Mary Beth Jennings

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 in Client–Clinician Interaction That Influence Hearing Aid Adoption

The influence of client–clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider–patient interaction on health outcomes. The purpose of this study was to identify factors in the client–clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client–clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client–clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction.

Exploring hearing aid use in older women through narratives

Abstract This study explored experiences surrounding hearing aid use and non-use in older women with hearing loss. A narrative approach was used to gain an in-depth understanding of the meaning and contextual issues that impact upon the adaptation process of older adults and their transitions in using hearing devices. Four women over the age of sixty who were identified as being consistent hearing aid users took part in three face-to-face interviews. 43 biographic-narrative-interview guiding framework was used to gather data in this study. Data were analyzed both holistically and thematically from a phenomenological perspective to identify the meaning and essence of the participants’ experiences. The results revealed an overarching theme of meaningful participation in life situations and events that were linked to purposeful use and non-use of hearing aids. Barriers and facilitators related to participation, which in turn affect hearing aid use and acceptance, were uncovered. The results of this study have implications for audiologic research, and practice. Sumario Este estudio exploró las experiencias alrededor del uso o no uso de auxiliares auditivos por ancianas con pérdidas auditivas. Se usaron las narraciones como enfoque, para lograr la comprensión exhaustiva del significado y de los aspectos contextuales que impactan el proceso de adaptación de los adultos mayores y su transición en el uso de instrumentos auditivos. Tomaron parte en tres entrevistas cara-a-cara, cuatro mujeres mayores de sesenta años, identificadas como usuarias consistentes de auxiliares auditivos. Se usó el marco guía de 43 de entrevistas biográficas-narrativas para obtener los datos de este estudio. Estos datos fueron analizados tanto holística como temáticamente, desde una perspectiva fenomenológica para identificar el significado y la esencia de las experiencias de las participantes. Los resultados revelaron un tema enarcado de participación significativa en situaciones de vida y eventos ligados al uso propositivo o al no uso de auxiliares auditivos. Las barreras y los facilitadores relacionados con la participación, que afectan en sus momentos el uso y la aceptación del auxiliar auditivo, no fueron cubiertos. Los resultados de este estudio tienen implicaciones para la investigación y la práctica audiológica.

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.

Towards a comprehensive approach for managing transitions of older workers with hearing loss

Demographic and legislative trends suggest that many older workers may remain at work past the traditional retirement age. This extended work trajectory poses new challenges and opportunities for workers with acquired hearing loss as they age. Workplaces require a new approach to enable transitions of older workers with hearing loss to remain safe and productive. A review of the literature on older workers, those with hearing loss, and strategies used to accommodate them suggests that individualized and piecemeal approaches are predominant. While universal design represents a fresh ideology that may help create more accessible and usable products and environments, its application to improve workplaces for older workers with hearing loss is limited. This paper proposes that occupational science be integrated with knowledge in hearing sciences, accessibility, and usability to assist with the transitions faced by older workers with hearing loss. A more comprehensive approach including the following three key components will be posited to examine the nexus of aging, hearing loss and work: (1) the use of an occupational perspective, along with concepts in hearing sciences to examine hearing demands and improve hearing access; (2) the use of contextual processes to promote physical and social change, and (3) the inclusion of Universal Design for Hearing (UDH) considerations as stakeholders develop more hearing friendly workplaces.

Psychometric properties of the self-efficacy for situational communication management questionnaire (SESMQ)

Objectives: Perceived self-efficacy (PSE) is one’s beliefs in one’s capabilities to organize and execute the courses of action required to manage prospective situations. In audiologic rehabilitation, PSE could influence a person with hearing loss’ activity limitations, participation restrictions, and response to audiologic rehabilitation. This article reports the psychometric properties of the Self-Efficacy for Situational Communication Management Questionnaire (SESMQ), developed to measure PSE for managing communication in adults with acquired hearing loss. Design: The SESMQ contains 20 situations that are rated on two scales (hearing ability and PSE). Respondents rate how well they can hear from 0 (not well at all) to 10 (very well) and their degree of confidence in managing communication in the situation, or PSE, from 0 (not confident at all) to 10 (very confident). Total scores on each scale can range from 0 to 200, with higher scores indicating greater hearing ability or PSE. Psychometric properties were determined using data collected from The National Centre for Audiology (London, Canada) and the Communication Disability Centre at The University of Queensland (Brisbane, Australia). Participants were 338 adults aged 50 to 93 years with an average high-frequency pure-tone hearing loss in the better ear of 46 dB HL; 157 of the participants owned hearing aids. Results: A two-factor solution was found to be optimal for the SESMQ, with hearing ability accounting for 46.4% of the variation and confidence accounting for 11.6% of the variation in SESMQ scores. Test–retest reliability on a subset of 40 participants resulted in intraclass correlation coefficients of 0.94 for the SESMQ, 0.93 for the hearing ability scale, and 0.94 for the confidence scale, The SESMQ and its scales exhibited high internal consistency, with Cronbach’s &agr; of 0.94 for the SESMQ, 0.93 for the hearing ability scale, and 0.94 for the confidence scale. Participants scored lower on the hearing scale items (92.6, SD = 37.1), on average, than on the PSE scale items (123.0, SD = 37.9). SESMQ hearing ability scores were significantly associated with duration of hearing loss, and duration of hearing aid ownership. Only the hearing ability scale of the SESMQ was negatively associated with hearing loss when controlling for age. SESMQ hearing ability and confidence scores were negatively associated with consequences of hearing loss and negative beliefs and attitudes toward hearing loss and its consequences. Conclusions: The results support the SESMQ as an informative measure of PSE specific to communication for adults with hearing loss. The SESMQ may prove useful in both research and clinical practice.

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.

Representations of workers with hearing loss in Canadian newspapers: a thematic analysis

Abstract Objective: Participation in the labour force with a hearing impairment presents a number of challenges. This study describes how Canadian newspapers represent workers with hearing loss. Design: Taking a critical framing theory approach, thematic analysis was performed through coding relevant articles, abstracting and hierarchically categorising themes. Study sample: Seven English-language Canadian newspapers were searched for publications between 1995 and 2016. Twenty-six articles met our criteria: discussing paid workers with hearing loss who used English rather than sign language on the job and making reference to workers’ competence. Results: We identified a global theme, Focussing on a good worklife or focussing on a limited worklife, composed of three organising themes (1) Prominent individuals struggle, take action, and continue despite hearing loss, (2) Workers with hearing loss in the community create their best day themselves, and (3) Workers with hearing loss, as a generalised whole, are portrayed as either competent or limited. Conclusions: The dominant framing portrays individual workers as ingenious, determined, and successful. Negative framings were predominantly generalisations to these workers as a group. To generate more positive framings, professionals can build relationships with consumer groups and, when contacted by the media, direct journalists to interview workers with hearing loss.

Assessing communication accessibility in the university classroom: Towards a goal of universal hearing accessibility

Measures of accessibility typically focus on the physical environment and aspects relating to getting into and out of spaces. The transient sound environment is less well characterized in typical accessibility measures. Hearing accessibility measures can be based upon physical indices or functional assessment. The physical measures are indices that use signal-to-noise ratios to evaluate audibility while the functional assessment tool adopts universal design for hearing (UDH) principles derived from principles of universal design. The UDH principles include (1) Optimization of the hearing environment for all; (2) Optimization of interactions between persons and objects to promote better hearing in an environment; (3) Optimization of opportunities for people to have multiple choices of interactions with one another; (4) Optimization of opportunities for people to perform different activities in and across environments; (5) Optimization of opportunities for people to have safe, private, and secure use of the environment while minimizing distraction, interference, or cognitive loading; and (6) Optimization of opportunities for people to use the environment without extra steps for hearing access during preparatory, use and/or after use phases. This paper compares the two approaches using case examples from post-secondary classrooms in order to describe the potential advantages and limitations of each.