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Audiology and eHealth

Digital Proficiency and Teleaudiology: Key Implications in Hearing Care

Ratanjee-Vanmali, Husmita; Swanepoel, De Wet PhD; Laplante-Lévesque, Ariane PhD

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doi: 10.1097/01.HJ.0000717160.38022.5c
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Editor's note: This is the last part of a four-part article series. Read parts one in the June 2020 issue (, two in the July 2020 issue (, and three in the August 2020 issue (

The current online behavior of people with hearing loss—characterized by increased access to and use of mobile technologies, internet, and social media1—creates an opportunity for audiologists to offer personalized, synchronous, and asynchronous eHealth services and solutions. In this article series, we've outlined the steps to create and implement a combined online and in-person hearing care model throughout the patient journey (review parts 1-3:,, But to ensure a person-centered approach via this hybrid model, audiologists must consider patients’ digital proficiency, which is the ability to perform a particular task or skill and can be assessed through self-report or behavioral observation. Measuring digital proficiency becomes particularly important in the rapidly evolving world of digital and remote health care, which has been accelerated by the COVID-19 pandemic.

Image: sanjeri, telehealth, hearing aids.
Table 1
Table 1:
Digital Proficiency Questionnaires.
Table 2
Table 2:
Website Traffic Data for 24 Months.


To date, many studies have been conducted on internet and computer use in the context of hearing care.5-10 Study findings have indicated that getting online information about hearing loss, screening, and interventions has been beneficial for people who do not typically present themselves to an audiologist to be more engaged in their hearing health care.9 These findings also suggest that the improved general digital competence of older adults is making online hearing interventions increasingly viable and even desirable options.6

Physical distancing and safety restrictions due to the COVID-19 pandemic has made the use of mobile and digital tools to deliver or triage patients requiring in-person care more important than ever.12 Therefore, measuring digital proficiency and the ability to use mobile devices is one way for audiologists to assess patient access, support, and ability to use and receive services online. Beyond COVID-19, we can only expect that individuals will continue to seek and receive health care online, owing not only to the pandemic but also to changes in patient preferences to seek health care in virtual ways.13 Measuring a patient's digital proficiency prior to remote service provision allows audiologists to form a holistic profile of a patient's abilities and to assess the availability of additional support—from the patient's family, friends, or health care facility personnel—to help the patient embrace digital solutions. Audiologists can then offer in-clinic or online support provided by themselves or by trained support staff and create personalized treatment plans.

Some studies have expressed concerns about patients’ access and skills to use the required technology in teleaudiology.14,15 New research points to the critical role of audiologists in promoting technological literacy to assist patients in a new hearing need, which is to communicate on virtual platforms.16 Convery and colleagues have shed light on the fact that while audiologists may not have acquired the necessary tools or infrastructure to offer eHealth services, patients, on the other hand, have access to internet-connected tools and technologies17 and are willing to use online hearing care.17-19


Determining a patient's digital proficiency beforehand allows the audiologist to better understand the patient's needs and tailor the intervention plan even before the first appointment. At our clinic, we used two shortened questionnaires, the Mobile Device Proficiency Questionnaire (MDPQ-16)20 and the Computer Proficiency Questionnaire (CPQ-12),21 to assess patient's self-reported digital proficiency in our studies.4 These questionnaires have been carefully developed and validated to tap into the important concepts of proficiency and allow for comparisons with other samples.20,21Table 1 shows a comparison of these two measures.

To our knowledge, no study to date has looked into mobile proficiency among online hearing health care seekers, which is increasingly becoming the mode of choice to access online information, with smartphone ownership increasing in the age group that needs audiology care the most.11 In the implementation of this project, we found that 83 percent of online hearing health seekers accessed our clinic's website ( from a mobile device (read parts one and two:, As such, in another study, we investigated mobile proficiency and its effects on the uptake of eHealth hearing care. We used an exact regression model in evaluating mobile device proficiency (MDPQ-16), speech reception thresholds, gender, age, and readiness (stage of change).4

This study was the first to report on self-perceived mobile device proficiency among people with hearing loss.4 We found that age, but not digital proficiency, was a predictor of patients’ uptake of hybrid hearing care services at our clinic. The older the patient, the more likely he or she was likely to continue with hearing health care and take up the intervention offered.4 The older patients have been aware of their hearing loss for a long period; comparatively, those who did not avail of audiology services were aware of their hearing loss for a shorter period.4

Our study also found higher mobile proficiency among adults with hearing loss compared with other studies on adults without hearing impairment.20,22 Computer literacy among adults in our study was slightly lower than a previous report.21 Mobile device use and proficiency in older adults have accelerated with 95 percent of online access in our study occurring on mobile devices (Table 2).


Using a validated digital proficiency questionnaire like the MDPQ-16 allows audiologists to assess the patient's technology savviness and usage. Assessment of a patient's digital capabilities before the first engagement allows for the personalization of treatment plans and support materials (including asynchronous online solutions) ahead of time.

One example from our study was a 100-year-old patient (now 101) who was found to have poor digital proficiency. Upon further assessment, we learned about his available support system. With his daughter's assistance, he was able to access hearing care via our hybrid model. Today, he is a successful hearing aid user and communicator.

Planning around mobile device proficiency is becoming increasingly important. Data from our two-year study showed that 87 percent of website visitors from the greater Durban area in South Africa used Android mobile devices (Table 2) and most online hearing screening tests (85%) were completed through a mobile device, emphasizing the importance of having a mobile-responsive web design ( Audiologists can either use the MDPQ-16 questionnaire in its entirety or opt to informally assess digital proficiency based on these two questionnaires. Audiologists can easily integrate digital proficiency screening of patients ahead of appointments to better guide patient interactions, provide person-centered care, and create tailored interventions.

Acknowledgment: The authors wish to thank the William Demant Foundation, which supported the establishment of the Hearing Research Clinic NPC and the research project through a grant. Professor Swanepoel, the second author has a relationship with the hearX Group (Pty) Ltd that includes equity, consulting, and potential royalties.


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2. Ratanjee-Vanmali, H., Swanepoel, D.S. & Laplante-Lévesque, A. (2019) Characteristics, behaviours and readiness of persons seeking hearing healthcare online, International Journal of Audiology, 58:2, 107-115, DOI: 10.1080/14992027.2018.1516895.
3. Ratanjee-Vanmali, H, Swanepoel, D.W., Laplante-Lévesque, A. (2020). Patient Uptake, Experience, and Satisfaction Using Web-Based and In-person Hearing Health Services: Process Evaluation Study. J Med Internet Res. 22(3):e15875. DOI: 10.2196/15875.
4. Ratanjee-Vanmali, H., Swanepoel, D.S. & Laplante-Lévesque, A. (in press). Digital proficiency is not a significant barrier for taking up hearing services with a hybrid online and in-person model. American Journal of Audiology.
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