Client involvement in health decision making, or shared decision making, is increasingly being advocated. For example, rehabilitation interventions such as hearing aids and communication programs can be presented as options to adults with hearing impairment seeking help for the first time. Our previous research focused on the predictors of intervention decisions when options were presented with a decision aid. However, not all participants took up the intervention they initially decided upon. Although it is interesting to understand what informs adults with hearing impairment's intervention decisions, it is their intervention uptake and outcomes which best represent the ultimate end result of the rehabilitation process. This prospective study investigated the predictors of uptake and of successful outcomes of hearing aids and communication programs in middle-aged and older adults with hearing impairment seeking help for the first time.
Using shared decision making, 153 participants with hearing impairment (average of air conduction thresholds at 0.5, 1, 2, and 4 kHz greater than 25 dB HL in at least one ear) aged 50 yr and older were presented with intervention options: hearing aids, communication programs (group or individual), and no intervention. Each participant received a decision aid and had at least 1 wk to consider intervention options before the intervention decision was made. Outcome measures for both hearing aids and communication programs at 3 mo after intervention completion were benefit (measured with the Client-Oriented Scale of Improvement), composite outcomes (measured with the International Outcome Inventory), and reduction in self-reported hearing disability (measured with the Hearing Handicap Questionnaire). Multivariate analysis (logistic and linear regression) identified predictors of intervention uptake and of successful outcomes when all other variables were held constant.
Almost a quarter of the 153 participants (24%) did not take up the intervention they initially decided upon: 6 mo after making their intervention decision, 66 participants (43%) obtained hearing aids, 28 participants (18%) completed communication programs, and 59 participants (39%) did not complete an intervention. Seven intervention uptake predictors were identified: (1) application for subsidized hearing services (participants more likely to obtain hearing aids and less likely to complete no intervention); (2) higher socioeconomic status (no intervention less likely); (3) greater communication self-efficacy (hearing aids less likely); (4) greater contemplation stage of change (no intervention less likely); (5) greater hearing disability perceived by others and self (communication programs less likely); (6) greater perceived communication program effectiveness (communication programs more likely); and (7) greater perceived suitability of individual communication program (hearing aids less likely and communication programs more likely). Six predictors of successful intervention outcomes were identified: (1) higher socioeconomic status; (2) greater initial self-reported hearing disability; (3) lower precontemplation stage of change; (4) greater action stage of change; (5) lower chance locus of control; and (6) greater hearing disability perceived by others and self.
Self-reported hearing disability and stages of change are the two most robust predictors of intervention uptake and successful outcomes. Clinicians should offer intervention options and should discuss these predictors when helping adults with hearing impairment make optimal decisions.