Audiology Services Research Articles

'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course.

Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.

Exploring the Performance of ChatGPT-4 in the Taiwan Audiologist Qualification Examination: Preliminary Observational Study Highlighting the Potential of AI Chatbots in Hearing Care.

Artificial intelligence (AI) chatbots, such as ChatGPT-4, have shown immense potential for application across various aspects of medicine, including medical education, clinical practice, and research. This study aimed to evaluate the performance of ChatGPT-4 in the 2023 Taiwan Audiologist Qualification Examination, thereby preliminarily exploring the potential utility of AI chatbots in the fields of audiology and hearing care services. ChatGPT-4 was tasked to provide answers and reasoning for the 2023 Taiwan Audiologist Qualification Examination. The examination encompassed six subjects: (1) basic auditory science, (2) behavioral audiology, (3) electrophysiological audiology, (4) principles and practice of hearing devices, (5) health and rehabilitation of the auditory and balance systems, and (6) auditory and speech communication disorders (including professional ethics). Each subject included 50 multiple-choice questions, with the exception of behavioral audiology, which had 49 questions, amounting to a total of 299 questions. The correct answer rates across the 6 subjects were as follows: 88% for basic auditory science, 63% for behavioral audiology, 58% for electrophysiological audiology, 72% for principles and practice of hearing devices, 80% for health and rehabilitation of the auditory and balance systems, and 86% for auditory and speech communication disorders (including professional ethics). The overall accuracy rate for the 299 questions was 75%, which surpasses the examination's passing criteria of an average 60% accuracy rate across all subjects. A comprehensive review of ChatGPT-4's responses indicated that incorrect answers were predominantly due to information errors. ChatGPT-4 demonstrated a robust performance in the Taiwan Audiologist Qualification Examination, showcasing effective logical reasoning skills. Our results suggest that with enhanced information accuracy, ChatGPT-4's performance could be further improved. This study indicates significant potential for the application of AI chatbots in audiology and hearing care services.

Impact of the Covid-19 pandemic on audiology service delivery: Observational study of the role of social media in patient communication.

The Covid-19 pandemic has highlighted an era in hearing health care that necessitates a comprehensive rethinking of audiology service delivery. There has been a significant increase in the number of individuals with hearing loss who seek information online. An estimated 430 million individuals worldwide suffer from hearing loss, including 11 million in the United Kingdom. The objective of this study was to identify National Health Service (NHS) audiology service social media posts and understand how they were used to communicate service changes within audiology departments at the onset of the Covid-19 pandemic. Facebook and Twitter posts relating to audiology were extracted over a six week period (March 23 to April 30 2020) from the United Kingdom. We manually filtered the posts to remove those not directly linked to NHS audiology service communication. The extracted data was then geospatially mapped, and themes of interest were identified via a manual review. We also calculated interactions (likes, shares, comments) per post to determine the posts' efficacy. A total of 981 Facebook and 291 Twitter posts were initially mined using our keywords, and following filtration, 174 posts related to NHS audiology change of service were included for analysis. The results were then analysed geographically, along with an assessment of the interactions and sentiment analysis within the included posts. NHS Trusts and Boards should consider incorporating and promoting social media to communicate service changes. Users would be notified of service modifications in real-time, and different modalities could be used (e.g. videos), resulting in a more efficient service.

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Family-Perceived Barriers and Facilitators Toward a Tele-Audiology Infant Diagnostic Testing Approach in Victoria, Australia.

Background: Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing diagnostic audiology services following a refer screen result. Methods: This study aimed to assess the opinions of families who had experienced infant diagnostic audiology assessments regarding a telehealth option for these appointments within Victoria, Australia. Families who attended in-person infant diagnostic audiology appointments were sent a questionnaire exploring their experiences of the service and their opinion regarding a proposed telehealth option for infant diagnostic audiology (50 responses received). These results were also compared to those of families who were surveyed following testing in 2020, where the audiologist conducted the appointment remotely to comply with COVID-19-related social distancing recommendations at the time (10 responses received). Results: There were not significant differences between the duration or number of appointments, perceived understanding of results, or concerns regarding a tele-audiology model between families who experienced face-to-face and tele-audiology infant diagnostic audiology appointments. Opinions of infant diagnostic audiology appointments utilizing telehealth technology were largely positive, and minimal technological difficulties were identified. Conclusion: Overall positive attitudes of many families with infant diagnostic appointment experiences toward a tele-audiology option of this service suggest that offering a telehealth model of appointments may be an appropriate model to improve service access for families requiring infant diagnostic audiology in Victoria.

Help-seeking journey to accessing audiology services in a peri-urban community in South Africa.

Hearing impairment is an invisible disability affecting one in five people globally. Its ability to affect participation in activities of daily living means that it requires prompt identification and intervention. This article aims to define the process of accessing audiologists from the onset of symptoms for adults with hearing impairment in a peri-urban community in South Africa. Twenty-three participants were recruited through purposive sampling from an audiology department of a public hospital. Semi-structured interviews were conducted using an interview guide, and data were mapped according to the participants' responses from the onset of ear and hearing symptoms to the point of audiologist consultation for analysis. Seventeen (74%) participants had long journeys to accessing the audiologist after seeking help from multiple providers, with those with short journeys (26%) being referred mostly by public healthcare providers. Despite participants being from one peri-urban community, their journeys were influenced by socio-economics, health illiteracy and other structural factors. Finally, Ear-Nose-Throat specialists linked participants with audiology services. Accessing audiology services is a complex process in some contexts. The disparities in the social environment, lifestyle factors and pluralistic healthcare models influence access to audiologists. Healthcare providers must take cognisance of the journeys of adults with hearing impairment in their clinical interventions. Universal health coverage, in the form of the planned National Health Insurance (NHI) for all South African citizens, will play an important role in addressing the societal inequalities in accessing healthcare. Factors leading to long journeys should be addressed to facilitate early intervention.Contribution:The study raises implications for the planned NHI in South Africa, suggesting that universal health coverage could play a vital role in addressing societal inequalities in accessing healthcare, including audiology services.

SWOT analysis of Russian universal newborn hearing screening program

Introduction. The negative impact of congenital hearing loss on child’s development, education and socialization can be reduced by early identification and intervention as a result of universal newborn hearing screening. The screening program needs continuous improvement by monitoring of outcomes and correction of algorithms. The SWOT analysis can be applied to make effective decisions. &#x0D; The purpose of the study is to identify strategies for the improvement of the Russian newborn hearing screening program based on SWOT analysis.&#x0D; Materials and methods. The study was based on the experience of two pediatric audiological centres in Novosibirsk and St. Petersburg. &#x0D; At the first stage, in accordance with the SWOT methodology, internal and external factors, the strengths and weaknesses of the Russian hearing screening program were identified, as well as the opportunities and threats that can affect the audiological care for children. At the second stage, pairwise analysis of strengths, weaknesses, opportunities and threats was carried out.&#x0D; Results. The strengths of the Russian hearing screening program are national level implementation, high coverage of newborns in maternity hospitals, the use of modern objective audiological methods. Weaknesses are associated with a lack of medical personnel, need to equipment replacement, number of cases lost to follow-up. Opportunities are the availability of high-quality domestic diagnostic equipment, possibility for active interaction of specialists and families. The threats are caused by an imperfect legal framework and funding mechanisms, low awareness of parents, related professionals and society about the problem of congenital hearing loss. &#x0D; Limitations. The study results are limited by the expertise of the authors without involving the wide range of stakeholders.&#x0D; Conclusion. The developed strategies can increase timely audiological service to hearing impaired children and their families and to plan the necessary resources in the face of modern challenges.

Hearing Outcomes in Patients with Cleft Lip and Palate in a Resource Limited Setting.

To compare hearing outcomes of early versus late tympanostomy tube insertion in patients with cleft lip and palate in a resource limited setting Retrospective cohort study. Conducted at Queen Sirikit National Institute of Child Health, a tertiary care hospital in Bangkok, Thailand. Included 76 patients under 18 with cleft anomalies undergoing tympanostomy tube insertion between January 2018 and July 2022, categorized into early ( n = 11) and late ( n = 65) tympanostomy groups. Early tympanostomy tube placement at ≤ 3 months old, coordinated with cleft lip repair, following failed transitory evoked otoacoustic emission (TEOAE) and Type B tympanogram. Late tympanostomy tube placement preceded by a diagnosis of middle ear effusion and typically a failed TEOAE and subsequent level of testing. Primary outcomes: normal hearing rates and age at normal hearing. Secondary outcomes: repeated tympanostomy tube placement rate, postoperative complications, and length of hospital stays. Early tympanostomy tube placement was associated with higher rates of normal hearing (100% vs. 75%. P = .103) and significantly younger age at normal hearing (11 vs. 19 months, P = .036). Time to normal hearing was shorter in the early group. Postoperative complications, including otorrhea, occurred more frequently in the early group, but differences were not significant. Early tympanostomy tube insertion improves hearing outcomes in pediatric patients with cleft lip and palate, achieving normal hearing at a significantly younger age. This approach offers a valuable alternative in resource-limited settings with constrained audiological services. Further research on long-term speech outcomes and cost-effectiveness is warranted.

Preparing for Otoferlin gene therapy trials: A survey of NHS Paediatric Audiology and Cochlear Implant services on diagnosis and management of Auditory Neuropathy Spectrum Disorder

ObjectivesGene therapy for monogenic hearing loss is on the horizon. The first trials in patients with Auditory Neuropathy Spectrum Disorder (ANSD) due to pathogenic variants in the Otoferlin (OTOF) gene will open this year. In the UK, the new NHS Genomic Medicine Service (GMS) offers genetic testing in each child diagnosed with congenital or early onset sensorineural hearing loss. This survey study aims to map preexisting clinical pathways for the diagnosis and management of children with ANSD and identify opportunities for improvement in early identification of OTOF- related ANSD. MethodsA Google form with 24 questions in English covering the ANSD clinical pathway was developed with clinicians involved in the diagnosis and management ANSD. The survey was disseminated via email to all Lead clinicians of NHS Tertiary Paediatric Audiology and Cochlear Implant Services within the UK. ResultsData was received from 27 (34 %) NHS Tertiary Paediatric Audiology Services and 8 (n = 57 %) Paediatric Cochlear Implant Services. Services follow existing national guidance and provide multidisciplinary care with structured patient pathways for referral, diagnosis, and management of children with ANSD and multidisciplinary input throughout. Clinicians are aware of the genetic causes of ANSD and new processes for genetic testing, but do not uniformly refer children with ANSD for testing for OTOF pathogenic variants. As such, they had difficulty estimating numbers of children with OTOF pathogenic variants under their care. ConclusionThose results highlight the urgency of implementing hearing gene panel sequencing for all children with ANSD to provide opportunities for early diagnosis and candidacy for OTOF gene therapy trials.

The colocation of primary care physicians and audiologists in the Chicago metro region reinforces racial, ethnic, and class inequities in spatial access to care

AbstractIn primary‐care‐centric models of care provision, specialist co‐location with primary care physicians (PCPs) can potentially improve care coordination and continuity. This study asks whether the co‐location of specialists with referring PCPs can reinforce racial, ethnic, and class inequities in spatial access to care. Given a US healthcare policy context wherein audiologist services are only reimbursed if they are medical practitioner‐referred, audiologists are hypothesized to co‐locate with PCPs. Using spatial cluster analysis and spatial regression approaches, this study quantifies the tendency for PCPs and audiologists to co‐locate and analyzes the consequences for spatial access disparities in the Chicago, Illinois metropolitan region. Audiologists and PCPs co‐cluster significantly across Chicagoland. The spatial lag model confirms racial, ethnic, and class disparities in network travel distance to audiology services in the core counties of the region. The results suggest that, for audiology services, health policies and the resultant interdependence across the hierarchy of care manifest spatially, possibly reinforcing service access disparities within segregated city regions.

Prontuário virtual para monitoramento audiológico de exposição ao ruído ocupacional

ABSTRACT Purpose: to develop and implement an electronic medical record for managing audiological assessments of workers exposed to occupational noise at a university. Methods: a computer system - the Electronic Audiology Record Program (PPVA, in Portuguese) - was developed with Microsoft Access for a university hospital’s audiology service, encompassing functional, occupational, and audiological information. After a testing period, the system was implemented in the service. Results: the PPVA is a personalized system that registers employees, audiological exams, clinical history, and risks for hearing loss induced by high sound pressure levels. It also generates reports indicating audiological monitoring frequency. Conclusion: the PPVA proved to meet the service’s needs, adequately. Its implementation improved the usability, efficiency, and quality of the service user records. Hence, it is a potential health surveillance tool, indicating that this type of instrument can benefit occupational hearing loss prevention programs.

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults.

Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

Audiologists’ Perception of Hearing and Balance Health-care Resources and Services in Saudi Arabia

Background: Hearing loss and balance disorders are the most commonly diagnosed health conditions. The prevalence of these conditions is on the rise as the population ages and diagnostic and treatment technologies become more advanced. The health-care system still struggles to meet many nations’ needs due to insufficient resources and services. The objective of the study was to evaluate audiologists’ perceptions of hearing and balance health-care resources and services in Saudi Arabia’s public health system. Materials and Methods: A questionnaire survey was conducted through E-mail, social media, mobile phone, and face-to-face with audiologists across the Kingdom of Saudi Arabia, with the final sample consisting of 66 audiologists. Results: The majority (92.4%) of audiologists in Saudi Arabia indicated that the services are inadequate because their hospitals lack adequate hearing health-care resources to provide efficient audiology services to patients. Video head impulse test and automated auditory brain stem response were perceived as unavailable in most hospitals. In addition, audiologists reported that vestibular rehabilitation services, cochlear implants, and the number of clinics were limited. Conclusion: Great efforts should be made to develop audiovestibular services, which include enhancing practitioners’ vestibular knowledge by implementing more vestibular workshops; more vestibular clinics are needed to overcome the shortage of vestibular services; creating public awareness campaigns about vestibular and audiology; and hiring additional audiologists where needed within Saudi Arabia.

Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting.

The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews). Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants. The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.

Barriers to and Facilitators of Implementing an Audiology Service Delivery Model in Mauritius’ Public Healthcare Sector

Barriers to and Facilitators of Implementing an Audiology Service Delivery Model in Mauritius’ Public Healthcare Sector

Barriers for Audiology, Speech, and Language Therapy Services to Cochlear Implant Recipients

Background: With the rise in cochlear implant use among children with hearing impairments, understanding the challenges in providing effective audiology, speech, and language therapy services is crucial. These services are vital for the successful integration of cochlear implant recipients into mainstream society, particularly in terms of language acquisition and social-educational outcomes. Objective: This study aimed to find out Barriers of audiology, speech, and language therapy services to cochlear implant. Methods: A cross-sectional survey design was employed, involving 74 participants selected through non-probability convenience sampling. The study utilized a structured questionnaire covering demographics, availability of audiology, speech, and language therapy services, and specific issues related to cochlear implant use. Data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Results: Among participants, 58.1% were aged 25-35 years; 67.6% were female. Educational levels varied, with 33.8% holding graduate degrees. Key barriers identified included distance to services, cost, and scheduling difficulties. 66.2% agreed that health insurance was a significant challenge, and 52.7% faced difficulties due to the unavailability of nearby speech therapists. Conclusion: The study highlights the critical need for accessible and tailored speech and language therapy services for cochlear implant recipients, especially in rural areas. Addressing these barriers requires concerted efforts from healthcare providers, policymakers, and community leaders to enhance the rehabilitation outcomes for cochlear implant recipients.

Knowledge and Attitudes of Parents and Caregivers in New Delhi to Childhood Hearing Loss and Hearing Services.

Parental and caregiver support is crucial for addressing childhood hearing loss in low and middle-income countries, where a significant burden of disabling hearing loss exists among children. This study aimed to assess the knowledge and attitudes of parents and caregivers regarding childhood hearing loss and available hearing services in both urban and rural settings in Delhi, India. A total of 314 participants were recruited and interviewed using a culturally adapted questionnaire consisting of 26 items, covering topics like biomedical and non-biomedical beliefs, knowledge of otitis media-related hearing loss, identification, and intervention. Statistical analysis of data was performed using Mann Whitney U tests and categorical principal component analysis (PCA). The study found that parents generally had a higher percentage of correct responses compared to caregivers in both urban and rural areas. Categorical PCA revealed variations in responses between fathers, mothers, and caregivers. In the urban group, mothers exhibited higher knowledge and more positive attitudes, while fathers showed lower involvement. In the rural group, while mothers demonstrated relatively higher awareness on all categories compared to fathers, these differences were highly relevant on questions concerning noise exposure, maternal medicine during pregnancy, and communication milestones. The findings emphasize the importance of considering regional and cultural factors when designing programs. Additionally, involving fathers in awareness campaigns and support networks is crucial to achieve comprehensive coverage in addressing childhood hearing loss. In conclusion, this study contributes valuable insights into the preparedness of parents and caregivers for audiology services and the need for contextually appropriate strategies to enhance childhood hearing health services in India.

Audiological Service Delivery and Uptake in New Zealand Regional Areas

Background: In New Zealand, as in many places, a significant proportion of the population lives outside the main urban centres. People living in regional areas have similar needs for audiological services as those living in urban centres; however, economic and geographical barriers can be a barrier to accessible services. The objective of this research was to explore factors that influence equitable audiological service provision and user uptake of services in regional areas of New Zealand. Methods: Fifteen participants who represented either audiological service users living in rural or non-urban areas (regional) or audiological service providers in these areas were recruited. Semi-structured interviews were conducted virtually and on average took forty minutes to complete. The interviews were transcribed and analysed using thematic analysis to identify themes and subthemes related to audiological service delivery and uptake. Results: Seven themes were identified. These are related to service provision, geographical barriers, and cultural appropriateness. Conclusions: This study provides a basis for understanding the challenges of delivering and accessing audiological services in non-urban areas in New Zealand, and in principle elsewhere. There is scope for future research to further understand policy directions needed to achieve equitable audiological service provision in regional areas.

Original Research Clinical attendance rate at a tertiary adult audiological service in South Africa.

Clinical non-attendance to audiological appointments may negatively affect early diagnosis and intervention as well as treatment outcomes for adults with hearing impairments. This study aimed to explore the attendance rate and factors influencing attendance and non-attendance at an adult audiology diagnostic clinic at a tertiary hospital in Gauteng, South Africa. A mixed-methods research design, utilising structured questionnaires and a retrospective record review was adopted. A total of 31 adult patients at a diagnostic audiology clinic were interviewed. Findings revealed an attendance rate of 47.62%, with 52.38% rate failure to return for follow-up appointments. Key reasons for attendance included understanding the need for appointments (57%), staff attitudes (42%) and appointment reminders (17%), and those for non-attendance included multiple appointments (33%), work commitments (28%), transport (8%) and forgetting about the appointment (8%). Six reasons for non-attendance were prominent in the current study: having multiple appointments (33%), work commitments (28%), forgetting the appointment (8%), transport difficulties (8%), attitudes and/or perceptions of the healthcare system (4%) and sequelae of hearing impairment (8%). This study reinforces previous research findings while highlighting that health literacy and Batho Pele (people first) ethos by staff positively influence attendance.Contribution:Current findings contribute towards contextually relevant evidence on the attendance rate in this sector for ear and hearing care, as well as additional insights into factors influencing this within the South African context. This information is crucial for clinical services provision planning as well as for policy formulation around resource allocation in the public healthcare sector.

Protocol for the development and validation of a patient-reported experience measure (PREM) for people with hearing loss: the PREM-HeLP

IntroductionHearing loss is a common chronic health condition and adversely affects communication and social function resulting in loneliness, social isolation and depression. We know little about the patient experience of...