of the situation; (2) perceived sense of control; (3) community affiliation; (4) burden of communication; and (5) coexisting issues related to hearing loss. Conclusions: The findings are discussed in relation to other concealable stigmatizing traits, stigma-theory, and social-cognitive theory. The clinical implications of these findings are discussed, with particular emphasis placed on worker self-efficacy. Sumario Objetivo: El objetivo de este estudio fue identificar los factores que llevan a los individuos a ocultar o revelar su pérdida auditiva en el lugar de trabajo. Diseño: Se escogió un paradigma cualitativo de investigación llamado descripción cualitativa para enfrentar el asunto. Muestra del Estudio: Doce sujetos con una hipoacusia adquirida en la edad adulta con empleos bien remunerados participaron en una entrevista semi-estructurada grabado en audio, diseñada para evaluar asuntos relacionados con la revelación de su problema auditivo. Se empleó una técnica de entrevista por provocación fotográfica durante la misma entrevista. Se usó un análisis de contenidos para extraer la información pertinente de las transcripciones literales. Resultados: Cinco temas recurrentes emergieron como consideraciones importantes en relación con este tópico: 1. Percepción de la importancia de la situación; 2. Percepción del sentido de control; 3. Afiliación a la comunidad; 4. Carga en la comunicación; y 5. Asuntos coexistentes relacionados con la hipoacusia. Conclusiones: Los hallazgos se discuten en relación con otros rasgos estigmatizantes ocultables, con la teoría del estigma y con la teoría social-cognitiva. Las implicaciones clínicas de estos hallazgos se discuten, con un énfasis particular puesto en la auto-eficacia del trabajador.

What’s in a name: Dual sensory impairment or deafblindness?

Communications about deafblindness within the clinical and research literature are littered with several terms that have not yet been well established or defined, such as deafblindness, dual sensory loss, or combined vision and hearing impairment. Depending on the context (e.g. service delivery for children, adults, or seniors) or the user (e.g. educators, clinicians, researchers, or clients), these terms are sometimes used interchangeably; such practice, however, can be misleading and does not assist the scientific goal of precise communication. The goal of this study was to review the existing definitions of these terms and their use through a systematic review of the literature and by conducting a qualitative survey to solicit the opinions of clinicians and researchers in the field of deafblindness. A systematic review of five databases resulted in 809 references containing terms relevant to deafblindness, which were then searched using the terms, such as deafblind, deaf-blind, deaf AND blind, dual, vision AND hearing, and combined, as they appeared in the titles and/or abstracts. In addition, a survey of researchers and rehabilitation professionals in this domain was conducted. The large majority of articles using deafblind-related terminology were published in clinician-oriented journals, whereas authors of high-impact research journal articles (many outside the domain of sensory rehabilitation) were more likely to utilize terms such as dual sensory or combined impairment. This segregation was similar in the 68 responses obtained through the survey. There is a need to harmonize the interpretation of terminology, specifically across professionals and interest groups relevant to deafblindness. Through the development of comparable terminology and clarity in communication, rehabilitation professionals will find it easier to access (and translate) research findings in their respective fields. In addition, the exchange of ideas between practitioners and researchers will be easier, resulting in more practically relevant research projects.

Coping With Extended Facedown Positioning After Macular Hole Surgery A Qualitative Diary Analysis

Background: Patients undergoing facedown positioning have to overcome physical and psychological challenges; however, their perspective and experience are rarely documented in the research literature. Objectives: The objective of this study was to examine the content of a self-motivated diary written by a person who underwent 77 days of facedown positioning after macular hole surgery. Her narrative about the obstacles during this postsurgical requirement resulted in an insightful description of several core topics relevant to patient care. Methods: The diary content was summarized using qualitative description procedures. This document was selected due to its unique rich nature. Thematic analysis was used to summarize and describe main topics of importance within the diary. Additional data sources (i.e., medical file, research literature, patient follow-up, and Web sites) were consulted to provide a more comprehensive understanding of the diary content. Results: On the basis of proximity of coded quotes and richness of content, seven areas of interest emerged, including the patients emotional state, quality of sleep, nutritional considerations, visual functioning, physical status, social support, and entertainment needs. Discussion: Potential patients and their caregivers can learn from the experiences of an individual who has coped successfully with this treatment. This analysis builds the groundwork for the refinement of guidelines for overcoming prevalent physical and psychological barriers.

Social identity management strategies used by workers with acquired hearing loss

OBJECTIVES There is a paucity of knowledge about social identity-management by persons with hearing loss. The objective of the study was to gain an understanding from the perspective of the participants, the ways in which workers with acquired hearing loss manage their identity in the workplace. PARTICIPANTS Twelve persons with acquired hearing loss, who were gainfully employed in a variety of settings and occupations in three Canadian cities, participated in audio-recorded semi-structured interviews. METHODS A secondary qualitative analysis was conducted on transcripts of interviews collected in a previous study on factors that influence disclosure of hearing loss in the workplace. A qualitative descriptive research paradigm was adopted and content analyses were used to extract pertinent information from verbatim transcripts. RESULTS Participants described a range of identity-management strategies enacted in the workplace. Five recurrent themes emerged as important considerations in the Art of Identity Management in the workplace: 1. Managing the situation, 2. Having a buddy system, 3. Feeling comfortable, 4. Using personal resources, 5. It gets easier with time. CONCLUSIONS Social identity-management is a complex process. Although persons with acquired hearing loss experience different challenges from other persons with invisible stigmas, similarities in the range of social identity-management strategies employed were evident in our findings. In addition, the social cognitive learning model of disclosure appears to be relevant to the experiences of our participants. The implications of the findings emphasize the importance of all stakeholders working collaboratively to address the issues of the growing population of workers with hearing loss.

The standpoint of persons with hearing loss on work disparities and workplace accommodations

OBJECTIVES The perspectives of persons who live and work with hearing loss were sought to examine workplace accommodation challenges and strategies. PARTICIPANTS A convenience sample of seven older adults with hearing loss participated in in-depth interviews. METHODS A systematic grounded theory approach informed the study design and analysis. Categories of facilitators and challenges in the data were identified through axial coding and clustering. Core categories of social processes emerged through constant comparison and theoretical sampling of the data to reveal the actions and interactions used to negotiate or implement adaptations or workplace accommodations. RESULTS Persons with hearing loss use a realm of strategies to live and work with a hearing loss. Social processes used to navigate the challenges to working with hearing loss and to manage optimal work performance included: self-accommodation, self-advocacy, self-management of hearing loss, and lobbying. CONCLUSIONS Success in overcoming work disparities for persons with hearing loss requires individuals to take control of identifying their needs within the workplace and at home, and to negotiate for specific accommodations. These strategies and processes draw attention to the need for a repository on contextualized workplace accommodation strategies for improving communication and hearing in the workplace. Further to this a best practice guide for use by workers, employers, and work rehabilitation and health care workers is indicated.

How to Make Low Vision "Sexy": A Starting Point for Interdisciplinary Student Recruitment

ABSTRACT: Professionals in the field of low vision are increasingly concerned about the paucity of optometry students who are expressing any interest in low vision as a clinical subspecialty. Concurrent with this apparent disinterest is an increased demand for these services as the baby boomer population becomes more predisposed to age-related vision loss. The authors of the present study conducted a qualitative survey to investigate ways to attract more young professionals into the field of low vision. The results of their survey revealed areas of concern including advertising, financial incentives, equipment and facility costs, relevance for practice, gaining experience, age-ism stereotypes, role models, and start-up opportunities, and yielded several suggestions that training institutions around the globe could consider and implement to redress the situation.KEYWORDS: low vision, qualitative survey, student recruitment Clinical low vision experts are becoming increasingly concerned about the paucity of optometry undergraduates who are expressing any interest in low vision as a clinical subspecialty. This apparent disinterest is occurring at a time when the demand for these services is increasing as the baby-boomer population becomes more predisposed to age-related vision loss. The con-cern about insufficient professional resources to cope with this looming population with low vision is not confined to the optometric profession. Occupational therapists have already recognized the need for recruitment strategies (Mulholland & Derdall, 2004, 2005); orientation and mobility and rehabilitation teachers are also preparing for the growing need of young pro-

Towards the development of the psychosocial impact of assistive devices scale for continence (C-PIADS)

© 2014 - IOS Press and the authors. All rights reserved. BACKGROUND: Current outcome measures for continence management devices do not adequately address psychosocial impact. The PIADS is an assessment tool that has been shown to reliably predict the adoption and use of assistive technology devices, but it is not widely used for continence devices.OBJECTIVE: To explore whether the PIADS requires modification to address the particular needs of continence device users and to inform any subsequent item development.METHODS: The study used interpretive methods in which qualitative information from semi-structured interviews was combined with the findings from cognitive interviews for questionnaire pre-testing. A total of 40 participants in UK and Canada were interviewed.CONCLUSIONS: The PIADS appears to fundamentally address many, but not all, of the important psychosocial concerns of adults who have continence difficulties. A version for continence, the C-PIADS, will require modification of the PIADS and is likely to contain some new items.RESULTS: Few participants had difficulty in understanding or relating to the majority of PIADS items. Several items were not considered relevant to continence and some areas for potential new items were uncovered. Embarrassment and concealment of urinary incontinence from others were common topics.