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Feasibility of Ecological Momentary Assessment of Hearing Difficulties Encountered by Hearing Aid Users

Galvez, Gino1; Turbin, Mitchel B.1; Thielman, Emily J.1; Istvan, Joseph A.1; Andrews, Judy A.2; Henry, James A.1,3

doi: 10.1097/AUD.0b013e3182498c41
Research Articles

Objectives: Measurement of outcomes has become increasingly important to assess the benefit of audiologic rehabilitation, including hearing aids, in adults. Data from questionnaires, however, are based on retrospective recall of events and experiences, and often can be inaccurate. Questionnaires also do not capture the daily variation that typically occurs in relevant events and experiences. Clinical researchers in a variety of fields have turned to a methodology known as ecological momentary assessment (EMA) to assess quotidian experiences associated with health problems. The objective of this study was to determine the feasibility of using EMA to obtain real-time responses from hearing aid users describing their experiences with challenging hearing situations.

Design: This study required three phases: (1) develop EMA methodology to assess hearing difficulties experienced by hearing aid users; (2) make use of focus groups to refine the methodology; and (3) test the methodology with 24 hearing aid users. Phase 3 participants carried a personal digital assistant 12 hr per day for 2 weeks. The personal digital assistant alerted participants to respond to questions four times a day. Each assessment started with a question to determine whether a hearing problem was experienced since the last alert. If “yes,” then up to 23 questions (depending on contingent response branching) obtained details about the situation. If “no,” then up to 11 questions obtained information that would help to explain why hearing was not a problem. Each participant completed the Hearing Handicap Inventory for the Elderly (HHIE) both before and after the 2-week EMA testing period to evaluate for “reactivity” (exacerbation of self-perceived hearing problems that could result from the repeated assessments).

Results: Participants responded to the alerts with a 77% compliance rate, providing a total of 991 completed momentary assessments (mean = 43.1 per participant). A substantial amount of data were obtained with the methodology. It is important to note that participants reported a “hearing problem situation since the last alert” 37.6% of the time (372 responses). The most common problem situation involved “face-to-face conversation” (53.8% of the time). The next most common problem situation was “telephone conversation” (17.2%) followed by “TV, radio, iPod, etc.” (15.3%), “environmental sounds” (9.7%), and “movies, lecture, etc.” (4.0%). Comparison of pre- and post-EMA mean HHIE scores revealed no significant difference (p > 0.05), indicating that reactivity did not occur for this group. It should be noted, however, that 37.5% of participants reported a greater sense of awareness regarding their hearing loss and use of hearing aids.

Conclusions: Results showed participants were compliant, gave positive feedback, and did not demonstrate reactivity based on pre- and post-HHIE scores. We conclude that EMA methodology is feasible with patients who use hearing aids and could potentially inform hearing healthcare (HHC) services. The next step is to develop and evaluate EMA protocols that provide detailed daily patient information to audiologists at each stage of HHC. The advantages of such an approach would be to obtain real-life outcome measures, and to determine within- and between-day variability in outcomes and associated factors. Such information at present is not available from patients who seek and use HHC services.

The use of questionnaires to measure audiologic rehabilitation outcomes can often be inaccurate because of retrospective recall of events and experiences. Ecological momentary assessment (EMA) is a methodological approach that can alleviate biases because participants are asked about immediate experiences in their natural environment. The objective of this feasibility study was to examine the applications of EMA to the evaluation of hearing difficulties encountered by hearing aid users. Twenty-four participants carried a personal digital assistant that was pro-grammed to perform EMA four times per day for 14 days. Results indicate that EMA methodology is feasible with hearing aid users.Supplemental Digital Content is available in the text.

1VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, Oregon; 2Oregon Research Institute, Eugene, Oregon; and 3Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon.

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 (

The authors thank Erin Conner for her work as a research assistant during the first half of this project. Administrative support and facilities were provided by VA National Center for Rehabilitative Auditory Research, Portland, Oregon; and by Oregon Health & Science University, Portland, Oregon.

A research grant was received from the National Institute on Deafness and Other Communications Disorders (R03DC009012). Research Career Scientist Award from VA Rehabilitation Research and Development Service (to J.A.H.; F7070S). The Rehabilitation Research Disability Supplement Award was received from VA Rehabilitation Research and Development Service (to M.B.T.; C3128I).

The contents of this report do not represent the views of the Department of Veterans Affairs or of the U.S. Government.

Address for Correspondence: James A. Henry, VA Medical Center, P.O. Box 1034, Portland, OR 97207, USA. E-mail:

Received June 2, 2011

Accepted December 20, 2011

© 2012 Lippincott Williams & Wilkins, Inc.