The VA spends over 100 million dollars each year on hearing aids, as a means of addressing the hearing- related problems experienced by many of our Veterans. Despite these expenditures, a number of Veterans do not use their hearing aids consistently. Poor adherence to treatment recommendations is not unique to audiology. Most healthcare interventions for chronic conditions, including using hearing aids, require a patient to make behavioral changes in their lifestyle. Other healthcare fields have established theories to explain how people change their behaviors and have developed tools to help patients through the process. The World Health Organization (WHO, 2012) recently advocated three well-established approaches to health behavior change: the Transtheoretical Stages-of-Change Model (Prochaska & DiClemente, 1984), Decisional Balance (Janis & Mann, 1977), and motivational interviewing (Miller & Rollnick, 2002). They, in conjunction with the Ida Institute, have operationalized these approaches for use in auditory rehabilitation by creating the circle, the box, and the line. The circle describes the stages of motivation to change behavior and gives strategies to support movement between the stages, the box is a matrix that asks the patient to list the pros and cons of making a change versus not making a change, and the line establishes readiness and self-efficacy regarding a behavioral change by using a visual-analog scale. While these three tools are promising, outcomes data regarding this application to auditory rehabilitation is needed. This proposal will explore the use of one of these tools, the line, presented in a manner consistent with motivational interviewing as a means for increasing hearing-aid use in previously unsuccessful hearing-aid users. This pilot investigation is geared towards identifying information crucial for conducting a large-scale randomized trial exploring the use of our proposed motivational intervention as a means for improving hearing- aid use, and potentially other patient outcomes. Pertinent information that will be collected includes quarterly recruitment rates, drop-out rates, outcome measures, effect sizes, and treatment fidelity. This study will be a randomized clinical trial, where unsuccessful first-time hearing aid users will be randomized to either receive our motivational intervention (treatment group) or to receive a standard-of care approach (control group). The treatment group will be introduced to the line in a manner that is consistent with motivational interviewing. Specifically, they will be asked two questions: 1) On a scale from 0 to 10, how important is it for you to improve your hearing right now?, and 2) On a scale from 0 to 10, how much do you believe in your ability to use hearing aids? These questions will be used to help the audiologist uncover the patient's readiness and motivation for change as well as the barriers that need to be removed to make and sustain a change. The audiologist and the subject will then work collaboratively to develop strategies to overcome the patient's stated barriers and a patient-specific treatment plan for increasing hearing-aid use will be developed and implemented. The control group, on the other hand, will review and practice material from a standard hearing-aid booklet with an audiologist. Both interventions will occur during a one-hour visit to the National Center for Rehabilitative Auditory Research. Outcome measures will include an assessment of hearing-aid use, a hearing-aid outcome questionnaire, an assessment of importance and readiness to change, two self-efficacy questionnaires, and an open-ended interview. Treatment fidelity also will be assessed using the Motivational Interviewing Treatment Integrity 3.1.1 (Moyers, Martin, Manuel, Miller & Ernst, 2010). The motivational intervention used in this study has the potential to increase a patient's use of their hearing aids. It also has the potential to improve hearing-aid outcomes. This is likely to occur because of the intervention's impact on importance, readiness for change, and self-efficacy. If successful, this intervention approach can be transitioned easily into the clinical environment resulting in immediate benefits for Veterans.
Hearing loss is the second most prevalent individual service-connected disability among Veterans receiving compensation from the Veterans Benefits Administration. 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 them successfully. Recently, the World Health Organization and the Ida Institute have proposed the use of motivational tools as a means to help a patient make the behavioral changes necessary for positive hearing-aid use. This pilot proposal will provide an initial evaluation of the efficacy of using one of these motivational tools post hearing-aid fitting with Veterans that are having problems adjusting to and using their new hearing aids. The goal of this intervention is to increase their use of hearing aids, as well as improve other outcomes related to hearing-aid use. Treatment fidelity also will be monitored and assessed. A multi-site clinical trial will follow.
