Long-Term Outcomes of Self-Fit vs Audiologist-Fit Hearing Aids.

Importance: With rising interest in over-the-counter (OTC) hearing aids as an alternative to traditional audiologist-fit devices, understanding their long-term efficacy is crucial. However, given the novelty of the US Food and Drug Administration category of OTC hearing aids, minimal evidence currently supports their long-term efficacy. Objective: To compare the long-term self-reported outcomes at 8 months of self-fit OTC hearing aids to the same hearing aids fit by audiologists. Design, Setting, and Participants: Building on a previous randomized clinical trial, this follow-up comparative effectiveness research study reassessed a number of the original participants that were not lost to follow-up. Participants were initially divided into those with self-fit OTC hearing aids and those with audiologist-fit devices. Approximately 8 months after fitting, participants completed self-reported questionnaires. Missing data were addressed through multiple imputation. The original noninferiority trial was conducted at the University of Pretoria in South Africa from April 2022 to August 2022. The current analysis took place between July 7, 2023, to November 20, 2023. Interventions: In the original trial, participants in the self-fit device group received a pair of OTC hearing aids and independently fit them with remote support as needed. The audiologist-fit device group received the same hearing aids fit by a certified audiologist using best practices. Main Outcomes and Measures: The main outcomes were self-reported hearing aid benefit, measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the International Outcome Inventory for Hearing Aids (IOI-HA). Results: Of 64 participants in the trial, 44 participants were included in the extension study (21 [47.7%] in the audiologist-fit group; 23 [52.3%] in the self-fit group). The mean (SD) age of these participants was 63.0 (13.2) years, and 21 (47.7%) were male. At the long-term follow-up, self-fit and audiologist-fit groups showed no significant differences in the APHAB global score (mean difference, 0.02 [95% CI, -7.1 to 7.1]; Cohen d, 0.01 [95% CI, -0.5 to 0.5]) or the IOI-HA total score (mean difference, 1.5 [95% CI, -1.4 to 4.4]; Cohen d, 0.3 [95% CI, -0.2 to 0.8]). From 6 weeks to 8 months, no clinically meaningful group-time interaction was found between groups for the APHAB global score (Cohen d, 0.1 [95% CI, -0.2 to 0.3]), but a significant interaction for the IOI-HA total score was found (Cohen d, -0.6 [95% CI, -0.8 to -0.3]), with the self-fit group generally performing better. Conclusion: This comparative effectiveness research study demonstrated that self-fit OTC hearing aids can offer comparable long-term benefits to audiologist-fit hearing aids for individuals with mild to moderate hearing loss.

Consumer Perspectives on Improving Hearing Aids: A Qualitative Study.

PURPOSE: Hearing aids play a pivotal role in mitigating the impact of hearing loss, yet their adoption and consistent usage remains suboptimal. Understanding the hearing aid needs of individuals with hearing loss is important to support uptake, use, and outcomes. The current study describes users' perspectives on how hearing aids can be improved. METHOD: A cross-sectional, qualitative, content analysis design was used for an open-ended question from an online survey, exploring user perspectives on hearing aid improvements. Participants were adult hearing aid users in the United States, surveyed from the HearingTracker and Lexie Hearing user database. RESULTS: A total of 628 participants (Mage = 66 years) were surveyed. The majority of participants used bilateral, behind-the-ear hearing aids that were obtained either through a hearing health care professional or online. Three domains, highlighting areas for hearing aid improvement, were identified. (a) The hearing aid features domain described user issues surrounding physical appearance and fit, general features, streaming, battery functionality, adjustments, smartphone applications, and hearing aid-related accessories. There was dissatisfaction with aesthetics and functionality, with a notable desire for improvements in physical appearance and fit (n = 161), and features to improve self-efficacy. (b) The sound quality domain described user issues surrounding sound perception and difficult situations. Participants highlighted unmet needs for clarity, especially in noisy environments (n = 143). (c) The service-delivery domain described user issues surrounding audiology services and general satisfaction, with criticisms centered on the high cost of hearing aids (n = 193) and the credibility of hearing health care professionals. CONCLUSIONS: Hearing aid users appreciated current technological advances but expressed a need for improvements, to better align devices with their requirements. Key areas included physical aesthetics, user control over device adjustments, sound clarity, cost accessibility, and trust between the user and hearing health care professional. Future designs should focus on features enhancing user autonomy and self-efficacy.

Digits-in-Noise Test as an Assessment Tool for Hearing Loss and Hearing Aids.

The aim of this study was to examine the relationship between an American English Digits in Noise (DIN) test and commonly used audiological measures to evaluate the DIN test's ability to detect hearing loss and validate hearing aid fitting. QuickSIN and DIN tests were completed by participants with untreated hearing loss (n = 46), prescription hearing aids (n = 15), and over-the-counter (OTC) hearing aids (n = 12). Performance on the QuickSIN showed moderate positive correlations with DIN for untreated hearing loss participants and prescription hearing aid users, but not for OTC hearing aid users. For untreated hearing loss participants, both QuickSIN and DIN tests showed positive moderate to strong correlations with high frequency puretone averages. In OTC users, DIN scores did not significantly change over a 6-month time period and were better when conducted remotely compared to in-person testing. Our results suggest that the DIN test may be a feasible monitoring option for individuals with hearing loss and those fitted with hearing aids. However, due to small sample size in this pilot study, future research is needed to examine DIN test's utility for fitting and validating OTC hearing aids.

Smartphone-Facilitated In-Situ Hearing Aid Audiometry for Community-Based Hearing Testing.

OBJECTIVES: Hearing loss prevalence is increasing, with an estimated 2.5 billion people affected globally by 2050. Scalable service delivery models using innovative technologies and task-shifting are World Health Organization priorities to improve access to hearing care, particularly in low- and middle-income countries. Smartphone-facilitated audiometry in the community using hearing aids covered by noise-attenuating ear cups ("in-situ") could support more accessible hearing care when provided by less trained individuals such as community health workers (CHWs). This study aimed to determine the validity of this method for potential hearing aid fitting. Study objectives included determining the maximum permissible ambient noise level (MPANL), inter-device reliability, clinical threshold accuracy, reliability, and performance in real-world settings. DESIGN: Experiment 1: 15 normal-hearing adult participants were evaluated to determine MPANLs for circumaural Peltor 3M earcups covering Lexie Lumen hearing aids with smartphone-facilitated in-situ audiometry. MPANLs were calculated by measuring the difference in attenuation between thresholds obtained with standard headphones and in-situ hearing aids. Experiment 2: Pure-tone frequency and intensity output of 14 same-model Lexie Lumen hearing aids were measured to determine inter-device reliability. Pure-tone stimuli were measured and analyzed to determine sound pressure levels in decibels and pure-tone frequency when connected to a test box 2cc coupler. Experiment 3: 85 adult participants were tested in a sound booth to determine the accuracy of automated in-situ pure-tone audiometry (PTA) compared to clinical PTA (500, 1000, 2000, 3000, 4000, 6000 Hz) facilitated by an audiologist. The first 39 participants were tested twice to determine test-retest reliability. Experiment 4: In a community setting, 144 adult participants were tested with automated in-situ audiometry facilitated by CHWs using a smartphone app. These participants were subsequently tested with automated mobile PTA (500, 1000, 2000, 4000 Hz). An additional 44 participants were tested twice to determine test-retest reliability. RESULTS: Experiment 1: MPANLs of the Peltor 3M earcup-covered hearing aids were higher than standard headphones across all frequencies, ranging from 24 to 47.3 dB SPL. Experiment 2: Inter-device performance reliability was high, with all inter-device differences across all intensities and frequencies less than 3 dB. Frequency output was consistent and differed less than 0.7% between devices. Experiments 3 and 4: 85.2% and 83.3% of automated in-situ audiometry thresholds were within 10 dB of thresholds obtained in the sound booth and in a community setting, respectively. Acceptable test-retest intraclass correlation coefficient (ICC) was evident across all thresholds obtained in a sound booth (ICC = 0.85 to 0.93) and in a community setting (ICC = 0.83 to 0.97). CONCLUSIONS: Smartphone-facilitated in-situ audiometry allows for reliable and valid community-based testing. A simple smartphone user interface and automated in-situ audiometry allow CHWs with minimal training to facilitate the testing. With the additional capability to program hearing aids via the smartphone after the initial test, this approach would have the potential to support widespread access to personalized hearing aid fittings facilitated by CHWs in low- and middle-income countries. This approach also supports self-fitting options based on in-situ thresholds, enabling testing and fitting via over the counter hearing aids.

Perceptions of Hearing Health Care: A Qualitative Analysis of Satisfied and Dissatisfied Online Reviews.

PURPOSE: The aim of this study was to examine the hearing health care experience of satisfied and dissatisfied consumers as reported on Google reviews. METHOD: Using qualitative thematic analysis, open-text responses from Google regarding hearing health care clinics across 40 U.S. cities were examined. During the original search, 13,168 reviews were identified. Purposive sampling led to a total of 8,420 five-star reviews and 321 one-star reviews. The sample consisted of 500 five-star (satisfied) and 234 one-star (dissatisfied) reviews, describing experiences with audiology clinics, excluding reviews related to ear, nose, and throat services; other medical specialties; and those not relevant to hearing health care. RESULTS: Satisfied and dissatisfied consumer reviews yielded nuanced dimensions of the hearing health care consumer experience, which were grouped into distinct domains, themes, and subthemes. Six and seven domains were identified from the satisfied and dissatisfied reviews, encompassing 23 and 26 themes, respectively. The overall experience domain revealed emotions ranging from contentment and gratitude to dissatisfaction and waning loyalty. The clinical outcomes domain highlights the pivotal contribution of well-being and hearing outcomes to the consumer experience, while the standard of care domain underscores shared expectations for punctuality, person-centered care, and efficient communication. Facility quality, professional competence, and inclusive care were also highlighted across positive and negative reviews. CONCLUSIONS: Findings indicate dimensions of satisfied and dissatisfied hearing health care consumer experiences, identifying areas for potential service refinement. These consumer experiences inform person-centric service delivery in hearing health care.

Hearing help-seeking, hearing device uptake and hearing health outcomes in individuals with subclinical hearing loss: a systematic review.

OBJECTIVE: This systematic review aims to examine the current literature on help-seeking, hearing device uptake, and hearing health outcomes in individuals with subclinical hearing loss. DESIGN: Systematic review. STUDY SAMPLE: Searches of three databases (CINAHL, MEDLINE (PubMed), and Scopus) yielded nine studies meeting the inclusion criteria. The quality of the included studies was determined using the National Institute of Health quality assessment tool. The studies' level of evidence was determined according to the Centre for Evidence-Based Medicine. RESULTS: All included studies involved adult participants. Three studies examined help-seeking. Self-reported difficulty, poor speech-in-noise performance, and emotional responses to the hearing difficulty were identified as factors influencing help-seeking. Six studies examined the use of hearing devices as an intervention, including hearing aids (n = 4), hearables (n = 1), and FM systems (n = 1). Using hearing devices improved self-perceived hearing difficulty, speech-in-noise understanding, and motivation to address hearing difficulties. No studies focused on hearing device uptake. The quality assessment indicated limited methodological rigour across the studies, with varying levels of evidence. CONCLUSIONS: Current evidence supports the use of hearing devices as an intervention for individuals with subclinical hearing loss. However, more research is essential, particularly focusing on help-seeking, diagnosis, treatment, and long-term outcomes using well-controlled study designs.

Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings: A systematic scoping review.

Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.

Digits in noise testing in a multilingual sample of Asian adults.

OBJECTIVE: Appropriate speech-in noise assessment is challenging in multilingual populations. This study aimed to assess whether first preferred language affected performance on an English Digits-in-noise (DIN) test in the local Asian multilingual population, controlling for hearing threshold, age, sex, English fluency and educational status. A secondary aim was to determine the association between DIN test scores and hearing thresholds. DESIGN: English digit-triplets in noise testing and pure-tone audiometry were conducted. Multiple regression analysis was performed with DIN scores and hearing thresholds as dependent variables. Correlation analysis was performed between DIN-SRT and hearing thresholds. STUDY SAMPLE: 165 subjects from the Singapore Longitudinal Ageing Study, a population-based longitudinal study of community-dwellers over 55 years of age. RESULTS: Mean DIN speech reception threshold (DIN-SRT) was -5.7 dB SNR (SD 3.6; range 6.7 to -11.2). Better ear pure tone average and English fluency were significantly associated with DIN-SRT. CONCLUSIONS: DIN performance was independent of first preferred language in a multilingual ageing Singaporean population after adjusting for age, gender and education. Those with poorer English fluency had a significantly lower DIN-SRT score. The DIN test has the potential to provide a quick, uniform method of testing speech in noise in this multilingual population.

The hearing aid effect across diverse African populations and various hearing device modalities.

INTRODUCTION: The stigma associated with wearing hearing aids, known as the "hearing aid effect," remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting. OBJECTIVE: To determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely area of residence and level of education across African communities. METHOD: The study used a cross-sectional design with 322 participants (161 rural, 161 urban); mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices [standard behind-the-ear hearing aid (BTE HA) with an earmould, mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, Airpod, receiver-in-canal (RIC), completely-in-canal (CIC) HA, and Personal Sound Amplification Product (PSAP)] worn by a peer model using a validated scale of eight attributes (attractiveness , age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with earmould were used as a benchmark for comparison. RESULTS: No hearing aid effect was observed across all participants (n=322) with device ratings ranging between neutral and positive. Significant differences between device ratings were evident for attractiveness for ST and PSAP and trustworthiness for ITC. In terms of residence, urban participants provided more favorable ratings compared to rural participants, with significant differences across three attribute ratings: hardworking for ST; attractiveness, hardworking for ITC; age for RIC and Airpod and hardworking for PSAP. For level of education, significant differences were found for attributes of attractiveness (H = 13.5; p = 0.001) for ITC; attractiveness (H = 14.7, p = 0.001) for PSAP; age (H = 9.5; p = 0.009) for RIC; age (H = 14.3; p<0.001) and intelligence (H = 15.1; p< 0.001) for Airpod and; hardworking (H =11.9, p = 0.003) for ST. CONCLUSION: Overall, participants had a neutral to positive view of hearing devices with preferences for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices.

Reasons for hearing aid uptake in the United States: a qualitative analysis of open-text responses from a large-scale survey of user-perspectives.

OBJECTIVE: This study aimed to explore the main reasons for hearing aid uptake from a user perspective and recommendations to others with hearing difficulties. DESIGN: A cross-sectional survey design was used. Responses to a single open-ended question were analysed using qualitative content analysis. STUDY SAMPLE: Participants (n = 642) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States. RESULTS: Participants had a mean age of 65.4 years (13.7 SD) and included 61.8% males, 37.7% females, 0.3% non-binary, and 0.2% preferred not to say. Reasons for hearing aid uptake were categorised into three domains (personal impact, social difficulties, and auditory difficulties), containing 11 main categories and 48 sub-categories. User recommendations to others with hearing difficulties constituted eight main categories (timely help, trial period, support, affordability, technology, direct-to-consumer hearing aids, adjustments, and advocacy) and 32 sub-categories. CONCLUSIONS: The decision to take up hearing aids included intrinsic factors like readiness to change and extrinsic factors such as the availability of finances. The most frequent recommendation to others was not to delay seeking hearing help and to get hearing aids. Our findings may support strategies to facilitate behaviour change for improved hearing aid uptake.

Factors influencing hearing aid use, benefit and satisfaction in adults: a systematic review of the past decade.

OBJECTIVE: This systematic review examined the audiological and non-audiological factors that influence hearing aid use, benefit and satisfaction in adults based on studies published during the last decade (2010 and 2023). DESIGN: Studies were identified by using PRISMA guidelines for systematic searches on five platforms (Web of Science, Scopus, PubMed, EBSCOhost including CINAHL and Academic Search Complete). The National Institute of Health Quality assessment tool and the Oxford Centre for Evidence Based Medicine tool were used for quality assessment and grading of level of evidence. RESULTS: Forty-six articles were included in the review. A total of 101 significant factors influencing hearing aid use (n = 47), benefit (n = 17) and satisfaction (n = 37) were identified. Clear determinants of hearing aid use, benefit and satisfaction included hearing sensitivity, self-reported hearing difficulty, speech perception, attitude and beliefs. 34 cross-sectional studies in this review were graded level 4, 9 cohort studies rated level 3, and 3 randomised control trials rated level 2. CONCLUSION: Factors associated with hearing aid outcomes identified in the past decade support previous evidence. New factors like social networks and service-delivery models, have also been identified. These factors require further investigations through high quality studies to further strengthen existing evidence.

Factors Associated With Hearing Aid Outcomes Including Social Networks, Self-Reported Mental Health, and Service Delivery Models.

PURPOSE: This study aims to identify and describe factors that influence hearing aid outcomes including social networks, self-reported mental health, and service delivery models. METHOD: A prospective cross-sectional online survey was sent to hearing aid users recruited through an online platform (http://www.hearingtracker.com) between October and November 2021. The survey contained questions on patient demographics, audiological variables, general health and social factors, and self-reported hearing aid outcomes using the International Outcome Inventory for Hearing Aids (IOI-HA). Regression models evaluated potential contributing factors of hearing aid outcomes on the IOI-HA. RESULTS: Three hundred ninety-eight hearing aid users completed the survey with an average age of 66.6 (SD = 13.0) years, of which 59.3% were male. Positive contributing factors of hearing aid outcomes (IOI-HA total score) were social network of people with hearing loss with hearing aids (p < .010; Exp[B] = 0.03, 95% CI [0.01, 0.1]), self-reported mental health (p < .05; Exp[B] = 0.6, 95% CI [0.01, 1.2]), work situation (p < .001; Exp[B] = 1.9, 95% CI [0.7, 2.8]), quality of life (p < .005; Exp[B] = 1.2, 95% CI [0.3, 1.1]), and self-reported hearing difficulty (p < .02; Exp[B] = 0.8, 95% CI [0.2, 1.5]). Negative contributing factors of hearing aid outcomes included social networks of people with hearing loss without hearing aids (p < .001; Exp[B] = -0.1, 95% CI [-0.2, -0.2]) and service delivery model of private or university clinic compared to big-box retailers (p < .001; Exp[B] = -1.6, 95% CI [-2.7, -0.7]). CONCLUSIONS: Novel factors including social network of persons with hearing loss who use hearing aids, self-reported mental health, service delivery model, and work situation are significant contributors to hearing aid outcomes. These newly identified factors can inform public hearing health promotion and individualized audiological care to optimize hearing aid outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24060486.

Patient-Reported Outcome Measures for Hearing Aid Benefit and Satisfaction: Content Validity and Readability.

PURPOSE: Numerous patient-reported outcome measures (PROMs) are available to measure hearing aid benefit and satisfaction. It is unclear to what extent currently available PROMs on hearing aid outcomes, often developed decades ago, meet current guidelines for good content validity and readability. This study evaluated the content validity and readability of PROMs that focus on perceived hearing aid benefit and/or satisfaction. METHOD: A literature review was conducted to identify eligible instruments. Content validity evaluation included mapping extracted questionnaire items to the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. In addition, study design in content validity methodology was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments study design checklist for PROM instruments. Readability was estimated using the Simple Measure of Gobbledygook measure. RESULTS: Thirteen questionnaires were identified and evaluated. Item content focused primarily on the components of environmental factors as well as activity limitations and participation restrictions with less emphasis on body functions and personal factors. The content validity methodology analysis revealed an underuse or lack of reporting of a qualitative methodology in assessing patient and professional perspectives. All the included questionnaires exceeded the recommended sixth-grade reading level. CONCLUSIONS: The categories covered by hearing aid PROMs vary considerably, with no single instrument comprehensively covering all the key ICF components. Future development of hearing aid outcome measures should consider a mixed methodology approach for improved content validity and ensure an appropriate reading level.

Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study.

BACKGROUND: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. OBJECTIVE: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. METHODS: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. RESULTS: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. CONCLUSIONS: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care.

Person-centered care: preferences and predictors in speech-language pathology and audiology practitioners.

Introduction: Increasingly person-centered care (PCC) is being recognized as an important aspect of speech-language pathology and audiology (SLP/A) service delivery. This study aimed to (i) identify preferences toward PCC; (ii) determine predictors of these preferences; and (iii) describe the understanding and views of PCC among SLP/A in South Africa. Methods: A mixed-method design was followed utilizing an online survey and four focus group discussions. The survey included demographic questions, the modified Patient-Practitioner Orientation Scale (mPPOS), the Ten-Item-Personality-Inventory (TIPI) and an open-ended question. The focus group discussions included prompting questions which facilitated an open-ended discussion. Results: A total of 91 practitioners (39.6% speech-language pathologists) completed the online survey, with nine (44.4% audiologists) participating in the focus group discussions. A high preference toward PCC was noted, with a total mean mPPOS score of 4.6 (0.6 SD). Quantile regression analysis revealed four predictors (age, home language, sector, and personality trait openness) associated with PCC preferences. Three main categories emerged from the open-ended question and focus group discussions: (i) Positive experiences with PCC; (ii) restrictions toward PCC, and (iii) PCC exposure. Discussion: Positive (age and personality trait openness) and negative (home language and sector of employment) predictors toward PCC exist among speech-language pathologists and audiologists, with an overall general preference toward PCC. Practitioners experience facilitators and barriers toward implementing PCC including the extent of personal experiences, available resources and tools as well as workplace culture. These aspects require further investigation.

Hearing and Functioning in Everyday Life Questionnaire: Development and Validation of an ICF-Based Instrument.

OBJECTIVES: Self-assessment instruments are commonly used in audiological rehabilitation. However, several studies highlight the lack of multidimensionality in existing outcome measures, with the consequence that they only partially capture aspects of functioning in everyday life for people living with hearing loss. This study aimed to develop and investigate the content validity of a self-assessment instrument based on the validated Brief International Classification of Functioning, Disability, and Health Core Set for Hearing Loss. DESIGN: The design was a two-part instrument development study. The first part focused on the item-generation process of the instrument, named the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) during an experts' workshop. The second part focused on international content validation of the instrument using group interviews. Strategic sampling was used and 30 adults with hearing loss from India, South Africa, and the United States participated in the group interviews. RESULTS: The expert's workshop resulted in the first version of the HFEQ containing 30 items. The results from group interviews show that the content of the HFEQ was considered to be valid concerning its relevance, comprehensiveness, and comprehensibility. A majority (73%) of the HFEQ items were perceived by the participants as relevant and easy to comprehend. For the remaining 27% of the items, the content was perceived to be relevant in all countries, but some terms and expressions were reported to require rewording or clearer examples. These modifications will be made in the next step of the development process. CONCLUSION: Content validation of the HFEQ demonstrates promising results, with participants perceiving the content as relevant and comprehensible. Further psychometric validation is required to investigate other psychometric properties, such as construct validity and reliability. The HFEQ has the potential to become a valuable new instrument for assessing everyday functioning in people with hearing loss in audiological rehabilitation and in research.

Developmental characteristics of young children in a low-income South African community.

Adequate early childhood development is critical for later-life success. Developmental profiles of specific populations are required to support implementation of early intervention services. Three hundred fifty-three caregivers of children with mean age 17.9 months (SD = 10.5) were selected from a primary healthcare clinic. Overall positive identification of signs of a developmental delay, with the Bayley Scales of Infant and Toddler Development III, was 51.8% (n = 183). Logistic regression analysis determined the effect of age and gender on results. Prevalence of developmental delay increased with age from 33.1% for children under 12 months to 61.7% and 66.3% for children between 13-24 months and 25-36 months, respectively. Females were 1.82 times (95% CI [1.16, 2.85]) more likely to have had no signs of developmental delay; 2.30 times (95% CI [1.14, 4.65]) in motor and 2.06 times (95% CI [1.23, 3.45]) in adaptive behaviour domains. One-third of children presented with low levels of adaptive behaviour functioning. One hundred and one (28.6%) participants across age groups displayed superior social-emotional ability, possibly due to familial structures and relationships. One-third of children presented with poor adaptive behaviour function, attributed to cultural differences. This study contributes to information on developmental characteristics of children in South Africa.

Prioritizing research on over-the-counter (OTC) hearing aids for age-related hearing loss.

Hearing aids are the most commonly used treatment for people with age-related hearing loss, however, hearing aid uptake is low, primarily due to high cost of the device, stigma, and a lack of perceived need. To address accessibility and affordability issues, the U.S. Food and Drug Administration created a new over-the-counter (OTC) hearing aid category. Various types of hearing devices are available for both individuals with hearing loss and for those with normal hearing, as hearing enhancement devices. Hearing aids (i.e., prescription hearing aids, self-fitting OTC hearing aids, and pre-set OTC hearing aids) are regulated by the FDA. The purpose of this article is to (a) provide a summary of existing research on direct-to-consumer (DTC) hearing devices such as Personal Sound Amplification Products (PSAPs) that informs OTC service delivery models; (b) provide an update on existing and ongoing randomized controlled trials on currently marketed OTC hearing aids; and (c) highlight the need for immediate research on OTC hearing aids and service delivery models to inform policy and clinical care. It remains to be seen what effect OTC hearing aids have on improving the uptake of hearing aids by individuals with mild-to-moderate hearing loss. However, there is scant research on all aspects of OTC hearing aids that are currently on the market. We conclude that high quality independent research must be prioritized to supplement evidence provided by the OTC hearing aid manufacturers for regulatory approval purposes.