Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting.

OBJECTIVES: The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol. DESIGN: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews). RESULTS: Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants. CONCLUSIONS: The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.

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.

Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model.

OBJECTIVE: To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being. DESIGN: A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change). STUDY SAMPLE: Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3). RESULTS: Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss. CONCLUSION: Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Barriers and facilitators to asking adults with hearing loss about their emotional and psychological well-being: a COM-B analysis.

OBJECTIVE: To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being. DESIGN: This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model. STUDY SAMPLE: Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated. RESULTS: Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice. CONCLUSIONS: Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being.

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.

"When that understanding is there, you work much better together": the role of family in audiological rehabilitation for older adults.

OBJECTIVE: This study aimed to explore the experiences and perceptions of adults with hearing impairment and family members regarding the role of family in audiological rehabilitation. DESIGN: A qualitative descriptive methodology was used. STUDY SAMPLE: A total of 37 people participated, 24 older adults with hearing impairment and 13 family members (11 spouses and 2 adult children). Four focus group interviews were conducted with the adults with hearing impairment, and 3 with family members. RESULTS: Five key themes emerged from analysis of the transcripts: (1) knowledge and understanding of hearing impairment and treatment; (2) the role of family members in rehabilitation is complex and multifaceted; (3) audiologists have an influential role in facilitating family member involvement; (4) the role of communication in rehabilitation; and (5) outcomes of family member involvement. Importantly, although perceptions were generally very positive, there was some uncertainty about the role of family. CONCLUSIONS: Audiologists have a key role in facilitating family involvement in audiological rehabilitation that is identified by adults with hearing impairment and their families. Although participants reported limited involvement in audiological rehabilitation currently, they identified potential for involvement in areas such as goal setting and decision-making.

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.

"It's Huge, in a Way." Conflicting Stakeholder Priorities for Managing Hearing Impairment for People Living with Dementia in Residential Aged Care Facilities.

OBJECTIVES: The aims of this study were to a) explore the impact of hearing impairment on people living with dementia in residential aged care facilities (RACFs) and b) investigate management of hearing impairment for this population. METHODS: A descriptive qualitative approach, consisting of semi-structured interviews, was conducted with 23 participants across four stakeholder groups (audiologists, care staff, family members and individuals with dementia and hearing impairment living in RACFs). RESULTS: Thematic analysis revealed an overarching theme of "different priorities for managing hearing impairment" that emerged from the data. Audiologists and care staff prioritized different practices for managing hearing impairment: audiologists emphasized hearing aids and care staff emphasized communication strategies. Care staff also identified that current management of hearing impairment was sub-optimal as they do not prioritize managing it. CONCLUSIONS: Residents with dementia and hearing impairment living in RACFs are not receiving optimal hearing management. Further research is required to understand the factors that influence this. CLINICAL IMPLICATIONS: Changes in practices of both care staff and audiologists are required to improve hearing impairment management for this population.

Exploring the complexity of how families are engaged in early speech-language pathology intervention using video-reflexive ethnography.

BACKGROUND: Despite being an important aspect of effective early intervention service delivery, 'engagement' has been inconsistently defined in paediatric healthcare. Previous research has identified that engagement in early speech-language pathology intervention is complex and multifaceted. However, more research is needed to understand the ways that different families may engage with intervention in different settings. AIMS: To explore the complexity of engagement in early speech-language pathology intervention from the perspectives of both families and their speech-language pathologists (SLPs). METHOD & PROCEDURES: Video-reflexive ethnography was used to explore engagement with 21 matched SLP-family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants during individual semi-structured interviews where participants were invited to reflect on the interactions captured (i.e., 'video-reflexive sessions'). Interview data were analysed using thematic analysis. OUTCOMES & RESULTS: Results from the interview data were organized into one overarching theme 'Families may have "different levels of engagement"', and four individual themes that reflected how families engage differently in various aspects of intervention, including (1) attending sessions and coming into the room; (2) actively participating in sessions; (3) continuing to actively participate outside sessions; and (4) having open and honest communication with their SLPs. CONCLUSIONS & IMPLICATIONS: Families may have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. Findings of this study prompt SLPs to move beyond using blanket statements about whether or not families are engaged, to instead describing in detail how families are uniquely engaged. What this paper adds What is already known on the subject In early speech-language pathology intervention, the term 'engagement' refers to (1) a complex, multifaceted state of families 'being engaged' in intervention both inside and outside sessions; and (2) a relational, co-constructed process where many families 'become engaged' in intervention as they work together with SLPs. Although research has acknowledged engagement may look different for each parent and family, little is known about how families are uniquely engaged in early speech pathology intervention in different settings. What this paper adds to existing knowledge This study is the first to explore engagement from the perspectives of both families and SLPs working together in intervention. Both groups of participants described the complexity of engagement in this setting and acknowledged that families engage differently in different aspects of intervention, which contribute to their unique profile of engagement. What are the potential or actual clinical implications of this work? Being able to identify potential indicators of engagement, such as the ones described in this study, provide opportunities for SLPs to take a reflexive approach to engaging with individual families, in line with principles of family-centred care. Findings of this study therefore prompt SLPs to reflect on how the families they work with are engaged in intervention, and to consider their own role in facilitating engagement. In addition, results highlight the importance of SLPs initiating open conversations with families themselves about how they would like to be engaged in intervention, and what support would be most beneficial to them.

Family-Centered Care in the Transition to Early Hearing Intervention.

This study aimed to explore and compare families' and professionals' perspectives on the implementation of family-centered care (FCC) (Moeller, Carr, Seaver, Stredler-Brown, & Holzinger, 2013) during the period between diagnosis of hearing loss (HL) and enrollment in early intervention (EI). A convergent mixed-methods study incorporating self-report questionnaires and semistructured in-depth interviews was used. Seventeen family members of children with HL and the 11 professionals who support these families participated in this study. The results suggested that the services engaged during the transition period partially adhered to the principles of FCC, including the provision of timely access to EI services and provision of emotional and social support. However, areas for improvement identified include strengthening family/professional partnerships, shared decision-making processes, collaborative teamwork, program monitoring, and consistency in the provision of information and support. Qualitative and quantitative research findings also indicated a lack of consistency in service provision during the transition period.

How Do Audiologists Respond to Emotional and Psychological Concerns Raised in the Audiology Setting? Three Case Vignettes.

OBJECTIVES: Emotional and psychological well-being are essential to overall health, but there is little research showing how to approach emotional and psychological concerns in the audiological setting. This study investigated audiologists' self-reported clinical behaviors in response to emotional and psychological concerns and/or symptoms raised by audiology clients. DESIGN: A sample of 83 Australia-based audiologists completed a survey including vignettes presenting older adults with hearing loss and experiencing symptoms consistent with either depression or grief. Content analysis was used to explore: (1) audiologists' self-reported usual response when clients present with emotional and psychological concerns and/or symptoms in the audiological setting; (2) audiologists' ability to identify and describe psychological symptoms; and (3) audiologists' self-reported clinical behaviors relating to client referral for psychological support. RESULTS: When asked to describe their usual clinical course of action in response to the vignettes, over one half the audiologists described actions that address the clients concerns related to psychological well-being. Where audiologists described how they would provide psychological support, they described modifications to the audiological rehabilitation program including involving significant others in the rehabilitation process, recommending additional support outside of the audiology setting (such as General Practitioner or psychologists), and providing emotional support and counseling. When prompted, the majority of participants recognized the two cases with depression as having a mental health condition; however, 48% of participants indicated the control case as also having a mental health condition. When asked directly, the majority of audiologists indicated that they would refer the three vignettes for specialist support; however, less than one third described referral to a General Practitioner and less than 5% described referral to a mental health professional as their normal course of action in the open response item. Twenty-five different professions/people were reported as potential sources for referral. CONCLUSION: These findings support the need for further training and/or resources for audiologists to enable them to appropriately detect, describe and refer for emotional and psychological concerns and/or symptoms raised by clients' in the audiology setting.

Is cortical automatic threshold estimation a feasible alternative for hearing threshold estimation with adults with dementia living in aged care?

Objective: This study explored the feasibility of cortical automatic threshold estimation (CATE), a fully automated late auditory evoked potential (AEP) test, as an alternative to pure-tone audiometry for hearing threshold estimation for adults with dementia living in aged care.Design: A single group cross-sectional study was conducted. Participants' dementia severity was determined through the Clinical Dementia Rating scale. Hearing thresholds were obtained for four audiometric frequencies in at least one ear by using both pure-tone audiometry and CATE.Study sample: Sixteen participants enrolled in the study, of which 14 completed at least one of the hearing tests. Twelve ears, from six participants, were included in the final correlation analysis.Results: Pearson correlation coefficients were significant between CATE and pure-tone audiometry for all frequencies: r2 = 0.52 (p = 0.008) for 500 Hz, r2 = 0.79 (p = 0.0001) for 1000 Hz, r2 = 0.71 (p = 0.0005) for 2000 Hz, and r2 = 0.92 (p < 0.0001) for 4000 Hz. Cortical thresholds were within 10 dB of behavioural thresholds for all four frequencies.Conclusions: Findings are encouraging for the feasibility of CATE as an alternative diagnostic test to pure-tone audiometry for adults living with dementia in aged care.

'We were just kind of handed it and then it was smoke bombed by everyone': How do external stakeholders contribute to parent rejection and the abandonment of AAC systems?

BACKGROUND: There are multiple stakeholders involved in the introduction of augmentative and alternative communication (AAC) systems to children with complex communication needs. Stakeholders such as speech-language pathologists (SLPs) and teachers who are external to the family unit play a key role in planning and implementing interventions. If this intervention is unsuccessful, it can result in parent rejection or abandonment of the AAC system. However, no studies explore the contribution of external stakeholders to AAC rejection and abandonment from the perspective of parents who have experienced such unsuccessful interventions. AIMS: To explore parents' perceptions of how external stakeholders may contribute to the rejection or abandonment of an AAC system. METHODS & PROCEDURES: Data were collected as a part of a larger study that explored parent experiences of AAC rejection and abandonment. Within this study, semi-structured interviews were completed with 12 parents who had rejected or abandoned an AAC system introduced to their child with complex communication needs. Data related to external stakeholder contributions were extracted from the interview transcripts, and a thematic analysis was conducted. OUTCOMES & RESULTS: Analysis revealed four themes that captured the role of external stakeholders in the rejection and abandonment of AAC systems: (1) parents were influenced by the attitudes and experience of professionals; (2) parents did not feel supported by SLPs; (3) communication between stakeholders was not effective; and (4) parents had difficulties using AAC without a supportive community. CONCLUSIONS & IMPLICATIONS: This study highlights the importance of family-centred service delivery when introducing an AAC system to the parent of a child with complex communication needs. SLPs may support parent acceptance of AAC systems by using family-centred practices such as listening to parents, acknowledging their expertise and finding compromises.

Nursing Management of Hearing Impairment in Nursing Facility Residents.

Hearing impairment (also known as hearing loss) is highly prevalent in residents of nursing facilities and its impacts are far-reaching. Hearing impairment has negative consequences for an individual's quality of life, psychosocial health, physical health, and mortality; these impacts are also exacerbated when hearing impairment cooccurs with other conditions, such as visual or cognitive impairment. These guidelines summarize the extensive evidence about the impacts of hearing impairment, the factors that are associated with increased risk of hearing impairment, assessment criteria for measuring impairment, and the management of residents' hearing impairment. Nursing interventions should focus on (a) cerumen management to reduce hearing impairment and allow for the use of hearing devices; (b) hearing device support so that residents can use hearing aids and/or other assistive listening devices; and (c) communication strategies so that conversations with residents can be facilitated. [Journal of Gerontological Nursing, 46(7), 15-25.].

Factors Associated With Successful Setup of a Self-Fitting Hearing Aid and the Need for Personalized Support.

OBJECTIVES: Self-fitting hearing aids have the potential to increase the accessibility of hearing health care. The aims of this study were to (1) identify factors that are associated with the ability to successfully set up a pair of commercially available self-fitting hearing aids; 2) identify factors that are associated with the need for knowledgeable, personalized support in performing the self-fitting procedure; and (3) evaluate performance of the individual steps in the self-fitting procedure. DESIGN: Sixty adults with hearing loss between the ages of 51 and 85 took part in the study. Half of the participants were current users of bilateral hearing aids; the other half had no previous hearing aid experience. At the first appointment, participants underwent assessments of health locus of control, hearing aid self-efficacy, cognitive status, problem-solving skills, demographic characteristics, and hearing thresholds. At the second appointment, participants followed a set of computer-based instructions accompanied by video clips to self-fit the hearing aids. The self-fitting procedure required participants to customize the physical fit of the hearing aids, insert the hearing aids into the ear, perform self-directed in situ audiometry, and adjust the resultant settings according to their preference. Participants had access to support with the self-fitting procedure from a trained clinical assistant (CA) at all times. RESULTS: Forty-one (68%) of the participants achieved a successful self-fitting. Participants who self-fit successfully were significantly more likely than those who were unsuccessful to have had previous experience with hearing aids and to own a mobile device (when controlling for four potential covariates). Of the 41 successful self-fitters, 15 (37%) performed the procedure independently and 26 (63%) sought support from the CA. The successful self-fitters who sought CA support were more likely than those who self-fit independently to have a health locus of control that is externally oriented toward powerful others. Success rates on the individual steps in the self-fitting procedure were relatively high. No one step was more problematic than any other, nor was there a systematic tendency for particular participants to make more errors than others. Steps that required use of the hearing aids in conjunction with the self-fitting app on the participant's mobile device had the highest rates of support use. CONCLUSIONS: The findings of this study suggest that nonaudiologic factors should be considered when selecting suitable candidates for the self-fitting hearing aids evaluated in this study. Although computer-based instructions and video clips were shown to improve self-fitting skill acquisition relative to past studies in which printed instruction booklets were used, the majority of people are still likely to require access to support from trained personnel while carrying out the self-fitting procedure, especially when this requires the use of an app.

Can adults living with dementia complete pure-tone audiometry? A systematic review.

OBJECTIVE: It is estimated that over 60% of adults with dementia will also have a hearing impairment, resulting in a dual sensory-cognitive communication disability. Hearing interventions may lessen the impact of hearing impairment on a communication disability; yet, for audiologists to recommend appropriate hearing interventions, the individual's hearing thresholds must first be accurately established. The gold standard test for establishing hearing thresholds is pure-tone audiometry (PTA). However, the ability of adults with dementia to successfully complete PTA is uncertain. This systematic review examined studies of adults with dementia to better determine the proportion who could complete PTA. DESIGN: Systematic review. STUDY SAMPLE: Studies were included that assessed hearing in older adults who were reported as having mild and greater dementia. From a total of 1,237 eligible studies, only three were found to meet all inclusion criteria. RESULTS: Across these three studies, the proportion of adults with dementia who could successfully complete PTA ranged from 56% to 59%. CONCLUSIONS: Further research is needed in this area, particularly for adults with moderate and severe stages of dementia. Future research should also consider the feasibility of complementary, non-behavioural hearing tests. This systematic review was registered with the PROSPERO database, registration number CRD42017073041.

"We don't know what we don't know": Providing information about communication to families of children with Down syndrome.

PURPOSE: Children with Down syndrome often present with a communication disability, and families require information to support their child's communication. Effective provision of information by professionals is an important part of family-centred practice. However, we currently do not know the specific communication information needs of families of children with Down syndrome. This study aimed to (1) explore families' experiences of communication information provision and (2) identify families' preferences regarding when, what and how they would like to receive information about communication. METHOD: A qualitative descriptive approach was used to explore the experiences and information needs of nine family members of children with Down syndrome aged 0-15 years. Data from semistructured, in-depth interviews were analysed using thematic analysis. RESULTS: Three core themes were identified: (1) We want more information about communication to be provided by professionals now and into the future so we can be "self-help people." (2) We want general information resources that help us support our child's communication. (3) We want to have a two-way partnership with professionals so we can share and receive specific information about our child's communication. CONCLUSION: Ineffective information provision restricts families' capacity to be self-help people in supporting communication development. Ongoing provision of both general and specific information about communication is needed in different formats. This study informs the development of resources to better meet families' information needs.

A qualitative investigation of families' needs in the transition to early intervention after diagnosis of hearing loss.

BACKGROUND: Families of children with hearing loss must make a number of decisions during the transition from diagnosis of hearing loss to enrolment in early intervention and thus require a wealth of information and support. This study aimed to investigate families' needs during this period and explore how these needs might differ for families of children with hearing loss who have additional disabilities. METHODS: An exploratory qualitative study incorporating semistructured in-depth interviews and thematic analysis was used. A total of 28 participants from two groups were involved: (a) family members of children with hearing loss (n = 17) and (b) professionals who support these families during the transition period from diagnosis of hearing loss to enrolment in early intervention (n = 11). RESULTS: Analysis of qualitative data revealed four major themes: (a) families require information that meet their specific needs; (b) families require supportive professionals to "walk the journey" with them; (c) some families want to connect with other families who "are in the same boat"; and (d) professional support needs differ for children with hearing loss who have additional disabilities. CONCLUSIONS: Families and professionals in this study identified a wide range of family needs during the transition to early intervention. The results highlighted the importance of providing individualized services and considering families' needs when providing family-centred services.

Speech pathologist perspectives on the acceptance versus rejection or abandonment of AAC systems for children with complex communication needs.

Despite the benefits of augmentative and alternative communication (AAC) systems for children with complex communication needs, these systems are not consistently accepted by parents. This study aimed to explore factors that contribute to the acceptance, rejection, or abandonment of AAC systems. Semi-structured interviews were conducted with 16 speech-language pathologists (SLPs) who had introduced at least one AAC system that was rejected or abandoned by the parent of a young child, as well as one that had been accepted. Thematic analysis revealed six themes that describe influences on parent acceptance of AAC systems: (a) The Way Parents View their Child, (b) Parents' Views on AAC Intervention, (c) Support Networks Around Parents, (d) The Capacity of and Demands on Parents, (e) Services Provided by SLPs, and (f) Specific Features of AAC Systems. Themes were largely consistent with the existing literature; however, SLPs raised the novel concept of parent grief and loss as a potential contributor to AAC abandonment. To increase AAC acceptance, SLPs should consider not only the child with complex communication needs, but also the child's parents, the AAC systems available, and their own clinical limitations.

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.