Abstract
BackgroundThe consequences of poorly managed hearing loss can be ameliorated with hearing aid use but rates of use are sub-optimal. The impact of audiologist behaviour on subsequent use, particularly over the long term, is unknown.PurposeThis study aimed to describe the role of the behaviour change wheel in developing an intervention to introduce and embed particular clinical behaviours into adult hearing aid fitting consultations, within the framework of the Medical Research Council guidance on complex interventions.MethodsFollowing the steps of the behaviour change wheel, audiologist behaviours that might influence hearing aid use were identified based on a systematic review and qualitative work with audiologists. An analysis, using the COM-B model, identified potential drivers of the target behaviours. This was used to select intervention functions and behaviour change techniques likely to influence behaviour in this context.ResultsThe target behaviours were as follows: giving information about the benefits of hearing aid use and the negative consequences of non-use, providing prompts for use and engaging in collaborative behavioural planning for use. The behavioural analysis suggested that psychological capability, opportunity and motivation were potential drivers of these behaviours. The intervention functions of education, coercion, training, environmental restructuring, modelling and enablement were selected and combined to develop a single complex intervention that seeks to address the target behaviours.
Highlights
The consequences of poorly managed hearing loss can be ameliorated with hearing aid use but rates of use are sub-optimal
Our literature search suggested that many negative health and psychosocial consequences of poorly managed acquired hearing loss can be ameliorated by hearing aid use [20, 62, 63], providing a rationale for addressing hearing aid use
Two behavioural problems arose from this analysis: low levels of uptake of hearing healthcare and sub-optimal levels of hearing aid use once they are fitted
Summary
The consequences of poorly managed hearing loss can be ameliorated with hearing aid use but rates of use are sub-optimal. The standard management for adult onset hearing loss, at least in the developed world, is hearing aid fitting [5]. A potential limitation is that they have lacked a theoretical basis to structure the investigation and analysis of reasons for non-use. This means that some potential drivers of behaviour, those where people may lack insight such as automatic or habitual behaviours, have been neglected as avenues for intervention development. Behavioural problems like this are not unique to hearing healthcare. It is estimated that between a quarter and a half of patients with chronic disease have problems adopting and maintaining behaviour such as taking medication and following a diet or exercise plan [28, 29]
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