Barriers and facilitators to delivery of group audiological rehabilitation programs: a survey based on the COM-B model.

OBJECTIVE: To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. DESIGN: A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. STUDY SAMPLE: Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. RESULTS: Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians' ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss. CONCLUSIONS: These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.

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

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

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities. DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round. STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round. RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified. CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

A multicentre study evaluating the effects of the Swedish ACE programme.

OBJECTIVE: This study investigated the effects of a modified Swedish version of an interactive group education programme, the Active Communication Education (ACE) programme, in five Swedish regions. This study also explored whether the pre- and post-programme outcomes differed with regard to region, age, gender, hearing loss (HL) or the attendance of significant others (SOs). DESIGN: An intervention study with between- and within-group measurements was applied. STUDY SAMPLE: Seventy-seven individuals with hearing impairments and a mean age of 73.9 years (SD = 9.8) from five different regions in Sweden participated in this study. RESULTS: Statistically significant short- and long-term effects on communication strategy use, activity and participation were observed. The ACE programme was most effective for older individuals, women and participants with more severe HL. Individuals who attended with an SO tended to use better communication strategies. No regional differences were observed. The qualitative results indicated that the programme increased individuals' ability to cope and restored their social identities. CONCLUSIONS: The ACE programme is effective, is recommended for implementation in clinical settings and is considered an alternative or additional treatment to hearing aid rehabilitation. Additional studies that include younger individuals and a control group are recommended.

Hearing outcomes in children with single sided deafness: Our experience at a tertiary paediatric otorhinolaryngology unit.

INTRODUCTION: Hearing rehabilitation options for single sided deafness (SSD) include contralateral routing of sound (CROS) aids and bone conduction devices (BCDs). This study aimed to review the management of children with SSD at our tertiary paediatric otolaryngology unit over the last 15 years. MATERIAL AND METHODS: A retrospective cohort study was performed. Primary hearing outcomes were measured using the Children's Home Inventory for Listening Difficulties (CHILD) questionnaire score and secondary hearing outcomes were measured using hearing thresholds for speech in noise. Outcomes were measured pre and post bone conduction device (BCD) trial. RESULTS: 49 patients with SSD were identified. 20 children had trial of a BCD. 16 patients had pre- and post- BCD trial CHILD scores available for analysis. There was a statistically significant improvement in CHILD scores and speech in noise testing at +5 dB and +0 dB following amplification with a BCD. The mean use of BCD was 1.3 h per day. DISCUSSION: We have described the management of children with SSD in our unit. This study demonstrated a statistically significant benefit of BCD use on hearing outcomes. However, device compliance is low suggesting hearing advice choice in the population is complex and further research is warranted.

Mental Fatigue in Patients with Hearing Loss and/or Tinnitus Undergoing Audiological Rehabilitation-A Pilot Study.

BACKGROUND: Both tinnitus and hearing loss are multidimensional. The purpose of this study was to identify and determine the degree of mental fatigue in patients with hearing loss and/or tinnitus participating in audiological rehabilitation, and to examine the self-reported mental fatigue scale (MFS) in this patient group. METHODS: Patients undergoing audiological rehabilitation at the Department of Audiology and Neurotology, Karolinska University Hospital, Sweden, between 2011 and 2017 who completed a self-reported MFS questionnaire were investigated. Data on 76 patients were analysed in this pilot study. Patients were also assessed using the Tinnitus Handicap Inventory (THI). RESULTS: The study population had an age range of 38-65 years, and most had normal hearing (37%) or mild to moderate hearing loss (46%). Only 17% had severe to profound hearing loss. A total of 56.5% had tinnitus, of whom 39.5% scored ≥57 on the THI, indicating severe tinnitus, whereas 43.5% reported no tinnitus. The MFS scores, ranging from 13 to 42.5 points, were divided into three severity levels for analysis: 10.5-15, 15.5-20, and ≥20.5. In total, 67% of the patients had MFS scores ≥ 20.5. Importantly, most of the participants (90%) with a THI score ≥ 57 belonged to that group. A significant positive correlation between a high MFS score and severe tinnitus was found. CONCLUSIONS: The study reveals that severe mental fatigue is more common in patients with severe tinnitus than sole hearing loss.

Understanding identity construction among deaf adolescents and young adults: implications for the delivery of person and family-centered care in audiological rehabilitation.

Introduction: The provision of holistic person and family-centered care in the audiological rehabilitation of adolescents and young adults (AYA) requires in-depth consideration of identity construction. The purpose of this research study was to describe the lived experience of identity construction among deaf AYA. The thoughts, perceptions, and feelings of AYA on their identity and the processes underlying the construction of identity, with a focus on navigating disability, social relations and roles, community assimilation and self-perception were explored. Methods: A qualitative interpretive phenomenological approach was adopted. Participants were a purposive sample of 5 AYA, aged 15 to 19 years. Participants had moderate to profound deafness and were enrolled in schools for the deaf where they partook in semi-structured phenomenological conversations, detailing their lived experiences with identity construction. Results: The superordinate themes of creating a self-concept, belonging, stress and being deaf emerged from participants' narratives. Identity construction occurs concurrently at several levels. At the personal level, AYA create self-conceived ideals of who they are. At relational level, identity is fostered through person-to-person and person-to-group interactions. At societal level, AYA navigate inherent challenges with hearing impairment and their positionality as deaf individuals. Conclusions: Understanding the nuances of identity construction gives insights for further research and highlights the self-ascribed identity domains and related psychosocial variables that appeal to person and family-centered care, uncovering opportunities and barriers to successful delivery. Findings have implications for the transitional care of deaf AYA that is responsive to their needs.

Rehabilitation of Severe-to-Profound Hearing Loss in Adults in Sweden.

Severe-to-profound hearing loss (STPHL) can affect a person negatively in many ways. Audiological rehabilitation is important for these patients. Patients receiving cochlear implants make up less than 10% of this group but have been studied extensively. In 2005, a national registry for adult patients with STPHL was introduced in Sweden. Its purpose was to evaluate and improve rehabilitation for all patients with STPHL. Data from the Swedish registry for adult patients with STPHL were used to evaluate variables affecting the audiological rehabilitation. Previous published data from the registry were reviewed, and new data from the follow-up questionnaire were presented. More than 90% of patients rehabilitated with hearing aids experienced a good or very good benefit of audiological rehabilitation. Tinnitus and vertigo affected quality of life negatively and were reported by many patients with STPHL (41% and 31%) at follow-up. To maintain the high number of patients who find audiological rehabilitation beneficial, individualized treatment plans and timely re-evaluations are crucial. Tinnitus and vertigo need to be addressed repeatedly in the rehabilitation process.

Rehabilitation of adult patients with severe-to-profound hearing impairment - why not cochlear implants?

Background: In Sweden, an estimated prevalence of adult patients with severe-to-profound hearing loss is 0.2%, which corresponds to roughly 20,000. We know little about the use of cochlear implants (CIs) in this population and why not most of them are not offered CI. Objectives: To investigate the reasons for no rehabilitation with CI among this patient group. Materials and methods: Data were collected from 1076 patients in the Swedish Quality Register of Otorhinolaryngology. A baseline questionnaire and the reason for no CI, was evaluated. Results: Only 14.5% of the patients started a CI investigation, and 8.5% were rehabilitated with CI. Significantly more women (56.5%) than men received CI. The most common reasons for not receiving CI, were hearing reason (30.5%), indicating satisfaction with technical equipment, and unknown reason (25%). The oldest patient group (81-100 years old) had the highest risk for unknown reasons. Patients receiving extended audiological rehabilitation (53.5%) had a significantly lower risk for unknown reasons. Conclusions: It is worrying that the oldest patient group (81-100 years old) seemed to have fewer chances to start a CI investigation. An extended audiological rehabilitation increased the chances that professionals would discuss CI. Significance: This study shows that surprisingly few patients are offered CI despite their severe-to-profound hearing loss.

The International Classification of Functioning, Disability and Health as a Framework for Providing Patient- and Family-Centered Audiological Care for Older Adults and Their Significant Others.

Hearing impairment is highly prevalent in the older population, and it impacts communication and quality of life for both the people with the hearing difficulties and their significant others. In this article, typical audiological assessment and management of an older adult is contrasted with a best practice approach wherein the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework is applied. The aim of the comparison is to demonstrate how the ICF expands our focus: rather than merely focusing on impairment, we also consider the activities, participation, and contextual factors for both the person with the hearing impairment and his or her family. A case example of an older patient and her spouse is provided, and their shared experience of the patient's hearing impairment is mapped onto the ICF framework. Family-centered hearing care is recommended for individualizing care and improving outcomes for older patients and their families.

Dual sensory loss: A major age-related increase of comorbid hearing loss and hearing aid ownership in visually impaired adults.

AIM: Despite increasing interest in visual and hearing impairment in the older population, little attention has been paid to concurrent hearing and vision loss, also known as dual sensory loss. The aim of the present study was to investigate the prevalence of comorbid hearing disability and hearing aid ownership in visually impaired older adults. METHODS: In a cross-sectional survey, a self-report hearing disability screener was administered to 1396 visually impaired patients (aged ≥ 50 years) of outpatient low vision rehabilitation centers in the Netherlands and Belgium. RESULTS: Of all participants, 44.8% (95% CI 42.2-47.5) had insufficient or poor hearing; the prevalence increased quadratically with age. Of all dual sensory impaired participants, 31.2% in the Netherlands and 55.7% in Belgium did not own hearing aids. CONCLUSIONS: The high prevalence of dual sensory loss calls for more awareness of related problems in these patients. Differences between the Netherlands and Belgium regarding hearing aid ownership might be due to different criteria used for hearing aid referral and insurance policies. For patients with dual sensory loss, specialized care implemented in low vision rehabilitation seems warranted.