What do hearing healthcare professionals do to promote hearing aid use and benefit among adults? A systematic review

Figures & data

Table 1. Search terms and Boolean operator used: Group terms combined by “AND”.

Key concept	Group 1: Behaviour Combine by “OR”	Group 2: Hearing healthcare professionals Combine by “OR”	Group 3: Hearing aid Combine by “OR”
Free text terms	Communication Conversation Interaction Discussion Counseling Approach Consultation Aural Rehabilitation Education	Hearing healthcare profession Ear, nose and throat specialist ENT Otolaryngologist Otorhinolaryngologist Rhinolaryngologist Audiologist Hearing specialist Hearing therapist Audiometrician Audiometrist Hearing aid specialist Hearing aid dispenser Hearing aid practitioner Hearing aid provider	Hearing aid Amplification Ear mold Earmould

Figure 1. PRISMA flowchart of the systematic search.

Table 2. Details of descriptive studies.

Author, year, (country)	Objective	Methodology			Results	CCAT score (X/40 (%))
		Study design (level of evidence)	Appointment phase	Participant
Dockens et al. (2017) (USA)	To examine audiologist – patient interactions.	Descriptive, observational study (VI)	Post-testing	1 audiologist, 6 adults	The audiologist was the dominant communication partner and produced on average of 43 words per turn compared with patient’s 15 words per turn during hearing aid consultations.	35/40 (88%); High quality
Ekberg, Barr, and Hickson (2017a) (Australia)	To examine audiologist-patient interactions during discussions about hearing aid cost	Descriptive, observational study (VI)	Post-testing	26 audiologists, 62 adults	Audiologists offered a single hearing aid cost option to patients in 76% of appointments leading to rejection of hearing aids by patients due to the cost. Additional consequences included longer appointment times and disconnected audiologist-patient interactions. Patients’ concerns about cost were mostly not addressed. Some audiologists offered a range of cost options which facilitated smoother interactions; acceptance of patient decisions by audiologists and fewer negative emotional reactions by patients.	36/40 (90%); High quality
Ekberg, Hickson, and Grenness (2017b) (Australia)	To examine conversation repair strategies used in audiologist-patient interactions	Descriptive, observational study (VI)	During and/or post-testing	26 audiologists, 63 adults	A lack of mutual gaze occurred between audiologists and patients in 76% of consultations (mostly when audiologists were talking with patients while performing other tasks).	35/40 (88%); High quality
Meyer et al. (2017) (Australia)	To describe content of audiologist-patient communication	Descriptive, observational study (VI)	Post-testing	26 audiologists, 56 adults	Audiologist-patient communications were described as ‘expanded biomedical’ in 45appointments and ‘narrowly biomedical’ (i.e. Focus on biomedical information with little discussion of psychosocial issues in 11 appointments (n = 56). Longer duration of appointments was associated with an ‘expanded biomedical’ interactions.	35/40 (88%); High quality
Sciacca et al. (2017) (Australia)	To describe complexity of language used by audiologists	Descriptive, observational study (VI)	Post-testing	26 audiologists, 62 adults	The complexity of audiologists’ language was estimated at grade 5 reading level. At least 3 jargon words (e.g. “low frequency”) were used by audiologists on average in each consultation, but the meaning of jargon words was usually not explained.	35/40 (88%); High quality
Barker, Mackenzie, and De Lusignan (2016) (UK)	To describe behaviour change techniques (Michie et al. 2013) used by audiologists	Descriptive, observational study (VI)	Fitting	9 audiologists, 9 adults	Audiologists were observed using 11 behaviour change techniques including; providing instruction on hearing aid use, practical instruction on how to use hearing aids, instruction on cleaning and operating hearing aids and providing information about social support availability and benefits of hearing-aid use.	38/40 (95%); High quality
Pryce et al. (2016) (UK)	To examine the decision-making process during audiologist-patient consultations	Qualitative, observational (VI)	Post-testing	5 audiologists, 5 adults	Audiologists led the decision-making process by giving advice and prescribing hearing aids. No alternative rehabilitation options were offered. Advice provided about hearing aids was general without relating the information to patients’ problems and preferences.	35/40 (88%); High quality
Grenness et al. (2015) (Australia)	To describe verbal communication between audiologists and patients/ companions	Descriptive, observational study (VI)	Post-testing	26 audiologists, 62 adults	Audiologists spent on average 29 (±18.6) minutes in discussion including 4 (±4.1) minutes discussing the patient’s hearing loss. Audiologists were the dominant communicative partner and produced on an average 421 utterances during a consultation compared to 261 utterances by patients. 48% of the content of audiologists’ discussion was categorised as “education and counselling”, which focused on technical aspects of the hearing aid. A hearing aid was recommended to all patients with hearing loss. Alternative hearing rehabilitation options were only provided when patients rejected hearing aids.	37/40 (93%); High quality
Ekberg, Grenness, and Hickson (2014) (Australia)	To examine how patients’ concerns about hearing aid are addressed by audiologists.	Descriptive, observational study (VI)	Post-testing	26 audiologists, 63 adults	Audiologists did not adequately attend to patients’ concerns about hearing aids during hearing aid discussions. Audiologists focused on informing patients about their hearing loss and then moved directly into a discussion of the technical aspects of hearing aids. As a result, patients re-raise their concerns about hearing aids and lengthen the appointment time. At the end of the consultation, patients either gave a weak agreement to try a hearing aid or left the appointment without a hearing aid.	36/40 (90%); High quality
Hindhede (2010) (Denmark)	To examine the audiologist-patient interactions	Qualitative, observational (VI)	Fitting	8 audiologists, 41 adults	Consultations were described as “information giving sessions”. The content of information provided by audiologists was similar across all audiologist-patients consultations. The content of the information related to acclimatisation to hearing aids and technical aspects of hearing aids rather than discussing the patients’ communicative needs. Audiologists did not address the concerns of patients about hearing aids and focused instead on adjusting the hearing aid.	23/40 (58%); Moderate quality
Nair and Cienkowski (2010) (USA)	To investigate the grade level of patient health literacy, language used by audiologists and hearing aid written materials.	Descriptive, observational study (VI)	Fitting	3 audiologists, 12 adults	Average patient health literacy was below a third-grade reading level (based on Flesch-Kincaid reading level). The complexity language used by audiologists was significantly higher than that of patients. However, the language used by audiologists was significantly less complex than in written materials. Audiologists did not adjust the complexity of language according to the demographic of patients.	23/40 (58%); Moderate quality
Doyle (1994) (Australia)	To describe features of audiologist-patient interactions	Descriptive, observational study (VI)	Post-testing	10 audiologists, 50 adults	Audiologists were the dominant communication partner; did 66% of the talking on average and asked three times more questions than patients. Audiologists spent on average 6 (±2.8) minutes to discussing the patient’s hearing loss and hearing aids. 43% of questions asked by audiologists were related to symptoms and causes of hearing loss. 49% of questions asked by patients related to the hearing aid, with 31% of patients’ questions being about hearing aid use and benefit.	31/40 (78%); High quality

Table 3. Details of intervention studies.

Author, year, (country)	Objective	Methodology					Results	CCAT score (X/40 (%))
		Study design (level of evidence)	Appoint. phase	Participant	Intervention	Measurements
Solheim et al. (2018) (Norway)	To investigate effectiveness of motivational interviewing (Miller and Rollnick 2012) on hearing aid use in adult patients who used their hearing aid fewer than 90 minutes per day.	Pretest-posttest (IV)	Fitting follow-up	1 audiologist, 47 adults (all participants received the motivational interviewing for 30 minutes.	Motivational Interview (Miller and Rollnick 2013)	Hearing aid use was measured via data logging at 6 months post-fitting (baseline) and at 3 months post-intervention. Hearing aid benefit was measured based on informal patient reports of perceived benefit or contentment with hearing aid (increased or not increased)	There is significant increase in hearing aid use according to data logging at 3 months post-intervention. 37 of 47 adults had increased hearing aid use from 21 minutes per day on average (SD= 29 minutes) at baseline (6-month post-fitting) to 1 hour and 52 minutes per day on average (SD= 1 hour and 40 minutes) at 3-month post-intervention. 21 of the 37 (57%) adults reported increased benefit or contentment with hearing aid at 3 months post-intervention.	30/40 (75%); High quality
Ferguson et al. (2016) (UK)	To evaluate the feasibility of incorporating the Motivation Tools (Clark 2010) into routine clinical practice and to test the impact of motivational engagement on hearing aid use and benefit in new hearing aid users.	Quasi-randomised controlled trial (III)	Fitting	5 audiologists, 68 adults (n = 32 received motivational engagement and n = 36 received standard care)	Motivational engagement using motivational tools by the Ida Institute; the Line, Box and Circle (Clark 2010)	Hearing aid use was measured via data logging and self-report questionnaires. Hearing aid benefit and satisfaction were measured using self-reported questionnaires; 1. GHABP (Gatehouse 1999) and 2. The Satisfaction with Amplification in Daily Life (SADL) (Cox and Alexander 2001). Outcomes were measured at hearing assessment, hearing aid fitting and/or at 10 weeks post- fitting.	There was no significant difference between intervention and control groups in hearing aid use measured via data logging, self-reported hearing aid use, benefit or satisfaction measured at follow up.	37/40 (93%); High quality
Aazh (2016a) (UK)	To evaluate the feasibility of a full-scale randomised control trial to investigate effectiveness of motivational interviewing (Miller and Rollnick 2012) on hearing aid use in adult patients who used their hearing aid fewer than four hours per day.	Randomised control trial (II)	Fitting follow-up	2 audiologists, 37 adults (n = 20 received “motivational interviewing” and n = 17 received standard care)	Motivational Interview (Miller and Rollnick 2012)	Hearing aid use was measured via data logging. Self-report questionnaires used; 1. International outcome Inventory for hearing aids (IOI-HA) (Cox and Alexander 2002), 2. International Outcome Inventory for Hearing Aid for the Significant Other (IOI-HA-SO) (Noble 2002), Client Oriented Scale of Improvement (COSI) (Dillon, James, and Ginis 1997) and Glasgow Hearing Aid Benefit Profile (GHABP) (Gatehouse 1999). Outcomes were measured at baseline and at one month after the intervention.	The intervention group had greater hearing aid use (7 ± 3.7 hours per day) compared to the control group (4 ± 3.6 hours per day according to data logging at follow up (Cohen’s d = 0.82). There was no significant difference in IOI-HA, IOI-HA-SO, COSI and GHABP questionnaire scores in both groups at one-month post intervention.	40/40 (100%); High quality
Naylor et al. (2015) (Sweden)	To test effects of two types of interactions (termed “narratives”) on hearing aid benefit in experienced and first-time hearing aid users. The acoustical setting of the hearing aid was identical for all patients.	Randomised controlled crossover trial (II)	Fitting	2 Audiologists, 24 experienced adult hearing aid patients + 16 new hearing aid users	Interactive (I) and Diagnostic (D) Narrative. All patients were randomized either to “I” or “D” group. All participants than received the alternative interaction after two weeks.	Self-reported hearing aid benefit was measured using the Hearing Handicap Inventory for the Elderly (HHIE) (Ventry and Weinstein 1982), International Outcome Inventory for Hearing Aids (IOI-HA) (Cox and Alexander 2002) and Hearing Aid Performance Questionnaire (HAPQ) (Gatehouse, Naylor, and Elberling 2006). Outcomes were measured two weeks post-intervention.	Experienced hearing aid users (n = 24): 20 of the 24 experienced users preferred either the interactive narrative or the diagnostic narrative. There was greater hearing aid benefit and lower hearing disability according to self-reported questionnaire scores (Cohen’s d = 0.48 (HAPQ) (Gatehouse, Naylor, and Elberling 2006), d = 0.43 (HHIE) (Ventry and Weinstein 1982), and d = 0.68 (IOI-HA) (Cox et al.2000)) for the preferred versus the non-preferred narrative. First-time hearing aid users (n = 16): 14 of the 16 users preferred either the interactive narrative or the diagnostic narrative. There was greater hearing aid benefit and lower hearing disability according to self-reported questionnaire scores (Cohen’s d = 0.30 (HAPQ) (Gatehouse, Naylor, and Elberling 2006), d = 0.45 (HHIE) (Ventry and Weinstein 1982)) for the preferred versus the non-preferred narrative. There was no difference in IOI-HA scores between narratives.	40/40 (100%); High quality
Saunders and Forsline 2012) (USA)	To compare informational counselling and performance perceptual counselling (Saunders and Forsline 2012) on hearing aid use and benefit in adult patients who were dissatisfied with their hearing aids.	Randomised control trial (II)	Fitting follow-up	1 audiologist, 69 adults (n = 35 received IC and n = 34 received PPC)	Informational and performance perceptual counselling (Saunders and Forsline 2012)	Self-reported hearing aid use- and benefit- related questionnaires were completed before the counselling session (Session 1) and 8–10 weeks after the counselling session (Session 2). Hearing aid use and benefit were measured using Hearing handicap inventory (HHI) (Newman et al. 1990; Ventry and Weinstein 1982), Abbreviated profile of hearing aid benefit (APHAB) (Cox and Alexander 1995) and IOI-HA (Cox and Alexander 2002) questionnaires.	No significant differences on the HHI, APHAB or IOI-HA in both groups at follow-up.	31/40 (78%); High quality

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