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BackgroundAdults living with hearing loss have highly variable knowledge of hearing aids, resulting in suboptimal use or nonuse. This issue can be addressed by the provision of high-quality educational resources. ObjectiveThis study aims to assess the everyday experiences of first-time hearing aid users when using a newly developed, theoretically informed cocreated mobile health (mHealth) educational intervention called m2Hear. This intervention aims to deliver greater opportunities for individualization and interactivity compared with our previously developed multimedia intervention, C2Hear. MethodsA total of 16 first-time hearing aid users trialed m2Hear for a period of 10-weeks in their everyday lives, after which individual semistructured interviews were completed. The data were analyzed using an established deductive thematic analysis procedure underpinned by the Capability, Opportunity, Motivation-Behavior model. The model stipulates that to engage in a target behavior, an individual must have physical and psychological capability, physical and social opportunity, and automatic and reflective motivation. ResultsCapability—m2Hear was viewed as a concise and comprehensive resource, suitable for a range of digital literacy skills. It was stated that m2Hear could be conveniently reused to provide useful reminders that facilitate knowledge of hearing aids and communication. Opportunity—m2Hear was simple and straightforward to use, enabling greater individualization and independence. The availability of m2Hear via mobile technologies also improved accessibility. Motivation—m2Hear provided greater support and reassurance, improving confidence and empowering users to self-manage their hearing loss. ConclusionsOverall, this qualitative study suggests that m2Hear supports first-time hearing aid users to successfully self-manage their hearing loss postfitting. Furthermore, this study demonstrates the utility of employing a combined theoretical and ecologically valid approach in the development of mHealth educational resources to meet the individual self-management needs of adults living with hearing loss. Trial RegistrationClinicalTrials.gov NCT03136718; https://clinicaltrials.gov/ct2/show/NCT03136718

BackgroundThe use of personal computers (PCs) and the Internet to provide health care information and interventions has increased substantially over the past decade. Yet the effectiveness of such an approach is highly dependent upon whether the target population has both access and the skill set required to use this technology. This is particularly relevant in the delivery of hearing health care because most people with hearing loss are over 50 years (average age for initial hearing aid fitting is 74 years). Although PC skill and Internet use by demographic factors have been examined previously, data do not currently exist that examine the effects of hearing difficulties on PC skill or Internet use in older adults. ObjectiveTo explore the effect that hearing difficulty has on PC skill and Internet use in an opportunistic sample of adults aged 50-74 years. MethodsPostal questionnaires about hearing difficulty, PC skill, and Internet use (n=3629) were distributed to adults aged 50-74 years through three family physician practices in Nottingham, United Kingdom. A subsample of 84 respondents completed a second detailed questionnaire on confidence in using a keyboard, mouse, and track pad. Summed scores were termed the “PC confidence index.” The PC confidence index was used to verify the PC skill categories in the postal questionnaire (ie, never used a computer, beginner, and competent). ResultsThe postal questionnaire response rate was 36.78% (1298/3529) and 95.15% (1235/1298) of these contained complete information. There was a significant between-category difference for PC skill by PC confidence index (P

Introduction: Untreated hearing loss is reported to negatively impact on an individual's quality of life, affecting their psychological and physical health and placing them at greater risk of developing dementia. Despite this, hearing loss management is often delayed by up to a decade. This is likely due to difficulties in navigating the hearing care pathway, and the absence of a central, unbiased reference point for consumer-friendly hearing health information and resources. We intend to co-design an online support service for adults with hearing loss with the following aims: 1) to understand unmet needs and consumer barriers to accessing hearing health information, 2) to identify solutions to these unmet needs that can be developed into prototype ideas, 3) to incrementally build on iterations of a prototype until a usable online support service is developed and ready for real-life testing with end-users, and 4) to test and evaluate the usability, accessibility, and effectiveness of the prototype from the consumer's perspective, so that the prototype can be refined into the final product. Methods and analysis: This will be a mixed method study. Consumers will be involved in all stages of the design of the project following the Hasso Plattner model of design thinking. The qualitative component will involve sprints and semi-structured interviews to access the consumer perspective and understand unmet needs and challenges regarding the access of online hearing health information. For the quantitative component, an online survey will be administered prior to prototype testing as part of the remote usability study to collect self-efficacy and eHealth literacy outcome measures via validated questionnaires. Data collection will also be performed post-prototype testing for evaluation purposes. Finally, heuristic evaluation of the prototype will be conducted by an eLearning expert to help refine the prototype into the final product. [ABSTRACT FROM AUTHOR]

Purpose: Unaddressed hearing loss can adversely affect employment and day-to-day work-life. Efficient and effective audiology support can help optimise hearing in the workplace. This study explores the audiological rehabilitation experiences of workers with hearing loss (WHL). Materials and methods: Twenty-four WHL with experience of a wide range of audiology services across the UK participated in semi-structured interviews. Interviews were analysed using inductive thematic analysis. Results: Three main themes were generated: Theme 1: mixed experiences with audiology services (subdivided into two subthemes and four sub-subthemes). Theme 2: audiology role in work support (subdivided into three subthemes). Theme 3: "I think support could be improved if..." (subdivided into two subthemes). Conclusion: The audiological rehabilitation for working-age adults with hearing loss needs improvements to deliver sufficient support and quality care. Some of the barriers to having better-functioning hearing healthcare require fundamental standards in healthcare quality, such as access to services, staff (including audiologists) deaf awareness, information and technology support, and personalised care that considers work-life needs. Further research is required to evaluate the feasibility and cost-effectiveness of improvements, such as support that extends beyond hearing aid care, whether from audiology or non-audiology services. IMPLICATION FOR REHABILITATION: Workers with hearing loss need audiologists' support to address their work life needs beyond hearing-aids care. Improving audiologists' competencies, audiology departments' efficiency and developing relevant resources may promote better healthcare for workers with hearing loss. Audiologists, employers, workers, and the healthcare system need to collaborate in developing person-centred solutions to sufficiently assist workers with hearing loss. [ABSTRACT FROM AUTHOR]

Aim: Best-practice in audiological rehabilitation takes a holistic client- and family-centred approach and considers hearing care in the context of personal well-being. Hearing loss not only impairs the ability to hear, but can also compromise the ability to communicate, thus negatively impacting both social and emotional well-being. Hearing care professionals play a key role in fostering their client's well-being. This paper aims to provide evidence-based recommendations to ensure inclusion of social-emotional well-being in audiologic rehabilitation clinical practice. Methods: A review of current research and expert opinion. Results: This guide proposes a 5-step plan which includes: identifying the client's social-emotional well-being; including family members in audiological rehabilitation; incorporating social-emotional needs and goals in an individualized management plan; relating identified hearing needs and goals to rehabilitation recommendations; and using counselling skills and techniques to explore and monitor social-emotional well-being. Each component of the 5-step plan is discussed and clinical considerations are presented. Conclusion: These comprehensive recommendations provide guidance to hearing care professionals looking to ensure clients' social-emotional well-being are considered throughout the rehabilitation journey. [ABSTRACT FROM AUTHOR]

To conduct the first phases in the development of a self-report measure of empowerment on the hearing health journey, specifically, item generation and content evaluation of the initial pool of items generated. A content expert panel survey and cognitive interviews were conducted. Descriptive statistics were obtained for the quantitative data, and the cognitive interviews were analysed using thematic analysis. Eleven researchers and clinicians participated in the content expert surveys. Sixteen experienced hearing aid users participated in the cognitive interviews, recruited from the USA and Australia. The items underwent five iterations based on feedback from the survey and interview data. This resulted in a set of 33 quality-tested potential survey items that were rated highly for relevance (mean = 3.96), clarity (mean = 3.70) and fit to dimensions of empowerment (mean = 3.92) (scale 0-4, where 4 was the maximum rating). Involving stakeholders in item generation and content evaluation increased relevance, clarity, fit to dimension, comprehensiveness, and acceptability of the items. This preliminary version of the 33-item measure underwent further psychometric refinement (Rasch analysis and traditional classical test theory testing) to validate it for clinical and research use (reported separately). [ABSTRACT FROM AUTHOR]

Objective electrophysiological measures can overcome difficulties in assessing cognition and hearing loss in people with dementia, and can be a useful adjunct to existing assessment tests. [ABSTRACT FROM AUTHOR]

There are many examples of remote technologies that are clinically effective and provide numerous benefits to adults with hearing loss. Despite this, the uptake of remote technologies for hearing healthcare has been both low and slow until the onset of the COVID-19 pandemic, which has been a key driver for change globally. The time is now right to take advantage of the many benefits that remote technologies offer, through clinical, consumer, or hybrid services and channels. These include greater access and choice, better interactivity and engagement, and tailoring of technologies to individual needs, leading to clients who are better informed, enabled, and empowered to self-manage their hearing loss. This article provides an overview of the clinical research evidence-base across a range of remote technologies along the hearing health journey. This includes qualitative, as well as quantitative, methods to ensure the end-users' voice is at the core of the research, thereby promoting person-centered principles. Most of these remote technologies are available and some are already in use, albeit not widespread. Finally, whenever new technologies or processes are implemented into services, be they clinical, hybrid, or consumer, careful consideration needs to be given to the required behavior change of the key people (e.g., clients and service providers) to facilitate and optimize implementation. [ABSTRACT FROM AUTHOR]

The first objective was to assess the feasibility of training on hearing aids and communication strategies by support workers in residential care via a cascade training model using two different training packages. The second was to identify key elements of these packages to inform the design of a multimedia training package. Quantitative and qualitative methodologies were used. A pre-post feasibility design assessed the questionnaire data from residential care support workers to measure knowledge and confidence at three stages during the training. Semi-structured interviews explored the support workers' experiences and adherence to cascading the training packages. Fourteen support workers employed by Sense (charity for deafblind people) were trained to become "Hearing Champions" and cascaded their learning to 117 support colleagues. Hearing Champions gained knowledge, skills and confidence, which were subsequently enhanced by sharing their learning with others. Despite individual and organisational barriers, they reported examples of improved practice and feelings of empowerment. It is feasible to deliver training to support workers in residential homes using the face-to-face "Hearing Champions" and multimedia C2Hear training methods by cascading training to their colleagues. Support workers expressed a preference for training that is portable, adaptable and interactive. [ABSTRACT FROM AUTHOR]

Purpose: Parental reports of communication, listening, and behavior in children receiving a clinical diagnosis of specific language impairment (SLI) or auditory processing disorder (APD) were compared with direct tests of intelligence, memory, language, phonology, literacy, and speech intelligibility. The primary aim was to identify whether there were differences between these characteristics in children with SLI or APD. Method: Normally hearing children who were clinically diagnosed with SLI (n = 22) or APD (n = 19), and a quasirandom sample of mainstream school (MS) children (n = 47) aged 6-13 years, underwent tests of verbal and nonverbal IQ, digit span, nonsense word repetition, Spoonerisms, reading, grammar, and sentence and VCV nonword intelligibility. Parents completed questionnaires on the children's communication, listening, and behavior. Results: There was generally no difference between the performance of the children with SLI and the children with APD on the questionnaire and test measures, and both groups consistently and significantly underperformed compared with the children in the MS group. Speech intelligibility in both noise and quiet was unimpaired in the SLI and APD groups. Conclusion: Despite clinical diagnoses of SLI or APD, the 2 groups of children had very similar behavioral and parental report profiles, suggesting that the children were differentially diagnosed based on their referral route rather than on actual differences.

To examine patient and audiologist experiences and perspectives of using a patient-centred telecare tool, the Ida Institute's Why Improve My Hearing? (WIMH) Tool, before and during the initial hearing assessment appointment. A qualitative study comprising individual semi-structured interviews using a maximum variation sampling strategy. The data were analysed using an established thematic analysis technique. Fifteen participants, including ten patients (i.e. adults with hearing loss) and five audiologists, were recruited from Adult Audiology Services within the United Kingdom's publicly-funded National Health Service (NHS). Three themes described the impact of using the WIMH Tool. Theme 1 (i.e. enhanced preparation before the appointment): the Tool helps patients to better understand and accept their hearing difficulties in advance of their first appointment. Theme 2 (i.e. enriched discussion during the appointment): the tool can enhance patient-centred communication, as well as the efficiency of the appointment. Theme 3 (i.e. varied impact on outcomes following the appointment): the Tool can improve patient motivation, readiness, and involvement in decision-making, though it may have limited impact on additional outcomes, such as adherence. The WIMH Tool can be successfully implemented in audiological practice, resulting in benefits before and during the initial hearing assessment appointment. [ABSTRACT FROM AUTHOR]

Background: Often considered an "invisible disability", hearing loss is one of the most prevalent chronic diseases and the third leading cause for years lived with disability worldwide. Hearing loss has substantial impacts on communication, psychological wellbeing, social connectedness, cognition, quality of life, and economic independence. The Hearing impairment in Adults: a Longitudinal Outcomes Study (HALOS) aims to evaluate the: (1) impacts of hearing devices (hearing aids and/or cochlear implants), (2) differences in timing of these interventions and in long-term outcomes between hearing aid and cochlear implant users, and (3) cost-effectiveness of early intervention for adult-onset hearing loss among hearing device users. Materials and methods: HALOS is a mixed-methods study collecting cross-sectional and longitudinal data on health and social outcomes from 908 hearing aid and/or cochlear implant users aged ≥40 years, recruited from hearing service providers across Australia. The quantitative component will involve an online survey at baseline (time of recruitment), 24-months, and 48-months and will collect audiological, health, psychosocial, functional and employment outcomes using validated instruments. The qualitative component will be conducted in a subset of participants at baseline and involve semi-structured interviews to understand the patient journey and perspectives on the Australian hearing service model. Ethics: This study has been approved by the Macquarie University Human Research Ethics Committee (ID: 11262) and Southern Adelaide Local Health Network (ID: LNR/22/SAC/88). Dissemination of results: Study findings will be disseminated to participants via a one-page summary, and to the public through publications in peer-reviewed journals and presentations at conferences. Trial registration: Australia New Zealand Clinical Trial Registry (ANZCTR) registration number: ACTRN12622000752763. [ABSTRACT FROM AUTHOR]

To examine the benefits of home-delivered auditory training for adult hearing aid users using live-voice conversations in the presence of a single-talker distractor (experimental group) or in quiet (active-control group). Randomised controlled trial. The experimental group held conversations with their nominated communication partner in the presence of a single-talker distractor set to a challenging level, 30 min/day, 5 days/week over 4 weeks. The active-control group held comparable conversations in quiet. Behavioural outcome measures of speech-in-noise perception, cognition and self-reported hearing difficulties were assessed pre- and post-training. Participant feedback was obtained. Thirty-nine hearing aid users (32 males, 7 females, mean age = 73.02 years, SD = 4.71 years) and their communication partners. The experimental group significantly improved and outperformed the active-control group for words-in-noise perception. Both groups achieved improvements in self-reported hearing difficulty while only the experimental group improved on dual-task. Subjectively, both groups found live-voice conversations beneficial and reported increased concentration and listening skills. Home-delivered live-voice auditory training with communication partners shows potential to improve outcomes for adult hearing aid users, regardless of the presence or absence of a competing speech distractor. Further research is required to assess mechanisms of benefit and distractor effects within carefully controlled experiments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to describe the emerging use of design thinking methodologies in hearing health care research using a participatory action approach with a consumer and community involvement panel, audiologists, and adults with hearing loss. Method: Two connected hearing health care projects that adopted design thinking principles are presented here as case studies. Case 1 investigated the applicability and acceptability of smart voice assistant technology as post--hearing aid fitting support. Case 2 investigated the feasibility of providing support for new adult patients with hearing loss before they attend their hearing assessment appointment. Discussion: The design thinking process provided a flexible structure in which researchers were able to empathize with stakeholders, define their unmet needs, and ideate potential connected hearing health care solutions to develop and evaluate prototypes in clinical and home settings. Conclusion: Utilizing a needs-based, collaborative design thinking approach to conduct development in hearing health care research is a viable and novel option to produce innovative, relevant, and translational hearing health solutions that address stakeholder needs. [ABSTRACT FROM AUTHOR]

Purpose: Parental reports of communication, listening, and behavior in children receiving a clinical diagnosis of specific language impairment (SLI) or auditory processing disorder (APD) were compared with direct tests of intelligence, memory, language, phonology, literacy, and speech intelligibility. The primary aim was to identify whether there were differences between these characteristics in children with SLI or APD. Method: Normally hearing children who were clinically diagnosed with SLI (n = 22) or APD (n = 19), and a quasirandom sample of mainstream school (MS) children (n = 47) aged 6-13 years, underwent tests of verbal and nonverbal IQ, digit span, nonsense word repetition, Spoonerisms, reading, grammar, and sentence and VCV nonword intelligibility. Parents completed questionnaires on the children's communication, listening, and behavior. Results: There was generally no difference between the performance of the children with SLI and the children with APD on the questionnaire and test measures, and both groups consistently and significantly underperformed compared with the children in the MS group. Speech intelligibility in both noise and quiet was unimpaired in the SLI and APD groups. Conclusion: Despite clinical diagnoses of SLI or APD, the 2 groups of children had very similar behavioral and parental report profiles, suggesting that the children were differentially diagnosed based on their referral route rather than on actual differences. KEY WORDS: communication, cognition, speech intelligibility, language, literacy, memory, comorbidity, For more than 30 years, much has been written about auditory processing disorder (APD), with an aim of understanding the nature of this complex and heterogeneous disorder (Cacace & McFarland, [...]

Background: A variety of outcome domains are currently measured for the assessment of hearing rehabilitation. To date, there is no consensus about which outcome domains should be measured, when they should be measured, and how they should be measured. In addition, most studies seeking to develop core outcome sets and measures for hearing rehabilitation services have primarily focussed on the opinions and expertise of researchers, and, to a lesser extent, clinicians, rather than also involving clients of those services. The principles of experience-based co-design suggest that health services, researchers, and policymakers should come together with clients and their families to design health services and define what metrics should be used for their success. Objectives: This study aimed to seek views and consensus from a range of key stakeholders to define which client-centred self-report outcome domains should be measured, when they should be measured, and how they should be measured, in a national publicly funded hearing rehabilitation scheme. In addition, the study aimed to identify current and future potential mechanisms and systems to standardise the collection of data and reporting of outcomes, to enable comparison across clients and hearing service providers. Methods: Two stakeholder groups participated in a three-round online Delphi process: (1) 79 professional stakeholders involved in the delivery of hearing services in Australia, and (2) 64 hearing rehabilitation services' clients identified by not-for-profit consumer organisations. An initial set of in-person workshops scoped the key issues upon which to develop the initial open-ended questions and subsequent Likert-scale statements addressing these issues. These statements were then distributed to both groups in an online survey. The respondent ratings were summarised, and the summary was returned to respondents along with a second round of the survey. This process was then repeated once more. The five most important outcome domains from both groups were then combined, and a consensus workshop of seven professionals and three client advocates agreed on the top four ranked domains. Results: A range of potential outcome domains were identified as relevant indicators of successful hearing rehabilitation. Communication ability, personal relationships, wellbeing, and participation restrictions were identified as a core outcome domain set that should be measured as a minimum for patients receiving hearing rehabilitation. There was little agreement on the preferred timepoints for collection of outcome measures, with respondents expressing the view that this should be established by research once a set of outcome measures has been selected. However, there was broad agreement that measurements of these domains should be collected at baseline (before the provision of hearing rehabilitation) and no earlier than 3 months following the completion of rehabilitation. Potential benefits and issues with the development of a national outcomes database/collection system were also identified and prioritised, with participants highlighting the importance of valid, high-quality, trustworthy, and comprehensive data collection. Conclusion: These results provide a Core Outcome Domain Set for the self-reported evaluation of hearing rehabilitation and provide important background information for the design of methods to implement them across hearing healthcare systems. However, the wide range of outcome domains identified as potentially providing important additional information and the lack of specific measures to address these domains strongly suggest that there is still more research to be done. Ongoing stakeholder engagement will continue to be vital for future implementation. In addition, further research is required to determine the optimal time following hearing rehabilitation to utilise any particular outcome measure. [ABSTRACT FROM AUTHOR]

To develop a consensus among hearing healthcare professionals in the UK on connected hearing health technologies and service delivery models. A three-round, electronic Delphi review was developed using a participatory-design approach. This included ten open-ended questions (round one) that informed 69 Likert-scaled statements (rounds two and three). An expert panel of 34 hearing health professionals representing all geographic regions of the UK from either the publicly funded National Health Service (n = 22) or independent sector (n = 12). The majority of statements (61%) showed ≥80% consensus, highlighting that there was broad agreement amongst professionals on connected hearing health technologies. For example, there was consensus that adults who report communication difficulties and have no medical contraindications would be ideal candidates. Furthermore, it was unanimously agreed that connected technologies could result in delays in diagnosis of treatable medical conditions, as well as result in inadequate amplification. Overall, the expert panel concurred that connected technologies could serve as "gateway products" that lead to earlier hearing aid uptake. This Delphi review identified overarching areas of agreement that may serve as a blueprint for future implementation of connected hearing health technologies through either conventional or new service delivery models in the UK. [ABSTRACT FROM AUTHOR]

To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. 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. These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services. [ABSTRACT FROM AUTHOR]

Related to the hearing health journey, this study aimed to: (i) explore how empowerment manifests itself from individuals' first awareness of hearing loss through to hearing aid fitting and then to becoming an active hearing aid user, (ii) identify points when the different dimensions of empowerment are most relevant, and (iii) conceptualise empowerment. A semi-structured interview study was conducted, followed by a template analysis of the data. Adult hearing aid users from Sweden (n = 8) and Australia (n = 10) who had worn hearing aids for between 6 and 36 months. The themes that emerged from the transcripts were knowledge, skills and strategies, participation, self-efficacy, and control. This study conceptualises empowerment along the hearing health journey as the process through which individuals with hearing-related challenges acquire and use knowledge, skills, and strategies, and increase self-efficacy, participation, and the feeling of control of their hearing health care, hearing solutions, and everyday lives. There are not specific points along the hearing health journey where any dimension is uniquely relevant, instead, each dimension is a dynamic component at all stages. [ABSTRACT FROM AUTHOR]

Background Social isolation is a major consequence of hearing loss. It includes an objective component (e.g. small social network) and a subjective component (e.g. loneliness). Objective To examine the perspectives of key stakeholders regarding (i) the relationship between hearing loss and social isolation and (ii) interventions to address hearing loss and social isolation. Design A phenomenological qualitative study. Setting A UK research centre with a role to engage patients and clinicians. Participants Hearing healthcare professionals (n  = 7) and adults with hearing loss (n  = 6) were recruited via maximum variation sampling. Methods Individual (n  = 3) and group (n  = 3) semi-structured interviews were conducted. Inductive thematic analysis was performed. Results Five themes were identified. Theme 1 (experience of isolation and hearing loss): hearing loss can cause people to feel disconnected at social events or to cease attending them. Theme 2 (complexity of isolation and hearing loss): the various causes of isolation (e.g. hearing loss, retirement, comorbidities) are difficult to disentangle. Theme 3 (downstream effects of isolation and hearing loss): hearing loss and/or isolation can lead to mental health problems, stigmatisation, fatigue and unemployment. Theme 4 (preferred components of an isolation intervention): an isolation intervention should be patient-led and patient-centred and take place in the community. Theme 5 (challenges to implementing an isolation intervention): barriers to implementing an isolation intervention include a lack of time, training and continuity. Conclusion This study demonstrated that social isolation arising from hearing loss is a substantial, complex problem and provided novel insights on implementing an intervention to address this issue. [ABSTRACT FROM AUTHOR]

To examine the extent to which there is a basic economic case for the provision of rehabilitation services within a publicly funded, device-centred approach to adult hearing services. Five representative cross-sectional surveys of people aged 50 years and over were conducted in Australia between 2013 and 2019 (n = 4663). Respondents were surveyed on self-rated hearing abilities, hearing aid usage and perceived benefits of device usage. A population estimate of non-device usage was derived from these data and the costs and benefits of the existing versus proposed hearing services pathways examined. Among respondents 27% reported that their hearing was fair or poor, and 14% reported hearing aid ownership. 45% of hearing aid owners were regular device users. Approximately 1:4 people (24%) who owned a hearing aid had not used it in the past three months; with an estimated cost of $au87.4 million per annum. The provision of hearing rehabilitation services in addition to or instead of hearing aids could provide clients with a more comprehensive service at an estimated saving of between 62% to 81% of existing program costs. Cost benefit analysis supports the provision of hearing rehabilitation within a hearing services program, either as an alternative to the existing service, or adjunct to it. Such a service would enhance client outcomes and reduce the level of wastage currently associated with the current device-centred approach. Clients identified as not being immediately ready to progress to hearing aids could benefit from rehabilitation programs while still having access to either assistive listening devices or hearing aids. The proposed approach could result in significant cost savings to publicly funded programs while ensuring better outcomes for service users through the more effective, efficient and ethical use of public monies. [ABSTRACT FROM AUTHOR]

To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss. Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss. A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists. Overall, participants rated all of the approaches highly on both benefit and likelihood of use; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales. Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals). [ABSTRACT FROM AUTHOR]

To (i) assess the delivery, accessibility, usability, acceptability, and adherence, and (ii) identify suitable outcome measures, for a mobile-enhanced multimedia educational programme (m2Hear) in first-time hearing aid users. A prospective, single-centre feasibility study. First-time hearing aid users (n = 59), recruited at their initial hearing assessment. Evaluations were made at 1-week and at 10–12 weeks post-hearing aid fitting. m2Hear was most commonly accessed via tablets (42.3%). Usability was high for the System Usability Scale (88.5%), and the uMARS, particularly for the Information (M = 4.7), Functionality (M = 4.5) and Aesthetics (M = 4.2) subscales (maximum score = 5). Participant feedback was positive, with a high percent agreeing that m2Hear aided understanding of hearing aids (98%), held their interest (86%), improved confidence to use hearing aids and communicate (84%), and provided additional information to audiologist's advice (82%). Learnings about practical hearing aid handling/maintenance skills and how to communicate with others were reportedly used equally in participant's everyday lives. m2Hear was convenient to use, clear, concise and comprehensive. Outcome measures of social participation resulted in large effect sizes (Cohen's d > 1.6). A theoretically-driven, personalised and co-designed educational m-health intervention is feasible and beneficial for use in the self-management of hearing loss and hearing aids. [ABSTRACT FROM AUTHOR]

To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss. A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other. An international sample of 65 audiologists. Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility. Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Innovations in user-driven hearing technology and services have placed greater control in the hands of the patient. While these advances could address issues of hearing health care accessibility, their success rests on the assumption that patients possess sufficient technological competence to self-manage these products and services successfully. The purpose of this tutorial is to highlight the importance of focusing on usability, rather than just performance outcomes, during the design, development, and evaluation of user-driven hearing technology and services. Method: This tutorial explores human--technology interaction and usability and discusses practical methods for applying these concepts in hearing health care research and development. Two case studies illustrate how usability can inform the design and development of interactive educational materials for patients and the evaluation of a commercially available mHealth app. Conclusions: In order to derive benefit from innovations in hearing health care, products and services must be intuitively usable in addition to being accessible and affordable. The discipline of human--technology interaction provides a relevant and useful framework to guide future research and development efforts in user-driven hearing health care. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the development of a novel mobile health (mHealth) educational intervention, called m2Hear, designed for first-time hearing aid users based on previously developed educational multimedia videos, or reusable learning objects (RLOs), branded C2Hear. Design: The development of m2Hear used theoretical and ecologically valid approaches. The COM-B model and associated Theoretical Domains Framework were employed to identify specific components (or "active ingredients") of the original RLOs that facilitate hearing aid use. An mHealth platform was then developed following an iterative, user-centred and participatory design approach. Study sample: Fifteen existing hearing aid users completed synchronous, real-time Think Aloud interviews. A sub-group of these participants (n = 5), along with patient and public involvement panel members (n = 4), subsequently reviewed the usability of the mHealth platform. Results: While factors associated with Capability featured strongly across all RLOs, topics relating to Opportunity and Motivation were also incorporated. The RLOs were broken-down into 42 shorter mobile-enhanced RLOs (or mRLOs). Each mRLO was labelled with a specific user-centred question generated from the Think Aloud interviews. The final mHealth platform was developed following four separate usability iterations. Conclusions: Overall, m2Hear provides greater opportunities for individualised learning and encourages greater interaction to facilitate self-management in first-time hearing aid users. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the effect of a multimedia educational programme for first-time hearing aid users (C2Hear reusable learning objects, RLOs), delivered at the hearing assessment on (1) self-efficacy for hearing aids (primary outcome), and (2) readiness for hearing rehabilitation and hearing aid knowledge (secondary outcomes). Design: A single-centre, prospective, pre-post, randomised controlled trial with two arms. The intervention group (n = 24) received RLOs, and the waitlist control group (n = 23) received a printed booklet on hearing aids. Outcomes were measured at the hearing assessment and hearing aid fitting appointments. Study sample: Fifty-six adult first-time hearing aid users attending a publicly funded audiology service. Results: The RLO group showed significantly greater improvement in self-efficacy and knowledge of hearing aids than the control group. A borderline effect of readiness for hearing rehabilitation was also found. Potential links between hearing aid self-efficacy and knowledge were identified. Conclusions: Early delivery of the RLOs results in greater hearing aid self-efficacy and knowledge at the hearing aid fitting appointment, with indications that RLOs increase readiness for hearing rehabilitation. As knowledge, self-efficacy and readiness are cornerstones of self-management, the C2Hear RLOs can prime first-time hearing aid users to better self-manage their hearing aids before they receive them. [ABSTRACT FROM AUTHOR]

Objective: To validate a method using self-reported speech communication effort in noise to estimate occupational noise levels by comparing with measured noise levels. Design: A comparative observational study. Reported vocal effort to communicate with a person at a distance of 1.2m during workplace-related tasks was used to provide an estimate of noise levels in the workplace. These estimated noise levels were compared against noise level measurements obtained using personal noise dosimetry badges for corresponding tasks undertaken by participants. Study sample: Participants (n=168) aged 16-25 years were recruited from companies where workplace noise levels were at least 85 dB(A). Results: Estimated noise levels using speech communication ability were evenly distributed above and below the measured noise levels (n=134), indicating a lack of systematic bias in the method. For 91% of participants, estimates of noise levels using speech communication were within ±6 dB of the measured levels, whilst 56% were within ±3 dB. Conclusions: Report of speech communication effort required in noise by employees is an effective method of estimating noise levels within the workplace. This can be used for retrospective noise level assessment where there are no recorded noise level measurements, such as for retrospective research studies or in medicolegal work. [ABSTRACT FROM AUTHOR]