Marie Öberg

Factors Influencing Help Seeking, Hearing Aid Uptake, Hearing Aid Use and Satisfaction With Hearing Aids: A Review of the Literature

Objectives: This descriptive summary of the literature provides an overview of the available studies (published between January 1980 and January 2009) on correlates of help-seeking behavior for hearing loss, hearing-aid uptake, hearing-aid use, and satisfaction with the device. Methods: Publications were identified by structured searches in Pubmed and Cinahl and by inspecting the reference lists of relevant articles. The articles covered different stages that a person with hearing impairment may go through: prior to hearing aid fitting, the period covering the fitting and the period post hearing aid fitting. Inclusion of articles occurred according to strict inclusion and exclusion criteria. Data were extracted by two independent researchers. Thirty-nine papers were included that identified 31 factors examined in relation to the four outcome measures. These covered personal factors (e.g., source of motivation, expectation, attitude), demographic factors (e.g., age, gender) and external factors (e.g., cost, counseling). Only two studies covered the actual fitting process. There was only one factor positively affecting all four outcome variables. This was self-reported hearing disability. The vast majority of studies showed no relationship of age and gender with any of the outcome domains. Discussion and conclusion: Whereas research of the last 28 years yielded valuable information regarding relevant and irrelevant factors in hearing aid health care, there are still many relevant issues that have never been investigated in controlled studies. These are discussed.

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.

Psychometric evaluation of hearing specific self-report measures and their associations with psychosocial and demographic variables

The main aim of this study was to collect descriptive data and to evaluate the psychometric properties of a range of self-report questionnaires in a Swedish population. Other aims were to investigate the correlations between these measures and the higher order factorial structure of the included questionnaires. One hundred and sixty-two first-time hearing aid users completed four standardized hearing specific questionnaires: the Hearing Handicap Inventory for the Elderly (HHIE); the Satisfaction with Amplification in Daily Life (SADL); the Communication Strategies Scale (CSS); and the International Outcome Inventory for Hearing Aids (IOI-HA). In addition, two psychosocial questionnaires were completed: the Sense of Coherence scale (SOC); and the Hospital Anxiety and Depression Scale (HADS). All measures were administered at one year post hearing aid fitting. Mean scores for the questionnaires were in agreement with previous studies. The questionnaires were found to be reliable and acceptable for further clinical use. Correlations were seen across different hearing specific questionnaires, and between hearing aid use and satisfaction. Psychosocial variables were more strongly associated with participation restriction and satisfaction than with the demographic variables, confirming the importance of subjective measures. The factor analysis extracted four factors: psychosocial well-being, hearing aid satisfaction, adaptive communications strategies, and residual participation restriction, and indicated that the number of questionnaires could be reduced. It is concluded that psychosocial factors are important to consider in hearing aid rehabilitation and their possible role should be further investigated in future studies.

A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users

Abstract Objective: Previous research shows that the internet can be used in the rehabilitation of hearing-aid users. By further developing the online program, it might be possible to foster behavioral changes that will positively affect hearing-aid users. Design: A randomized controlled study with two groups of participants. The intervention group underwent a five-week online intervention while the control group was referred to a waiting list. Questionnaires were used as outcome measures. Study sample: Seventy-six experienced hearing-aid users participated in the study, ranging in age from 26 to 81 years (mean 69.3 years). Results: The findings showed significant improvements in the intervention group after the intervention, measured by the hearing handicap inventory for the elderly. The effects were maintained and improved at the follow-up. Furthermore, the results indicated that the participants in the intervention group improved at two items of the international outcome inventory for hearing aids, and the effects were partly maintained at the follow-up. Finally, significant improvements in the domain of psychosocial wellbeing were found at the follow-up. Conclusions: This study provides further evidence that the internet can be used to deliver intervention of rehabilitation to hearing-aid users.

Hearing difficulties, uptake, and outcomes of hearing aids in people 85 years of age

Abstract Objective: The aim of this study was to investigate self-reported hearing difficulties, uptake, and hearing-aid outcomes and their relationships to demographic, cognitive, psychosocial, and health variables in 85 year olds. Design and study sample: Three hundred and forty-six elderly adults participated in a survey that included questionnaires and home visits. Fifty-five percent of participants admitted to having hearing difficulties, and 59% of these owned hearing aids. The participants’ most frequently cited reason for not acquiring hearing aids was that they did not think their hearing problem was perceived as severe enough. Participants with hearing difficulties who did not own hearing aids showed worse general and mental health. Many of the elderly participants were successful in their rehabilitation, and their hearing-aid outcomes were similar to those of a younger group, with the exception of a greater proportion of non-users among the elderly. Conclusion: Many older people with self-reported hearing difficulties do not acquire hearing aids, despite this studys findings that older people are likely to have success with hearing rehabilitation. It is important to make greater efforts to try to increase elderly adults’ awareness of hearing loss and the benefits of hearing rehabilitation.

Internet Access and Use in Adults With Hearing Loss

Background The future rehabilitation of adults with hearing loss is likely to involve online tools used by individuals at home. Online tools could also be useful for people who are not seeking professional help for their hearing problems. Hearing impairment is a disability that increases with age, and increased age is still associated with reduced use of the Internet. Therefore, to continue the research on online audiological rehabilitative tools for people with hearing loss, it is important to determine if and to what extent adults with hearing loss use the Internet. Objective To evaluate the use of the Internet and email in a group of adults with hearing loss and to investigate if their use of Internet and email differed between genders, among different age groups, and how it compared with the general population in Sweden. Methods Questionnaires containing multiple-choice questions about Internet access, email use, and educational level were mailed to individuals with hearing loss, who were registered as patients at a hearing aid clinic. Out of the 269 invited participants, 158 returned a completed questionnaire, which was a response rate of 58.7%. Results The results showed that 60% (94/158) of the participants with hearing loss used computers and the Internet. The degree of hearing loss in the group of participants did not explain the level of Internet usage, while factors of age, gender, and education did (P<.001). More men than women used the Internet (OR 2.54, 95% CI 1.32-4.91, P<.001). Use of the Internet was higher in the youngest age group (25-64 years) compared to the oldest age group (75-96 years, P=.001). A higher usage of the Internet was observed in the participants with hearing loss, especially the elderly, when compared with the general population of Sweden (OR 1.74, 95% CI 1.23-3.17, P=.04). Conclusions We conclude that the use of computers and the Internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden, but that this use is even higher in specific age groups. These results are important for the future work in developing and evaluating rehabilitative educational online tools for adults with hearing loss.

Internet-based hearing screening using speech-in-noise validation and comparisons of self-reported hearing problems, quality of life and phonological representation

Objectives For the last decade a host of different projects have been launched to allow persons who are concerned about their hearing status to quickly and at a low cost test their hearing ability. Most often, this is carried out without collecting complementary information that could be correlated with hearing impairment. In this two-part study we first, present the development and validation of a novel Internet-based hearing test, and second, report on the associations between this test and phonological representation, quality of life and self-reported hearing difficulties. Design Cross-sectional study. Setting An opportunity sample of participants was recruited at the Stockholm central station for the first study. All parts of the second study were conducted via the Internet, with testing and self-report forms adapted for online use. Participants The first part of the study was carried out in direct contact with the participants, and participants from the second study were recruited by means of advertisements in newspapers and on webpages. The only exclusion criterion was that participants had to be over 18 years old. Most participants were between 60 and 69 years old. There were almost an equal number of men and women (total n=316). Outcome measures 48 participants failed the Internet-based hearing screening test. The group failing the test reported more problems on the Amsterdam Inventory of Auditory Disability. In addition, they were found to have diminished phonological representational skills. However, no difference in quality of life was found. Conclusions Almost one in five participants was in need of contacting their local hearing clinic. This group had more complaints regarding tinnitus and hyperacusis, rated their own hearing as worse than those who passed, and had a poorer capability of generating accurate phonological representations. This study suggests that it is feasible to screen for hearing status online, and obtain valid data.

Development and initial validation of the “Clinical Global Impression” to measure outcomes for audiological rehabilitation

Purpose. The aim of this study was to develop and validate an interview instrument for assessing outcome following hearing aid fitting based on clinical global impressions. Method. The Audiological Rehabilitation Clinical Global Impression (AR-CGI) was developed and used in a telephone interview in two separate samples. The first sample (N = 69) consisted of hearing aid owners who had participated in two intervention studies, and the second sample consisted of hearing aid owners receiving regular services from a hearing clinic (N = 21). Following the semi-structured telephone interview, participants were categorised into three categories: successful, successful with some limitations or unsuccessful. Results. A vast majority were categorised as successful (80% of the intervention sample and 71% of the clinical sample). Those categorised as successful were found to differ from those categorised as less successful in terms of age and self-reported hearing aid use, depressed mood and residual participation restriction, but they did not differ in terms of degree of hearing loss. Conclusions. It is suggested that the brevity and usefulness of the AR-CGI makes it a potential tool for further use in audiological settings.

The effects of a sound awareness pre-fitting intervention: A randomized controlled trial

The objective of the study was to evaluate the effects of an individual pre-fitting intervention for first-time hearing aid users. Thirty-eight hearing impaired adults were randomly assigned to a sound awareness pre-fitting intervention (n=19) or to a control group (n=19). The purpose of the sound awareness training was to facilitate the users’ acclimatization to amplified sound. The pre-fitting intervention consisted of three visits and was followed by conventional hearing aid fitting that was identical for both groups. Standardized questionnaires were administered before and after the pre-fitting intervention, after the conventional hearing aid fitting, and at a one-year follow-up. The follow-up also included a clinical assessment by means of a telephone interview performed by an independent audiologist. The pre-intervention did not result in any major improvement over and above the control group. However, improvements were found for both groups following hearing aid fitting. In addition, most participants were considered as successful users in the interview. Future research should target individuals in need of extended hearing aid rehabilitation.

Short- and Long-Term Effects of the Modified Swedish Version of the Active Communication Education (ACE) Program for Adults with Hearing Loss

BACKGROUND In Sweden, there is a lack of evidence-based rehabilitation programs for hearing loss. The Active Communication Education program (ACE) has successfully been used in Australia and was translated and evaluated in a Swedish pilot study. The pilot study included 23 participants (age 87 yr). No statistically significant effects were found, but the qualitative assessments indicated that this population found the program to be beneficial. The participants requested more focus on the psychosocial consequences of hearing loss, and the modules in the original ACE program were modified. PURPOSE The aim of this study was to explore the effects of a modified Swedish version of the ACE program in a population aged 39-82 yr old. RESEARCH DESIGN Design was a between-group and within-group intervention study. STUDY SAMPLE The participants were recruited from the hearing health clinic in Linköping during 2010 and 2012. A total of 73 participants agreed to undergo the ACE, and 67 (92%) completed three or more sessions. INTERVENTION The ACE program consists of five weekly 2 hr group sessions with 6 to 10 participants per group. DATA COLLECTION AND ANALYSIS The outcomes were measured before initiation of the program, 3 wk after program completion, and 6 mo after program completion and included communication strategy use, activity and participation, health-related quality of life, and anxiety and depression. In addition, outcomes were measured after program completion using the International Outcome Inventory-Alternative Interventions, a modified version of the Client Oriented Scale of Improvement, and qualitative feedback was obtained about the response to the program and actions taken as a result of participation. The treatment effects were examined using repeated-measures analyses of variance. RESULTS Statistically significant effects were found for communication strategy use, activity and participation, and psychosocial well-being. Statistically significant effects were found for gender and degree of hearing loss, indicating that women and those with mild hearing loss significantly improved communication strategies. CONCLUSIONS It is suggested that the program be implemented as part of regular audiological rehabilitation and offered in an early stage of rehabilitation.