Motivational engagement in first-time hearing aid users: A feasibility study

Figures & data

Table 1. Reflections on the clinical use of the Motivation Tools. The participatory workshop revealed a number of take-home messages that are relevant to clinical practice.

What do they add?	The tools provide a framework upon which the audiologist can help the patient to reveal information, which can direct the hearing assessment and hearing-aid fitting appointments and subsequent counselling towards a more patient-centred approach.
	The tools appear to tap into the patient’s needs and motivations more readily than a standard clinical history.
	The scores are less important than the responses that are revealed – it’s not the score, it’s what you do with the score.
When to use?	The tools are best employed at the initial hearing assessment to help assess and/or reveal the patient’s needs that might not surface in a standard clinic appointment.
	The tools can be used routinely in clinic, although they may not work with all patients.
How to use?	Patients respond best when recording their own scores rather than the audiologist doing it for them, allowing the patient to become an active participant in their own care and management.
What can go?	Elements of the history asked as standard (e.g. use of phone, television) can be preferentially replaced with the tools without detriment to the patient or creating additional time constraints.
Why use?	For all these reasons, the audiologists were enthusiastic to use these patient-centred tools routinely in clinical practice.

Figure 1. (A) Boxplot showing median ratings for The Line questions 1 (Readiness) and 2 (Self-efficacy) at the assessment appointment and fitting appointment for M+ and M- groups. Line questions were used as the intervention with the M+ group, and with the M- group as a simple measure of readiness and self-efficacy only. (B) Percentage of M + participants classified by the audiologist according to one of five stages of change (The Circle) at assessment and fitting appointments. (C) Percentage of M+ participants falling within one of the four PAM Activation levels (see text) at assessment and follow-up. (D) Percentage of M- participants falling within one of the four PAM Activation levels at assessment and follow-up. PAM = Patient Activation Measure.

Table 2. Mean and standard deviation (or median and interquartile range) for self-report measures completed at assessment (HHCIR, HADS, PAM) and follow-up (HADS, PAM, GHABP, SADL, MARS-HA, datalogging), for both M+ (assessment, n = 32; follow-up, n = 28) and M- (assessment, n = 36; follow-up, n = 25) groups. Uncorrected p-value is provided for differences between groups, with bold indicating significance following Holm-Bonferroni correction. HHCIR = Hearing Health Care Intervention Readiness, HADS = Hospital Anxiety and Depression Scale, PAM = Patient Activation Measure, GHABP = Glasgow Hearing Aid Benefit Profile, SADL = Satisfaction with Amplification in Daily Life, MARS-HA = Measure of Audiologic Rehabilitation Self-efficacy for Hearing Aids.

			M+		M−		p
Assessment	HHCIR	Overall	24.21	(6.56)	21.12	(7.68)	.097
		Readiness^1	12	(2)	10	(4)	.145
		Communication^1	12	(4)	11	(6.5)	.103
		Social isolation^1	0	(4)	0	(2.5)	.363
		Self-efficacy^1	4	(0)	4	(2)	<.001
	HADS	Overall	4.98	(2.41)	7.33	(4.21)	.028
		Anxiety	3.90	(2.81)	7.23	(4.70)	.007
		Depression	6.05	(2.52)	7.42	(4.41)	.137
	PAM	Activation score	61.03	(13.79)	57.76	(10.26)	.289
		Level of activation	2.79	(1.07)	2.74	(.92)	.841
Follow-up	HADS	Overall	4.80	(3.48)	5.81	(2.85)	.285
		Anxiety	4.33	(3.86)	5.41	(3.06)	.355
		Depression	5.88	(3.89)	6.38	(3.15)	.639
	PAM	Activation score	67.39	(15.49)	65.55	(14.95)	.683
		Level of activation	3.19	(.94)	3.14	(1.11)	.869
	GHABP	Overall	78.55%	(16.57)	80.49%	(18.22)	.698
		Use^1	100%	(43.75)	100%	(25.0)	.586
		Benefit	65.83%	(19.03)	68.26%	(23.76)	.754
		Satisfaction	78.33%	(17.48)	73.41%	(22.43)	.498
		Residual disability	16.59%	(14.55)	15.48%	(13.12)	.785
	SADL	Overall	5.71	(.86)	5.31	(.57)	.082
		Positive effect	5.33	(1.17)	5.03	(.19)	.331
		Negative features	5.56	(1.31)	4.84	(1.30)	.069
		Personal image	6.30	(1.19)	5.87	(1.09)	.203
		Service & Cost	6.26	(.91)	6.17	(.66)	.699
	MARS-HA	Overall	85.25%	(12.16%)	81.32%	(13.20)	.279
		Basic handling^1	97.14%	(11.43)	97.14%	(15.71)	.324
		Adjustment^1	93.33%	(13.33%)	96.67%	(23.33)	.457
		Aided listening	86.35%	(16.29)	85.54%	(12.86)	.850
		Advanced handling	66.59%	(25.21)	56.15%	(31.15)	.196
	Datalogging (hours per day)		10.01	(5.10)	8.73	(5.35)	.415

¹Median (interquartile range) reported as data skewed.

Table 3. Significant (p <.05) Spearman rank (r_s) correlation coefficients between HHCIR administered at assessment and outcome measures administered at follow-up for the M+ and M- groups. Bold indicates significance.

Group	Outcome measure	HHCIR	rs	p
M+	HADS overall	Overall	.48	.014
		Communication	.46	.020
		Social isolation	.43	.033
	Anxiety	Overall	.59	.008
		Communication	.56	.012
	Depression	Overall	.51	.011
		Communication	.52	.041
		Social isolation	.51	.011
M-	GHABP overall	Overall	.56	.007
		Readiness	.65	.001
		Communication	.52	.013
	Use	Overall	.48	.028
		Readiness	.46	.036
		Communication	.44	.044
	Benefit	Overall	.49	.047
		Readiness	.58	.014
	Satisfaction	Overall	.72	.001
		Readiness,	.79	<.001
		Communication	.67	.003
		Self-efficacy	.71	.001
	Residual disability	Readiness	−.51	.018
		Self-efficacy	−.46	.036
	MARS-HA overall	Self-efficacy	.52	.010
	Aided listening	Self-efficacy	.58	.004
	Basic handling	Self-efficacy	.47	.025
	Adjustment	Self-efficacy	.51	.012
	Datalogging	Overall	.50	.026
		Readiness	.53	.017
		Self-efficacy	.56	.040

Table 4. Summary of multiple regression analysis for each outcome measure predicted by HHCIR scores based on significant Spearman rank correlation coefficients, for both M+ and M- groups. Bold indicates significance (p <.05).

Group	Outcome measure	HHCIR	R	R^2	β	t (df)	p
M+	HADS Overall	Overall	.58	.34	.32	3.45 (23)	.002
		Communication & Social isolation	.68	.42^a	.27	1.55 (22)	.136
					.75	3.11 (22)	.005
	Anxiety	Overall	.57	.31	.41	2.88 (17)	.010
		Communication	.51	.26	.75	2.47 (17)	.024
	Depression	Overall	.63	.39	.38	3.78 (22)	.001
		Communication & Social isolation	.74	.51^a	.29	1.61 (21)	.122
					1.10	4.62 (22)	< .001
M−	GHABP Overall	Overall	.71	.51	1.86	4.54 (20)	< .001
		Readiness &	.81	.63^a	5.36	6.19 (20)	< .001
		Communication			.70	.74 (19)	.471
	Use	Overall	.66	.43	2.35	3.81 (19)	.001
		Readiness &	.74	.49^a	6.51	4.40 (19)	<.001
		Communication			1.85	1.16 (18)	.254
	Benefit	Overall	.59	.35	2.04	2.86 (15)	.012
		Readiness	.71	.50	5.77	3.87 (15)	.002
	Satisfaction	Overall	.74	.55	2.41	4.3 (15)	.001
		Readiness,	.82	.60^a	6.01	4.82 (15)	<.001
		Communication &			.45	.26 (13)	.798
		Self-efficacy			7.70	1.70 (14)	.167
	Residual disability	Readiness &	.53	.20^a	−2.29	−2.41 (19)	.026
		Self-efficacy			−3.82	−1.01 (18)	.325
	MARS-HA Overall	Self-efficacy	.55	.31	6.17	3.05 (21)	.006
	Aided listening	Self-efficacy	.51	.26	5.55	2.73 (21)	.013
	Basic handling	Self-efficacy	.61	.37	5.40	3.48 (21)	.002
	Adjustment	Self-efficacy	.58	.34	6.40	3.29 (21)	.004
	Datalogging	Overall	.42	.17	.31	1.95 (18)	.067
		Readiness &	.54	.29	1.05	2.72 (18)	.014
		Self-efficacy			.28	.19 (17)	.855

^aAdjusted R-square as predictors in model > 1 variable.