Hearing Aid Self-efficacy Research Articles

Interaction effect of self-efficacy and joint problems on hearing aid abandonment among older adults

Objective We assessed the interaction between self-efficacy and joint problems and self-efficacy and visual problems on the risk of hearing aid abandonment in older adults. Design A retrospective cohort study comprising older adults who received hearing aids in Chile was conducted. Hearing aid self-efficacy was measured using the S-MARS-HA questionnaire, while joint and visual problems were assessed through self-reported questions. Survival regression models were conducted to investigate the interaction between self-efficacy and joint problems, as well as self-efficacy and visual problems. Study sample The study included 355 older adults who received hearing aids through the Chilean public health sector. Results A significant interaction effect indicated that the relationship between self-efficacy and the risk abandonment was influenced by joint problems (p < 0.05). In the subpopulation with joint problems, self-efficacy was associated with a reduced risk of hearing aid abandonment (HR = 0.81), whereas in the subpopulation without joint problems, the protective effect was more pronounced (HR = 0.52). The interaction between self-efficacy and visual problems was not significant. Conclusions The interaction between self-efficacy and joint problems was associated with the risk of abandonment. Addressing limitations associated with joint problems and individuals’ confidence in using their hearing aids could reduce the abandonment.

Impact of patient attributes on the relationship between hearing handicap and readiness to pursue audiologic rehabilitation

Objective This study explored whether select patient attributes were significant predictors of readiness to pursue hearing aids (HAs) and estimated the impacts of hearing aid self-efficacy (HASE) and emotional states, on the relationship between perceived hearing handicap and readiness to pursue HAs. Design & study sample Sixty-two adults with self-reported hearing difficulties and no previous experience with HAs self-reported their hearing handicap, HASE, personality, emotional states in varying contexts, and readiness to pursue HAs. Results Individuals with greater hearing handicap and who had experienced hearing loss for a shorter duration were more ready to pursue HAs. Having higher HASE, more positive emotional states in “Social” situations, higher scores for the Agreeableness, and having lower Conscientiousness personality trait scores also independently predicted readiness. Neither HASE nor reported emotional states had a significant impact on the relationship between perceived hearing handicap and readiness to pursue HAs. Conclusions Certain patient characteristics independently motivate people towards or away from pursuing HAs. However, it remains unclear whether targeted modification of these attributes would directly facilitate behaviour change. Future research should further explore these questions to facilitate a more individualised audiologic rehabilitation.

Shared experiences among successful hearing aid users with high hearing aid self-efficacy

Objective While targeted rehabilitation can enhance hearing aid self-efficacy (HASE), little research has been done to determine the factors contributing to its predictive value. By investigating the experiences of individuals who successfully use HAs and have high levels of HASE, we hoped to illuminate specific strategies and/or sources of support these individuals share that might explain why high HASE is often linked to successful outcomes. Design and study sample This qualitative study explored the experiences of five older adults who were successful HA users and reported having high HASE. Semi-structured interview guides were developed using the transtheoretical model of behavioral change as a framework. Interviews were analyzed thematically and holistically. Results Participants attributed their HA success to: intrinsic motivation to improve their hearing, confident self-reliance when making health decisions, willingness to act on advice from trusted others, pro-social personal attributes, positive expectations about HA outcomes, and actively pursuing an optimal HA outcome. Conclusions For these participants, internal factors related to emotional state and source of motivation, and, to a lesser extent, verbal persuasion played a crucial role in their long-term success. This suggests that external influencers might be less impactful in facilitating success for those with high HASE.

"It Depends on the Situation": How Hearing-Specific Contexts Affect the Way Adults With Hearing Loss Report Their Personal Attributes.

This study examined how adults with untreated hearing loss respond to surveys about their self-efficacy, personality traits, and affective states when assessed "in general" and in listening-related contexts. We also explored the associations between hearing aid self-efficacy (HASE) and listening-related personality traits and affective states. Sixty-two adults with self-reported hearing difficulties and no experience with hearing aids (HAs) participated in this descriptive study. Participants self-reported their self-efficacy, personality, and affective states in general and in listening-related contexts. Paired t tests and repeated measures with Holm-Šídák corrections were performed to explore differences between reports of patient traits in different contexts. Multiple regression analyses were conducted to explore significant associations. On average, there were no significant differences between general and listening-related self-efficacy or personality traits. However, our participants indicated significantly more negative affective states in listening-related situations compared to in general. There was a small positive association between HASE and reported affective states in "General" and "Listening at Home" contexts. This study confirms that context-specific measures are not required to accurately assess self-efficacy and personality traits in the initial stages of the hearing health journey. However, reported affective states were listening dependent for this sample. Although reported affective states were related to HASE, context-dependent measures did not provide additional insight into participants' self-efficacy for successful HA use. This suggests that rehabilitation protocols designed to promote HASE and positive affect in general and listening-related situations could facilitate HA success.

An exploration of associations between hearing aid self-efficacy and other measurable characteristics of naïve and experienced hearing aid users

Objective The present study aimed to clarify the associations between Hearing Aid Self-efficacy (HASE) and other traits such as working memory, personality and hearing aid (HA) experience. Design and study sample Fifty-four adults (both naïve and experienced HA users) were included in this exploratory descriptive study. Their working memory, personality, HASE, HA experience and practical HA skills were evaluated. Results HA experience had a significant positive association with self-efficacy for basic and advanced HA handling abilities. Working memory and personality traits were not related to HASE. For the experienced HA users, HASE was not related to HA skills. However, the openness personality trait had a significant positive association with HA skills. Conclusions The positive association between HASE and HA experience supported the theory that HASE might be improved through mastery experiences. Possessing certain cognitive abilities or specific personality traits is not a prerequisite for having high HASE. This study also supports previous findings that HASE is not related to HA skills, bringing into question whether improving HASE will also improve HA outcomes. However, for experienced participants, aspects of personality and cognition might play a role in mediating the association between HASE and HA skills.

Investigating the Role of Auditory Processing Abilities in Long-Term Self-Reported Hearing Aid Outcomes among Adults Age 60+ Years.

Self-reported hearing aid outcomes among older adults are variable and important to improve. The extent of the role of auditory processing in long-term hearing aid outcomes is not well understood. To determine how auditory processing abilities are related to self-reported hearing aid satisfaction and benefit along with either aided audibility alone or exploratory factors suggested by previous literature. Descriptive analyses and multiple regression analyses of cross-sectional self-reported outcomes. Adult participants, >60 years (n = 78), fitted with bilateral hearing aids to treat symmetric, mild to moderate sensorineural hearing loss. Participants were recruited from a single audiology clinic to complete a series of questionnaires, behavioral assessments, and obtain data from their hearing aids, including real ear measures and data logging of hearing aid use. Multiple linear regressions were used to determine the amount of variance explained by predictive factors in self-reported hearing aid satisfaction and benefit. The primary predictive factors included gap detection threshold, spatial advantage score, dichotic difference score, and aided audibility. Exploratory factors included personality, self-efficacy, self-report of disability, and hearing aid use. All interpretations of statistical significance used p < 0.05. Effect sizes were determined using Cohen's f 2 with a medium effect suggesting clinical relevance. Gap detection threshold was a statistically significant predictor in both primary regression models with a medium effect size for satisfaction and a small effect size for benefit. When additional exploratory factors were included in the regression models with auditory processing abilities, gap detection and self-efficacy were both significant predictors of hearing aid satisfaction with medium effect sizes, explaining 10 and 17% of the variance, respectively. There were no medium effect sizes found for other predictor variables in either the primary or exploratory hearing aid benefit models. Additional factors were statistically significant in the models, explaining a small amount of variance, but did not meet the medium effect size criterion. This study provides initial evidence supporting the incorporation of measures of gap detection ability and hearing aid self-efficacy into clinical practice for the interpretation of postfitting long-term hearing aid satisfaction.

Does educational level predict hearing aid self-efficacy in experienced older adult hearing aid users from Latin America? Validation process of the Spanish version of the MARS-HA questionnaire.

Hearing aids are the most common rehabilitation strategy for age-related hearing loss. However, 25% to 50% of older adults fitted with hearing aids do not wear them post-fitting. Hearing aid self-efficacy has been suggested as one of the key factors that may explain adherence to hearing aids in older adults. The primary aim of this study was to determine a possible association between educational level and hearing aid self-efficacy in older adult hearing aid users from a Latin American country (i.e., Chile). The secondary aim was to determine if in this sample of older adults, hearing aid self-efficacy predicted hearing aid adherence as previously suggested by other studies. The MARS-HA (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids) questionnaire was used to measure hearing aid self-efficacy. This questionnaire was initially adapted into Spanish (S-MARS-HA) using forward and backward translations by bilingual English-Spanish speakers. A sample of 252 older adults fitted with hearing aids at a public hospital in Santiago, Chile, was investigated. Educational level was measured as the number of years of formal education. Participants responded to the S-MARS-HA along with questions exploring social support, attitudes in using hearing aids, participation in social events, and vision and joint problems. Hearing aid adherence was investigated with the use of a question from the International Outcome Inventory for Hearing Aids. All these procedures were conducted at the participants' homes. Pure-tone average (PTA; 500-4000 Hz) in the fitted ear was obtained from the participants' medical records. Univariate and multivariate regression models were constructed to investigate the association between educational level and hearing aid self-efficacy controlling for the covariates of interest (e.g., social support, attitudes in using hearing aids, PTA). The S-MARS-HA showed an adequate construct validity along with a good reliability. Results of the multivariate regression analyses showed that educational level significantly predicted hearing aid self-efficacy. Covariates significantly associated with this outcome included attitudes in using hearing aids and PTA in the fitted ear. Finally, a significant association between hearing aid self-efficacy and adherence to hearing aid use was observed. In conclusion, this study showed a significant association between educational level and hearing aid self-efficacy in older adults from a developing Latin American country. Thus, this variable should be considered when designing and delivering aural rehabilitation programs such as hearing aids to older adults, especially those from developing countries.

Improving self-efficacy for hearing aid self-management: the early delivery of a multimedia-based education programme in first-time hearing aid users

Objectives: This study examined the effect of a multimedia educational programme for first-time hearing aid users (C2Hear reusable learning objects, RLOs), delivered at the hearing assessment on (1) self-efficacy for hearing aids (primary outcome), and (2) readiness for hearing rehabilitation and hearing aid knowledge (secondary outcomes).Design: A single-centre, prospective, pre-post, randomised controlled trial with two arms. The intervention group (n = 24) received RLOs, and the waitlist control group (n = 23) received a printed booklet on hearing aids. Outcomes were measured at the hearing assessment and hearing aid fitting appointments.Study sample: Fifty-six adult first-time hearing aid users attending a publicly funded audiology service.Results: The RLO group showed significantly greater improvement in self-efficacy and knowledge of hearing aids than the control group. A borderline effect of readiness for hearing rehabilitation was also found. Potential links between hearing aid self-efficacy and knowledge were identified.Conclusions: Early delivery of the RLOs results in greater hearing aid self-efficacy and knowledge at the hearing aid fitting appointment, with indications that RLOs increase readiness for hearing rehabilitation. As knowledge, self-efficacy and readiness are cornerstones of self-management, the C2Hear RLOs can prime first-time hearing aid users to better self-manage their hearing aids before they receive them.

Factors Associated With Successful Setup of a Self-Fitting Hearing Aid and the Need for Personalized Support.

Self-fitting hearing aids have the potential to increase the accessibility of hearing health care. The aims of this study were to (1) identify factors that are associated with the ability to successfully set up a pair of commercially available self-fitting hearing aids; 2) identify factors that are associated with the need for knowledgeable, personalized support in performing the self-fitting procedure; and (3) evaluate performance of the individual steps in the self-fitting procedure. Sixty adults with hearing loss between the ages of 51 and 85 took part in the study. Half of the participants were current users of bilateral hearing aids; the other half had no previous hearing aid experience. At the first appointment, participants underwent assessments of health locus of control, hearing aid self-efficacy, cognitive status, problem-solving skills, demographic characteristics, and hearing thresholds. At the second appointment, participants followed a set of computer-based instructions accompanied by video clips to self-fit the hearing aids. The self-fitting procedure required participants to customize the physical fit of the hearing aids, insert the hearing aids into the ear, perform self-directed in situ audiometry, and adjust the resultant settings according to their preference. Participants had access to support with the self-fitting procedure from a trained clinical assistant (CA) at all times. Forty-one (68%) of the participants achieved a successful self-fitting. Participants who self-fit successfully were significantly more likely than those who were unsuccessful to have had previous experience with hearing aids and to own a mobile device (when controlling for four potential covariates). Of the 41 successful self-fitters, 15 (37%) performed the procedure independently and 26 (63%) sought support from the CA. The successful self-fitters who sought CA support were more likely than those who self-fit independently to have a health locus of control that is externally oriented toward powerful others. Success rates on the individual steps in the self-fitting procedure were relatively high. No one step was more problematic than any other, nor was there a systematic tendency for particular participants to make more errors than others. Steps that required use of the hearing aids in conjunction with the self-fitting app on the participant's mobile device had the highest rates of support use. The findings of this study suggest that nonaudiologic factors should be considered when selecting suitable candidates for the self-fitting hearing aids evaluated in this study. Although computer-based instructions and video clips were shown to improve self-fitting skill acquisition relative to past studies in which printed instruction booklets were used, the majority of people are still likely to require access to support from trained personnel while carrying out the self-fitting procedure, especially when this requires the use of an app.

Predictors of hearing loss self-management in older adults

Purpose: To determine the factor structure of a clinical tool for the assessment of hearing loss self-management, and to identify predictors of the total score on the assessment and the extracted factor scores.Materials and methods: Hearing loss self-management assessments were conducted with 62 older adults. The factor structure of the assessment was determined by exploratory factor analysis. Multiple linear regression analyses identified significant contributors to the total score and to each of the extracted factors.Results: Three factors were identified, each representing a distinct domain of hearing loss self-management: Actions, Psychosocial Behaviours, and Knowledge. The most common significant predictor was hearing health care experience, which predicted self-management overall and in the Actions and Knowledge domains. Health literacy predicted hearing loss self-management overall and in the Psychosocial Behaviours domain. Actions were additionally predicted by hearing aid self-efficacy and gender, Psychosocial Behaviours by health locus of control, and Knowledge by age.Conclusions: The results of the factor analysis suggested that hearing loss self-management is a multidimensional construct. Each domain of hearing loss self-management was influenced by different contextual factors. Subsequent interventions to improve hearing loss self-management should therefore be domain-specific and tailored to relevant contextual factors.Implications for rehabilitationHearing loss is a chronic health condition that requires on-going self-management of its effects on everyday life.Hearing loss self-management is multidimensional and encompasses the domains of Actions, Psychosocial Behaviours, and Knowledge.Different contextual factors influence each hearing loss self-management domain, including previous experience receiving hearing health care services, health literacy, hearing aid self-efficacy, health locus of control, age, and gender.Audiological rehabilitation programs should thus ensure that interventions to improve hearing loss self-management are domain- and context-specific.

Improving Hearing Aid Self-Efficacy and Utility Through Revising a Hearing Aid User Guide: A Pilot Study.

This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance. In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised guides (Doak, Doak, & Root, 1996). SAM and readability were improved following the revision. Participants in the revised guide group performed significantly better on the utility task and on the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids subscales than participants in the original guide group. These results are encouraging as they indicate that there is scope to influence self-efficacy and utility performance through the use of appropriate HAUGs.

The Relationship Between Hearing Aid Self-Efficacy and Hearing Aid Satisfaction

The purpose of this study was to investigate the relationship between self-efficacy for hearing aids (HAs) and satisfaction with HAs in a group of adult HA owners. Forty-seven adults acquiring HAs (new and experienced owners) completed a demographic questionnaire, the Hearing Handicap Questionnaire (Gatehouse & Noble, 2004), and received an audiometric evaluation prior to HA fitting. Twelve weeks following the completion of the HA fitting, they completed the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (Smith & West, 2006) and the Satisfaction with Amplification in Daily Life (Cox & Alexander, 1999) questionnaires. There were no significant differences between experienced and new HA owners in terms of self-efficacy or HA satisfaction. The majority of participants had adequate self-efficacy for basic HA handling and adjustment to HAs. Fewer participants had adequate self-efficacy for aided listening and advanced handling of HAs. HA self-efficacy was related to HA satisfaction in three domains: positive effect and negative features of HAs and service and cost. Many HA owners do not have adequate self-efficacy in important HA-related domains. Clinical intervention to improve self-efficacy for HAs may help improve HA satisfaction.

Factors affecting reliability and validity of self-directed automatic in situ audiometry: implications for self-fitting hearing AIDS.

A reliable and valid method for the automatic in situ measurement of hearing thresholds is a prerequisite for the feasibility of a self-fitting hearing aid, whether such a device becomes an automated component of an audiological management program or is fitted by the user independently of a clinician. Issues that must be addressed before implementation of the procedure into a self-fitting hearing aid include the role of real-ear-to-dial difference correction factors in ensuring accurate results and the ability of potential users to successfully self-direct the procedure. The purpose of this study was to evaluate the reliability and validity of an automatic audiometry algorithm that is fully implemented in a wearable hearing aid, to determine to what extent reliability and validity are affected when the procedure is self-directed by the user, and to investigate contributors to a successful outcome. Design was a two-phase correlational study. A total of 60 adults with mild to moderately severe hearing loss participated in both studies: 20 in Study 1 and 40 in Study 2. Twenty-seven participants in Study 2 attended with a partner. Participants in both phases were selected for inclusion if their thresholds were within the output limitations of the test device. In both phases, participants performed automatic audiometry through a receiver-in-canal, behind-the-ear hearing aid coupled to an open dome. In Study 1, the experimenter directed the task. In Study 2, participants followed a set of written, illustrated instructions to perform automatic audiometry independently of the experimenter, with optional assistance from a lay partner. Standardized measures of hearing aid self-efficacy, locus of control, cognitive function, health literacy, and manual dexterity were administered. Statistical analysis examined the repeatability of automatic audiometry; the match between automatically and manually measured thresholds; and contributors to successful, independent completion of the automatic audiometry procedure. When the procedure was directed by an audiologist, automatic audiometry yielded reliable and valid thresholds. Reliability and validity were negatively affected when the procedure was self-directed by the user, but the results were still clinically acceptable: test-retest correspondence was 10 dB or lower in 97% of cases, and 91% of automatic thresholds were within 10 dB of their manual counterparts. However, only 58% of participants were able to achieve a complete audiogram in both ears. Cognitive function significantly influenced accurate and independent performance of the automatic audiometry procedure; accuracy was further affected by locus of control and level of education. Several characteristics of the automatic audiometry algorithm played an additional role in the outcome. Average transducer- and coupling-specific correction factors are sufficient for a self-directed in situ audiometry procedure to yield clinically reliable and valid hearing thresholds. Before implementation in a self-fitting hearing aid, however, the algorithm and test instructions should be refined in an effort to increase the proportion of users who are able to achieve complete audiometric results. Further evaluation of the procedure, particularly among populations likely to form the primary audience of a self-fitting hearing aid, should be undertaken.

Exploring the Relationship Between Hearing Aid Self-Efficacy and Hearing Aid Management

Hearing loss is a highly prevalent condition affecting a significant portion of the adult population. Hearing aids are an effective and common rehabilitation strategy for individuals with hearing loss. A wide range of factors, however, can hamper and even preclude successful hearing aid use. Self-efficacy, a concept that reflects perceptions of one's ability to perform particular tasks or behaviors, has been shown to be an important factor in the successful management of chronic illness including conditions such as diabetes, cardiovascular disease, as well as arthritis and other sources of chronic pain. Improving or strengthening patients' self-efficacy beliefs can improve health outcomes. The role of self-efficacy in the management of hearing loss and hearing aids is still being explored; hence, the extent to which, and the ways in which, self-efficacy may be related to audiologic outcomes remains largely unexplained. The purpose of this article is to examine emerging evidence regarding the relationship between perceived self-efficacy and rehabilitation outcomes among adult hearing aid users and to discuss an apparent discrepancy between patients' reported self-efficacy and their demonstrated skill in managing hearing aids.

Identifying the barriers and facilitators to optimal hearing aid self-efficacy

Objective: Many older adults with hearing impairment are not confident in their ability to use hearing aids (i.e. experience low hearing aid self-efficacy), which has been found to be a barrier to hearing help-seeking and hearing aid use. This study aimed to determine what factors were associated with achieving adequate hearing aid self-efficacy. Design: A retrospective research design was employed wherein hearing aid self-efficacy was the primary outcome. Explanatory variables included personal demographics, visual disability, and experiences related to participants’ hearing ability and hearing aids. Study sample: A total of 307 older adults with hearing impairment participated in the study (147 non hearing aid owners and 160 hearing aid owners). Results: Non-hearing aid owners were more likely to report adequate hearing aid self-efficacy if they reported no visual disability, had experienced hearing loss for longer, reported more positive support from a significant other, and were not anxious about wearing hearing aids. Hearing aid owners were more likely to report adequate hearing aid self-efficacy if they had had a positive hearing aid experience and no visual disability. Conclusions: More research is needed to develop and evaluate intervention approaches that promote optimal levels of hearing aid self-efficacy among older adults with hearing impairment.

Development of a hearing aid self-efficacy questionnaire

Discontinued hearing-aid use is caused by a number of factors, most of which may lead to low hearing-aid self-efficacy (i.e. low confidence in one's ability to B a successful hearing-aid user). This paper describes the development of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA), which was constructed in accordance with published recommendations for self-efficacy questionnaire development. The psychometric properties of the MARS-HA were evaluated with new and experienced hearing-aid users. The results revealed strong internal consistency and good test-retest reliability in both groups, with the following subscales identified both for the new users and the experienced users: (1) basic handling, (2) advanced handling, (3) adjustment to hearing aids, and (4) aided listening skills. Validity was established through the examination of expected differences based on group comparisons, training effects, and the impact of particular hearing aid features. The MARS-HA is a reliable and valid measure of hearing-aid self-efficacy and can be used to assist clinicians in identifying areas of low confidence that require additional audiologic training.

Hearing Aid Self-Efficacy of New and Experienced Hearing Aid Users

Hearing Aid Self-Efficacy of New and Experienced Hearing Aid Users