Relationship between self-reported listening and communication difficulties and executive function: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Listening and communication difficulties can limit people's participation in activity and adversely affect their quality of life. Hearing, as well as listening and communication difficulties, can be measured either by using behavioural tests or self-report measures, and the outcomes are not always closely linked. The association between behaviourally measured and self-reported hearing is strong, whereas the association between behavioural and self-reported measures of listening and communication difficulties is much weaker, suggesting they assess different aspects of listening. While behavioural measures of listening and communication difficulties have been associated with poorer cognitive performance including executive functions, the same association has not always been shown for self-report measures. The objective of this systematic review and meta-analysis is to understand the relationship between executive function and self-reported listening and communication difficulties in adults with hearing loss, and where possible, potential covariates of age and pure-tone audiometric thresholds. METHODS AND ANALYSIS: Studies will be eligible for inclusion if they report data from both a self-report measure of listening difficulties and a behavioural measure of executive function. Eight databases are to be searched: MEDLINE (via Ovid SP), EMBASE (via Ovid SP), PsycINFO (via Ovid SP), ASSIA (via ProQuest), Cumulative Index to Nursing and Allied Health Literature or CINAHL (via EBSCO Host), Scopus, PubMed and Web of Science (Science and Social Science Citation Index). The JBI critical appraisal tool will be used to assess risk of bias for included studies. Results will be synthesised primarily using a meta-analysis, and where sufficient quantitative data are not available, a narrative synthesis will be carried out to describe key results. ETHICS AND DISSEMINATION: No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines. PROSPERO REGISTRATION NUMBER: CRD42022293546.

Spoken Sentence Complexity and Grammar Use in Children with CIs.

This study investigated if the language profiles of prelingually deaf children with bilateral cochlear implants (CIs) and children with typical hearing (TH) matched on their quantitative score on clinical spoken expressive language tasks differed in terms of sentence complexity, sentence length, and severity of grammatical errors. No significant differences were found between the groups in terms of (1) proportion of simple, conjoined, and complex sentences; (2) mean length of utterance based on words and syllables; and (3) proportion of local and global grammatical errors. The results indicate that the quantitative scores on the clinical spoken expressive language tasks are related to similar spoken language profiles in children with CIs and children with TH. These findings suggest that these tests can be used for meaningful comparisons of expressive spoken language skills. However, more studies are needed on the real-life expressive language skills of children with CIs, as clinical tests often rely on one specific modality (in this study: spoken language) and might therefore not accurately represent the language skills of the children.

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.

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.

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.

The initial evaluation of an Internet-based support system for audiologists and first-time hearing aid clients.

OBJECTIVES: Audiologists provide professional contact and support between appointments to clients with hearing impairment using telephone and e-mail, but more advanced and flexible technological platforms are also possible. The present study aimed to evaluate the clinical application of an Internet-based support system for audiologists and their first-time hearing aid clients. DESIGN: An Internet-based support system developed by Månsson et al. (2013) for psychologists and their clients was adapted for audiologic purposes. Three audiologic clinics in Sweden tested the support system with their clients. STUDY SAMPLE: Twenty-three clients managed by four audiologists used and evaluated the support system. In addition, five of the clients and all four audiologists were interviewed and their responses were analyzed using content analysis. RESULTS: The clients and the audiologists reported positive experiences and overall satisfaction but audiologists reported that the support system did not address the needs of all clients. More positive experiences and greater satisfaction with the support system were associated with reductions on self-reported consequences of hearing loss and positive hearing aids outcomes. CONCLUSIONS: An Internet-based support system can be used in audiologic rehabilitation. Both audiologists and clients recognized the system's potential value to offer an online support to the provision of audiologic services.

Bridging the Gap Between Hearing Screening and Successful Rehabilitation: Research Protocol of a Randomized Controlled Trial of Motivational Interviewing via Internet.

PURPOSE: Studies point to low help-seeking after a failed hearing screening. This research forum article presents the research protocol for a randomized controlled trial of motivational interviewing via the Internet to promote help-seeking in people who have failed an online hearing screening. METHOD: Adults who fail a Swedish online hearing screening, including a speech-in-noise recognition test, will be randomized to either an intervention group (participating in motivational interviewing) or an active control group (reading a book on history of hearing aids). Both of the conditions will be delivered via the Internet. The primary outcome is experience with seeking health care and using hearing aids 9 months after the intervention. Secondary outcomes are changes in before and after measures of self-reported hearing difficulties, anxiety, depression, and quality of life. Stages of change and self-efficacy in hearing help-seeking are measured immediately after intervention and at a 9-month follow-up for the purpose of mediation analysis. RESULTS: The results of this randomized controlled trial may help bridge the gap between hearing screening and successful hearing rehabilitation. CONCLUSION: Although no large instantaneous benefits are expected, a slow change toward healthy behaviors­seeking health care and using hearing aids­would shed light on how to use the Internet to assist people with hearing impairment.

The Process of Developing an Internet-Based Support System for Audiologists and First-Time Hearing Aid Clients.

BACKGROUND: In audiologic practice, complementary information sources and access to the clinician between appointments improve information retention and facilitate adjustment behaviors. An Internet-based support system is a novel way to support information sharing and clinician access. PURPOSE: This research forum article describes the process of developing an Internet-based support system for audiologists and their first-time hearing aid clients. METHOD: The iterative development process, including revisions by 4 research audiologists and 4 clinical audiologists, is described. The final system is exemplified. CONCLUSION: An Internet-based support system was successfully developed for audiologic practice.

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.