Dietary Health Communication and Conversation Analysis: A Scoping Review.

Globally, many people don't eat a healthy diet despite policies and public health frameworks deployed to improve dietary status. Healthy diets can prevent, manage, and even reverse chronic disease, highlighting the importance of health professionals addressing healthy diets in clinical consultations. Conversation analysis (CA) is a method that can be used to understand dietary talk in these clinical consultations; however, it is unclear to what extent CA has been used for this purpose. Using PRISMA guidelines, a scoping review was conducted with the aim of identifying and summarizing research where CA was used to examine the dietary health conversations between health professionals and adults. A systematic search resulted in 4161 articles retrieved, with 13 studies meeting inclusion criteria. Included studies used CA to examine a variety of phases of dietary health encounters, including dietary assessment, advice-giving and resistance to this dietary advice, and dietary (lifestyle) behavior change negotiations, with n = 6 using audio or video recording, respectively. Studies were conducted in seven countries and across primary, secondary, and tertiary settings. We highlighted that dietary talk, irrespective of purpose (e.g., evaluation, assessment, or persuasion [e.g., behavior change]), is under-researched within the CA field. This is a need for further research using CA on dietary talk across a range of settings, conditions, populations, and talk purposes to understand how health professionals impact patient dietary behaviors. Such understanding has the potential to contribute to the improvement of dietary health communication approaches and patient outcomes.

A laughing matter? Managing hearing difficulties in real life everyday social interactions with adults with hearing loss.

OBJECTIVE: This study examines the interactional management of hearing difficulties and hearing aids (HAs) in real-life, video-recorded social interactions with adults with hearing loss (HL) and their families/friends. DESIGN: 32 video-recordings in various social settings were analysed using Conversation Analysis. STUDY SAMPLE: 20 adults with HL and their families/friends. RESULTS: HL and/or HAs did not typically become explicit in conversation. When adults with HL' hearing difficulties did become explicit in the conversation, they were typically accompanied by laughter/humour. Sometimes the humour/laughter was initiated by the person with HL themselves (i.e. self-directed joking) but more frequently it was initiated by someone else within the conversation (i.e. a tease). CONCLUSIONS: The findings display the management of the "to tell or not to tell" dilemma in practice, and how humour was often used to lighten the tension when "telling" about HL and/or HAs. The findings also highlight that not all humour is equal: there are different outcomes for adults with HL depending on who initiated the humour/laughter within the context of the interaction. This study highlights stigma-in-action - how stigma related to HL and/or HAs is occasioned and managed within real-life social interactions.

The experience of stigma related to hearing loss and hearing aids: perspectives of adults with hearing loss, their families, and hearing care professionals.

OBJECTIVES: To explore when and how stigma-induced identity threat is experienced by adults with hearing loss (HL) and their family members (affiliate stigma) from the perspectives of adults with HL, their family members, and hearing care professionals. DESIGN: Qualitative descriptive methodology with semi-structured interviews. STUDY SAMPLE: Adults with acquired HL (n = 20), their nominated family members (n = 20), and hearing care professionals (n = 25). RESULTS: All groups of participants believed that both HL and hearing aids were associated with stigma for adults with HL. Two themes were identified, specifically: (1) an association between HL and hearing aids and the stereotypes of ageing, disability, and difference; and (2) varied views on the existence and experience of stigma for adults with HL. Hearing care professionals focused on the stigma of hearing aids more than HL, whereas adult participants focused on stigma of HL. Family member data indicated that they experienced little affiliate stigma. CONCLUSIONS: Stigma-induced identity threat related to HL and, to a lesser extent, hearing aids exists for adults with HL. Shared perceptions that associate HL and hearing aids with ageing stereotypes were reported to contribute to the identity threat, as were some situational cues and personal characteristics.

To tell or not to tell? Exploring the social process of stigma for adults with hearing loss and their families: introduction to the special issue.

OBJECTIVE: Stigma has long been implicated as a reason why adults with acquired hearing loss are slow to seek help and for sub-optimal uptake of hearing devices. However, the field has not developed a comprehensive understanding of why stigma occurs, nor has it related this comprehensive knowledge to a theoretical framework. DESIGN: This special issue presents results from a two-phase, multi-method study to systematically investigate how stigma is experienced by adults with hearing loss and their families, how they manage it in everyday life, and how these experiences relate to the decision to wear hearing aids. STUDY SAMPLE: Phase 1 of the study involved 20 dyads of adults with hearing loss and their family members. Phase 2 involved 331 adults with hearing loss and 313 family members. RESULTS: Results of the study are presented in each of the subsequent papers that are part of this special issue. Results are mapped onto the Major and O'Brien model of stigma-induced identity threat in each paper. CONCLUSIONS: This paper provides an introduction to the Special Issue and describes the methods for the overall study that is the focus of the papers within the issue.

Improving the implementation of family-centred care in adult audiology appointments: a feasibility intervention study.

OBJECTIVE: There is mounting evidence for implementing family-centred care (FCC) in adult audiology services, however FCC is not typically observed in adult clinical practice. This study implemented an intervention to increase family member attendance and involvement within adult audiology appointments. DESIGN: The study involved a mixed method design over three key phases: Standard Care, Intervention I (increasing family member attendance), and Intervention II (increasing family member involvement). STUDY SAMPLE: Staff from four private audiology clinics within one organisation participated in the intervention. Data was collected from different clients in each phase (n = 27 Standard Care, n = 30 Intervention I, and n = 23 Intervention II). RESULTS: Family member attendance increased from 26% of appointments in Standard Care to 40% at Intervention I, and 48% at Intervention II. Family member involvement also showed improvement on some measures (video analysis) although talk time did not significantly increase. Significant improvements in client satisfaction with services were found (Net Promoter Score and Measure of Processes of Care). CONCLUSION: The implementation of FCC in audiology clinics needs to be an ongoing, whole-of-clinic approach, including staff in all roles. Increasing family member attendance at adult audiology appointments can lead to benefits to client satisfaction with services.

How Can eHealth Meet the Hearing and Communication Needs of Adults With Hearing Impairment and their Significant Others? A Group Concept Mapping Study.

OBJECTIVES: To seek the perspectives of key stakeholders regarding: (1) how eHealth could help meet the hearing and communication needs of adults with hearing impairment and their significant others; and (2) how helpful each aspect of eHealth would be to key stakeholders personally. DESIGN: Group concept mapping, a mixed-methods participatory research method, was used to seek the perspectives of key stakeholders: adults with hearing impairment (n = 39), significant others (n = 28), and hearing care professionals (n = 56). All participants completed a short online survey before completing one or more of the following activities: brainstorming, sorting, and rating. Brainstorming required participants to generate ideas in response to the focus prompt, "One way I would like to use information and communication technologies to address the hearing and communication needs of adults with hearing loss and their family and friends is to…." The sorting task required participants to sort all statements into groups that made sense to them. Finally, the rating task required participants to rate each of the statements according to "How helpful would this idea be to you?" using a 5-point Likert scale. Hierarchical cluster analysis was applied to the "sorting" data to develop a cluster map using the Concept Systems software. The "rating" data were subsequently analyzed at a cluster level and an individual-item level using descriptive statistics. Differences in cluster ratings between stakeholder groups were examined using Kruskal-Wallis tests. RESULTS: Overall, 123 statements were generated by participants in response to the focus prompt and were included in subsequent analyses. Based on the "sorting" data and hierarchical cluster analysis, a seven-cluster map was deemed to be the best representation of the data. Three key themes emerged from the data, including using eHealth to (1) Educate and Involve Others; (2) Support Aural Rehabilitation; and (3) Educate About and Demonstrate the Impacts of Hearing Impairment and Benefits of Hearing Rehabilitation. Overall median rating scores for each cluster ranged from 3.97 (educate and involve significant others) to 3.44 (empower adults with hearing impairment to manage their hearing impairment from home). CONCLUSIONS: These research findings demonstrate the broad range of clinical applications of eHealth that have the capacity to support the implementation of patient- and family-centered hearing care, with self-directed educational tools and resources typically being rated as most helpful. Therefore, eHealth appears to be a viable option for enabling a more biopsychosocial approach to hearing healthcare and educating and involving significant others in the hearing rehabilitation process without adding more pressure on clinical time. More research is needed to inform the subsequent development of eHealth interventions, and it is recommended that health behavior change theory be adhered to for such interventions.

Enhancing paediatric palliative care: A rapid review to inform continued development of care for children with life-limiting conditions.

AIM: Following the establishment of paediatric palliative care services over recent decades, this study sought to identify information to inform future policy and practice. METHODS: A rapid review using thematic synthesis was conducted to synthesise existing information about improving paediatric palliative care. Information was extracted in relation to key areas for investment and change: quality, access, advance care planning, skills, research, collaboration and community awareness. RESULTS: A total of 2228 literature sources were screened, with 369 included. Synthesised information identified clear ways to improve quality of care, access to care, advance care planning, and research and data collection. The synthesis identified knowledge gaps in understanding how to improve skills in paediatric palliative care, collaboration across Australian jurisdictions and community awareness. CONCLUSIONS: The findings of this review bring together information from a vast range of sources to provide action-oriented information to target investment and change in paediatric palliative care over the coming decades.

Attending to child agency in paediatric palliative care consultations: Adults' use of tag questions directed to the child.

Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video-recorded paediatric palliative care consultations. Detailed turn-by-turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a 'tag question', which follows some statement (e.g. 'he loves that, don't ya'). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.

Communicating with patients and families about illness progression and end of life: a review of studies using direct observation of clinical practice.

BACKGROUND: There is growing recognition that a diverse range of healthcare professionals need competence in palliative approaches to care. Effective communication is a core component of such practice. This article informs evidence-based communication about illness progression and end of life through a rapid review of studies that directly observe how experienced clinicians manage such discussions. METHODS: The current rapid review updates findings of a 2014 systematic review, focussing more specifically on evidence related to illness progression and end-of-life conversations. Literature searches were conducted in nine bibliographic databases. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about illness progression or end of life were eligible for inclusion in the review. An aggregative approach was used to synthesise the findings of included studies. RESULTS: Following screening, 26 sources were deemed to meet eligibility criteria. Synthesis of study findings identified the structure and functioning of ten communication practices used in discussions about illness progression and end-of-life. CONCLUSION: The ten practices identified underpin five evidence-based recommendations for communicating with patients or family members about illness progression and end of life.

Use of the Behaviour Change Wheel to design an intervention to improve the implementation of family-centred care in adult audiology services.

OBJECTIVE: This study describes the development of an intervention to improve family-centred care in adult audiology services. DESIGN: The Behaviour Change Wheel (BCW) was followed to develop the intervention. The BCW involves eight steps across three stages: (1) understanding the behaviour, (2) identifying intervention options, and (3) identifying content and implementation options. STUDY SAMPLE: The data in Stage 1 comprised of 13 interviews with clinic staff. The research team drew on their own expertise and empirical research to complete Stages 2 and 3. RESULTS: A two-phase, face-to-face intervention was developed to change clinic staff' behaviours to address two problem behaviours: (1) increase family member attendance to adult audiology appointments; and (2) increase family member involvement within appointments. Three target behaviours were chosen for the intervention to address the two problem behaviours. A variety of intervention functions and behaviour change techniques were incorporated into the intervention. CONCLUSION: The BCW provided a useful framework for developing a whole-of-clinic intervention to increase family member attendance and involvement in adult audiology appointments. Recent research in social psychology has suggested that this type of family involvement and support in healthcare is a strong predictor of well-being for adult clients and their families.

The pervasive relevance of COVID-19 within routine paediatric palliative care consultations during the pandemic: A conversation analytic study.

BACKGROUND: The importance of caring for children with complex and serious conditions means that paediatric palliative care must continue during pandemics. The recent pandemic of Coronavirus Disease 2019 (COVID-19) provides a natural experiment to study health communication during pandemic times. However, it is unknown how communication within consultations might change during pandemics. AIM: This study, a sub-study of a larger project, aimed to examine real-world instances of communication in paediatric palliative care consultations prior to and during the COVID-19 pandemic to understand how clinicians and families talk about the pandemic. DESIGN: Paediatric palliative care consultations prior to, during, and immediately following the initial peak of COVID-19 cases in Australia were video recorded and analysed using Conversation Analysis methods. SETTING/PARTICIPANTS: Twenty-five paediatric palliative care consultations (including face-to-face outpatient, telehealth outpatient and inpatient consultations) were video recorded within a public children's hospital in Australia. Participants included 14 health professionals, 15 child patients, 23 adult family members and 5 child siblings. RESULTS: There was a pervasive relevance of both serious and non-serious talk about COVID-19 within the consultations recorded during the pandemic. Topics typical of a standard paediatric palliative care consultation often led to discussion of the pandemic. Clinicians (55%) and parents (45%) initiated talk about the pandemic. CONCLUSIONS: Clinicians should not be surprised by the pervasiveness of COVID-19 or other pandemic talk within standard paediatric palliative care consultations. This awareness will enable clinicians to flexibly address family needs and concerns about pandemic-related matters that may impact health and wellbeing.

Identifying clients' readiness for hearing rehabilitation within initial audiology appointments: a pilot intervention study.

Objective: The current study sought to explore audiologists' use of the Ida Institute Motivation Tools to help them identify clients' readiness for change within initial assessment appointments.Design: The study involved a mixed methods intervention design. Data were collected pre- and post-training audiologists to use the Ida Motivation tools in their appointments. Appointments were video-recorded and analysed using conversation analysis. Clients and audiologists also completed questionnaires within each appointment to measure clients' readiness-for-change.Study sample: Participants included 5 audiologists and 22 adult clients from two Audiology clinics.Results: Audiologists incorporated the Ida Motivation tools into the post-training appointments without a significant increase in appointment time. The Ida tools solicited responses from clients that displayed their ambivalence regarding hearing rehabilitation/aids within their talk. Post-training, audiologists' perceptions of clients' stage of readiness were not significantly more likely to match clients' self-reported stage on the URICA.Conclusions: The Ida Motivation tools may be useful to solicit clients' ambivalent feelings towards hearing rehabilitation/aids, however, it is important for audiologists to actively listen for ambivalence within clients' interactional responses to the tools in order judge clients' readiness.

Identifying barriers and facilitators to implementing family-centred care in adult audiology practices: a COM-B interview study exploring staff perspectives.

Objective: This study explored staff perspectives of the barriers and facilitators to improving the implementation of family-centred care (FCC) in audiology practice.Design: Semi-structured interviews, informed by the COM-B (Capability-Opportunity-Motivation-Behaviour) model, were conducted with staff members at a private hearing care company in Australia.Study Sample: Thirteen participants were interviewed including managers, clinicians, and front-of-house staff.Results: Staff with different roles had different perspectives on barriers; however, the main barriers included: (1) insufficient knowledge regarding the principles of FCC and its benefits; (2) insufficient knowledge regarding the reasons why a family member should attend the appointment; (3) inadequate skills in how to ask for family member attendance; (4) experiencing discomfort when asking clients to bring a family member to their appointment; (5) inconsistent training and tools to support the implementation of FCC; (6) organisational culture not supporting FCC; and (7) a lack of confidence in abilities to manage conflict between clients and family members within appointments.Conclusions: The study indicated that there were numerous barriers to be overcome for staff to further implement FCC into their current practice. The interview findings will be used to develop an intervention to improve the implementation of FCC in audiology practice.

Specialist call handlers' perspectives on providing help on a cancer helpline: A qualitative interview study.

OBJECTIVE: To identify call handlers' key experiences of providing telephone help on a cancer helpline. METHODS: Semi-structured qualitative interviews with 30 call handlers from three UK-based cancer helplines. Transcribed interview data were analysed thematically. RESULTS: Thematic analysis identified three themes: (a) call handlers' perceptions of their role on the helpline, (b) challenges of working on a helpline and (c) the need for training/keeping up with competencies. Call handlers reported satisfaction with their experience. However, there are tensions: whilst advice is formally not part of the remit of the helpline, in practice the boundary between giving advice and giving information can be blurred. No follow-up with callers could be difficult and experienced as a lost opportunity to help. Managing patient expectations could be challenging, and interviewees described particular difficulties with distressed callers. Training for the role was commonplace, but there was sometimes a desire for more opportunities. CONCLUSION: There are challenges faced by helpline staff, and it can be difficult to manage callers' distress and expectations of what they might get from a call experience. Recognising the skill and complexity of the call handler role is important, as it is meeting call handlers' support and training needs. Support is important to minimise the risk to their own emotional well-being.

"You'll have to be my eyes and ears": A conversation analytic study of physical examination on a health helpline.

AIMS AND OBJECTIVES: To explore the accomplishment of physical examination on a health helpline. By focusing on the ways in which callers are asked to examine themselves and report information to nurses, we aim to provide insight into how physical examination at a distance is achieved. BACKGROUND: Physical examination is a routine feature of healthcare encounters. In face-to-face settings, patients are subject to professional scrutiny through talk, touch and observation. Health professionals working on helplines face challenges in assessing signs of illness when they do not have physical access to patients. DESIGN AND METHODS: Conversation analysis was used to explore sequences of interaction between nurses and callers that involved physical examination. ANALYSIS: Analysis examined how physical examination was routinely accomplished in a helpline environment. Nurses typically guided callers in self-examination by drawing on gross categorisations that required reporting of large-scale characteristics of symptoms (e.g., whether a body part looked "normal"). Physical examination was also regularly accomplished by nurses through two-component speaking turns: a prefacing component that involved instructions about self-examination; followed by a second component that included an information-soliciting question. These practices resulted in callers successfully accomplishing physical examination, despite their lack of professional medical knowledge. CONCLUSIONS: This study identifies the communicative practices used by nurses to accomplish physical examination in helpline calls. Such practices involved asking questions that sought general, rather than specific, information and the prefacing of questions with simple instructions on how to undertake self-examination. RELEVANCE TO CLINICAL PRACTICE: Previous research indicates that physical examination in telehealth can be challenging, particularly in environments where clinicians need patients to examine themselves. This study identifies how nurses on a helpline manage this challenge. The findings highlight ways in which nurses can recruit patients to undertake tasks that would typically be undertaken by clinicians in physically co-present consultations.

Parent-directed commentaries during children's hearing habilitation appointments: a practice in family-centred care.

BACKGROUND: Family-centred care (FCC) is recognized as best practice in the delivery of early intervention services for children with hearing loss (HL) and their families. However, there has been little research involving direct observation of family-centred communication practices in paediatric hearing habilitation appointments, which means little is currently known about how family members are involved within appointments, and how FCC is accomplished by health professionals through their interactions with families. AIMS: To examine the interaction between hearing healthcare professionals, children with HL, and their parents within video-recorded paediatric hearing habilitation appointments (including both audiology and speech and language therapy appointments), with a particular focus on how parents were involved in the interaction. METHODS & PROCEDURES: The data for this study involved a corpus of 48 video-recorded paediatric hearing habilitation appointments from three clinical sites (including 33 audiology appointments and 15 speech pathology appointments). Participants included 14 audiologists, 8 speech and language therapists, 41 children with HL (aged 18 months and over) and 48 of their attending family members (e.g., parents/carers). The data were analyzed using conversation analysis. OUTCOMES & RESULTS: Analysis revealed one specific practice that health professionals used to engage parents in the interaction during child-directed assessment and therapy tasks: that of 'parent-directed commentaries', where health professionals shifted their attention to the parent(s) to describe or evaluate what they were observing during appointment tasks. Health professionals were observed to produce two types of parent-directed commentaries: (1) a positive evaluation of the child's just-prior response; and (2) an account for the child's prior behaviour (sometimes also accompanied by a positive evaluation). These commentaries appeared at systematic points in the interaction when the child had been displaying difficulty with their response to the health professional. The parent-directed commentaries accomplished several important functions: they engaged the parent's attention in the interaction; focused the parent's attention on positive responses from the child (while shrouding less positive responses); played down potential negative perceptions of the child's previous missed/incorrect responses; and provided parents with reassurance of their child's progress during the ongoing task. CONCLUSIONS & IMPLICATIONS: The parent-directed commentaries identified in this study provide an example of the practical, interactional resources that health professionals can draw on within paediatric appointments to facilitate FCC with parents.

A descriptive survey of cancer helplines in the United Kingdom: Who they are, the services offered, and the accessibility of those services.

BACKGROUND: There are more than 1500 UK health helplines in operation, yet we have scant knowledge about the resources in place to support the seeking and delivering of cancer-related telephone help and support. This research aimed to identify and describe cancer and cancer-related helpline service provision: the number of helplines available, the variety of services provided, and the accessibility of those services. METHOD: This study used online national questionnaire survey sent to 95 cancer and cancer-related helplines in the United Kingdom. RESULTS: A total of 69 (73%) of 95 surveyed cancer and cancer-related helplines completed the survey. Most helplines/organizations were registered charities, supported by donations; 73.5% of helplines had national coverage. Most helplines served all age-groups, ethnic groups, and men and women. Only 13.4% had a number that was free from landlines and most mobile networks, and 56.6% could only be contacted during working hours. More than 50% of helplines reported no provisions for callers with additional needs, and 55% had no clinical staff available to callers. Ongoing support and training for helpline staff was available but variable. CONCLUSION: Although cancer helplines in the United Kingdom offer reasonably broad coverage across the country, there are still potential barriers to accessibility. There are also opportunities to optimize the training of staff/volunteers across the sector. There are further prospects for helplines to enhance services and sustain appropriate and realistic quality standards.

Difficult conversations: talking about cost in audiology consultations with older adults.

OBJECTIVE: Financial cost is a barrier for many older adults in their decision to obtain hearing aids (HAs). This study aimed to examine conversations about the cost of HAs in detail within initial audiology appointments. DESIGN: Sixty-two initial audiology appointments were video-recorded. The data were analysed using conversation analysis. STUDY SAMPLE: Participants included 26 audiologists, 62 older adults and 17 companions. RESULTS: Audiologists and clients displayed interactional difficulty during conversations about cost. Clients often had emotional responses to the cost of HAs, which were not attended to by audiologists. It was typical for audiologists to present one HA cost option at a time, which led to multiple rejections from clients which made the interactions difficult. Alternatively, when audiologists offered multiple cost options at once this led to a smoother interaction. CONCLUSIONS: Audiologists and clients were observed to have difficulty talking about HA costs. Offering clients multiple HA cost options at the same time can engage clients in the decision-making process and lead to a smoother interaction between audiologist and client in the management phase of appointments.

Conversation breakdowns in the audiology clinic: the importance of mutual gaze.

BACKGROUND: Conversational breakdowns are a persistent concern for older adults with hearing impairment (HI). Previous studies in experimental settings have investigated potential causes of breakdowns in conversations with a person with HI, and effective strategies for repairing these breakdowns. However, little research has explored the causes of hearing-related communication breakdowns, and their repairs, in extended, naturally occurring conversations in a healthcare setting. AIMS: To analyse systematically instances of clients' initiations of repair within video-recorded initial audiology appointments, and to examine the interactional environment in which they occurred. METHODS & PROCEDURES: Participants included 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 of the 63 appointments. Conversation analysis (CA) was used to examine the video-recorded audiology appointments with older adults with HI. The corpus was systematically analysed for all instances of 'other-initiated repair' by clients (initiation of repair targeting the prior speakers' turn). A collection of 51 instances of other-initiated repair were identified. These instances were analysed in detail for: (1) the interactional environment in which they occurred; (2) the strategy by which the client initiated repair; and (3) the strategies used by the audiologist to repair the communication breakdown. OUTCOMES & RESULTS: In 76% (n = 39) of the 51 cases of other-initiated repair from the client, there was a lack of mutual gaze between participants (i.e., either the audiologist or the client were looking away or facing in another direction during the prior turn). More specifically, many of these instances occurred when the audiologist was speaking to the client while multitasking. Audiologists used multiple-repair strategies in their responsive turn in an attempt to repair the communication breakdown efficiently. CONCLUSIONS & IMPLICATIONS: These findings, from extended, naturally occurring conversations with older adults with HI in clinic settings, highlight the importance of face-to-face communication even in quiet one-to-one settings. Clinicians should remain aware of their movements and gaze when speaking to clients during appointments. The findings also provide further support for the importance of communication programs in hearing rehabilitation.

Application of the transtheoretical model of behaviour change for identifying older clients' readiness for hearing rehabilitation during history-taking in audiology appointments.

OBJECTIVES: The transtheoretical model (TTM) of behaviour change focuses on clients' readiness for adopting new health behaviours. This study explores how clients' readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients' readiness has consequences for the rehabilitation decisions they make within the initial appointment. DESIGN: Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. STUDY SAMPLE: The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. RESULTS: Clients' readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). CONCLUSIONS: The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients' needs, attitudes, desires, and psychological readiness for action in order to optimize clients' hearing outcomes.