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Stages of Change in Adults With Acquired Hearing Impairment Seeking Help for the First Time: Application of the Transtheoretical Model in Audiologic Rehabilitation

Laplante-Lévesque, Ariane1,2; Hickson, Louise1; Worrall, Linda1

doi: 10.1097/AUD.0b013e3182772c49
Research Articles

Objectives: This study investigated the application of the transtheoretical (stages-of-change) model in audiologic rehabilitation. More specifically, it described the University of Rhode Island Change Assessment (URICA) scores of adults with acquired hearing impairment. It reported the psychometric properties (construct, concurrent, and predictive validity) of the stages-of-change model in this population.

Design: At baseline, 153 adults with acquired hearing impairment seeking help for the first time completed the URICA as well as measures of degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Participants were subsequently offered intervention options: hearing aids, communication programs, and no intervention. Their intervention uptake and adherence were assessed 6 months later and their intervention outcomes were assessed 3 months after intervention completion. First, the stages-of-change construct validity was evaluated by investigating the URICA factor structure (principal component analysis), internal consistency, and correlations between stage scores. The URICA scores were reported in terms of the scores for each stage of change, composite scores, stages with highest scores, and stage clusters (cluster analysis). Second, the concurrent validity was assessed by examining associations between stages of change and degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Third, the predictive validity was evaluated by investigating associations between stages of change and intervention uptake, adherence, and outcomes.

Results: First, in terms of construct validity, the principal component analysis identified four instead of three stages (precontemplation, contemplation, preparation, and action) for which the internal consistency was good. Most of the sample was in the action stage. Correlations between stage scores supported the model. Cluster analysis identified four stages-of-change clusters, which the authors named active change, initiation, disengagement, and ambivalence. In terms of concurrent validity, participants who reported a more advanced stage of change had a more severe hearing impairment, reported greater hearing disability, and had a hearing impairment for a longer period of time. In terms of predictive validity, participants who reported a more advanced stage of change were more likely to take up an intervention and to report successful intervention outcomes. However, stages of change did not predict intervention adherence.

Conclusions: The majority of the sample was in the action stage. The construct, concurrent, and predictive validity of the stages-of-change model were good. The stages-of-change model has some validity in the rehabilitation of adults with hearing impairment. The data support that change might be better represented on a continuum rather than by movement from one step to the next. Of all the measures, the precontemplation stage score had the best concurrent and predictive validity. Therefore, further research should focus on addressing the precontemplation stage with a measure suitable for clinical use.

The application of the transtheoretical (stages-of-change) model in audiologic rehabilitation was investigated. The psychometric properties of the University of Rhode Island Change Assessment (URICA) were investigated in 153 adults with acquired hearing impairment seeking help for the first time. This article depicts stages of change and reports their construct validity. It describes concurrent validity: associations between URICA scores and degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. It also describes predictive validity: associations between URICA scores and intervention uptake, adherence, and outcomes (assessed longitudinally). The model’s construct, concurrent, and predictive validity are good.

1School of Health and Rehabilitation Sciences, University of Queensland, Australia; and 2Eriksholm Research Centre, Oticon, Denmark.

ACKNOWLEDGMENTS: The authors sincerely thank the Office of Hearing Services of the Australian government’s Department of Health and Ageing for their recruitment assistance and the study participants for their enthusiasm. Asad Khan provided statistical advice, Michelle Nicholls and Tamar Philp assisted with data collection, Martin Rune Andersen assisted with figure preparation, and Thomas Lunner provided input on an earlier version of this article.

The first author acknowledges the financial support of the Australian Department of Education, Science, and Training.

The authors declare no conflict of interest.

Address for correspondence: Ariane Laplante-Lévesque, Eriksholm Research Centre, Oticon A/S, Rørtangvej 20, Snekkersten, 3070, Denmark. E-mail: arl@eriksholm.com

Received February 15, 2012

Accepted September 23, 2012

© 2013 by Lippincott Williams & Wilkins