Behavior Change Theories and Tools Could Help Grow Teleaudiology Adoption : The Hearing Journal

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Teleaudiology Today

Behavior Change Theories and Tools Could Help Grow Teleaudiology Adoption

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doi: 10.1097/
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Although teleaudiology utilization certainly increased during the COVID-19 pandemic as a necessity to continue business operations and minimize loss in revenue, many audiologists have since returned to a primarily in-person health care delivery model since many pandemic-related restrictions have been lifted across the nation.


Compared with other areas of health care, audiology had a history of limited telehealth utilization before the COVID-19 pandemic. But despite historic reluctance to adopt more telehealth services in audiology practices, reliance on teleaudiology grew significantly during the pandemic. Patients have cited satisfaction with remote care due to factors such as improved communication, increased access, reduced travel, reduced health delivery costs, decreased missed appointments, and decreased wait times. Still, teleaudiology utilization dipped again as pandemic concerns subsided.

In the article “Health Behavior and Motivational Engagement Models Can Explain and Modify Teleaudiology Uptake,” which was published in its entirety in American Journal of Audiology, the authors explore how various behavior change theories can explain teleaudiology reluctance and potentially offer a path forward to increased uptake.


Provider reluctance toward teleaudiology adoption is not technically a health behavior, but the authors theorize that the same principles associated with health behavior change apply in this scenario.

The Health Belief Model identifies factors that influence specific health behavior adoption, (e.g., health screenings or vaccinations). Identified factors include perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action. This model has been cited in the literature to explain why such a low percentage of individuals with hearing loss actually purchase hearing aids. Before the pandemic, there were likely no cues to action for audiologists providing exclusively in-person care.

The Transtheoretical Model of health behavior was originally intended as a therapeutic approach to smoking cessation and has later been applied to eating disorders, addiction, HIV prevention, and adherence to drug therapy. This model acknowledges the difficulty of behavior change and explains that most individuals progress and regress through a six-stage cyclical process: precontemplation, contemplation, preparation, action, maintenance, and termination/relapse. When related to the exploration of teleaudiology use during the pandemic, the changing health care climate caused providers to go through the precontemplation, contemplation, and preparation stages until they took action by training providers to deliver remote care, and then perfected and expanded their services as part of the maintenance stage.

The COM-B model of behavior change says that for an individual to exhibit a change in behavior (B) at any moment in time, they must possess the capability (C), the opportunity (O), and the motivation (M) to do so. This model has previously been used to describe health behavior decisions such as getting tested for sexually transmitted diseases. The loss of revenue stemming from the pandemic shutdown most likely resulted in a change in motivation among providers to offer teleaudiology.

“While health behavior theories may seem a logical approach to explain hearing aid adoption, how might these theories be applied to the adoption of teleaudiology services?” asked the study authors. “We posit that clinicians likely undergo a similar decision-making process when contemplating any significant change to their clinical practice.”


Three tools from the Ida Institute that have previously helped clinicians and patients explore resistance to hearing aid use are “The Line,” “The Box,” and “The Circle.” They are based, respectively, on Miller and Rollnick’s Motivational Engagement Theory; Prochaska, Velicer, and colleagues’ Decisional Balance Theory; and Prochaska and DiClemente’s Transtheoretical Model of Change.

“We propose that health behavior models such as the Health Belief, Transtheoretical, and COM-B models, and motivational engagement techniques such as The Line, The Box, and The Circle, as applied to health care provider behavior, are appropriate models to explain and potentially modify teleaudiology acceptance and uptake among clinicians,” write the study authors.

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