Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review.

INTRODUCTION: Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. AIMS: The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature. METHODOLOGY: A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. RESULTS: The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response plans. CONCLUSION: Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of available evidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.

Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study.

BACKGROUND: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. OBJECTIVE: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. METHODS: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic's Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. RESULTS: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. CONCLUSIONS: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally.

The Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor: multicentric evaluation of outcomes in adults and children.

Objective: This study evaluated the outcomes of the Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor.Design: Neuro One users were upgraded to Neuro 2. Monosyllabic word identification was evaluated in adults with Neuro One after ≥5 months, with Neuro 2 at upgrade, and with Neuro 2 after 3 months. Self-reported listening ability, satisfaction, and usability were measured in adults and children.Study sample: Participants were 44 adults and 26 children.Results: Speech identification scores in quiet and noise were 58% and 45% with Neuro One and 67% and 55% with Neuro 2 after 3 months, respectively. Hearing impairment duration and number of active electrodes significantly predicted speech identification in noise with Neuro 2. Significantly higher questionnaire ratings were obtained for Neuro 2 than Neuro One regarding listening ability in complex listening situations, comfort and music, as well as nine aspects of satisfaction and usability.Conclusion: This study demonstrates the clinical superiority of the Neuro 2 sound processor over Neuro One in terms of speech identification in quiet and in noise and reported patient benefit and satisfaction. Given the study design, sources of improvement may include factors unrelated to the sound processor itself.

How Do Hearing Aid Owners Respond to Hearing Aid Problems?

BACKGROUND: Although hearing aids can improve hearing and communication, problems that arise following the acquisition of hearing aids can result in their disuse. This study aimed to gather perspectives of hearing aid owners and hearing health care clinicians about how hearing aid owners respond to problems that arise following hearing aid fitting, and then use these perspectives to generate a conceptual framework to better understand these responses. METHODS: Seventeen hearing aid owners and 21 hearing health care clinicians generated, sorted, and rated statements regarding how hearing aid owners respond to problems associated with hearing aid use. Concept mapping was used to identify key themes and to develop a conceptual framework. RESULTS: Participants identified four concepts regarding how hearing aid owners respond to problems associated with hearing aids: (1) Seeking External Help; (2) Problem Solving; (3) Putting Up with Problems; and (4) Negative Emotional Response. Participants described behaviors of the clinician and significant others that influenced their decision to seek help for hearing aid problems. Participants recognized that these behaviors could either have a helpful or unhelpful impact. CONCLUSIONS: Despite the ongoing support offered to clients after they acquire hearing aids, they are hesitant to seek help from their clinician and instead engage in a myriad of helpful and unhelpful behaviors in response to problems that arise with their hearing aid. Previous positive or negative experiences with the clinic, clinician, or significant other influenced these actions, highlighting the influential role of these individuals' in the success of the rehabilitation program. The data generated from this study suggests that clinicians could improve hearing aid problem resolution by providing technical and emotional support, including to significant others, and promoting client empowerment and self-management.

Individualised active communication education (I-ACE): another clinical option for adults with hearing impairment with a focus on problem solving and self-management.

Objective: This clinical note describes the Individualised - Active Communication Education (I-ACE) programme designed to improve problem solving and self-management in adults with hearing impairment. Design: The I-ACE was offered to adult clients seeking help for the first time and effects were measured for participants using self-report questionnaires: the Client Oriented Scale of Improvement (goal attainment), the Hearing Handicap Questionnaire (hearing disability), and the International Outcome Inventory - Alternative Interventions (outcomes) immediately after programme completion and 3 months later. Participants also provided qualitative feedback about I-ACE. Study sample: Twenty-three participants completed I-ACE, with 22 completing all self-report questionnaires and 23 participants providing qualitative feedback. Results: The participants reported positive outcomes and goal attainment, but no change in hearing disability post-programme. The effects were maintained 3 months later. Qualitative feedback indicated that I-ACE supported participants in recognising and increasing awareness of their hearing difficulties and in developing potential solutions to these difficulties. Participants also enjoyed the opportunity to involve communication partners. Conclusion: I-ACE is an appropriate option for adults with hearing impairment who wish to become more aware of their hearing difficulties and how to solve them.

Characteristics, behaviours and readiness of persons seeking hearing healthcare online.

OBJECTIVE: This study describes characteristics, behaviours and readiness of people who are interested in seeking hearing healthcare (HHC) online. DESIGN: A non-profit clinic was established from which services through a virtual clinic are offered. Most of the patient-audiologist interactions are conducted online. We used online means to invite individuals to take a free online digit-in-noise (DIN) test. Upon failing the test, individuals reported their readiness to seek HHC by using two tools: the line and the staging algorithm. STUDY SAMPLE: Individuals ≥18 years of age, within the greater Durban area, South Africa, were eligible to participate in the study. RESULTS: A total of 462 individuals completed the online DIN test during the first 3 months. Of those, 58.66% (271/462) failed the test and 11.04% (51/462) submitted their details for further contact from the clinic audiologist. Five individuals proceeded to a comprehensive hearing evaluation and hearing aid trial: all those individuals showed readiness to seek further HHC on the measurement tools. These individuals have reported knowing of their hearing challenges prior to taking the test and have waited for a period of between 5 and 16 years before seeking HHC. A significant association between age and DIN test result was found. CONCLUSION: This explorative study is the first clinic to utilise digital tools across the entire patient journey in combination with face-to-face interactions in providing HHC. Internet-connected devices provide an opportunity for individuals to seek HHC and for providers to offer initial services to detect, counsel and support persons through the initial engagement process of seeking HHC. This may open up new audiology patient pathways through online hearing screening, assessment of readiness to seek further HHC and enhancement of service delivery using hybrid services by combining online and face-to-face modes of synchronous and asynchronous communication.

eHealth and the hearing aid adult patient journey: a state-of-the-art review.

The number and variety of eHealth services for adults and older adults who use hearing aids (HAs) are growing rapidly. This area holds promise to increase cost-efficiency, enable better access to care, and improve patient outcomes and satisfaction. Despite the increasing interest in this field, an up-to-date picture of recent research in the area of eHealth for adults with HAs is lacking. In this state-of-the-art review we assessed the literature from the past decade about eHealth use in the HA adult patient journey. Systematic searches were conducted in CINAHL, PubMed, Scopus, and Web of Science. A total of 34 peer-reviewed empirical records were identified from the searches and from the reference lists of searched records. Records were characterized based on: eHealth platform (i.e.: offline, Internet-based, or mobile-based), service [i.e.: education and information, screening and assessment, hearing rehabilitation, or general (tele-audiology)], and phase of the patient journey (i.e.: pre-fitting, fitting, or post-fitting). The review highlighted a growing interest in the field, as revealed by an increasing trend over the search period, from 2 records in 2009-2010 up to 17 records in 2015-2016. Internet-based platforms were the most frequently used (present in more than half of the included records), with a stable trend in the period. About one-third of the records introduced services over offline platforms, whereas mobile-based platforms were used only in 6 out of 34 records, suggesting that the clinical uptake of mobile services is still limited compared to more mature offline and Internet-based platforms. Most of the eHealth services observed were related to the areas of education and information (42.5%) and hearing rehabilitation (40.4%), whereas 10.7% were related to screening and assessment, and 6.4% to general tele-audiology services. Many services covered different phases of the patient journey, especially the fitting and post-fitting phases. Overall, this review showed that the field of eHealth in the context of HA rehabilitation in adults has grown in the recent past. Research is still needed to increase the uptake and efficacy of eHealth in clinical practice, especially in terms of technology developments, technical and clinical validation, and optimization of strategies for service delivery.

Exploring Hearing Aid Problems: Perspectives of Hearing Aid Owners and Clinicians.

OBJECTIVES: To gather perspectives of hearing aid owners and hearing healthcare clinicians with regard to problems that arise after hearing aid fitting and use these perspectives to generate a conceptual framework to gain a better understanding of these problems. DESIGN: Participants included a group of 17 hearing aid owners and a group of 21 hearing healthcare clinicians; data collection occurred separately for each group. Participants each attended two group sessions in Perth, Western Australia, wherein they: (1) generated statements describing the problems associated with hearing aids and (2) grouped and rated the statements to identify key themes. Concept mapping was used to generate a conceptual framework. RESULTS: Participants identified four concepts regarding hearing aid problems as follows: (1) hearing aid management; (2) hearing aid sound quality and performance; (3) feelings, thoughts, and behaviors; and (4) information and training. While hearing aid owners and clinicians generated similar results regarding the concepts derived, the clinicians reported that the problems identified had a greater negative impact on hearing aid success than did hearing aid owners. CONCLUSIONS: The magnitude and diversity of hearing aid problems identified in this study highlight the ongoing challenges that hearing aid owners face and suggest that current processes for hearing aid fitting can be improved. Problems relating to hearing aid management were most often deemed to have the greatest impact on hearing aid success and be the most preventable/solvable, and thus are a good starting point when addressing hearing aid-related problems.

Stages of change in audiology: comparison of three self-assessment measures.

OBJECTIVE: In a clinical setting, theories of health behaviour change could help audiologists and other hearing health care professionals understand the barriers that prevent people with hearing problems to seek audiological help. The transtheoretical (stages of change) model of health behaviour change is one of these theories. It describes a person's journey towards health behaviour change (e.g. seeking help or taking up rehabilitation) in separate stages: precontemplation, contemplation, preparation, action, and, finally, maintenance. A short self-assessment measure of stages of change may guide the clinician and facilitate first appointments. This article describes correlations between three stages of change measures of different lengths, one 24-item and two one-item. DESIGN: Participants were recruited through an online hearing screening study. Adults who failed the speech-in-noise recognition screening test and who had never undergone a hearing aid fitting were invited to complete further questionnaires online, including the three stages of change measures. STUDY SAMPLE: In total, 224 adults completed the three measures. RESULTS: A majority of the participants were categorised as being in one of the information- and help-seeking stage of change (contemplation or preparation). The three stages of change measures were significantly correlated. Conclusions Our results support further investigating the use of a one-item measure to determine stages of change in people with hearing impairment.

Description of Adults Seeking Hearing Help for the First Time According to Two Health Behavior Change Approaches: Transtheoretical Model (Stages of Change) and Health Belief Model.

OBJECTIVES: Several models of health behavior change are commonly used in health psychology. This study applied the constructs delineated by two models-the transtheoretical model (in which readiness for health behavior change can be described with the stages of precontemplation, contemplation and action) and the health belief model (in which susceptibility, severity, benefits, barriers, self-efficacy, and cues to action are thought to determine likelihood of health behavior change)-to adults seeking hearing help for the first time. DESIGN: One hundred eighty-two participants (mean age: 69.5 years) were recruited following an initial hearing assessment by an audiologist. Participants' mean four-frequency pure-tone average was 35.4 dB HL, with 25.8% having no hearing impairment, 50.5% having a slight impairment, and 23.1% having a moderate or severe impairment using the World Health Organization definition of hearing loss. Participants' hearing-related attitudes and beliefs toward hearing health behaviors were examined using the University of Rhode Island Change Assessment (URICA) and the health beliefs questionnaire (HBQ), which assess the constructs of the transtheoretical model and the health belief model, respectively. Participants also provided demographic information, and completed the hearing handicap inventory (HHI) to assess participation restrictions, and the psychosocial impact of hearing loss (PIHL) to assess the extent to which hearing impacts competence, self-esteem, and adaptability. RESULTS: Degree of hearing impairment was associated with participation restrictions, perceived competence, self-esteem and adaptability, and attitudes and beliefs measured by the URICA and the HBQ. As degree of impairment increased, participation restrictions measured by the HHI, and impacts of hearing loss, as measured by the PIHL, increased. The majority of first-time help seekers in this study were in the action stage of change. Furthermore, relative to individuals with less hearing impairment, individuals with more hearing impairment were at more advanced stages of change as measured by the URICA (i.e., higher contemplation and action scores relative to their precontemplation score), and they perceived fewer barriers and more susceptibility, severity, benefits and cues to action as measured by the HBQ. Multiple regression analyses showed participation restrictions (HHI scores) to be a highly significant predictor of stages of change explaining 30% to 37% of the variance, as were duration of hearing difficulty, and perceived benefits, severity, self-efficacy and cues to action assessed by the HBQ. CONCLUSIONS: The main predictors of stages of change in first-time help seekers were reported participation restrictions and duration of hearing difficulty, with constructs from the health belief model also explaining some of the variance in stages of change scores. The transtheoretical model and the health belief model are valuable for understanding hearing health behaviors and can be applied when developing interventions to promote help seeking.

A qualitative investigation of decision making during help-seeking for adult hearing loss.

OBJECTIVE: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. DESIGN: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. STUDY SAMPLE: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. RESULTS: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. CONCLUSIONS: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss.

Measuring motivation using the transtheoretical (stages of change) model: A follow-up study of people who failed an online hearing screening.

OBJECTIVE: Acceptance and readiness to seek professional help have shown to be important factors for favourable audiological rehabilitation outcomes. Theories from health psychology such as the transtheoretical (stages-of-change) model could help understand behavioural change in people with hearing impairment. In recent studies, the University of Rhode Island change assessment (URICA) has been found to have good predictive validity. DESIGN: In a previous study, 224 Swedish adults who had failed an online hearing screening completed URICA and two other measures of stages of change. This follow-up aimed to: (1) determine prevalence of help-seeking at a hearing clinic and hearing aid uptake, and (2) explore the predictive validity of the stages of change measures by a follow-up on the 224 participants who had failed a hearing screening 18 months previously. STUDY SAMPLE: A total of 122 people (54%) completed the follow-up online questionnaire, including the three measures and questions regarding experience with hearing help-seeking and hearing aid uptake. RESULTS: Since failing the online hearing screening, 61% of participants had sought help. A good predictive validity for a one-item measure of stages of change was reported. CONCLUSIONS: The Staging algorithm was the stages of change measure with the best ability to predict help-seeking 18 months later.

Health behavior theories as predictors of hearing-aid uptake and outcomes.

OBJECTIVE: To understand hearing behaviors of adults seeking help for the first time through the application of two models of health behavior change: the transtheoretical model and the health belief model. DESIGN: The relationships between attitudes and beliefs were examined relative to hearing-aid uptake and outcomes six months later. STUDY SAMPLE: One hundred and sixty adults completed the University of Rhode Island change assessment (targeting the transtheoretical model), and the hearing beliefs questionnaire (targeting the health belief model), as well as the hearing handicap inventory and the psychosocial impact of hearing loss scale, within two months of an initial hearing assessment. Six months later, participants completed these same questionnaires, while those who had taken up hearing aids also completed hearing-aid outcome questionnaires. RESULTS: (1) Attitudes and beliefs were associated with future hearing-aid uptake, and were effective at modeling this behavior; (2) attitudes and beliefs changed following behavior change, and (3) attitudes and beliefs following behavior change were better predictors of hearing-aid outcomes than pre-behavior change attitudes and beliefs. CONCLUSION: A counseling-based intervention targeting the attitudes and beliefs assessed by the transtheoretical model and the health belief model has the potential to increase uptake of hearing health care.

Communication patterns in audiologic rehabilitation history-taking: audiologists, patients, and their companions.

OBJECTIVES: The nature of communication between patient and practitioner influences patient outcomes. Specifically, the history-taking phase of a consultation plays a role in the development of a relationship and in the success of subsequent shared decision making. There is limited research investigating patient-centered communication in audiology, and this study may be the first to investigate verbal communication in an adult audiologic rehabilitation context. This research aimed, first, to describe the nature of verbal communication involving audiologists, patients, and companions in the history-taking phase of initial audiology consultations and, second, to determine factors associated with communication dynamics. DESIGN: Sixty-three initial audiology consultations involving patients over the age of 55, their companions when present, and audiologists were audio-video recorded. Consultations were coded using the Roter Interaction Analysis System and divided into three consultation phases: history, examination, and counseling. This study analyzed only the history-taking phase in terms of opening structure, communication profiles of each speaker, and communication dynamics. Associations between communication dynamics (verbal dominance, content balance, and communication control) and 11 variables were evaluated using Linear Mixed Model methods. RESULTS: The mean length of the history-taking phase was 8.8 min (range 1.7 to 22.6). A companion was present in 27% of consultations. Results were grouped into three areas of communication: opening structure, information exchange, and relationship building. Examination of the history opening structure revealed audiologists' tendency to control the agenda by initiating consultations with a closed-ended question 62% of the time, followed by interruption of patient talk after 21.3 sec, on average. The aforementioned behaviors were associated with increased verbal dominance throughout the history and increased control over the content of questions. For the remainder of the history, audiologists asked 97% of the questions and did so primarily in closed-ended form. This resulted in the audiologist talking as much as the patient and much more than the companions when they were present. Questions asked by the audiologist were balanced in topic: biomedical and psychosocial/lifestyle; however, few emotionally focused utterances were observed from any speaker (less than 5% of utter ances). CONCLUSIONS: Analysis of verbal communication involving audiologists, patients, and companions in the history-taking phase in 63 initial audiology consultations revealed a communicative exchange that was audiologist-controlled and structured, but covered both medical and lifestyle content. Audiologists often attempted to create a relationship with their patients; however, little emotional relationship building occurred, which may have implications later in the consultation when management decisions are being made. These results are not in line with patient-centered communication principles. Further research and changes to clinical practice are warranted to transform patient-centered communication from an ideal to a reality.

Stages of change in adults who have failed an online hearing screening.

OBJECTIVES: Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. DESIGN: In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. RESULTS: A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. CONCLUSIONS: The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

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

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 patient's 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.

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.

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 α 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.

Patient-centred audiological rehabilitation: perspectives of older adults who own hearing aids.

OBJECTIVE: Patient-centred care is a term frequently associated with quality health care. Despite extensive literature from a range of health-care professions that provide description and measurement of patient-centred care, a definition of patient-centredness in audiological rehabilitation is lacking. The current study aimed to define patient-centred care specific to audiological rehabilitation from the perspective of older adults who have owned hearing aids for at least one year. DESIGN: Research interviews were conducted with a purposive sample of older adults concerning their perceptions of patient-centredness in audiological rehabilitation, and qualitative content analysis was undertaken. STUDY SAMPLE: The participant sample included ten adults over the age of 60 years who had owned hearing aids for at least one year. RESULTS: Data analysis revealed three dimensions to patient-centred audiological rehabilitation: the therapeutic relationship, the players (audiologist and patient), and clinical processes. Individualised care was seen as an overarching theme linking each of these dimensions. CONCLUSIONS: This study reported two models: the first model describes what older adults with hearing aids believe constitutes patient-centred audiological rehabilitation. The second provides a guide to operationalised patient-centred care. Further research is required to address questions pertaining to the presence, nature, and impact of patient-centred audiological rehabilitation.

An Australian survey of audiologists' preferences for patient-centredness.

OBJECTIVE: Patient-centredness is becoming a core value of health services worldwide, however it remains largely unexplored in audiology. This study investigated audiologists' preferences for patient-centredness and identified factors that explain audiologists' preferences for patient-centredness. DESIGN: All members of the Audiological Society of Australia received two questionnaires: (1) a descriptive questionnaire (e.g. age, gender, place of residence, years in practice, employment characteristics), and (2) a modified patient-practitioner orientation scale (PPOS; Krupat et al, 2000) which measures preferences for two aspects of patient-centredness, sharing and caring. STUDY SAMPLE: In total 663 (46%) audiologists returned both questionnaires fully completed. RESULTS: Mean PPOS scores indicated that audiologists prefer patient-centredness. Linear regression modelling identified that older audiologists, that had practiced longer, and who worked in community education, industrial audiology, or teaching had a significantly greater preference for patient-centredness than their peers. In contrast, audiologists who practiced in a private environment and who worked in the area of assessment of adults had a significantly lesser preference for patient-centredness than their peers. CONCLUSIONS: Audiologists prefer client-centredness and age, years of experience, and employment characteristics can partly explain preferences for patient-centredness. Future research should explore the relationships between patient-centredness and intervention outcomes in audiology.