Conversations about mental illness and health in adult audiological rehabilitation.

OBJECTIVE: To understand the nature of mental health discussions in audiological rehabilitation, specifically, the types of conversations, when and how they are initiated, and the participant factors associated with discussing mental health. DESIGN: A cross-sectional descriptive survey including quantitative (multiple choice) and qualitative (free-text) questions regarding mental health discussions between audiologists and clients. STUDY SAMPLE: A convenience sample of 118 Australian audiologists working in adult audiological rehabilitation. RESULTS: The majority of participants (95.8%) reported having engaged in discussions with clients about mental illness and health at some point throughout their career. The frequency of these discussions varied across participants: 7% rarely discuss, 50% discuss occasionally, 30% discuss with about half their clients and 13% have discussions with most clients. Many participants (85.6%) reported that clients would initiate these conversations, most often via disclosing the impacts of hearing loss on clients' lives. CONCLUSIONS: Most audiologists will encounter clients with mental health concerns, and many will engage in conversations about psychological symptoms, therefore, training audiologists to recognise and address verbal and non-verbal cues regarding mental health may help to promote person-centred care and potentially improve outcomes.

Changes in audiologists' mental wellbeing during the COVID-19 pandemic: the supportive role of professional associations, workplaces and hearing device manufacturers.

Objective: The purpose of this study was to explore whether self-reported mental wellbeing (anxiety, depression and loneliness) in audiologists has changed over the course of the COVID-19 pandemic and to examine possible factors contributing to audiologists' current state of mental wellbeing.Design: Two cross-sectional surveys were distributed at two different time points during the COVID-19 pandemic screening for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3).Study sample: 117 audiologists from around the world.Results: Findings demonstrated that over the course of the COVID-19 pandemic audiologists' levels of depression decreased, levels of anxiety were low and stable, whilst levels of loneliness were stable and high. Younger age was associated with lower levels of mental well-being. Responses to open text questions suggests that audiologists could be supported through development of clear and consistent guidelines on COVID-19 workplace restrictions, allowing for more workplace flexibility and providing mental health support through employee assistance programs.Conclusions: The rates of anxiety, depression and loneliness observed highlight the continued need for mental health and workplace interventions to support audiologists throughout the COVID-19 pandemic and the subsequent recovery period.

Patient's perceptions of presbycusis and associated tinnitus counselling practices within the KwaZulu-Natal province.

BACKGROUND:  Counselling manages the psychosocial effects of presbycusis and associated tinnitus, which is best conducted through patient-centred care (PCC). However, there is a paucity of research on implementing PCC within audiology and on patients' perceptions of counselling practice, making the focus on patient benefit and satisfaction crucial. Furthermore, PCC has been documented to be suitable in addressing the psychosocial effects of hearing loss and associated tinnitus, as it focuses on the adult patient playing an integral part of the management processes, providing improved patient outcomes. OBJECTIVES:  This study aimed to explore patients' perceptions of presbycusis and associated tinnitus counselling practices by audiologists within KwaZulu-Natal (KZN). METHOD:  Qualitative phenomenological semi-structured telephonic interviews were conducted through purposive sampling, consisting of seven patients with presbycusis and associated tinnitus who were recruited from private and public facilities in KZN. Data were analysed through hybrid thematic analysis following Braun and Clark's steps. RESULTS:  Six categories were identified: perceptions on counselling methods, efficacy and tools, audiological rehabilitative training, multicultural sensitivity, patient satisfaction and recommendations on improving counselling practices as PCC adaptation. Themes were then extracted from these categories. The overall outcome of the study found that patients had positive perceptions of methods and tools, and audiologists were viewed as adequately trained. Furthermore, they were satisfied and benefitted from counselling practices and found clinicians to be culturally sensitive in their practice. However, recommendations were made towards linguistic sensitivity and satisfaction evaluations. CONCLUSION:  Therefore, implementing PCC into counselling practice may achieve positive patient perceptions, thus highlighting the need to identify barriers and improve the implementation of PCC into practice, especially in resource-constrained contexts.

Audiologists' presbycusis and associated tinnitus counselling practices within the KwaZulu-Natal province.

BACKGROUND:  Counselling plays an integral part in the management of presbycusis and tinnitus. Counselling can be conducted by implementing patient-centred care (PCC), showing improved patient outcomes; however, it has been poorly implemented in healthcare in South Africa (SA), particularly in the field of audiology for this condition. OBJECTIVES:  This study aimed to report on audiologists' presbycusis and tinnitus counselling practices as guided by the PCC framework within KwaZulu-Natal (KZN). METHOD:  Quantitative semi-structured online surveys were conducted using purposive sampling of 41 audiologists practising in both the public and private sectors within KZN. RESULTS:  This study revealed that 7.3% (n = 3) of participants provided only compensation for hearing loss without counselling, and only 2.4% (n = 1) of participants offered group counselling. Apart from this, 7.9% (n = 3) reported that tools and resources in counselling were not useful, whilst 12.5% (n = 5) reported that counselling was not multiculturally sensitive. Furthermore, a p = 0.044 suggests the public sector reported a dire need for improved training in counselling as compared with the private sector. CONCLUSION:  Audiologists have been providing services within PCC to the best of their capabilities and their environments; however, there is still room to better implement PCC for improved patient outcomes. PCC has not been fully implemented into counselling practices in terms of patient preferences, emotional support, involvement of significant others, integrated care and education.

'I had nothing. It's just life experience that helped me through that situation': Australian audiologists' perspectives on audiological clinical practice for traumatic brain injury and rehabilitation.

OBJECTIVE: Australian Audiologists' perspectives on standard non-specialized clinical practice in the context of Traumatic Brain Injury (TBI) were examined, including the perceived barriers to optimal service provision. DESIGN: A qualitative research design utilizing semi-structured interviews was conducted using purposive sampling. Nine participants were interviewed about their understanding of the impact of TBI on hearing and balance; identification, diagnosis and management of auditory and vestibular dysfunction following TBI; barriers to service delivery; training relating to complex clients (i.e., TBI); and awareness of referral pathways. RESULTS: Three major themes, each with subthemes, were evident in the data. The major themes reflected general considerations of audiological professional culture and specific issues related to knowledge of TBI and clinical practice with patients. Analysis revealed that professional culture seemed to act as a contextual barrier and interacted with the perceived lack of TBI related knowledge to hinder optimal clinical practice in this patient population. CONCLUSION: Application of the biopsychosocial model, including interdisciplinary care in the management of patients with TBI, is needed. An improvement in theoretical and practical knowledge encompassing the wide-ranging effects of TBI is critical for the optimal audiological service delivery.

Hearing healthcare for workers with hearing loss: audiologists' experiences and views.

PURPOSE: This study explored audiologists' perspectives regarding their interactions with workers with hearing loss (WHL). MATERIALS AND METHODS: Semi-structured interviews were conducted with twenty-five audiologists working in the National Health Service (NHS) and independent companies (IC) in the UK and were thematically analysed. RESULTS: The developed themes and sub-themes (shown in parenthesis) are (1) Current practices and routines (Same approach for most patients; Variations between hearing care services; Audiologists' personal experience of hearing loss) (2) Perceived challenges (Non-routine and challenging cases; The role of hearing technology; Concerns about lack of awareness and knowledge; Communication difficulties between services, Limited funding and resources) (3) Scope for better support (Would like to be informed; Other potential service improvements). CONCLUSIONS: This study revealed that audiologists' perceived deficiencies in the hearing rehabilitation for WHL and identified ways to improve it. Key priorities for improvement were found to include addressing audiologists' informational and training needs, facilitating WHLs' access to appointments, improving communication between services, raising awareness in the workplace, developing relevant resources and extending funding for provision of longer appointments and hearing technologies. This is the first time this information has been reported in the literature. Opportunities for conducting further research in this area are suggested.Implications for rehabilitationWorkers with hearing loss face many challenges in work life and have the option of audiologic rehabilitation to alleviate their difficulties and improve their wellbeing; however, this study suggests that workers' audiological care needs improvements.Audiologists should assess and consider patients' work needs and psychosocial concerns in consultations to provide personalised care.Audiology educational programmes, services, and the healthcare system can assist audiologists in helping workers with hearing loss by providing updated knowledge, continuous training and improved interprofessional communication and patients' access to useful resources.

Audiology in the time of COVID-19: practices and opinions of audiologists in the UK.

OBJECTIVE: To document changes in audiology practice resulting from COVID-19 restrictions and to assess audiologists' opinions about teleaudiology. DESIGN: A survey consisting of closed-set and open-ended questions that assessed working practices during the COVID-19 restrictions and audiologists' attitudes towards teleaudiology. SAMPLE: About 120 audiologists in the UK recruited via snowball sampling through social media and emails. RESULTS: About 30% of respondents said they had used teleaudiology prior to COVID-19 restrictions; 98% had done at the time of survey completion, and 86% said they would continue to do so even when restrictions are lifted. Reasons for prior non-use of teleaudiology were associated with clinical limitations/needs, available infrastructure and patient preferences. Respondents believe teleaudiology will improve travel, convenience, flexibility and scheduling, that it will have little/no impact on satisfaction and quality of care, but that it will negatively impact personal interactions. Concerns about teleaudiology focussed on communication, inability to conduct some clinical procedures and technology. CONCLUSIONS: Respondents' experience with teleaudiology has generally been positive however improvements to infrastructure and training are necessary, and because many procedures must be conducted in-person, it will always be necessary to have hybrid-care pathways available.

Knowledge and Awareness of Ear Protection Devices for Sound Sensitivity by Individuals With Autism Spectrum Disorders.

Purpose Sensitivity to sounds and atypical reactions to sensory input by individuals with autism spectrum disorder (ASD) have been reported in the literature. In response to this sensitivity, some individuals use ear protection devices (EPDs) such as noise-canceling headphones, earplugs, or earmuffs to attenuate the perceived unpleasant sounds. Given the communication deficits often noted in this population and the essential role of hearing in speech and language development, the impact of wearing EPDs to attenuate sound needs to be explored. The purpose of this study was to obtain information from various stakeholders regarding their opinions about use of EPDs in individuals with ASD and perceived benefits and possible concerns of EPD use. Method A survey was constructed to assess the opinions of speech-language pathologists, audiologists, teachers, and graduate students about EPDs among individuals with ASD. A total of 255 professionals and graduate students completed the survey. Results The vast majority of respondents indicated a level of awareness of EPDs within this population. Regarding observed use of such devices, the majority of participants (66%) reported observing individuals with ASD using EPDs. The most commonly used devices observed were headphones (91%), followed by earmuffs (44%) and earplugs (33%). Respondents who had experience recommending and/or using EPDs with individuals with ASD were asked to report on major reasons why the devices were used and the perceived benefits and possible negative effects. Conclusions There appears to be uncertainty among various stakeholders of the benefits and possible negative effects of EPD use by individuals with ASD. Additionally, there is a dearth of research in this area, and the necessity for specific guidelines for recommending and monitoring EPD use is indicated.

Clinicians' views of using cortical auditory evoked potentials (CAEP) in the permanent childhood hearing impairment patient pathway.

Objective: To obtain clinicians' views on the use of cortical auditory evoked potentials (CAEP) in the clinical pathway.Design: A questionnaire aimed at clinicians who use the HEARLab system with the Aided Cortical Assessment (ACA) Module. Results compared for Australians (where HEARLab produced) to other countries.Sample: The questionnaire was completed by 49 clinicians; 33 from Australia and 13 clinicians outside of Australia and 3 clinicians, destination unknown.Results: The findings of this research demonstrated that clinicians using CAEPs found them valuable for clinical practice. CAEPs were used to verify or modify hearing aid fittings and were used for counselling parents to reinforce the need for hearing aids. With the use of speech token as the stimulus clinicians had more relevant information to increase confidence in decision-making on paediatric hearing management.Conclusions: The main benefit from the use of CAEPs (using speech token stimuli) was for infant hearing aid fitting programmes, to facilitate earlier decisions relating to hearing aid fitting, for fine-tuning the aids and as an additional measure for cochlear implant referrals.

Student perceptions of two simulated learning environments in paediatric audiology.

Objective: To determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology.Design: A one-shot case study design.Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic.Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness.Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.

A Systematic Review of Interventions to Reduce the Effects of Cognitive Biases in the Decision-Making of Audiologists.

BACKGROUND: Audiologists are constantly making decisions that are key to optimizing client/patient outcomes, and these decisions may be vulnerable to cognitive biases. PURPOSE: The purpose was to determine the present state of knowledge within the field of audiology regarding the potential impact of cognitive biases on clinical decision-making and the use of interventions to reduce such impact. RESEARCH DESIGN: A systematic review was conducted to identify and consider the outcomes of all studies in which an intervention, strategy, or procedure was implemented with the aim of reducing the impact of cognitive biases on the decision-making of audiologists. DATA COLLECTION: The review was part of a larger scale search which included the broader disciplines of health science and medicine. Electronic database searches were supplemented by citation searches of relevant reviews and a gray literature search. Following title and abstract screening, 201 full-text studies were considered for inclusion. RESULTS: No studies were found which fulfilled the eligibility criteria. CONCLUSIONS: Despite initial calls to respond to these types of cognitive biases being made three decades ago, no peer-reviewed scientific studies testing strategies to reduce the impact of cognitive biases on the decision-making of audiologists were found. There is a clear need for a more concerted research effort in this area if audiologists are to consistently deliver truly evidence-based care.

Shifting and transforming the practice of audiology: The inclusion of traditional healing.

BACKGROUND: Societal diversity encompasses an array of cultural, religious and spiritual beliefs that influence an individual's perspective of illness and diseases. Healthcare providers are challenged with the task of considering these diversities in clinical practice. The symbiotic relationship between the healthcare provider and the traditional healer in any healthcare field is rare. OBJECTIVES: The aims were to determine the perspectives of audiologists with regard to traditional healing in South Africa (SA) and to document if and how the audiologist engages with traditional healing in practice. METHOD: A questionnaire containing closed and open-ended questions was utilised. Thematic analysis was conducted on the qualitative data, and the quantitative data were displayed using tables and figures. RESULTS: Forty-one audiologists working at public and private hospitals and clinics in SA were included in this study. The personal experiences of audiologists resulted in varying definitions of a traditional healer. Audiologists reported that patients utilised traditional healing methods such as pouring urine or motor oil into the ear. Strategies of accommodation included being culturally appropriate during conversations, respecting and acknowledging the individual's cultural and religious beliefs. Twenty-seven audiologists were willing to collaborate with traditional healers to support the patient. CONCLUSION: There is a need for an integral holistic model of care in Audiology. There is a lack of communication structures to facilitate the implementation of a collaborative model of care in the current medical model of practice of Audiology. The global trend of holistic and person-centred care is evident, and the field of Audiology cannot negate the role of traditional healers as alternate healthcare providers in SA.

Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists.

BACKGROUND: Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one's quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients. AIM: The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus. METHOD: Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified. RESULTS: The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants' years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus. CONCLUSION: The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Large Vestibular Aqueduct Syndrome: Parents' and Audiologists' Perspectives.

BACKGROUND: Large vestibular aqueduct syndrome (LVAS) is an auditory disorder that is difficult to diagnose and manage; it is confirmed when the vestibular aqueduct is >1.5 mm in diameter. Diagnosis of LVAS in children can devastate parents and challenge healthcare professionals who serve these patients and their families. PURPOSE: This study surveyed parents of children with LVAS about their knowledge of and experiences with LVAS and their attitudes about the support provided to them by healthcare professionals. This study also surveyed audiologists about their knowledge of and experiences with LVAS and their level of confidence in serving families with children having this disorder. RESEARCH DESIGN: Cross-sectional survey. STUDY SAMPLE: 100 parents, mostly mothers, and 144 audiologists responded to invitations to participate in surveys designed to elicit information about their knowledge of, experiences with, and attitudes toward LVAS. DATA COLLECTION AND ANALYSIS: Invitations via links to participate in a survey on surveymonkey.com were posted in LVAS support group pages on Facebook.com for parents and sent to audiologists randomly selected from the American Academy of Audiology Membership Directory. Descriptive statistics were used to analyze trends in parents' and audiologists' responses. RESULTS: A response rate could not be obtained for the parents' survey because it was impossible to know how many parents actually viewed the invitation to participate via Facebook.com. The response rate for the audiologists' survey was 10%. Most of the parents reported that their children had clinical trajectories similar to those of cases reported in the literature, and said they needed more information from their healthcare providers, especially pediatricians and primary care physicians. Most of the audiologists felt confident in their knowledge of and/or skills in aiding in the diagnosis and/or treatment of LVAS, except for issues surrounding cochlear implants. Audiologists were interested in obtaining continuing education about LVAS from multiple sources. CONCLUSIONS: Parents of children having LVAS need greater support from their healthcare providers, who in turn need additional information on the topic and should collaborate for supportive and appropriate interprofessional care.

Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education.

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

Perceived Gaps in Genetics Training Among Audiologists and Speech-Language Pathologists: Lessons From a National Survey.

Purpose The aim of this study was to assess knowledge, self-rated confidence, and perceived relevance of genetics in the clinical practice of audiologists and speech-language pathologists (SLPs) toward a better understanding of the need for genetics education, given that genetics plays a growing role in the diagnosis of hearing impairment and communication disorders. Method A survey consisting of 8 demographic items and 16 content questions was returned by 233 audiologists and 283 SLPs. Knowledge of applied genetics was queried with clinical scenarios in a multiple-choice format. Self-assessment of clinical confidence and perceived relevance of genetics in one's field was queried with questions and statements rated on 5-point Likert scales. The benefit of additional training in genetics was rated with a yes/no question, and if answered with yes, suggested topics were entered. Results A large significant gap between confidence in one's own genetics skills and the perceived relevance of genetics was evident, regardless of professional group. Over one third of the audiologists and over two thirds of the SLPs indicated low or somewhat low confidence in their own ability to implement principles of genetics, whereas over two thirds of both groups agreed that genetics is relevant for their field. Regardless of group, confidence scores were significantly and positively associated with relevance scores. Over 80% of respondents in both groups indicated that they would benefit from additional training in genetics. Most commonly suggested topics included genetic causes, general information about genetics, and making referrals. Conclusion Both audiologists and SLPs felt that genetics is relevant for their fields and that additional training in genetics would be beneficial. Future studies should evaluate the effect of genetics training on patient outcomes and the need for incorporating genetics more extensively into audiology and speech-language pathology training programs.

What do hearing healthcare professionals do to promote hearing aid use and benefit among adults? A systematic review.

OBJECTIVE: To conduct a systematic review of the evidence in relation to what hearing healthcare professionals do during hearing aid consultations and identifying which behaviours promote hearing aid use and benefit among adult patients. DESIGN: Searches were performed in electronic databases MEDLINE, EMBASE, CINAHL, PsycInfo, Web of Science, PubMed and Google Scholar. The Crowe Critical Appraisal Tool and Melnyk Levels of Evidence were used to assess quality and level of evidence of eligible studies. Behaviours of hearing healthcare professionals were summarised descriptively. STUDY SAMPLE: 17 studies met the inclusion criteria. RESULTS: Twelve studies described behaviours of audiologists and five studies were intervention studies. Audiologists were typically task- or technically-oriented and/or dominated the interaction during hearing aid consultations. Two intervention studies suggested that use of motivational interviewing techniques by audiologists may increase hearing aid use in patients. CONCLUSIONS: Most studies of clinicians' behaviours were descriptive, with very little research linking clinician behaviour to patient outcomes. The present review sets the research agenda for better-controlled intervention studies to identify which clinician behaviours better promote patient hearing aid outcomes and develop an evidence base for best clinical practice.

Towards patient-centred communication: an observational study of supervised audiology student-patient hearing assessments.

OBJECTIVE: This study has two interconnected aims. The first was to better understand how audiology students co-construct hearing assessments with patients while supervised by a clinical educator. The second was to investigate how students' communication aligns with principles of patient-centred communication. STUDY SAMPLE: Twenty-three final year audiology students from two Australian universities participated in the study. RESULTS: The supervised student-patient hearing appointments were video-recorded and transcribed. Genre analysis, a form of discourse analysis, was carried out to identify the structure and communication patterns. The six-function model of medical communication was adopted as an analytical framework to map students' patient-centred communication. The findings showed generic structure of the hearing assessments were the main stages of taking a history, providing a diagnosis, and initiating management plans. For patient-centred communication functions, students demonstrated their ability to foster the relationship and gather information. The communication functions of decision-making, enablement, and responding to patients' emotions were rarely observed. A significant relationship was found between clinical educators' interjection as a function of students' patient-centred communication tendencies. CONCLUSION: To enhance students' patient-centred communication, teaching should include explaining and planning as well as addressing additional aspects of patient-centred communication. Support of clinical educators is needed to optimise students' communication skills learning.

Audiological follow-up in a risk-based newborn hearing screening programme: An exploratory study of the influencing factors.

BACKGROUND:  Follow-up return rate in Early Hearing Detection and Intervention (EHDI) programmes is of specific importance as it ensures that benchmarks are met and that no child with suspected hearing loss is left unidentified. OBJECTIVES:  The aim of this study was to determine the factors influencing audiological follow-up of high-risk infants in a risk-based newborn hearing screening programme. METHOD:  A non-experimental, exploratory, qualitative research design was employed. Purposive sampling was used. The study was conducted at a secondary level hospital in the public health care sector in South Africa. Participants comprised 10 caregivers (age range 26-40 years) of infants who had been enrolled in a risk-based newborn hearing screening programme, and returned for follow-up appointments. Data were collected using semi-structured interviews. Responses were recorded by the researcher and a colleague to ensure rigour and trustworthiness of findings. Data were analysed using thematic analysis for open-ended questions and descriptive statistics for the closed-ended questions. RESULTS:  The most common positive contributors that facilitated participants' attendance at follow-up appointments were: having friendly audiologists; a clear line of communication between caregiver and audiologist and a reminder of the appointment. The most significant perceived challenge that participants described in returning for the follow-up appointment was living in far proximity from the hospital. CONCLUSION:  Findings of the study revealed that influencing factors on follow-up return rate are demographic, socio-economic, and interpersonal in nature and further suggested the need for an all-inclusive appointment day. It may be of importance to not only look at what is being done to improve the follow-up return rate but also how it should be done in terms of professional-to-patient communication and interactions.

The child doesn't hear? On breaking bad news as perceived by parents and audiologists.

OBJECTIVE: The object of this study was to explore how parents experienced receiving the news of their child's hearing loss, and how audiologists experienced the situation of conveying the diagnosis, in order to examine improvements to the current process. METHOD: A questionnaire regarding different aspects of breaking the news was developed. 48 Arabic and Hebrew speaking parents of hearing impaired children answered the questionnaire. A similar questionnaire was filled out by 31 audiologists. RESULTS: Findings demonstrate parents' general satisfaction with the manner in which the diagnosis was delivered. According to the parents' reports, receiving the diagnosis evoked negative feelings of fear, depression and difficulty believing the diagnosis. Parents' feelings were influenced by their cultural background, such as their ethnic identity, religious practice and difficulties due to language barriers. The audiologists described concern and anxiety when breaking bad news, but they felt they were able to present the diagnosis. The audiologists felt that they were not trained in this aspect, and the ability was acquired through experience. Both parents and audiologists agreed that the audiologist should be the professional to deliver the diagnosis. All emphasized sensitivity and professionalism as necessary qualities. Whereas audiologists were of the opinion that the most important information to transmit was the type of hearing loss, the parents were most interested in discussing their feelings, the rehabilitation process, and talking to other parents. CONCLUSIONS: Overall, results reveal that breaking bad news of a child's hearing loss has been done fairly well. Due to the parents' reports of the need for emotional support, it is suggested that audiologists receive further training and adjust to personal and cultural differences. Recommendations include establishing an appropriate setting and ensuring that an interpreter is available when necessary. Further emotional support may be provided through establishment of a family support network.