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.

Implementation science challenges: hearing care professionals identify barriers to clinical research.

OBJECTIVES: Conducting research in clinical settings is challenging. The aim of this study was to increase our understanding of hearing care professionals' perceptions of barriers to participating in such research. DESIGN: A modified group concept mapping approach was used to gain anonymous responses from 124 hearing care professionals to the statement: "One reason why it is hard to conduct intervention research studies in my centre/practice is….". Participants were asked for reasons other than 'time' as this is universally reported as a barrier to clinical research. RESULTS: A total of 107 distinct reasons were provided by participants and these were sorted into 5 clusters: "Competing demands/pressures" (18 statements), "Not a priority for management/organisation" (14 statements), "Lack of opportunity/support" (19 statements), "Clinician's knowledge, confidence, and beliefs" (24 statements), and "Recruitment/adherence to protocols is challenging" (32 statements). Identified barriers were generally similar to those reported in other healthcare settings, with unique barriers being those associated with a fear of scrutiny and lack of trust in the "academic elite". CONCLUSION: Findings highlight the importance of researchers, clinicians, and clinic managers working together at all stages of the research process in order for clinical research to be successful.

'We're not told why--we're just told': qualitative reflections about the Western Australian Go for 2&5® fruit and vegetable campaign.

OBJECTIVE: To explore why there is a lack of acceptance among Western Australian (WA) adults of the Go for 2&5® fruit and vegetable social marketing message to consume at least five servings of vegetables per day. DESIGN: A series of focus group discussions comprised of homogeneous groups varied by sex and age, until saturation of themes was achieved, followed by thematic analysis. SETTING: Part of qualitative research for the Go for 2&5® fruit and vegetable social marketing campaign in WA (2009 population: 2.2 million). SUBJECTS: WA adults stratified by sex and age groups (18-29 and 30-55 years) drawn from the second and third quartiles of socio-economic disadvantage. RESULTS: Familiarity with the Go for 2&5® message was excellent. Understanding of what constitutes 'two servings of fruit' was excellent and regarded by participants as highly achievable. Understanding of what constitutes 'five servings of vegetables' was suboptimal with widespread overestimation contributing to the belief that it is unrealistic. Participants did not know how the 2&5 recommendation was formulated and believed that daily consumption of two servings of fruit and five of vegetables would confer no greater health benefit than one of fruit and three of vegetables. Participants assumed that the 2&5 recommendation was 'aspirational' in the sense that it was purposely exaggerated to simply encourage greater overall consumption. CONCLUSIONS: A convincing case needs to be presented to WA adults as to why they should consume five servings of vegetables per day. Continuing efforts to educate incorporating what constitutes a serving will assist perceptions that the recommendation is realistic.

A preliminary investigation into the application of processing instruction as therapy for aphasia in Spanish speakers.

PURPOSE: This study was a preliminary investigation into the use of processing instruction (PI) to improve the use of the personal 'a' to assign thematic roles in Spanish sentences for second language (L2) learners and persons with aphasia (PWA). Evidence suggests that PI is an effective teaching method for L2 learners with errant processing strategies. However its use with PWA with an acquired inability to process syntactic cues is unknown. METHODS: Thirty non-impaired Spanish as a second language learners and two Spanish-speaking PWA participated in this study. PI involved the use of explicit instruction and structured input activities with nouns and pronouns. Each participant's performance was assessed pre and post treatment. Two experimental and one control groups of L2 learners completed the PI activities over two days. PWA completed PI in individual sessions over four day and received additional cues. CONCLUSIONS: L2 learners who received PI demonstrated significant improvement in the comprehension and production of 'a'. However, the Spanish-speaking PWA demonstrated mixed results. Both of the PWA exhibited gains in the comprehension of 'a' on referential tasks. One participant with aphasia demonstrated improved comprehension post-testing, and neither participant demonstrated gains on production post-testing. Results suggest that PI may be useful for increasing syntactic comprehension in people with aphasia. Findings from the current study are used to guide suggestions for further modification and use of PI as a treatment strategy for PWA. LEARNING OUTCOMES: Readers will be able to: (a) define processing instruction, (b) discuss the role of specific syntactic cues in Spanish comprehension, and (c) explain how PI might be modified for use with Spanish speakers with aphasia.