Abstract
Objectives: The transtheoretical model (TTM) of behaviour change focuses on clients’ readiness for adopting new health behaviours. This study explores how clients’ readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients’ readiness has consequences for the rehabilitation decisions they make within the initial appointment. Design: Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. Study sample: The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. Results: Clients’ readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). Conclusions: The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients’ needs, attitudes, desires, and psychological readiness for action in order to optimize clients’ hearing outcomes.
Highlights
Despite the increasing incidence of hearing impairment (HI) among the older population, as compared to younger adults, audiologists often encounter reluctance to seek professional help (Meyer & Hickson, 2012)
Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations in the management phase of the appointment
In the remaining 21% of consultations, no recommendation of hearing aids was made as clients experienced no selfreported hearing impairment; no hearing loss was diagnosed; or the level of hearing loss was not deemed appropriate for hearing-aid fitting
Summary
Despite the increasing incidence of hearing impairment (HI) among the older population, as compared to younger adults, audiologists often encounter reluctance to seek professional help (Meyer & Hickson, 2012). There is an underutilization of hearing aids among those who have been fitted with them (Chien & Lin, 2012; Gopinath et al, 2011; Hartley et al, 2010) These findings highlight that help-seeking is not synonymous with a readiness for obtaining and using hearing aids. Older adults who attend audiology appointments to have their hearing tested cannot universally be assumed to be psychologically ready for hearing aids (Claesen & Pryce, 2012). They may be attending only to appease others, may not have considered hearing aids as a treatment option, or may consider hearing aids an undesirable option. The decision to go ahead with hearing rehabilitation, acquiring hearing aids, requires a major shift in attitudes and behaviour
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