Pediatric Hearing Aid Use: Parent-Reported Challenges Karen Muñoz,1,2 Whitney A. Olson,1 Michael P. Twohig,3 Elizabeth Preston,1 Kristina Blaiser,1 and Karl R. White,2,3 Key words: Hearing aid management, Hearing loss, Parent challenges, Pediatric.
Objectives: The aim of this study was to investigate parent-reported challenges related to hearing aid management and parental psychosocial characteristics during the first 3 years of the child’s life.
(Ear & Hearing 2015;36;279–287)
Design: Using a cross-sectional survey design, surveys were distributed to parents of children with hearing loss via state Early Intervention programs in Utah and Indiana. Packets contained one family demographic form and two sets of three questionnaires to obtain responses from mothers and fathers separately: the Parent Hearing Aid Management Inventory explored parent access to information, parent confidence in performing skills, expectations, communication with the audiologist, and hearing aid use challenges. The Acceptance and Action Questionnaire measured psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual’s ability to take value-based actions. The Patient Health Questionnaire identified symptoms of depression. Thirty-seven families completed questionnaires (35 mothers and 20 fathers).
INTRODUCTION Practice recommendations indicate infants with hearing loss should be identified and receiving intervention services before 6 months of age (Joint Committee on Infant Hearing 2007). Although benchmarks for timeliness of services are being met more frequently (Centers for Disease Control and Prevention 2011; Muñoz et al. 2013), many families still encounter challenges accessing needed services (Holte et al. 2012). When children receive effective intervention following early identification they have opportunities to develop language on par with their normal-hearing peers. In addition to services from professionals with expertise in childhood hearing loss, parents play a critical role in optimizing developmental outcomes during the intervention process. Parent understanding about how hearing loss affects child development, the intervention needed, and how to integrate new skills related to managing the child’s hearing loss into daily routines is critical for effective management and language development. However, parents may experience difficulties in integrating new skills into their daily lives for a variety of reasons. Both fathers and mothers have integral roles in caring for their child’s needs. To provide family-centered services, it is important to understand the perspectives of each parent. Because effective use of hearing aids is foundation for spoken language development, understanding parent challenges with hearing aid management, and their psychosocial experiences when hearing aids are fitted in early childhood can help audiologists and other healthcare professionals to better support families. Before the widespread implementation of newborn hearing screening, children with hearing loss were often not identified until close to 2 years of age (Young & Tattersall 2007) when parents became worried about delays in the child’s speech and language development. The implementation of state Early Hearing Detection and Intervention programs over the past 15 years has led to a decrease in the age of hearing loss identification from 2.5 years to 2 to 3 months (White et al. 2010). As a result, parents are frequently given the news of their child’s hearing loss within the first few weeks of life. This process occurs before most parents are able to recognize a problem with their child’s hearing based on behavioral reactions to sound or delays in development. Identification of hearing loss can lead to feelings of grief for many parents (Kurtzer-White & Luterman 2003), affecting their ability to follow through and manage needs related to their child’s hearing loss. However, people experience grief in different ways, and gender role socialization is one influential factor (Martin & Doka 2000). Awareness of parent
Results: Most responses were parents of toddlers (M = 22 months) who had been wearing binaural hearing aids for an average of 15 months. Both mothers and fathers reported that even though the amount of information they received was overwhelming, most (84%) preferred to have all the information at the beginning, rather than to receive it over an extended time period. Parents reported an array of challenges related to hearing aid management, with the majority related to daily management, hearing aid use, and emotional adjustment. Sixty-six percent of parents reported an audiologist taught them how to complete a listening check using a stethoscope, however, only one-third reported doing a daily hearing aid listening check. Both mothers and fathers reported a wide range of variability in their confidence in performing activities related to hearing aid management, and most reported minimal confidence in their ability to troubleshoot hearing aid problems. More than half of the parents reported child behavior and activities, such as playing outside, as a major hearing aid use challenge. Parents reported hearing aids were worn all waking hours by 35% of children and less than 5 hr/day by 31%. Almost half of the parents (47%) did not feel that they had enough time to talk about their emotions when speaking with their audiologist(s), 69% reported the audiologist did not help them know what to expect related to emotions about their child’s hearing loss, and 22% reported symptoms of depression. Conclusions: Parents reported an array of challenges, even after their child had been wearing hearing aids for a prolonged time, revealing critical implications for how to provide audiological care. Audiologists have an important role in partnering with parents to identify and jointly problem-solving challenges related to their child’s hearing aid use. Supporting parents includes not only addressing technical aspects of hearing testing and hearing aid function but also addressing parent thoughts, feelings, and emotions.
Department of Communicative Disorders and Deaf Education, Utah State University, Logan, Utah, USA; 2National Center for Hearing Assessment and Management, Utah State University, Logan, Utah, USA; and 3Department of Psychology, Utah State University, Logan, Utah, USA. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com).
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experiences and perspectives and how they influence daily hearing aid management is central to audiologists’ ability to provide effective support, an area that has not previously been investigated with fathers.
PSYCHOSOCIAL CONSIDERATIONS Mothers of children with disabilities have been found to have an elevated risk of depression and increased distress (Singer 2006; Thurston et al. 2011). Singer (2006) found that 29% of mothers of children with developmental delays (N = 6641) exhibited elevated levels of depression symptoms, compared with 19% of mothers of children with no delay (N = 26,438). Thurston et al. (2011), in a study of families of children with various disabilities (N = 429), found that 42% of parents exhibited symptoms of depression, and recommended that rehabilitation efforts address parental mental health in addition to the child’s needs. Parents of children with disabilities often experience feelings of uncertainty about their child’s comfort, health and development, and how to ensure their child is being adequately represented (Stewart & Mishel 2000). Such feelings of uncertainty have been found to increase family distress and care burden (Garwick et al. 2002). Studies that have been done to investigate psychosocial experiences for parents of children with hearing loss are limited. Targeted participants in past research have included parents of school-aged children (Calderon & Greenberg 1999; Meinzen-Derr et al. 2008) and parents of children with severeto-profound hearing loss (Meadow-Orlans 1995; Calderon & Greenberg 1999; Lederberg & Golbach 2002), but the actual samples have included very few fathers. Results from studies that included parents of children younger than 5 have had varied findings, including finding stress to be higher for parents of children with severe-to-profound hearing loss (N = 20) compared with parents of children with normal hearing (N = 20; Meadow-Orlans 1995); finding that stress decreased over time (N = 23; Lederberg & Golbach 2002), and finding that stress in mothers of children with mild-to-profound degrees of hearing loss (N = 184) was not higher than mothers of children with normal hearing (Pipp-Siegel et al. 2002). The influence of parental psychosocial well-being on daily management for children with hearing loss has not been addressed.
PROFESSIONAL SUPPORT Parents of children with disabilities have indicated that professionals provide an important source of support. Lindblad et al. (2005) conducted a qualitative study with 10 families of children with severe disabilities to explore parental perceptions of professional support. They found that professionals have the responsibility to aid parents in gaining confidence and have an influential and important role in providing support to parents of a child with a disability. In a qualitative study of 10 parents of children with hearing loss (Fitzpatrick et al. 2008), parents expressed that support from professionals and other parents was important. The ability to routinely identify hearing loss, fit hearing aids, and begin early intervention (EI) in infancy is relatively new. Because of newborn hearing screening programs, audiologists and other hearing care professionals are regularly working with families beginning earlier in a child’s life, and are also working
with families that did not suspect their child had a hearing loss and are emotionally unprepared for the changes the diagnosis brings to their family life. There are no studies related to how hearing aid management experiences and challenges may differ between mothers and fathers even though both parents are often involved in the care of the child. It was predicted that fathers' experiences and perceptions would tend to differ from mothers' because mothers are more frequently the primary caregiver during the early years of the children's lives. Consistent use of hearing aids is critical for optimizing spoken language development. For this reason, the aim of this study was to investigate challenges experienced by mothers and fathers related to confidence with skills, perception of benefit, hearing aid management, and the influence of challenges on hearing aid use, as well as parental psychosocial characteristics during the first 3 years of life for children who have hearing loss.
MATERIALS AND METHODS This study used a cross-sectional survey design. Utah State University Institutional Review Board Approval was obtained and parents received a letter of information with the study materials.
Instruments The study included the following four questionnaires: Family demographic form: It was used to obtain demographic information (e.g., age, ethnicity, parent educational level, family income). Parent Hearing Aid Management Inventory (PHAMI): It explored parent access to information and experiences in four domains such as (1) parent confidence in performing skills, (2) expectations, (3) communication with the audiologist, and (4) hearing aid use challenges (the PHAMI was developed for this study, see Supplemental Appendix A [http://links.lww.com/EANDH/A169] for more details). Acceptance and Action Questionnaire ([AAQ-II], Bond et al. 2011): A 7-item questionnaire designed to measure an individual’s psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual’s ability to take value-based actions. Patient Health Questionnaire ([PHQ-9], Pfizer 1999): A 9-item questionnaire designed to identify symptoms of depression.
Participants and Recruitment Eighty English-speaking families with children aged from birth to 3 years with bilateral hearing loss who were using hearing aids were recruited, 50 from Indiana and 30 from Utah, through state EI agencies where they were receiving services. A recruitment flyer and letter of information were included with the materials mailed to the participants. Study packets included forms for both the mother and father to complete. As an incentive, a $10 bill was included in the packet for their time to complete the questionnaires. Parent responses were anonymous and returned via postage-paid envelopes provided in the packet. Of the 80 packets mailed, 12 no longer had a valid address and were
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returned, resulting in delivery of 68 packets. Usable responses were received from 37 families (35 mothers and 20 fathers) for a response rate of 54%. Four parents did not return a completed demographic form.
Procedures Packets containing one family demographic form and two sets (one for the mother and one for the father) of the other three questionnaires (i.e., PHAMI, AAQ-II, and PHQ-9) were mailed to the state EI coordinators. The EI coordinator randomly selected families that met the inclusion criteria (i.e., child aged birth to 3 years, bilateral hearing loss, fitted with hearing aids, and English spoken in the home), labeled the packets, and mailed the packets to the families. Parents completed the forms and returned them to the researcher in a postage-paid envelope. The EI coordinator mailed a reminder post card to the recruited families 2 weeks after the initial packets were mailed.
Analysis The data were coded and double entered into an excel spreadsheet by two different individuals, compared for discrepancies, and discrepancies were remedied by the researcher in the final data set. Descriptive statistics were calculated using SPSS (v21) and descriptive statistics were used to identify trends. Results were analyzed to determine if there were differences between mothers and fathers. Internal consistency was calculated using Cronbach’s alpha for scales in the PHAMI.
RESULTS Responses for this study were primarily for parents of toddlers (M = 22 months; SD = 8.07; range: 0 to 22 months) who had experience with hearing aids (M = 15 months; SD = 8.70; range: 1–31 months). Information about the presence of multiple disabilities and degree of hearing loss was not collected. It is important to note that the majority of responses for the present study were for Caucasian children of college-educated parents, living in two-parent homes with spoken language as the primary mode of communication. Table 1 summarizes information for families that completed the demographic form. Even though each parent completed a separate questionnaire, it was not known whether parents completed the questionnaires together or independently. Both mothers and fathers were included to investigate how perspectives about hearing aid management may have differed. Results were analyzed separately for mothers and fathers as groups and as natural dyads in the same household. Additional considerations that may influence responses include the parents’ ability to accurately recall how they received information, what information was given, and that information may have been received from other sources not reflected on the questionnaire. Differences in responses between mothers and fathers were determined based on mean differences. When the 95% confidence interval did not include zero, the difference between mothers and fathers were statistically significant at p ≤ 0.05. The magnitude of the differences between mothers and fathers was determined using Cohen’s d, where a small effect is considered 0.20, a medium effect 0.50, and a large effect 0.80. Statistically significant results are described, and all results are reported in the tables.
TABLE 1. Family demographics Demographic Variables
% (N)
Child Female Current age (in mo) Age hearing loss confirmed Age hearing aids fitted Child’s primary mode of communication Spoken language Sign language Spoken language and sign language Child’s ethnicity Caucasian Other/multicultural Primary caregiver Mother Father Mother and father Other Language spoken in home English Family members with hearing loss None Sibling Parent Other Number of children in home One or two Three or more Child lives with Both parents Mother’s educational level High school degree or less Some college or college degree Father’s educational level High school degree or less Some college or college degree Family annual income Less than 20,000 20,000–40,000 41,000–80,000 More than 80,000
89 (33) 42 (14)
M (SD)
22 (8.07) 3 (5.69) 7 (6.40)
73 (24) 15 (5) 12 (4)
91 (30) 9 (3) 33 (11) 3 (1) 55 (18) 9 (3) 82 (27) 63 (20) 13 (4) 6 (2) 18 (6) 58 (19) 42 (14) 85 (28) 15 (5) 85 (28) 24 (7) 76 (22) 6 (2) 31 (10) 41 (13) 22 (7)
Sources of Instruction After the diagnosis of a child’s hearing loss, parents need a foundation of knowledge and skills from which to learn how to manage their child’s hearing aids. Parents’ responses to the PHAMI indicated their recall of who provided information and how it was given. Information Regarding Hearing Loss/Hearing Aids • Parents were asked to report the sources for the information they received (i.e., audiologist, other provider, a parent, not provided) on a list of 10 items related to hearing loss and hearing aids (see questionnaire, Supplemental Appendix B [http:// links.lww.com/EANDH/A170]). There were no statistically significant differences between mothers and fathers for the extent of information received from each source (see Table 2). There were also no differences between mothers and fathers in the same household (n = 15).
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Overall, parents reported audiologists were their primary source for information; however, 30% did not remember receiving information regarding necessary referrals (e.g., medical specialists, EI) or hearing aid wear schedule from their audiologist. Parents reported other providers were a common source of information regarding referrals and developmental milestones; however, only 31% recalled receiving information about daily hearing aid use from other providers, and 15% of parents reported not being given information about hearing aid use from any source. Almost half of the parents (43%) reported they were not given information about other types of hearing devices (e.g., FM systems, cochlear implants). Hearing Aid Management Skills • Parents were asked to report who taught them specific skills (i.e., audiologist, other provider, a parent, not provided) from a list of 13 items (see Supplemental Appendix B [http://links.lww.com/EANDH/ A170]). There were statistically significant differences between mothers and fathers related to the source for learning skills, revealing mothers received more instruction from audiologists (d = 0.69) and other providers (d = 0.60) than did fathers, and more fathers than mothers reported learning skills from another parent (d = 0.81) (see Table 2). Overall, parents reported that audiologists were their primary source for learning skills. Some parents, however, reported certain skills were not taught by their audiologist, including how to troubleshoot hearing aids (64%; n = 55), how to do a Ling 6 Sound Test (41%; n = 54), how to teach others to perform a hearing aid listening check (43%; n = 53), how to teach others to insert their child’s hearing aids (56%; n = 55), and emphasizing the importance of hearing aid use to others (67%; n = 54). Parents reported that other providers infrequently taught them hearing aid management skills (
Objectives: The aim of this study was to investigate parent-reported challenges related to hearing aid management and parental psychosocial characteristics during the first 3 years of the child’s life.
(Ear & Hearing 2015;36;279–287)
Design: Using a cross-sectional survey design, surveys were distributed to parents of children with hearing loss via state Early Intervention programs in Utah and Indiana. Packets contained one family demographic form and two sets of three questionnaires to obtain responses from mothers and fathers separately: the Parent Hearing Aid Management Inventory explored parent access to information, parent confidence in performing skills, expectations, communication with the audiologist, and hearing aid use challenges. The Acceptance and Action Questionnaire measured psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual’s ability to take value-based actions. The Patient Health Questionnaire identified symptoms of depression. Thirty-seven families completed questionnaires (35 mothers and 20 fathers).
INTRODUCTION Practice recommendations indicate infants with hearing loss should be identified and receiving intervention services before 6 months of age (Joint Committee on Infant Hearing 2007). Although benchmarks for timeliness of services are being met more frequently (Centers for Disease Control and Prevention 2011; Muñoz et al. 2013), many families still encounter challenges accessing needed services (Holte et al. 2012). When children receive effective intervention following early identification they have opportunities to develop language on par with their normal-hearing peers. In addition to services from professionals with expertise in childhood hearing loss, parents play a critical role in optimizing developmental outcomes during the intervention process. Parent understanding about how hearing loss affects child development, the intervention needed, and how to integrate new skills related to managing the child’s hearing loss into daily routines is critical for effective management and language development. However, parents may experience difficulties in integrating new skills into their daily lives for a variety of reasons. Both fathers and mothers have integral roles in caring for their child’s needs. To provide family-centered services, it is important to understand the perspectives of each parent. Because effective use of hearing aids is foundation for spoken language development, understanding parent challenges with hearing aid management, and their psychosocial experiences when hearing aids are fitted in early childhood can help audiologists and other healthcare professionals to better support families. Before the widespread implementation of newborn hearing screening, children with hearing loss were often not identified until close to 2 years of age (Young & Tattersall 2007) when parents became worried about delays in the child’s speech and language development. The implementation of state Early Hearing Detection and Intervention programs over the past 15 years has led to a decrease in the age of hearing loss identification from 2.5 years to 2 to 3 months (White et al. 2010). As a result, parents are frequently given the news of their child’s hearing loss within the first few weeks of life. This process occurs before most parents are able to recognize a problem with their child’s hearing based on behavioral reactions to sound or delays in development. Identification of hearing loss can lead to feelings of grief for many parents (Kurtzer-White & Luterman 2003), affecting their ability to follow through and manage needs related to their child’s hearing loss. However, people experience grief in different ways, and gender role socialization is one influential factor (Martin & Doka 2000). Awareness of parent
Results: Most responses were parents of toddlers (M = 22 months) who had been wearing binaural hearing aids for an average of 15 months. Both mothers and fathers reported that even though the amount of information they received was overwhelming, most (84%) preferred to have all the information at the beginning, rather than to receive it over an extended time period. Parents reported an array of challenges related to hearing aid management, with the majority related to daily management, hearing aid use, and emotional adjustment. Sixty-six percent of parents reported an audiologist taught them how to complete a listening check using a stethoscope, however, only one-third reported doing a daily hearing aid listening check. Both mothers and fathers reported a wide range of variability in their confidence in performing activities related to hearing aid management, and most reported minimal confidence in their ability to troubleshoot hearing aid problems. More than half of the parents reported child behavior and activities, such as playing outside, as a major hearing aid use challenge. Parents reported hearing aids were worn all waking hours by 35% of children and less than 5 hr/day by 31%. Almost half of the parents (47%) did not feel that they had enough time to talk about their emotions when speaking with their audiologist(s), 69% reported the audiologist did not help them know what to expect related to emotions about their child’s hearing loss, and 22% reported symptoms of depression. Conclusions: Parents reported an array of challenges, even after their child had been wearing hearing aids for a prolonged time, revealing critical implications for how to provide audiological care. Audiologists have an important role in partnering with parents to identify and jointly problem-solving challenges related to their child’s hearing aid use. Supporting parents includes not only addressing technical aspects of hearing testing and hearing aid function but also addressing parent thoughts, feelings, and emotions.
Department of Communicative Disorders and Deaf Education, Utah State University, Logan, Utah, USA; 2National Center for Hearing Assessment and Management, Utah State University, Logan, Utah, USA; and 3Department of Psychology, Utah State University, Logan, Utah, USA. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com).
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experiences and perspectives and how they influence daily hearing aid management is central to audiologists’ ability to provide effective support, an area that has not previously been investigated with fathers.
PSYCHOSOCIAL CONSIDERATIONS Mothers of children with disabilities have been found to have an elevated risk of depression and increased distress (Singer 2006; Thurston et al. 2011). Singer (2006) found that 29% of mothers of children with developmental delays (N = 6641) exhibited elevated levels of depression symptoms, compared with 19% of mothers of children with no delay (N = 26,438). Thurston et al. (2011), in a study of families of children with various disabilities (N = 429), found that 42% of parents exhibited symptoms of depression, and recommended that rehabilitation efforts address parental mental health in addition to the child’s needs. Parents of children with disabilities often experience feelings of uncertainty about their child’s comfort, health and development, and how to ensure their child is being adequately represented (Stewart & Mishel 2000). Such feelings of uncertainty have been found to increase family distress and care burden (Garwick et al. 2002). Studies that have been done to investigate psychosocial experiences for parents of children with hearing loss are limited. Targeted participants in past research have included parents of school-aged children (Calderon & Greenberg 1999; Meinzen-Derr et al. 2008) and parents of children with severeto-profound hearing loss (Meadow-Orlans 1995; Calderon & Greenberg 1999; Lederberg & Golbach 2002), but the actual samples have included very few fathers. Results from studies that included parents of children younger than 5 have had varied findings, including finding stress to be higher for parents of children with severe-to-profound hearing loss (N = 20) compared with parents of children with normal hearing (N = 20; Meadow-Orlans 1995); finding that stress decreased over time (N = 23; Lederberg & Golbach 2002), and finding that stress in mothers of children with mild-to-profound degrees of hearing loss (N = 184) was not higher than mothers of children with normal hearing (Pipp-Siegel et al. 2002). The influence of parental psychosocial well-being on daily management for children with hearing loss has not been addressed.
PROFESSIONAL SUPPORT Parents of children with disabilities have indicated that professionals provide an important source of support. Lindblad et al. (2005) conducted a qualitative study with 10 families of children with severe disabilities to explore parental perceptions of professional support. They found that professionals have the responsibility to aid parents in gaining confidence and have an influential and important role in providing support to parents of a child with a disability. In a qualitative study of 10 parents of children with hearing loss (Fitzpatrick et al. 2008), parents expressed that support from professionals and other parents was important. The ability to routinely identify hearing loss, fit hearing aids, and begin early intervention (EI) in infancy is relatively new. Because of newborn hearing screening programs, audiologists and other hearing care professionals are regularly working with families beginning earlier in a child’s life, and are also working
with families that did not suspect their child had a hearing loss and are emotionally unprepared for the changes the diagnosis brings to their family life. There are no studies related to how hearing aid management experiences and challenges may differ between mothers and fathers even though both parents are often involved in the care of the child. It was predicted that fathers' experiences and perceptions would tend to differ from mothers' because mothers are more frequently the primary caregiver during the early years of the children's lives. Consistent use of hearing aids is critical for optimizing spoken language development. For this reason, the aim of this study was to investigate challenges experienced by mothers and fathers related to confidence with skills, perception of benefit, hearing aid management, and the influence of challenges on hearing aid use, as well as parental psychosocial characteristics during the first 3 years of life for children who have hearing loss.
MATERIALS AND METHODS This study used a cross-sectional survey design. Utah State University Institutional Review Board Approval was obtained and parents received a letter of information with the study materials.
Instruments The study included the following four questionnaires: Family demographic form: It was used to obtain demographic information (e.g., age, ethnicity, parent educational level, family income). Parent Hearing Aid Management Inventory (PHAMI): It explored parent access to information and experiences in four domains such as (1) parent confidence in performing skills, (2) expectations, (3) communication with the audiologist, and (4) hearing aid use challenges (the PHAMI was developed for this study, see Supplemental Appendix A [http://links.lww.com/EANDH/A169] for more details). Acceptance and Action Questionnaire ([AAQ-II], Bond et al. 2011): A 7-item questionnaire designed to measure an individual’s psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual’s ability to take value-based actions. Patient Health Questionnaire ([PHQ-9], Pfizer 1999): A 9-item questionnaire designed to identify symptoms of depression.
Participants and Recruitment Eighty English-speaking families with children aged from birth to 3 years with bilateral hearing loss who were using hearing aids were recruited, 50 from Indiana and 30 from Utah, through state EI agencies where they were receiving services. A recruitment flyer and letter of information were included with the materials mailed to the participants. Study packets included forms for both the mother and father to complete. As an incentive, a $10 bill was included in the packet for their time to complete the questionnaires. Parent responses were anonymous and returned via postage-paid envelopes provided in the packet. Of the 80 packets mailed, 12 no longer had a valid address and were
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returned, resulting in delivery of 68 packets. Usable responses were received from 37 families (35 mothers and 20 fathers) for a response rate of 54%. Four parents did not return a completed demographic form.
Procedures Packets containing one family demographic form and two sets (one for the mother and one for the father) of the other three questionnaires (i.e., PHAMI, AAQ-II, and PHQ-9) were mailed to the state EI coordinators. The EI coordinator randomly selected families that met the inclusion criteria (i.e., child aged birth to 3 years, bilateral hearing loss, fitted with hearing aids, and English spoken in the home), labeled the packets, and mailed the packets to the families. Parents completed the forms and returned them to the researcher in a postage-paid envelope. The EI coordinator mailed a reminder post card to the recruited families 2 weeks after the initial packets were mailed.
Analysis The data were coded and double entered into an excel spreadsheet by two different individuals, compared for discrepancies, and discrepancies were remedied by the researcher in the final data set. Descriptive statistics were calculated using SPSS (v21) and descriptive statistics were used to identify trends. Results were analyzed to determine if there were differences between mothers and fathers. Internal consistency was calculated using Cronbach’s alpha for scales in the PHAMI.
RESULTS Responses for this study were primarily for parents of toddlers (M = 22 months; SD = 8.07; range: 0 to 22 months) who had experience with hearing aids (M = 15 months; SD = 8.70; range: 1–31 months). Information about the presence of multiple disabilities and degree of hearing loss was not collected. It is important to note that the majority of responses for the present study were for Caucasian children of college-educated parents, living in two-parent homes with spoken language as the primary mode of communication. Table 1 summarizes information for families that completed the demographic form. Even though each parent completed a separate questionnaire, it was not known whether parents completed the questionnaires together or independently. Both mothers and fathers were included to investigate how perspectives about hearing aid management may have differed. Results were analyzed separately for mothers and fathers as groups and as natural dyads in the same household. Additional considerations that may influence responses include the parents’ ability to accurately recall how they received information, what information was given, and that information may have been received from other sources not reflected on the questionnaire. Differences in responses between mothers and fathers were determined based on mean differences. When the 95% confidence interval did not include zero, the difference between mothers and fathers were statistically significant at p ≤ 0.05. The magnitude of the differences between mothers and fathers was determined using Cohen’s d, where a small effect is considered 0.20, a medium effect 0.50, and a large effect 0.80. Statistically significant results are described, and all results are reported in the tables.
TABLE 1. Family demographics Demographic Variables
% (N)
Child Female Current age (in mo) Age hearing loss confirmed Age hearing aids fitted Child’s primary mode of communication Spoken language Sign language Spoken language and sign language Child’s ethnicity Caucasian Other/multicultural Primary caregiver Mother Father Mother and father Other Language spoken in home English Family members with hearing loss None Sibling Parent Other Number of children in home One or two Three or more Child lives with Both parents Mother’s educational level High school degree or less Some college or college degree Father’s educational level High school degree or less Some college or college degree Family annual income Less than 20,000 20,000–40,000 41,000–80,000 More than 80,000
89 (33) 42 (14)
M (SD)
22 (8.07) 3 (5.69) 7 (6.40)
73 (24) 15 (5) 12 (4)
91 (30) 9 (3) 33 (11) 3 (1) 55 (18) 9 (3) 82 (27) 63 (20) 13 (4) 6 (2) 18 (6) 58 (19) 42 (14) 85 (28) 15 (5) 85 (28) 24 (7) 76 (22) 6 (2) 31 (10) 41 (13) 22 (7)
Sources of Instruction After the diagnosis of a child’s hearing loss, parents need a foundation of knowledge and skills from which to learn how to manage their child’s hearing aids. Parents’ responses to the PHAMI indicated their recall of who provided information and how it was given. Information Regarding Hearing Loss/Hearing Aids • Parents were asked to report the sources for the information they received (i.e., audiologist, other provider, a parent, not provided) on a list of 10 items related to hearing loss and hearing aids (see questionnaire, Supplemental Appendix B [http:// links.lww.com/EANDH/A170]). There were no statistically significant differences between mothers and fathers for the extent of information received from each source (see Table 2). There were also no differences between mothers and fathers in the same household (n = 15).
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Overall, parents reported audiologists were their primary source for information; however, 30% did not remember receiving information regarding necessary referrals (e.g., medical specialists, EI) or hearing aid wear schedule from their audiologist. Parents reported other providers were a common source of information regarding referrals and developmental milestones; however, only 31% recalled receiving information about daily hearing aid use from other providers, and 15% of parents reported not being given information about hearing aid use from any source. Almost half of the parents (43%) reported they were not given information about other types of hearing devices (e.g., FM systems, cochlear implants). Hearing Aid Management Skills • Parents were asked to report who taught them specific skills (i.e., audiologist, other provider, a parent, not provided) from a list of 13 items (see Supplemental Appendix B [http://links.lww.com/EANDH/ A170]). There were statistically significant differences between mothers and fathers related to the source for learning skills, revealing mothers received more instruction from audiologists (d = 0.69) and other providers (d = 0.60) than did fathers, and more fathers than mothers reported learning skills from another parent (d = 0.81) (see Table 2). Overall, parents reported that audiologists were their primary source for learning skills. Some parents, however, reported certain skills were not taught by their audiologist, including how to troubleshoot hearing aids (64%; n = 55), how to do a Ling 6 Sound Test (41%; n = 54), how to teach others to perform a hearing aid listening check (43%; n = 53), how to teach others to insert their child’s hearing aids (56%; n = 55), and emphasizing the importance of hearing aid use to others (67%; n = 54). Parents reported that other providers infrequently taught them hearing aid management skills (
