Helminth-derived molecules improve 5-fluorouracil treatment on experimental colon tumorigenesis.

Colorectal cancer (CRC) is one of the most prevalent fatal neoplasias worldwide. Despite efforts to improve the early diagnosis of CRC, the mortality rate of patients is still nearly 50%. The primary treatment strategy for CRC is surgery, which may be accompanied by chemotherapy and radiotherapy. The conventional and first-line chemotherapeutic agent utilized is 5-fluorouracil (5FU). However, it has low efficiency. Combination treatment with leucovorin and oxaliplatin or irinotecan improves the effectiveness of 5FU therapy. Unfortunately, most patients develop drug resistance, leading to disease progression. Here, we evaluated the effect of a potential alternative adjuvant treatment for 5FU, helminth-derived Taenia crassiceps (TcES) molecules, on treating advanced colitis-associated colon cancer. The use of TcES enhanced the effects of 5FU on established colonic tumors by downregulating the expression of the immunoregulatory cytokines, Il-10 and Tgf-ß, and proinflammatory cytokines, Tnf-α and Il-17a, and reducing the levels of molecular markers associated with malignancy, cyclin D1, and Ki67, both involved in apoptosis inhibition and the signaling pathway of ß-catenin. TcES+5FU therapy promoted NK cell recruitment and the release of Granzyme B1 at the tumor site, consequently inducing tumor cell death. Additionally, it restored P53 activity which relates to decreased Mdm2 expression. In vitro assays with human colon cancer cell lines showed that therapy with TcES+5FU significantly reduced cell proliferation and migration by modulating the P53 and P21 signaling pathways. Our findings demonstrate, for the first time in vivo, that helminth-derived excreted/secreted products may potentiate the effect of 5FU on established colon tumors.

Discussing Patient Emotions in Audiology: Provider Experiences With the Implementation Process of Hearing Loss Psychological Inflexibility Screenings.

PURPOSE: This study aimed to investigate barriers and facilitators experienced by clinical educators and graduate students when talking with patients about difficult emotions and thoughts related to their hearing. METHOD: A longitudinal observational design was used and an Implementation Research Logic Model guided the process. Five clinical educators and five graduate students participated in the study. Participants completed pre- and postmeasures and attended individual debriefing sessions during the 8-month study period. RESULTS: Four themes emerged from the debriefing sessions: (a) learning process, (b) confidence, (c) barriers, and (d) supervision. Participants described that the Acceptance and Action Questionnaire-Managing Child Hearing Loss and Acceptance and Action Questionnaire-Adult Hearing Loss served as a reminder to ask about patients' internal barriers and increased awareness of their discomfort in talking about patient emotions. Participants also described barriers and struggles related to supporting students in gaining counseling skills. CONCLUSIONS: Screening for internal challenges helped clinicians remember to talk with patients about their difficult thoughts and emotions. Clinician hesitancy to engage in conversations with patients about their emotions can interfere with opportunities for patients to share their struggles and with training student in these skills.

Acceso vascular seguro y de calidad en el paciente geriátrico: valorando la satisfacción profesional / Safe and quality vascular access for the geriatric patient: giving value to professional satisfaction

Introducción: El Hospital Central de la Cruz Roja San José y Santa Adela (Madrid) promovió la mejora en calidad asistencial poniendo en práctica los avances en dispositivos intravenosos basados en evidencia científica, creando un equipo de terapia intravenosa que canaliza y forma al personal para mantener catéteres centrales de inserción periférica y líneas medias. Objetivos: Evaluar la satisfacción de las enfermeras ante los catéteres y la presencia de un equipo especializado en terapia y accesos vasculares. Metodología: Estudio observacional, descriptivo y transversal, basado en una encuesta de satisfacción anónima y voluntaria, creada ad hoc por los investigadores. Con una participación final de 45 enfermeras del área médica. Resultados: El 100% afirmó conocer la existencia de los dispositivos en el hospital. Se obtuvieron datos sobre la información recibida en el mantenimiento de los dispositivos. En función a su comodidad y confort los describen, en su mayoría, como óptimo para el paciente, evitando además las punciones múltiples y reiteradas, notando el 91% de los participantes reducción en su carga de trabajo. El estudio refleja que las complicaciones más asiduas son: obstrucción y salida accidental del catéter. El 97,7% refiere la necesidad de un equipo específico para la canalización y ayuda ante adversidades. Conclusiones: Los resultados obtenidos muestran un alto grado de satisfacción con el uso de estos catéteres, igualmente ponen en valor la necesidad de un equipo formado para la valoración e inserción de estos dispositivos y de apoyo en los cuidados.(AU)

Introduction: The Red Cross’s Central Hospital San José and Santa Adela (Madrid) promoted the improvement in care quality, putting into practice the advances in intravenous devices based on scientific evidence, building an intravenous therapy team that manages and trains staff to maintain central catheters of peripheral insertion and midlines. Objective: To evaluate the satisfaction of nurses with catheters and the presence of a specialized team in therapy and vascular access. Methodology: Observational, descriptive and cross-sectional study, based on an anonymous and voluntary satisfaction survey, created ad hoc by the researchers. With a final entry of 45 nurses from the medical area. Results: 100% stated that they were aware of the existence of the devices in the hospital. Data was obtained on the information received in the maintenance of the devices. Based on convenience and comfort, they are mostly described as optimal for the patient, avoiding multiple and repeated punctures as well, with 91% of the participants noting a reduction in their workload. The study reflects that the most frequent complications are obstruction and accidental exit of the catheter. 97.7% refer to the need for a specific team for managing and helping in the face of adversity. Conclusions: The results obtained show a high degree of satisfaction with the use of these catheters. They also highlight the need for a team trained to assess and insert these devices and supporting nursing.(AU)

Successes of a Focused Mothers' Own Milk (MOM) Program in Counteracting Unintended Effects of a Donor Milk Program on MOM Rates at Discharge.

Background: Avoidance of early formula feeding (EFF) and advancement of mother's own milk (MOM) in very low birth weight (VLBW) infants are important health influencers to decrease serious morbidities. Objective: To present the challenges and feeding strategy successes implemented to counteract a decline in MOM at discharge after initiation of donor milk (DM) to avoid EFF in racially and ethnically diverse VLBW infants. Patients and Methods: Retrospective review of prospectively tracked inborn surviving VLBW infants and their mothers admitted to neonatal intensive care unit from 2010 to 2020 during three feeding strategy implementations baby friendly (BF), DM program, and MOM bundle. Analysis included type of feeding (MOM, DM, or formula) and maternal with descriptive and comparative statistical analysis as indicated. Results: Analysis included 616 VLBW infants. Initiation of BF program resulted in 58.5% of infants discharged on MOM with 41.5% exposed to EFF. Initiation of the DM program resulted in a decline in EFF to 5% and decline in MOM at discharge to 26%. MOM bundle strategy resulted in an increase in MOM at discharge to 41% with sustained EFF exposure 0%. MOM at discharge varied among maternal racial and ethnic backgrounds in all epochs. Early DM use was not different among mothers by race or ethnicity with DM by African American (AA) mothers 89% > White mothers 83% > Other/Hispanic mothers 75%. MOM at discharge was lowest for AA mothers 33% < Hispanic mothers 40% < White mothers 55% < Asian/Other mothers at 60%. Conclusion: Changes in VLBW feeding strategies to avoid EFF utilizing DM can be successful among diverse maternal racial and ethnic populations. Nursing and maternal education coupled with early lactation support and attention to maternal individual long-term feeding plans were critical to improve MOM at discharge among mothers of all racial-ethnic backgrounds for successful attainment of MOM utilization in term corrected VLBW infants at discharge.

Lactation Support as a Proxy Measure of Family-Centered Care Quality in Neonates with Life-Limiting Conditions-A Comparative Study.

BACKGROUND: Lactation support is an important measure of Family-Centered Care (FCC) in the Neonatal Intensive Care Unit (NICU). Life-limiting conditions (LLCs) raise complex ethical care issues for providers and parents in the NICU and represent a key and often overlooked population for whom FCC is particularly important. We investigated healthcare disparities in FCC lactation support quality in infants with LLCs. METHODS: A retrospective cohort of inborn infants with or without LLCs admitted to the NICU between 2015-2023 included 395 infants with 219 LLC infants and 176 matched non-LLC infants and were compared on LLC supports. RESULTS: The LLC cohort experienced greater skin-to-skin support, but less lactation specialist visits, breast pumps provided, and human milk oral care use. LLC infants also experienced less maternal visitation, use of donor milk (LLC: 15.5%, non-LLC: 33.5%), and breastfeeds (LLC: 24.2%, non-LLC: 43.2%), with lower mean human milk provision (LLC: 36.6%, non-LLC: 67.1%). LLC infants who survived to discharge had similar human milk use as non-LLC infants (LLC: 49.8%, non-LLC: 50.6%). CONCLUSION: Lactation support was significantly absent for families and infants who presented with LLCs in the NICU, suggesting that policies can be altered to increase lactation support FCC quality for this population.

Peripartum Traumas and Mental Health Outcomes in a Low-Income Sample of NICU Mothers: A Call for Family-Centered, Trauma-Informed Care.

Postpartum depression (PPD), postpartum anxiety (PPA), and post-traumatic stress disorder (PTSD) among birthing people have increased substantially, contributing to adverse maternal/infant dyad outcomes, with a high prevalence in the neonatal intensive care unit (NICU). Despite calls for trauma-informed care in the NICU and high rates of post-traumatic stress, little research has examined the rates of or the relationships between peripartum mood and adverse child experiences (ACEs) in NICU mothers or evaluated which peripartum traumas are most distressing. This study employed structural equation modeling (SEM) to explore whether peripartum-related traumas and NICU-related stressors mediated the associations between ACEs and mental health outcomes in 119 lower-income, racially diverse mothers in a Level IV NICU. Mental health concerns were prevalent and highly comorbid, including 51.3% PPA, 34.5% PPD, 39.5% post-traumatic stress, and 37% with ≥4 ACEs. The majority (53.8%) of mothers endorsed multiple peripartum traumas; NICU admission was the most common trauma (61%), followed by birth (19%), pregnancy (9%), and a medical event in the NICU (9%). Our SEMs had good fit and demonstrated that ACEs predicted peripartum distress. Trauma-informed care efforts should employ transdiagnostic approaches and recognize that women commonly present to the NICU with childhood trauma history and cumulative peripartum traumas.

Increasing Pediatric Hearing Aid Use: Considerations for Clinical Practice.

PURPOSE: Hearing aid use can be variable for young children, and inconsistent wear time can undermine spoken language development. This study explored the effectiveness of hearing aid data logging (DL) awareness and coaching sessions on increasing hours of hearing aid use. We also collected qualitative data on challenges participants experienced managing hearing aid use. METHOD: We used a single-subject design that included three conditions, during a 6-week period, in the same order for each participant. Condition A was baseline, Condition B was DL monitoring alone, and Condition C was remote coaching calls plus DL monitoring. RESULTS: Hours of hearing aid use increased for each child from baseline to the end of the study, ranging from 1.19 to 4.4 hr. Mothers reported that the coaching calls were beneficial and helped them identify and problem-solve issues. CONCLUSIONS: Parents were able to increase hours of hearing aid use with DL awareness and coaching support. Tele-audiology offers an opportunity to provide parents with more frequent support that can be individualized based on their situation, challenges, and family needs.

Pediatric Hearing Aid Management: Experiences and Perspectives of Spanish-Speaking Parents.

PURPOSE: The purpose of the study was twofold: (a) to explore hearing aid management experiences of Spanish-speaking parents who have young children using hearing aids and (b) to explore parents' access to the Internet and perceptions about remote audiology services. METHOD: The study used a mixed methods design. Data were collected through a phone interview. RESULTS: Eleven mothers of children aged 14-60 months participated. Most of the children (9/11) had a bilateral hearing loss, and two had an additional disability. Three themes emerged for hearing aid management experiences: audiology services, routines, and emotional challenges/supports. Parents had variable levels of confidence in their skills ranging from no confidence to complete confidence, with the greatest variability for three items: (a) using the listening tube to make sure that the sound quality of the hearing aid is good, (b) removing moisture from the earmold tubing, and (c) troubleshooting problems when your child's hearing aids are not working. All participants reported having consistent Internet access and had positive perceptions about the possibility of remote audiology services. CONCLUSIONS: This study provided insights into hearing aid management experiences and perceptions of Spanish-speaking parents. Parents described variability for audiology services, routines for hearing aid use and care, and access to other parents of children with hearing loss. Spanish-speaking parents present additional elements in the hearing care process that need to be incorporated in planning. Remote services may be an opportunity to enhance access to support that could improve effectiveness of hearing aid management.

Impact of the COVID-19 Pandemic on a Clinical Trial: A Quantitative Report on Study Engagement and Strategies.

INTRODUCTION: The COVID-19 pandemic impacted clinical research worldwide potentially altering research findings. The study purpose was to measure the effect of the pandemic on recruitment, retention, assessment, and intervention completion rates. METHODS: Enrollment and participation data from a clinical trial evaluating efficacy of a physical therapy intervention for high-risk preterm infants were compared across 3 pandemic periods (February 2019 through November 2021). RESULTS: Recruitment, retention, assessment, and intervention completion rates were lowest during the peak pandemic period. CONCLUSIONS: In compliance with the Human Subjects Review Board, and for the participants' and staff safety, transition from in-person to telehealth or hybrid visits was required to continue this longitudinal study. Despite the negative effect of the pandemic, parental resilience and commitment to the study was clear. Flexibility, quick action, dedication, and efficiency of the research team were key elements enabling study continuation with successful transition to telehealth assessments/interventions during the peak pandemic period.

Factors Influencing Receipt and Type of Therapy Services in the NICU.

Understanding the type and frequency of current neonatal intensive care unit (NICU) therapy services and predictors of referral for therapy services is a crucial first step to supporting positive long-term outcomes in very preterm infants. This study enrolled 83 very preterm infants (<32 weeks, gestational age mean 26.5 ± 2.0 weeks; 38 male) from a longitudinal clinical trial. Race, neonatal medical index, neuroimaging, and frequency of therapy sessions were extracted from medical records. The Test of Infant Motor Performance and the General Movement Assessment were administered. Average weekly sessions of occupational therapy, physical therapy, and speech therapy were significantly different by type, but the magnitude and direction of the difference depended upon the discharge week. Infants at high risk for cerebral palsy based on their baseline General Movements Assessment scores received more therapy sessions than infants at low risk for cerebral palsy. Baseline General Movements Assessment was related to the mean number of occupational therapy sessions but not physical therapy or speech therapy sessions. Neonatal Medical Index scores and Test of Infant Motor Performance scores were not predictive of combined therapy services. Medical and developmental risk factors, as well as outcomes from therapy assessments, should be the basis for referral for therapy services in the neonatal intensive care unit.

Phase 2 of collaborative action around the implementation of virtual hearing aid care: Evaluation of a clinical practice guideline.

RATIONALE: Following the onset of the COVID-19 pandemic, a clinical practice guideline (CPG) around virtual hearing aid practices was developed to fill a knowledge gap within the field of audiology. Details outlining the development and mobilization of this draft guideline were outlined as Phase 1 (described in a paired paper). AIMS AND OBJECTIVES: This study describes Phase 2 of this project as part of the Knowledge-to-Action Framework, including an evaluation of the methodological quality of the guideline and the resulting tailored version of the document (v2.0). METHOD: The Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality and to guide revisions. Twenty-two clinicians, from a variety of clinical backgrounds, participated in the evaluation. RESULTS AND CONCLUSION: Findings reported across six domains suggest high mean scores, ranging from 78% to 81%, in order of scope and purpose (highest rated), stakeholder involvement, rigour of development, applicability, clarity of presentation, and editorial independence. Specific recommendations made by in international co-creation team during the evaluation informed the final version of the CPG. Future development and evaluation efforts should aim to include greater representation from nontraditional practice contexts to strengthen global applicability.

Phase 1 of collaborative action around the implementation of virtual hearing aid care: Development of a clinical practice guideline.

RATIONALE: There is a growing demand for comprehensive, evidence-based, and accessible clinical practice guidelines (CPGs) to address virtual service delivery. This demand was particularly evident within the field of hearing healthcare during the COVID-19 pandemic, when providers were faced with an immediate need to offer services at a distance. Considering the recent advancement in information and communication technologies, the slow uptake of virtual care, and the lack of knowledge tools to support clinical integration in hearing healthcare, a Knowledge-to-Action Framework was used to address the virtual care delivery research-to-practice gap. AIMS AND OBJECTIVES: This paper outlines the development of a CPG specific to provider-directed virtual hearing aid care. Clinical integration of the guideline took place during the COVID-19 pandemic and in alignment with an umbrella project aimed at implementing and evaluating virtual hearing aid care incorporating many different stakeholders. METHOD: Evidence from two systematic literature reviews guided the CPG development. Collaborative actions around knowledge creation resulted in the development of a draft CPG (v1.9) and the mobilisation of the guideline into participating clinical sites. RESULTS AND CONCLUSION: Literature review findings are discussed along with the co-creation process that included 13 team members, from various research and clinical backgrounds, who participated in the writing, revising, and finalising of the draft version of the guideline.

Resonance Raman Spectroscopy Tissue Oxygenation Measurements in Neonates.

INTRODUCTION: Current oxygen monitoring by pulse oximetry has limitations and cannot provide estimates of the oxygen content in the microvasculature, where oxygen is used. Resonance Raman spectroscopy (RRS) provides noninvasive microvascular oxygen measurement. The objectives of this study were to (i) measure the correlation between preductal RRS microvascular oxygen saturations (RRS-StO2) and central venous oxygen saturation (SCVO2), (ii) develop normative data for RRS-StO2 measurements in healthy preterm infants, and (iii) determine the effect of blood transfusion on RRS-StO2. METHODS: Thirty-three buccal and thenar RRS-StO2 measurements were performed in 26 subjects to correlate RRS-StO2 with SCVO2. Thirty-one measurements were performed in 28 subjects to develop normative RRS-StO2 values, and eight subjects were enrolled in the transfusion group to assess changes in RRS-StO2 with blood transfusion. RESULTS: There were good correlations for buccal (r = 0.692) and thenar (r = 0.768) RRS-StO2 versus SCVO2. The median RRS-StO2 in healthy subjects was 76% (IQR 68.7-80.8). There was a significant increase of 7.8 ± 4.6% in the thenar RRS-StO2 after blood transfusion. CONCLUSIONS: RRS appears to be a safe and noninvasive means of monitoring microvascular oxygenation. Thenar RRS-StO2 measurements are more feasible and practical to use than buccal. In healthy preterm infants, the median RRS-StO2 was calculated based on measurements across various gestational age and gender. More studies evaluating the effects of gestational age of RRS-StO2 in various critical clinical settings are needed to confirm the findings.

Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL): validation with hearing aid users.

OBJECTIVE: Individuals who are deaf or hard of hearing (DHH) may find adherence to their hearing devices difficult due to internal experiences related to their hearing loss such as sadness or frustration. The Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) is the only measure available to assess psychological inflexibility as it relates to hearing loss. The purpose of this study was to confirm the single latent structure of the AAQ-AHL (through confirmatory factory analysis) and test convergent and discriminant validity. DESIGN: Cross-sectional data was used to further validate the AAQ-AHL. STUDY SAMPLE: Participants were 146 adults who had diagnosed hearing loss and used a hearing aid. RESULTS: Results revealed the AAQ-AHL has a single latent structure, correlated to other similar constructs (psychological flexibility and hearing aid efficacy), and not correlated to unrelated constructs (hearing loss severity). These results suggest that the AAQ-AHL is a valid instrument to assess psychological flexibility as it relates to hearing aid use. CONCLUSION: Together, the findings imply the AAQ-AHL has strong psychometric properties and justification to use in a clinical setting.

Moderators and predictors in a parent hearing aid management eHealth program.

OBJECTIVE: Consistent hearing aid use is essential for spoken language development of children who are hard of hearing. A recent randomised controlled trial of an eHealth hearing aid management education program found the intervention increased knowledge, perceptions, confidence, and device monitoring among parents of young children. Yet, it is not known which variables can be a point of emphasis to improve treatment outcomes. The purpose of this study was to investigate potential moderators and predictors in the eHealth program. DESIGN: Randomised controlled trial. STUDY SAMPLE: Parents (N = 78) of children (42 months or younger) were randomised to the intervention or treatment-as-usual (TAU) group. RESULTS: Results revealed that high psychological inflexibility, low parent activation, and low hours of hearing aid use may moderate device monitoring frequency and knowledge; parents in the intervention improved over time compared to the TAU group. Psychological inflexibility and parent activation also predicted treatment outcomes. CONCLUSION: The findings suggest the need to address parent psychological inflexibility related to hearing loss management, parents' role in their child's hearing aid management, and reported hours of hearing aid use as part of hearing aid service delivery. Identification of barriers to hearing aid management can assist audiologists in adjusting support to improve outcomes.

Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series.

Infants born very preterm (VPT; ≤29 weeks of gestation) are at high risk of developmental disabilities and abnormalities in neural white matter characteristics. Early physical therapy interventions such as Supporting Play Exploration and Early Development Intervention (SPEEDI2) are associated with improvements in developmental outcomes. Six VPT infants were enrolled in a randomised clinical trial of SPEEDI2 during the transition from the neonatal intensive care unit to home over four time points. Magnetic resonance imaging scans and fixel-based analysis were performed, and fibre density (FD), fibre cross-section (FC), and fibre density and cross-section values (FDC) were computed. Changes in white matter microstructure and macrostructure were positively correlated with cognitive, motor, and motor-based problem solving over time on developmental assessments. In all infants, the greatest increase in FD, FC, and FDC occurred between Visit 1 and 2 (mean chronological age: 2.68-6.22 months), suggesting that this is a potential window of time to optimally support adaptive development. Results warrant further studies with larger groups to formally compare the impact of intervention and disparity on neurodevelopmental outcomes in infants born VPT.

Intervention Research to Increase Pediatric Hearing Device Use: A Scoping Review.

PURPOSE: This study is a scoping review examining interventions to increase hearing device use for children. METHOD: Online databases were used to identify peer-reviewed journal articles published prior to November 1, 2021, yielding 1,288 after duplications were removed. Four articles met the inclusion criteria after articles were screened by title name and abstract and subsequent full-text screening of six articles. A qualitative analysis was conducted to identify features of the intervention studies related to the participants, design, intervention, key findings, and limitations. RESULTS: The included studies were published between 1982 and 2021, and in all four studies, the children used hearing aids. All four of the studies used a longitudinal design to address hearing aid use problems, with the timeframe ranging from approximately 1 month to 6 months and had variable success in increasing use time. None of the studies included a protocol, such as counseling skills, for addressing internal challenges that interfere with hearing aid use. CONCLUSIONS: Review of the limited research in this area found variable effectiveness for the interventions studied. There is an urgent need for research in this area to inform clinical practice and provide evidence-based interventions to address malleable factors that interfere with audibility for children who use hearing devices.

Ascorbic Acid and the Premature Infant.

Little information exists about the plasma target nutritional needs of the >15 million premature infants <37 weeks gestation. Investigating ascorbic acid's (AscA) role in infant health, our study details the relationship of infant characteristics and maternal health on infant plasma AscA level (pAscA) during postnatal development. Furthermore, we determined pAscA influence during the first week of life (EpAscA) with later infant morbidities. We hypothesize that pAscA is influenced by gestational organ immaturity, as well as maternal factors, with EpAscA associated with greater morbidity risk. We conducted a prospective longitudinal observational study of pAscA, demographics and hospital course detailed in infants ≤34 weeks. Sixty-three subjects were included, with >200 urine and plasma data points analyzed. Maternal smoking, exposure to magnesium sulfate (MgSO4) and advancing gestational and postnatal age were associated with lower pAscA. Non-white infants and those ≤30 weeks that developed bronchopulmonary dysplasia or retinopathy of prematurity had lower pAscA. Prenatal smoking, MgSO4, birth gestational age and race negatively influence pAscA. These results show prenatal and postnatal developmental factors influencing initial pAscA and metabolism, potentially setting the stage for organ health and risk for disease. Assessment of dietary targets may need adjustment in this population.

eHealth Education and Support for Pediatric Hearing Aid Management: Parent Goals, Questions, and Challenges.

PURPOSE: The purpose of this study was to investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management. METHOD: Coaching phone calls were audio-recorded, transcribed, and qualitatively analyzed for emergent themes within the categories of goals, questions, and challenges. RESULTS: Emergent themes revealed that parent goals were focused on self-efficacy, routines, device care, and child development. Emergent themes for questions revealed that parents asked questions related to the device care, audiology appointments, confirmation of learning, and child development. For challenges, emergent themes revealed parents' own struggles (e.g., with emotions), issues related to working with their audiologist, child factors, and anticipated challenges. CONCLUSIONS: The eHealth intervention allowed parents to raise questions and discuss their challenges in a supportive environment. Supportive accountability helped participants identify and address barriers to hearing aid management based on their priorities and current challenges. Providing supplemental learning support, in addition to routine audiology visits, can help parents develop more effective hearing aid management routines.