Abstract
Hearing aid intervention typically occurs after significant delay, or not at all, resulting in an unmet need for many people with hearing loss. Computer-based auditory training (CBAT) may provide generalized benefits to real-world listening, particularly in adverse listening conditions, and can be conveniently delivered in the home environment. Yet as with any intervention, adherence to CBAT is critical to its success. The main aim of this investigation was to explore motivations for uptake, engagement and adherence with home-delivered CBAT in a randomized controlled trial of adults with mild sensorineural hearing loss (SNHL), with a view to informing future CBAT development. A secondary aim examined perceived benefits of CBAT. Participants (n = 44, 50–74 years olds with mild SNHL who did not have hearing aids) completed a 4-week program of phoneme discrimination CBAT at home. Participants' experiences of CBAT were captured using a post-training questionnaire (n = 44) and two focus groups (n = 5 per group). A mixed-methods approach examined participants' experiences with the intervention, the usability and desirability of the CBAT software, and participants' motivations for CBAT uptake, engagement and adherence. Self-Determination Theory (SDT) was used as a theoretical framework for the interpretation of results. Participants found the CBAT intervention easy to use, interesting and enjoyable. Initial participation in the study was associated with extrinsic motivation (e.g., hearing difficulties). Engagement and adherence with CBAT was influenced by intrinsic (e.g., a desire to achieve higher scores), and extrinsic (e.g., to help others with hearing loss) motivations. Perceived post-training benefits included better concentration and attention leading to improved listening. CBAT also prompted further help-seeking behaviors for some individuals. We see this as an important first-step for informing future theory-driven development of effective CBAT interventions.
Highlights
In 2008, the World Health Organization estimated that over 360 million people worldwide had a disabling hearing loss
Recent findings from a large cohort study identified an association between hearing loss and incident dementia, whereby the risk increases with the degree of impairment (Lin et al, 2011a,b)
Auditory training: For Computer-based auditory training (CBAT), robust phoneme discrimination learning was found for both immediate training and delayed training groups, with the largest improvements in threshold shown for phoneme pairs with the poorest initial thresholds
Summary
In 2008, the World Health Organization estimated that over 360 million people worldwide had a disabling hearing loss. Evidence from our own research takes this further by suggesting that the benefits of auditory training may be primarily driven by top–down mechanisms, and that these benefits are most evident for challenging listening conditions that index executive processes such as the updating of working memory and attentional control (Ferguson and Henshaw, 2015a,b) These conclusions are based on the results of a randomized controlled trial of 44 adults with mild bilateral sensorineural hearing loss (SNHL) (Ferguson et al, 2014). In a recent systematic review of 13 articles assessing the efficacy of individual computer-based auditory training (CBAT) for people with hearing loss (Henshaw and Ferguson, 2013), compliance with CBAT was reported in less than half (6/13) of the studies Where it was reported, compliance rates were high for both laboratory-based (81%) and home-based (73–100%) interventions. A secondary aim sought to qualitatively examine the perceived benefits of the CBAT intervention and compare this with the published (quantitative) behavioral RCT results (Ferguson et al, 2014)
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