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Photo-Sharing as an Audiological Rehabilitation Tool

Saunders, Gabrielle H. PhD

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doi: 10.1097/01.HJ.0000582436.09398.32
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EDITORS NOTE: If you are interested in receiving a photo-sharing toolkit, contact [email protected] with your name and mailing address.

Photo-sharing is the use of patients’ personal photos to facilitate communication, understand needs, and enhance audiological counseling. It is an adaptation of a method known as photovoice, which is used for community-based research and action.1 Specific to the practice of audiology in a world in which smartphone cameras are ubiquitous, photo-sharing can provide hearing care professionals (HCPs) with insight about a patient's lifestyle, communication priorities, and specific listening environments. It can help HCPs make patient-specific rehabilitation recommendations, including communication strategies tailored to the patient's own life. It can also help HCPs engage in patient-centered care by facilitating conversations about hearing and communication that are meaningful to the patient. For the patient, photo-sharing can promote self-reflection, increase awareness of successes and difficulties with hearing instruments and listening situations, and facilitate communication between the person with hearing loss and their family members about hearing-related challenges.

iStock/metamorworks, healthcare, photos, community

We recently illustrated these benefits in a feasibility study2 conducted at the National Center for Rehabilitative Auditory Research (NCRAR) in Portland, OR. We examined whether photo-sharing was helpful for: 1) facilitating provision of tailored communication strategies counseling, 2) post-fitting hearing aid counseling with new hearing aid users, and 3) enhancing communication between partners regarding the impacts of hearing loss. Participants in the study attended two research visits. During visit one, they were instructed on what photos to take and why. During visit two, the photographs were discussed during a debriefing session and used for counseling.

The photos that participants were requested to take differed by group. Those in group one were instructed to take photographs of situations in which they had encountered hearing difficulties, so we could discuss communication strategies to use in those situations. Participants in group two were asked to take photographs of typical daily activities in which they found their new hearing aids to be either particularly helpful or problematic. We used this information to troubleshoot specific listening problems, discuss communication strategies, and provide encouragement about successes with the hearing aids. The participants in group three and their communication partners were asked to take photographs that represented typical shared daily activities in which communication was a problem. Partners were instructed to take photographs independently so that the perspective of both individuals would be represented. We used the photos to compare perspectives and experiences and to provide problem-solving advice.


We learned a lot from the participants and the research team that conducted the study. For example:

  • Participants were very willing to take and share their own photos, sharing between four and 29 photos each.
  • Debriefing sessions can be very intense, with participants sharing highly personal reflections, some of which are hearing-related while others are beyond the scope of audiological practice.
  • Participants would be willing to share photos with their audiologist if they understood how and why doing so would help their auditory rehabilitation.
  • Participants gained insights by taking photos and, as a result, changed their behaviors. Specifically, photo-sharing:
    • enhanced participants’ appreciation of their hearing aids:
    • “What I found was that the sounds that were pleasant to me, and that I enjoyed, were mostly outside [sounds], and that surprised me.”
    • “It made me appreciate wearing my hearing aids more. There was a period where I was like ‘oh, I don't need them …’”
    • resulted in increased hearing aid use:
    • “… It made me realize that I had to wear them all the time, instead of like wear them three days and then don't wear them two days, and then wear them one day and then don't wear them two days.”
    • “I wore the hearing aids, which is something I was avoiding before.”
    • facilitated learning and problem-solving:
    • “It made you think a bit more … What the real challenges are, instead of just living those challenges.”
    • “It made me think about what areas I have problems hearing and what things could be done to help them out.”
    • enabled conversation with others about hearing loss:
    • “It made us (a couple in the study) actually think about… Did force us to think about more of the situations… it was positive because it gives us an opportunity to be more aware of what's going on and get some of our frustrations out in the open.”
    • “I enjoyed doing [the study] because I eventually told people what I was doing, I brought it up in conversation and then it helped create understanding and also people's willingness to bring something up that they might not have brought up…”


From the research team's perspective, we learned that photo-sharing helped them provide highly tailored counseling because the photos provided details about specific listening situations that are unavailable from verbal descriptions. For example, one participant shared a photograph of his wife sitting at the kitchen table, and noted he had difficulty hearing his wife at mealtimes. The photo showed her face was backlit because she was sitting in front of a window. The research audiologist explained that this made it difficult for the participant to see his wife's facial cues, and suggested they change their seating arrangement. This information would have been difficult, if not impossible, to obtain without the photograph.

Photo-sharing also provided the research team with immediate insights into each participant's lifestyle and listening priorities. This information should be used when selecting assistive technology. Specifically, some participants’ photos illustrated a varied and socially engaged lifestyle (photos of social gatherings, meals in restaurants, etc.). Some illustrated a solitary lifestyle (photos limited to the home and watching TV), while others illustrated a lifestyle that revolved around outdoor activities such as hiking, walking, and jogging.

The research team found photo-sharing to be helpful in facilitating communication between couples, allowing them to hear each other's perspectives in a safe environment. For example, one participant with hearing loss shared a photo of him and his wife in a restaurant. He said he shared it because it represented his problems hearing the wait staff and his reliance on his wife for assistance. His wife replied that he did indeed rely on her, and added that she felt uncomfortable in this role. Because the topic had never been discussed before, the husband was surprised. This provided an opportunity for the research audiologist to suggest that the husband should politely advocate for himself instead of relying on his wife.

The research team also highlighted additional points, which are perhaps the most important. First, the team reported that participants could easily identify with the provided counseling because the situations were meaningful to them. Second, the team felt that photo-sharing enhanced rapport and trust with the participants. Data showed that high trust and good rapport strongly and positively impact clinical outcomes.3 Thus, these are highly valuable aspects of photo-sharing.

Finally, it is important to consider privacy when using photo-sharing. In our study, we gave participants detailed guidelines and specific strategies for ensuring that other people in photographs were not identifiable unless they had provided written consent. In the clinical setting, privacy is equally important; we recommend that HCPs provide patients with privacy guidelines. We also suggest that you don't transfer patients’ photographs to your clinic's computer system. Instead, have patients share their photos directly from their cell phone.

At Eriksholm Research Centre, we recently developed a photo-sharing toolkit that consists of a clinician manual and four different patient instruction booklets. The clinician manual describes how you can use photo-sharing in your practice, while the four instruction booklets provide patient instructions for four use case scenarios: patient lifestyle, hearing aid troubleshooting, hearing aid counseling, and couples communication. We are evaluating the toolkit and practicalities of implementing photo-sharing in clinical practices with HCPs who are willing to try the technique and provide us with feedback about their experiences. Other ongoing photo-sharing projects will examine the impact of this tool on the outcomes of long-term hearing aid use.


1. Wang C, Burris MA Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav. 1997 Jun;24(3):369-87.
2. Saunders GH, Dillard LK, Frederick MT, Silverman SC Examining the Utility of Photovoice as an Audiological Counseling Tool. J Am Acad Audiol. 2019 May;30(5):406-416.
3. Riedl D, Schüßler G The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review. Z Psychosom Med Psychother. 2017 Jun;63(2):131-150.
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