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Hearing in Real-Life Environments (HERE)

Structure and Reliability of a Questionnaire on Perceived Hearing for Older Adults

Heinrich, Antje1,2,5; Mikkola, Tuija M.3,5; Polku, Hannele4; Törmäkangas, Timo4; Viljanen, Anne4

doi: 10.1097/AUD.0000000000000622
Research Article

Objectives: The ability to hear in a variety of social situations and environments is vital for social participation and a high quality of life. One way to assess hearing ability is by means of self-report questionnaire. For questionnaires to be useful, their measurement properties, based on careful validation, have to be known. Only recently has consensus been reached concerning how to perform such validation and been published as COSMIN (consensus-based standards for the selection of health status measurement instruments) guidelines. Here the authors use these guidelines to evaluate the measurement properties of the “Hearing in Real-Life Environments” (HERE) questionnaire, a newly developed self-report measure that assesses speech perception, spatial orientation, and the social-emotional consequences of hearing impairment in older adults. The aim is to illustrate the process of validation and encourage similar examinations of other frequently used questionnaires.

Design: The HERE questionnaire includes 15 items with a numeric rating scale from 0 to 10 for each item and allows the assessment of hearing with and without hearing aids. The evaluation was performed in two cohorts of community-dwelling older adults from Finland (n = 581, mean 82 years) and the United Kingdom (n = 50, mean 69 years). The internal structure of the questionnaire and its relationship to age, hearing level, and self-reported and behavioral measures of speech perception was assessed and, when possible, compared between cohorts.

Results: The results of the factor analysis showed that the HERE’s internal structure was similar across cohorts. In both cohorts, the factor analysis showed a satisfactory solution for three factors (speech hearing, spatial hearing, and socio-emotional consequences), with a high internal consistency for each factor (Cronbach’s α’s for the factors from 0.90 to 0.97). Test–retest analysis showed the HERE overall mean score to be stable and highly replicable over time (intraclass correlation coefficient = 0.86, standard error of measurement of the test score = 0.92). The HERE overall mean score correlated highly with another self-report measure of speech perception, the Speech Spatial Qualities of Hearing questionnaire (standardized regression coefficient [β] = −0.75, p < 0.001), moderately highly with behaviorally assessed hearing level (best-ear average: β = 0.45 to 0.46), and moderately highly with behaviorally measured intelligibility of sentences in noise (β = −0.50, p < 0.001).

Conclusions: Using the COSMIN guidelines, the authors show that the HERE is a valid, reliable, and stable questionnaire for the assessment of self-reported speech perception, sound localization, and the socio-emotional consequences of hearing impairment in the context of social functioning. The authors also show that cross-cultural data collected using different data collection strategies can be combined with a range of statistical methods to validate a questionnaire.

1Medical Research Council Institute of Hearing Research, School of Medicine, The University of Nottingham, United Kingdom

2Manchester Centre for Audiology and Deafness, School of Health Sciences (ManCAD), University of Manchester, United Kingdom

3Folkhälsan Research Center, Helsinki, Finland

4Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Finland

5These Authors contributed equally to this work.

Received April 27, 2017; accepted April 23, 2018.

A. H. and T. M. M. contributed equally to this work.

This research was funded by grant BB/K021508/1 from the Biotechnology and Biological Sciences Research Council (to A. H.), grant U135097128 from the Medical Research Council (to A. H.), grant 263729 from the Academy of Finland (to A. V.), and from the Juho Vainio Foundation (to H. P.).

Part of the results were presented at Gerontologia 2017 in Turku, Finland.

The authors have no conflicts of interest to disclose.

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Address for correspondence: Antje Heinrich, Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, United Kingdom. E-mail:

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