Connected hearing healthcare: shifting from theory to practice

Foreword

Connected health is an umbrella term encompassing telehealth, ehealth, mhealth and other terms that describe remote/virtual healthcare service delivery models. This overarching term describes a model that utilises technology to maximise healthcare resources, with the potential to provide increased, flexible opportunities for patients to engage with healthcare practitioners and to better manage the care process. Broadly speaking, connected health can address global health issues related to access, equity, and quality of care; thereby offering the potential to improve healthcare delivery and management in both rural and urban populations.

Connected hearing healthcare therefore offers great potential to embrace the rapid technological innovation being experienced in the field of audiology. As such, tele-audiology and eAudiology are examples of increasingly used terms, demonstrating how technological innovation within audiology is being leveraged to develop a care model that connects all stakeholders in proactive and efficient ways to improve hearing services for patients. Until recently, connected hearing healthcare had yet to be widely implemented into clinical practice, indicating that technological innovation is only one piece of the puzzle. When adapting this new model of care, hearing healthcare practitioners will rely on current and evolving research, implementation efforts, and stakeholder support to fully embrace connected hearing healthcare. These factors have of course been accelerated by the emergence of the global COVID-19 pandemic early in 2020, and it is highly likely that the impact of the pandemic will continue to positively influence the rapid take-up and changes in connected hearing healthcare across the world over the coming years.

This supplement was conceived in Miami in December 2018 when the guest editors attended a meeting of the Phonak Expert Circle on eAudiology. We were of course completely unaware of the huge changes in delivery of hearing healthcare that would ensue only 15 months later. The supplement focuses on research across four continents (North America, South Africa, Europe and Australia) highlighting the multi-level complexity of connected hearing healthcare and key technologies and factors, other than the pandemic, that influence the shift from theory to practice.

The first article by Muñoz and colleagues presents a scoping review of applied tele-audiology research over the past decade. This review highlights the expanding and changing technological landscape of healthcare services with the potential to provide greater opportunities and flexibility for audiologists and patients. Clear opportunities for interdisciplinary collaboration are also highlighted, with discussion around the benefits that can be realised from the provision of specialised training and hands-on assistance and/or support in connecting individuals to follow-up care, educational support, and beyond.

Glista and colleagues present a conceptual framework, developed with concept mapping methodology, around the audiologist-perceived factors that influence the clinical uptake of remote follow-up hearing aid support services. These findings highlight the need to tailor future planning and development efforts in the advancement of connected hearing healthcare research, tools, and guidance around technology and infrastructure, hearing healthcare regulations, as well as considerations centred on the client, the audiologist, implementation, and finances.

The study by Dawood and colleagues compares the outcomes of a community-based mhealth hearing screening program delivered by specialist (school health nurses) and non-specialist (community health workers) health workers to a large sample of school children in South Africa. Findings suggest no difference in the screening outcome between the two health worker groups. This demonstrates that low-cost automated mobile technologies can be successfully used to deliver community screening with minimally- trained health personnel.

Research by Ferguson and colleagues addresses a void in the clinical venue with regards to educating and reinforcing hearing aid and communication knowledge for first-time hearing aid users. Their study demonstrated high usability, acceptability, and adherence in using an individualised, interactive multimedia mhealth educational program (m2Hear). The results support the notion that self-management and improved patient outcomes, including participation, hearing aid knowledge and self-efficacy, can be facilitated with innovative education and training using accessible mobile-based tools such as m2Hear.

A pilot study by Muñoz and colleagues includes an ehealth program designed to provide education to parents of young children who use hearing aids. Findings suggest successful implementation of the eHealth education program, along with participant benefits related to increased knowledge and confidence, which are important skills for hearing aid management. This pilot study also highlights the need for further research to help realise the potential of such programs, on a larger scale.

Tau and colleagues compare in-person, tele-audiology, and blended service delivery models for hearing aid consultations. The authors found improved outcomes for all models of delivery. This provides promising information to support use of flexible service delivery models to address patients’ hearing aid needs. Patient satisfaction was high for all delivery methods; however, standard in-person delivery was significantly greater, suggesting there are opportunities to identify how to improve the patient experience for remote services.

The summary of research by Timmer and colleagues presented evidence on mobile device apps at various stages along the patient’s rehabilitation journey. This incorporated the use of ecological momentary assessment to raise awareness and assess individualised hearing difficulties and listening experiences, and to provide a guide for hearing aid handling. This research shows that app usability is rated positively by older adults, and smartphone apps are an acceptable means to enhance and complement face-to-face interactions in the clinic.

The final article in the supplement by Glista and colleagues explored real-world hearing aid experiences of school-aged children using ecological momentary assessment. The authors obtained feedback from children while they were engaged in listening environments of importance in their daily life. The information obtained from the study provided useful insights for hearing aid programming and increases understanding around the provision of personalised hearing aid support for children.

Guest foreword: Connected technologies in hearing healthcare’s own fourth industrial revolution

Connected health is a result of the generalised changes in healthcare with the advent of the fourth industrial revolution that is rapidly changing the way we live, work, and relate to each other (Schwab 2017). Until recently the three most important drivers of this health and healthcare revolution have been identified as the unsustainable rise in costs, the rapid evolution of science and medicine, and the digitalisation of health and healthcare (World Economic Forum 2019). In 2020, an unexpected fourth, and more urgent, driver of change emerged in the form of a global pandemic that has escalated connected healthcare as a primary and in some cases sole avenue of care.

The importance of this timely supplement on connected hearing healthcare, launched before COVID-19, has only been elevated with the unprecedented global pandemic. Where much of the previous implementation of telehealth services has been driven primarily by convenience and preference, COVID-19 has escalated the importance of connected healthcare as a matter of safety, first and foremost (Swanepoel and Hall 2020). The predominant patient caseload for hearing healthcare is the elderly, who are at the highest risk of COVID-19 mortality and morbidity. Furthermore, the clinic-based settings for audiology services are high-risk settings for infection due to factors such as confined clinic spaces, equipment setup, and duration of consultations (De Sousa et al. 2020).

One of the fundamental shifts that is reshaping health care in the fourth industrial revolution is a move away from clinic-centred point-of-care models through connected telehealth technologies towards a seamless continuum of care (World Economic Forum 2019). The papers in this supplement include a comprehensive overview of new technologies, their implementation, and the service-delivery models they enable across the continuum of audiological care from screening, diagnosis, treatment, and support. These innovative technologies and models of care are important steps towards more fully integrated approaches with the potential to improve hearing health outcomes and efficiency, contain costs, and keep innovation central to the future of hearing healthcare delivery.

Guest foreword contribution from Prof De Wet Swanepoel

Department of Speech-Language Pathology and Audiology

University of Pretoria

Pretoria, South Africa

Guest editor: Danielle Glista

Guest editor: Melanie Ferguson

Guest editor: Karen Muñoz

Guest editor: Evelyn Davies-Venn

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work and open access was sponsored by Phonak Headquarters in Staefa, Switzerland.