Using Telehealth to Promote Help-Seeking After Failed Hearing Tests : The Hearing Journal

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Teleaudiology Today

Using Telehealth to Promote Help-Seeking After Failed Hearing Tests

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doi: 10.1097/01.HJ.0000800756.89025.c4
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Hearing screening apps on mobile devices are intended to make screening more accessible, detect hearing loss early, and open pathways to health care interventions. But what do individuals do when a mobile hearing test tells them their hearing failed? A recent study revealed that a failed result from mobile hearing screening doesn’t always prompt people to consult an audiologist. Majority may still be “precontemplating” it.

In the study, “Characteristics and Help-Seeking Behavior of People Failing a Smart Device Self-Test for Hearing,” 3,092 participants who failed a mobile screening test were surveyed on their help-seeking behaviors and follow-up actions. Despite their failed hearing test, 75% of them remained in the “precontemplation stage,” where they did not think they had a hearing issue and thus had no need for interventions.

“This study makes it clear that a failed hearing screening test result by itself is insufficient motivation for following up with an audiology appointment,” said De Wet Swanepoel, PhD, audiology professor at the University of Pretoria, in an interview with The Hearing Journal.


The study used a model called stages of change (SoC) to describe the participants’ attitudes and behaviors toward getting hearing care interventions. The four stages of change were:

  1. Precontemplation: “I don’t think I have a hearing problem, so I don’t need to do anything about it.”
  2. Contemplation: “I think I have a hearing problem, but I am not yet ready to take action; I might do so in the future.”
  3. Preparation: “I know I have a hearing problem. I intend to take action soon.”
  4. Action: “I know I have a hearing problem. I am here to take action now.”

An individual’s stage of change was a factor in whether they sought a follow-up with an audiologist after their failed hearing test.

“In our study, the main factors that contributed to someone following up after a failed screening test result included 1) a more advanced stage of change, 2) poorer speech recognition in noise, and 3) older age,” said Swanepoel.

By contrast, participants who were only in the precontemplation stage were significantly younger. The study noted that “fewer difficulties related to hearing loss may be perceived” among younger individuals, as younger age is associated with better speech recognition in noise. This might help explain why younger people tended not to be in advanced stages of change.

Swanepoel added, “Individuals in the precontemplation stage of change did not believe they had a hearing problem despite failing the screening test. As a result, these persons were very unlikely to follow up with an audiologist. In fact, those in the contemplation, preparation, and action stages of change were 2.5 times more likely to follow-up with an audiologist after a failed screening outcome than those in the precontemplation stage.”


The study supports previous research findings that population-based hearing screening may not be enough to motivate people to get hearing health care.

“The individual’s readiness to consider and take up a potential intervention is a critical component that should accompany the test result,” Swanepoel said. “In combination, being in the contemplation, preparation, or action stages of change alongside a failed screening result – these factors can support and even facilitate follow-up appointments with audiologists.

“For example, an online hearing test like hearDigits also includes a staging algorithm to establish what someone’s stage of change is. Audiologists who offer this test on their websites can use the screening outcome (pass/fail) in combination with the stage of change, the severity of the speech-in-noise deficit and age to prioritize follow-up through telehealth or a remote consultation toward an appointment for possible diagnostic testing and treatment.

“A mobile hearing screening app like hearWHO or a similar test on your website offers a helpful tool to promote awareness about the importance of knowing your hearing status.”

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