Self-report outcome measures for adult hearing aid services: some uses, users, and options.

Abstract

In many instances throughout the world, audiology developed as a technically orientated discipline with heavy emphasis on the engineering aspects of equipment and hearing aids. Many of the techniques in audiology were primarily diagnostic in origin and the rehabilitative elements of hearing aid provision, beyond simple amplification, were relatively slow to develop. I distinctly remember as a young scientist, on entering the field of hearing and its assessment, encountering articles whose primary purpose was to establish and justify the very position and role of self-report measures in the scientifically oriented practice of audiology. Such arguments were necessary to bring to the attention of both researchers and practitioners the primary focus of intervention for hearing deficits beyond the fitting of simple amplification. Few would attempt to argue that the primary role of a rehabilitative (as opposed to a diagnostic) audiologist or service is to fit hearing aids. Rather there is an almost universal acceptance that the objective of interventions is to overcome the deficits in the domains of disability, handicap, and health-related quality of life that occur as a consequence of impaired hearing. For definition of the terms disability and handicap and their likely successors activity and participation, readers are referred to publications provided by the World Health Organization (WHO, 1980; WHO, 1997). The experience of disability and handicap can only be understood and assessed via reports from impaired individuals and those with whom they interact. Inspection of any modern audiologic journal or textbook will demonstrate evaluations that revolve around the reports from hearing-impaired listeners of the impacts of hearing impairment and the extent to which interventions and improvements in interventions either do or do not alleviate those deficits. Self-report measures of disability and handicap, and hence the benefits of intervention, now constitute an unassailable element in our understanding of the consequences of impaired hearing and essential components for the evaluation and optimization of interventions designed to alleviate those deficits. Exclusive reliance on procedures such as aided benefit scores on speech tasks has all but disappeared. Self-report has come of age. It is fair, however, to point out that in everyday audiologic practice, the formalized use of self-report measurements to evaluate and guide management options has not kept pace with their standing in more research and evaluation-orientated exercises. The objective of this article is to examine some of the applications, constraints, and requirements for and upon self-report outcome measures. These mainly derive from research enterprises, but are directed toward routine clinical environments and the peculiar constraints and restrictions that they impose. Given the wide literature concerning self-report measures, the article will focus on a series of issues rather than attempt a general survey of the research and clinical literature. I do intend, however, to provide appropriate references for wider reading so that the particular arguments and viewpoints that I advance can be evaluated in the context of a wider knowledge base.