Despite evidence that hearing aids provide benefit for hearing-impaired individuals, and that untreated hearing loss can have negative consequences, many individuals use their hearing aids less than is considered optimal. Studies indicate that an inability to use the hearing aids, i part, underlies this problem. This inability may stem from a lack of knowledge or a physical limitation, such as poor vision or manual dexterity. Either way, studies indicate that the current process for teaching hearing-aid users about their hearing aids (known as hearing-aid orientation, HAO), may be inadequate. Recognizing this problem, our long-term goal is to improve the delivery of HAO information by developing tools that use established principles for good patient-provider communication. These tools will therefore be appropriate for the 1/3 of US individuals who have basic or below basic health literacy, and for individuals with age-related vision, dexterity, and learning and memory limitations. For this study, three tools will be developed and evaluated: (1) a written Hearing Aid Information Guide (HAIG) targeted to the individual's hearing-aid style and settings, (2) a take-home hearing-aid-orientation DVD (HAO DVD), and (3) the teach-back technique through which the provider can confirm the patient understands and can conduct hearing-aid-management tasks (TBT). Using a comparative effectiveness research framework, the study will compare the relative effectiveness of the three tools with the standard-of-care (SoC) HAO. Outcomes to be examined are the ability to manage and use hearing aids (primary outcome), knowledge about hearing-aid management and use, hearing-aid self-efficacy, and overall hearing-aid outcome (secondary outcomes). To this end, Veterans who are about to become first-time hearing-aid users will be recruited from the Portland VA Medical Center's Audiology Clinic. At a research visit that will take place prior to participants receiving their hearing aids, participants will complete assessments of health literacy, manual dexterity and hepatic sensitivity, visual acuity, and learning and memory. These measures will be used as potential predictors/covariates of outcome. Participants will then attend their hearing-aid-fitting appointment at the audiology clinic and will receive the SoC HAO from a clinical audiologist. At the end of that appointment, they will be assigned to one of the four study arms and will receive that intervention: (1) SoC alone, (2) SoC + HAIG, (3) SoC + HAO DVD, or (4) SoC + TBT. Four weeks later, participants will attend a second research visit at which outcomes will be assessed using the Practical Hearing Aid Skills Test-Revised (Doherty&Desjardins, 2012) to assess actual ability to manage hearing aids (primary outcome measure), the Hearing Aid Probed Recall Inventory (Reese &Smith, 2006) to assess HAO knowledge, the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (West &Smith, 2007) to assess hearing-aid self efficacy, and the International Outcome Inventory for Hearing Aids (Cox et al., 2000) to assess overall hearing-aid outcome (secondary outcome measures). They will also be interviewed to we can learn their opinions about the intervention they received, as well as the other interventions. The long-term goal of this project is to improve the delivery of HAO information. Each of the proposed HAO tools will result in better hearing-aid outcomes than the current standard of practice for HAO because they were developed using established guidelines for patient-provider communication. If this is true, the tools can be transitioned easily into the clinical environment, resulting in immediate benefits for our Veterans This information will help us determine which tool(s) should be further developed, evaluated, and used to create best practices for HAO.

Public Health Relevance

Hearing loss is the second most prevalent service-connected disability among Veterans. Hearing aids are the most common technological intervention for hearing loss. The VA, therefore, spends a considerable amount of money on them. Despite these expenditures, there are some Veterans who do not use their hearing aids successfully. Research has demonstrated that this inconsistent use may be related to a patient's inability to effectively take care of, and use, hearing aids. The proposed investigation will compare the effectiveness of three different tools for enhancing the educational efforts (hearing-aid orientation) typically provided by clinica audiologists when dispensing hearing aids. Each of these educational tools were developed using established methods for improving patient-provider communication. We hypothesize that the use of these tools will result in better hearing-aid outcomes for our Veteran patients than using the current standard-of-care procedures.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Sensory Systems/Communication (RRD3)
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Portland VA Medical Center
United States
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