As audiologists, we deal with hearing aids day in and day out—but do we get too used to dealing with them and forget what it's like for a patient who has most likely never even seen one before? While clinicians are primarily responsible for selecting and programming hearing aids, the hearing aid owner is responsible for the ongoing use, handling, maintenance, care, and overall management of the device. Many patients leave the clinic with instructions that can be overwhelming or easily forgotten before they get home. The responsibility of ensuring that patients wear their hearing aids and get long-term assistance sits with audiologists, and admittedly, this can be difficult in the hustle and bustle of having a clinic.
Hearing aid training for patients is a vital component of audiology care and rehabilitation. You may nod and say, “Yes, I know and provide it to my patients!” However, it has been reported that the amount of time spent on hearing aid training during clinical consultations is limited, with hearing aid owners reporting having received less than one hour of hearing aid-related counseling during their entire rehabilitation program.1 Furthermore, much of the hearing aid information is delivered verbally, with hearing aid owners unable to recall up to 65 percent of the information provided during the consultation.2 It is therefore not surprising that up to 90 percent of hearing aid owners have difficulties with basic hearing aid management tasks.3 Such poor hearing aid knowledge and management skills are likely influenced by the variance in quality, mode of delivery, and extent of hearing aid training provided by clinicians. Although previous studies have described some aspects of the skill and knowledge required for hearing aid management, it was only recently that a comprehensive list of the knowledge, skills, and tasks required for hearing aid management was generated.4 Having a better understanding of the depth and breadth of knowledge and skills required for successful hearing aid use can assist clinicians in improving the delivery of hearing aid training.
IDENTIFYING DEVICE MANAGEMENT SKILLS
This study used a group concept mapping approach to ask the participants (24 hearing aid owners and 22 hearing health care clinicians), “What must hearing aid owners do in order to use, handle, manage, maintain, and care for their hearing aids?” Participants identified 111 unique items that described hearing aid management, highlighting the magnitude of information that clinicians need to impart and patients are expected to learn when obtaining hearing aids. The participants’ responses varied in nature; some were knowledge-based (e.g., “know to put the whisker [retention line] in the ear and not to leave it hanging out”), task-based (e.g., “learn how to use the volume control”), and others were psychosocial (e.g., “develop confidence in own ability to manage hearing aids” and “be aware of the limitations of hearing aids and have realistic expectations from the outset”).
Each participant grouped the statements, which were then explored using hierarchical cluster analysis to generate concept maps of the grouped data. Six concepts that described hearing aid management skills were identified: (1) daily hearing aid use, (2) hearing aid maintenance and repairs, (3) learning to come to terms with hearing aids, (4) communication strategies; (5) working with your clinician, and (6) advanced hearing aid knowledge (see Table 1 online: http://bit.ly/2EXvwsZ). These concepts described not only the physical management of hearing aids but also the changes required in emotional and behavioral approaches associated with hearing aid use. This underlines the importance of giving attention to the patient themselves and not focusing too intently on the device when providing audiological rehabilitation.
Participants were also asked to rate the importance of each statement to the overall success with hearing aids from 1 (minimally important) to 5 (extremely important). The mean ratings for the importance of each individual statement ranged from 2.55 to 4.74, indicating that patients considered all statements to be important. Notably, the opinions of clinicians on the importance of each statement did not vary from those of hearing aid owners, except on one concept: Clinicians considered advanced hearing aid knowledge to be significantly less important than the other five concepts (Fig. 1). It is possible that due to the large amount of information and training that audiologists are expected to administer in a very short period, clinicians make a judgement call as to which hearing aid owners require certain types of information or training and which do not. Therefore, advanced hearing aid knowledge may serve as extra information that some hearing aid owners do not receive but would like to. These findings are consistent with previous qualitative studies wherein hearing aid owners described receiving insufficient information.
STRATEGIES FOR CLINICIANS
The hearing aid management tasks identified in this study serve as a reminder to clinicians of the enormous amount of information that patients are expected to know during the rehabilitation process. Although it is not surprising that patients have varied preference for the amount of information and level of detail or technicality they would want to know, the study results support the need for a patient-centered approach to providing information.
Clinicians could improve the transfer of hearing aid knowledge by asking patients about the amount of detail they want to know and their preferred mode of delivery. Clinicians should also check if they understand what is being discussed, then provide written information using simple language.
Clinicians are urged to evaluate their clinical practices and consider including checklists, alternative training methods, supplemental materials, and modes of skill evaluation to address the hearing aid management deficits that have been observed in clinical studies. Alternative training methods may include group training,5 use of recorded electronic materials,6 and online training programs.7
Providing hearing aid management training is only half the equation. The ultimate goal is for the hearing aid owner to learn the skills and knowledge the clinician wants to impart. The only way for the clinician to know whether the training was effective is to assess the hearing aid owners’ level of knowledge and skill relating to hearing aid management, which can be done using self- and clinician-administered surveys.8 A self-administered survey, such as the Hearing Aid Skills and Knowledge Inventory (HASKI), may reduce clinical load, save consultation time, and facilitate more frequent use of their hearing aid than face-to-face consultations allow. For example, completing a self-report survey on hearing aid handling skills in the weeks or months following hearing aid acquisition may identify gaps in skills that were not acquired by the user. Furthermore, completing a self-report survey on handling skills at intervals over an extended period of time following hearing aid acquisition may identify age-related changes in hearing aid handling skills, such as those arising from reduced cognitive function, vision, or finger dexterity. It may also identify changing requirements, such as new listening situations or connectivity to newly acquired devices.
The importance of good hearing aid management skills is evidenced by their association with patients’ improved hearing aid use9 and higher self-reported benefits and satisfaction from hearing aids.10 These findings indicate that clinicians are key to improving patients’ hearing aid outcomes by addressing hearing aid management deficits and emphasizing the importance of effective hearing aid training during the aural rehabilitation program.
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1. Kochkin, S., Beck, D., Christensen, L., Compton-Conley, C., Fligor, B., Kricos, P., Turner, R. (2012). MarkeTrak VIII: The impact of the hearing healthcare professional on hearing aid user success. The Hearing Review
2. El-Molla, F., Smith, Z., Henshaw, H., & Ferguson, M. (2012). Retention of rehabilitation information by first-time hearing aid users with and without interactive patient information. Paper presented at the meeting of the British Academy of Audiology, Manchester, United Kingdom.
3. Bennett, R. J., Meyer, C., Taljaard, D. S., & Eikelboom, R. H. (2017). Are hearing aid owners able to identify and self-report handling difficulties? A pilot study. International Journal of Audiology
4. Bennett, R. J., Meyer, C. J., Eikelboom, R. H., Taljaard, D. S., & Atlas, M. D. (2018a). Investigating what hearing aid owners do in order to use, handle, manage, maintain and care for their hearing aids: perspectives of clinicians and hearing aid owners. American Journal of Audiology
5. Abrahamson, J. (2000). Group audiologic rehabilitation. Paper presented at the Seminars in hearing.
6. Ferguson, M., Brandreth, M., Brassington, W., Leighton, P., & Wharrad, H. (2015). A Randomized Controlled Trial to Evaluate the Benefits of a Multimedia Educational Program for First-Time Hearing Aid Users. Ear and Hearing
7. Thorén, E. S., Oberg, M., Wanstrom, G., Andersson, G., & Lunner, T. (2014). A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users. Int J Audiol
, 53(7), 452-461.
8. Bennett, R. J., Meyer, C. J., Eikelboom, R. H., & Atlas, M. D. (2018b). Evaluating hearing aid management: Development and validation of the Hearing Aid Skills and Knowledge Inventory (HASKI). American Journal of Audiology
9. Kumar, M., Hickey, S., & Shaw, S. (2000). Manual dexterity and successful hearing aid use. J Laryngol Otol
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10. Bennett, R. J., Meyer, C. J., Eikelboom, R. H., Atlas, J. D., & Atlas, M. D. (2018c). Factors associated with self-reported hearing aid management skills and knowledge. American Journal of Audiology-accepted July 2018.