International Journal of Audiology 2014; 53: S1–S2
Foreword
Improving uptake and outcomes of hearing aid fitting for older adults: What are the barriers and facilitators?
Worldwide, we are faced with an ageing population. As the prevalence of age-related hearing impairment increases, there is an imperative to better address the hearing health care needs of older adults. Advances in hearing aid technology have led to more satisfied hearing aid users; however, there remains a large proportion of older adults with hearing impairment who are reluctant to trial hearing aids, and a proportion who report poor outcomes with hearing aids. This special issue presents a series of papers that investigate the issues surrounding hearing aid uptake and outcomes. As per standard procedures for the International Journal of Audiology, all submissions were peer reviewed by external reviewers prior to being accepted for publication. The opening two papers of the special issue (Meyer, Hickson, Lovelock, Lampert & Khan; Hickson, Meyer, Lovelock, Lampert & Khan) discuss the results of a large retrospective study that identified the combination of factors (audiological and non-audiological) important for help-seeking for hearing impairment and success with hearing aids. Many studies in the past have identified key factors (e.g. attitude towards hearing aids, degree of hearing loss, self-perceived hearing difficulties); however, the studies presented in this issue are unique in
that they looked at the impact of more than 40 factors on help-seeking for hearing impairment and hearing aid success, and used multivariate modelling to elucidate which of these were most important. The most important facilitators of help-seeking and successful hearing aid use were positive attitudinal beliefs about hearing aids, the support of significant others, and self-efficacy for hearing aids. Self-efficacy refers to the level of confidence an individual has in his or her ability to manage and adapt to using hearing aids. The finding that hearing aid self-efficacy was important for uptake and success with hearing aids led to the development of three smaller studies which feature next in this special issue. The first of these papers (Meyer, Hickson & Fletcher) looked in depth at hearing aid self-efficacy and the factors associated with selfefficacy. It became clear that non-hearing aid owners differed from hearing aid owners; however, one factor that was associated with adequate hearing aid self-efficacy within both cohorts was good selfreported vision. Given that hearing aids are small, advanced forms of technology, it also seemed feasible that the low levels of hearing aid self-efficacy reported by non-hearing aid owners and unsuccessful hearing aid owners could in fact be attributed to a more general fear of technology. Accordingly, the next paper (Ham, Bunn, Meyer, Khan & Hickson) examined if hearing aid uptake and success with hearing aids was also associated with the use of general, everyday and advanced technologies (e.g. mobile phones and navigation systems, respectively). It was hypothesised that non-hearing aid owners and unsuccessful hearing aid owners would use fewer advanced technologies, relative to successful hearing aid users; however the analysis did not support that hypothesis. In the third paper of the series (Caposecco, Hickson & Meyer), we considered the potential importance of written hearing aid user guides for improving self-efficacy. If designed appropriately for older adults, user guides could be a valuable resource to address the barrier of low self-efficacy for hearing aids evident in some older adults. It was evident from this research that hearing aid user guides are poorly designed for the target population of older adults and are therefore unlikely to promote self-efficacy. There were numerous problems with the user guides, in particular in terms of their scope, layout, and typography, vocabulary, and reading level. We hope this research will inform the development of improved user guides for hearing aids in the future. Another factor that is often claimed to influence successful hearing aid use is a client’s tolerance for listening in the presence of background noise. With this in mind, a study was conducted to explore the potential clinical utility of an Australian version of the acceptable noise level test (Walravens, Keidser, Hartley & Hickson). Unfortunately the research indicated that the test had low test-retest reliability and there was no evidence that it was of value as a predictor of long-term hearing aid use. To this point in the special issue, the focus of the research is on clientrelated factors that are important for hearing aid uptake and success with hearing aids. In the remaining three papers the focus is shifted to the critical role of the audiologist in hearing rehabilitation. As an introduction to this next section, a review is presented of current literature on patient-centred care and what this means for audiology (Grenness, Hickson, Laplante-Lévesque & Davidson). Patient-centred care
ISSN 1499-2027 print/ISSN 1708-8186 online © 2014 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society DOI: 10.3109/14992027.2013.875265
S2
Foreword
practices stress the need to inform and involve patients in the management of their health conditions and are considered particularly important for those with chronic health conditions, such as hearing impairment. The following two papers in the special issue then look at the application of patient-centred care in audiology, from the perspectives of older adults with hearing impairment (Grenness, Hickson, Laplante-Lévesque & Davidson) and audiologists (Laplante-Lévesque, Hickson & Grenness). Grenness et al interviewed a sample of ten older adults who had owned hearing aids about their perceptions of patientcentredness in audiological rehabilitation. Participants talked about the need to individualize care and the importance of the therapeutic relationship with their audiologist. Laplante-Lévesque et al surveyed 663 audiologists and found that, overall, they report preferences for patient-centredness, although there were significant differences in preferences, depending on age and work setting. Relationships between such self-reported preferences, real-life clinical practice, and the influence of patient-centredness on the outcomes of audiological rehabilitation remain to be explored. We hope this special issue sheds new light on barriers to, and facilitators of, successful hearing rehabilitation for older adults. In
each of the articles the authors make recommendations for clinical practice that aim to improve uptake rates and success with hearing aids in the future. Based on the evidence presented here, we believe that major gains are possible if audiological rehabilitation is more patient-centred, includes family members as much as possible, and addresses client attitudes to hearing aids and their self-efficacy for managing the devices.
Guest Foreword
client more centrally in their own hearing healthcare might increase the take up and use of hearing technology and rehabilitation, the evidence base to support this contention was scarce. The HEARing CRC, with its longer-term funding, provided a window of opportunity to conduct a range of controlled studies to identify barriers to the take up and use of intervention and rehabilitation services, and the outcomes of these studies are presented in this supplement. A key focus of the HEARing CRC is to conduct research and innovation that leads to improved clinical services and benefits to end users. Translation of research into impact requires that information is communicated to those who can actually apply the findings, and so we are delighted to support this special supplement to the International Journal of Audiology, and hope that it will provide useful insights and ideas for clinicians in delivering hearing healthcare. From its outset, these studies have been expertly led by Professor Louise Hickson, for which we are extremely grateful. Louise has been well supported by her core study team at the University of Queensland, as well as many other speech pathologists, educationalists, and audiologists from other member organizations of The Hearing Cooperative Research Centre. We are extremely grateful to the participants, and for the funding provided by the Cooperative Research Centres Program - an Australian Government Initiative.
It is well recognized that hearing loss has a significant personal, professional, and social impact, as well as carrying a broad financial cost to the individual and the State. The HEARing Cooperative Research Centre, an initiative of the Australian Government first established in 1992, is a collaboration of some twenty-five member organizations, including universities, hearing healthcare industry, government services and research, clinical agencies and hospitals, early intervention centres, and professional audiologists, focused on the twin challenges of more effective prevention and improved remediation of hearing loss. Some eight years ago, we realized that current models of hearing rehabilitation were not delivering the anticipated benefits. Whilst researchers believed it likely that a different approach, involving the
Acknowledgements We are very grateful to Dr Christopher Lind for coordinating the article reviews and for his expert input and advice. The publication of this special supplement in the International Journal of Audiology has been made possible through the generous funding support of the HEARing CRC Limited, an Australian Government Initiative. Louise Hickson*,† & Carly Meyer*,† *The HEARing Cooperative Research Centre, Australia, †School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
Robert Cowan Chief Executive Officer, The HEARing Cooperative Research Centre, Australia President, International Society of Audiology
Copyright of International Journal of Audiology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Foreword
Improving uptake and outcomes of hearing aid fitting for older adults: What are the barriers and facilitators?
Worldwide, we are faced with an ageing population. As the prevalence of age-related hearing impairment increases, there is an imperative to better address the hearing health care needs of older adults. Advances in hearing aid technology have led to more satisfied hearing aid users; however, there remains a large proportion of older adults with hearing impairment who are reluctant to trial hearing aids, and a proportion who report poor outcomes with hearing aids. This special issue presents a series of papers that investigate the issues surrounding hearing aid uptake and outcomes. As per standard procedures for the International Journal of Audiology, all submissions were peer reviewed by external reviewers prior to being accepted for publication. The opening two papers of the special issue (Meyer, Hickson, Lovelock, Lampert & Khan; Hickson, Meyer, Lovelock, Lampert & Khan) discuss the results of a large retrospective study that identified the combination of factors (audiological and non-audiological) important for help-seeking for hearing impairment and success with hearing aids. Many studies in the past have identified key factors (e.g. attitude towards hearing aids, degree of hearing loss, self-perceived hearing difficulties); however, the studies presented in this issue are unique in
that they looked at the impact of more than 40 factors on help-seeking for hearing impairment and hearing aid success, and used multivariate modelling to elucidate which of these were most important. The most important facilitators of help-seeking and successful hearing aid use were positive attitudinal beliefs about hearing aids, the support of significant others, and self-efficacy for hearing aids. Self-efficacy refers to the level of confidence an individual has in his or her ability to manage and adapt to using hearing aids. The finding that hearing aid self-efficacy was important for uptake and success with hearing aids led to the development of three smaller studies which feature next in this special issue. The first of these papers (Meyer, Hickson & Fletcher) looked in depth at hearing aid self-efficacy and the factors associated with selfefficacy. It became clear that non-hearing aid owners differed from hearing aid owners; however, one factor that was associated with adequate hearing aid self-efficacy within both cohorts was good selfreported vision. Given that hearing aids are small, advanced forms of technology, it also seemed feasible that the low levels of hearing aid self-efficacy reported by non-hearing aid owners and unsuccessful hearing aid owners could in fact be attributed to a more general fear of technology. Accordingly, the next paper (Ham, Bunn, Meyer, Khan & Hickson) examined if hearing aid uptake and success with hearing aids was also associated with the use of general, everyday and advanced technologies (e.g. mobile phones and navigation systems, respectively). It was hypothesised that non-hearing aid owners and unsuccessful hearing aid owners would use fewer advanced technologies, relative to successful hearing aid users; however the analysis did not support that hypothesis. In the third paper of the series (Caposecco, Hickson & Meyer), we considered the potential importance of written hearing aid user guides for improving self-efficacy. If designed appropriately for older adults, user guides could be a valuable resource to address the barrier of low self-efficacy for hearing aids evident in some older adults. It was evident from this research that hearing aid user guides are poorly designed for the target population of older adults and are therefore unlikely to promote self-efficacy. There were numerous problems with the user guides, in particular in terms of their scope, layout, and typography, vocabulary, and reading level. We hope this research will inform the development of improved user guides for hearing aids in the future. Another factor that is often claimed to influence successful hearing aid use is a client’s tolerance for listening in the presence of background noise. With this in mind, a study was conducted to explore the potential clinical utility of an Australian version of the acceptable noise level test (Walravens, Keidser, Hartley & Hickson). Unfortunately the research indicated that the test had low test-retest reliability and there was no evidence that it was of value as a predictor of long-term hearing aid use. To this point in the special issue, the focus of the research is on clientrelated factors that are important for hearing aid uptake and success with hearing aids. In the remaining three papers the focus is shifted to the critical role of the audiologist in hearing rehabilitation. As an introduction to this next section, a review is presented of current literature on patient-centred care and what this means for audiology (Grenness, Hickson, Laplante-Lévesque & Davidson). Patient-centred care
ISSN 1499-2027 print/ISSN 1708-8186 online © 2014 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society DOI: 10.3109/14992027.2013.875265
S2
Foreword
practices stress the need to inform and involve patients in the management of their health conditions and are considered particularly important for those with chronic health conditions, such as hearing impairment. The following two papers in the special issue then look at the application of patient-centred care in audiology, from the perspectives of older adults with hearing impairment (Grenness, Hickson, Laplante-Lévesque & Davidson) and audiologists (Laplante-Lévesque, Hickson & Grenness). Grenness et al interviewed a sample of ten older adults who had owned hearing aids about their perceptions of patientcentredness in audiological rehabilitation. Participants talked about the need to individualize care and the importance of the therapeutic relationship with their audiologist. Laplante-Lévesque et al surveyed 663 audiologists and found that, overall, they report preferences for patient-centredness, although there were significant differences in preferences, depending on age and work setting. Relationships between such self-reported preferences, real-life clinical practice, and the influence of patient-centredness on the outcomes of audiological rehabilitation remain to be explored. We hope this special issue sheds new light on barriers to, and facilitators of, successful hearing rehabilitation for older adults. In
each of the articles the authors make recommendations for clinical practice that aim to improve uptake rates and success with hearing aids in the future. Based on the evidence presented here, we believe that major gains are possible if audiological rehabilitation is more patient-centred, includes family members as much as possible, and addresses client attitudes to hearing aids and their self-efficacy for managing the devices.
Guest Foreword
client more centrally in their own hearing healthcare might increase the take up and use of hearing technology and rehabilitation, the evidence base to support this contention was scarce. The HEARing CRC, with its longer-term funding, provided a window of opportunity to conduct a range of controlled studies to identify barriers to the take up and use of intervention and rehabilitation services, and the outcomes of these studies are presented in this supplement. A key focus of the HEARing CRC is to conduct research and innovation that leads to improved clinical services and benefits to end users. Translation of research into impact requires that information is communicated to those who can actually apply the findings, and so we are delighted to support this special supplement to the International Journal of Audiology, and hope that it will provide useful insights and ideas for clinicians in delivering hearing healthcare. From its outset, these studies have been expertly led by Professor Louise Hickson, for which we are extremely grateful. Louise has been well supported by her core study team at the University of Queensland, as well as many other speech pathologists, educationalists, and audiologists from other member organizations of The Hearing Cooperative Research Centre. We are extremely grateful to the participants, and for the funding provided by the Cooperative Research Centres Program - an Australian Government Initiative.
It is well recognized that hearing loss has a significant personal, professional, and social impact, as well as carrying a broad financial cost to the individual and the State. The HEARing Cooperative Research Centre, an initiative of the Australian Government first established in 1992, is a collaboration of some twenty-five member organizations, including universities, hearing healthcare industry, government services and research, clinical agencies and hospitals, early intervention centres, and professional audiologists, focused on the twin challenges of more effective prevention and improved remediation of hearing loss. Some eight years ago, we realized that current models of hearing rehabilitation were not delivering the anticipated benefits. Whilst researchers believed it likely that a different approach, involving the
Acknowledgements We are very grateful to Dr Christopher Lind for coordinating the article reviews and for his expert input and advice. The publication of this special supplement in the International Journal of Audiology has been made possible through the generous funding support of the HEARing CRC Limited, an Australian Government Initiative. Louise Hickson*,† & Carly Meyer*,† *The HEARing Cooperative Research Centre, Australia, †School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
Robert Cowan Chief Executive Officer, The HEARing Cooperative Research Centre, Australia President, International Society of Audiology
Copyright of International Journal of Audiology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
