Communication strategies, personal adjustments, and need for recovery in employees with hearing loss who receive a communication group-training

Abstract

Purpose

Communication group-trainings are part of current aural rehabilitation practices, but their effect has not yet been investigated systematically in working adults. The purpose of this study was to describe the communication strategies (CS), personal adjustments (PA) and need for recovery (NFR) of employees with hearing loss before and directly after a communication group-training.

Methods

Nine employees were included at two audiological centres that provided a different group-training. Two online questionnaires were completed, at baseline and after completing the training.

Results

Most employees used more adequate CS after the group-training, but there seems to be a difference between the improvement in PA between the centres. No trends towards a decrease in NFR were observed.

Conclusion

It is still challenging to reduce the work difficulties that are encountered by employees with hearing loss. The inter-centre differences point out a need for standardization. Suggestions for improvements are provided and should be further investigated in a larger population.

Keywords:

• Adaptation
• communication training
• hearing loss
• psychological
• work

Introduction

Hearing loss in the working population affects work functioning [1,6]. It causes hearing and communication difficulties, for example during group-meetings or in noisy/reverberant workplaces. In an attempt to overcome these difficulties, different coping strategies can be used [2,3]. Employees with hearing loss often put extra effort and concentration when listening, use assistive listening devices, inform their colleagues about the hearing loss, or withdraw from difficult working situations. Although some of these strategies might be effective to reduce the hearing and communication difficulties at the workplace, not all of the difficulties can be compensated for [13]. The benefit of assistive listening devices is smaller in noisy environments [15] and it can be demanding and fatiguing to continuously put in extra effort and concentration when listening at work [11]. Moreover, communication difficulties can result in the inability to complete work tasks, making mistakes in work [6], and feelings of stress, frustration, and incompetency [9,12,24].

A great amount of evidence regarding the impact of hearing loss on employment status has recently been summarized in a systematic review [20] and a scoping review [6]. Compared to those with normal hearing, employees with hearing loss are more likely to earn less, take more sick leave, become unemployed or partially unemployed, and take earlier retirement. Therefore, there lies great social and economic importance in good rehabilitation services for employees with hearing loss.

It is increasingly acknowledged that aural rehabilitation services for employees with hearing loss require a multidimensional approach, because of the interplay between hearing loss, personal factors, and work characteristics [6,29]. However, the focus of current practices is often on technical interventions, rather than on perceptual training or counselling services on how to cope with hearing loss at work [6,29]. A reason might be that rehabilitation services for employees with hearing loss are not standardized and poorly documented [6,7]. For example, it is unclear what interventions can best be provided individually or in a group-setting, what the duration and intensity of counselling should be, and what tools should be used to describe and evaluate the effects of rehabilitation services on work functioning in employees with hearing loss.

The outcome Need For Recovery (NFR) has been suggested to be a valuable tool for evaluating the effects of aural rehabilitation services in employees with hearing loss, because of its predictive value of occupational or health problems [4,5,17,19,22]. NFR is a generic outcome measure that represents the need to recuperate from work-induced fatigue [28]. It is a multidimensional construct that is influenced by personal and work-related factors, such as coping-behaviour [16] and work demands [23]. Specifically for employees with hearing loss, hearing-related coping behaviour was shown to be associated with the NFR [26].

So far, three studies evaluated the effect of aural rehabilitation services on the NFR of employees with hearing loss [8,25,27]. One study did assess the effect of hearing aid uptake only [27] and the other two studies assessed a multidimensional approach. An individual speech reading (lip reading) training was incidentally offered [25] and individual counselling was offered in 14% [8] and 31% of the included employees [25]. A positive effect on the NFR was only reported in the last study. It was concluded that the NFR can be improved by aural rehabilitation, although this was only the case in part of the employees. An analysis of the change scores that were associated with a change in the NFR revealed that especially interventions that affect personal adjustments (PA) may be promising to reduce the NFR. PA are part of the hearing-related coping behaviour and includes self-acceptance, acceptance of hearing loss, and having little stress and withdrawal.

Instruction or counselling on coping behaviour can also be provided in a group-setting of communication training. This training includes speech reading (lip reading) training and instruction or counselling on effective communication strategies (CS) and PA. A group-training might be more effective than individually tailored instruction or counselling, because usually, it takes more time to participate in a group-training (“higher dose of the intervention”) and group-training provides the opportunity to interact with other employees with hearing loss and share experiences [10]. This training is part of the routine clinical practice of most Dutch audiological centres. In some centres, the communication group-training is provided in separate groups for employees with hearing loss. In other centres, employees with hearing loss participate in this training together with non-working adults. The effects of communication training on the CS, PA, and NFR of employees with hearing loss have not yet been investigated. Therefore, the aim of this study is to describe the CS, PA and NFR in a small sample of employees with hearing loss before and directly after participating in a communication group-training.

Materials and methods

Study design

This study focussed on employees with hearing loss who received communication group-training in the period from October 2020 to January 2022. To provide a broad description of current practices, employees were included at two audiological centres in the Netherlands, respectively Libra Revalidation and Audiology (AC1) and Adelante Audiology and Communication (AC2). Outcomes were measured by an online questionnaire before the start of the training (T₀) and directly after the last meeting of the training (T₁). The time interval between T₀ and T₁ ranged from 7 to 12 weeks.

Ethical considerations

The Ethics Committee of the Academic Medical centre declared that no formal approval of the detailed protocol was required according to the Dutch Medical Research Involving Human Subjects Act (No. W19_501).

Participants

Eligible employees participated in the communication group-training of AC1 between 2020 and 2022 or in the communication group-training of AC2 between 2021 and 2022. The inclusion criteria further required the employees to be aged between 18 and 67, to work at least 8 h per week, to have hearing complaints in the work situation, and to complete the informed consent form and both questionnaires.

Communication training

The content of the communication group-training at AC1 and AC2 is summarized in Table 1. The training consists of a speech reading training, instruction about hearing loss, instruction about assistive listening devices, and instruction or counselling on daily life situations. The communication training is mainly provided by a social worker and a speech therapist. A PowerPoint presentation is used to display program information and to provide information during the instructions. One session is partly facilitated by an audiologist who provides instruction about hearing loss and technical devices. During breaks and plenary discussions, interaction between participants is encouraged.

Table 1. Characteristics and content of the communication group-training at the two participating audiological centres (AC1 and AC2).

	AC1	AC2	Provided by
Duration course	10,5 h	22 h	–
Working participants only	No	Yes	–
Speech reading training	45%	30%	Speech therapist
Instruction about hearing loss	12%	20%	Audiologist
Instruction about technical devices	10%	10%	Audiologist
Counselling on personal situations	33%	20%	Social worker
Counselling on work situations	0%	20%	Social worker

AC: Audiological Centre.

AC1

The training in AC1 consists of 6 meetings. Per group, 5 to 6 participants can participate together with their significant others (often their spouse). The participants can be both working or non-working. Only working adults were included in this study. In every session, speech reading training and counselling are provided. The counselling focuses on the themes of psychological defense responses (fight, flight, freeze) and communication strategies. The participants are encouraged to reflect on their communication needs and to use CS in their personal lives. At AC1, videos have been made of people coping with hearing loss in different social situations. After watching a video, the strategies that were used are discussed and related to the personal situation of the participants. Participants can also introduce difficulties that they encounter in their personal lives. During one session, the “Hoorinfotheek” is visited. This is a centre that provides information and advice about assistive listening devices, including external microphones, wake-up systems, induction loops, and wireless headphones.

AC2

The communication training in AC2 consists of 11 meetings of 120 min each. Per group, 3 or 4 participants can take part together with their significant others. Employees participate in groups that include working participants only.

Before the first meeting, an individual session takes place to prepare the employee for the communication training. Another individual session takes place three months after the last meeting to evaluate the training. This evaluative session thus took place after T₁.

In every session, speech reading training and counselling are provided. Counselling focuses on personal and work situations. Employees are encouraged to reflect on their communication needs, use CS, and make PA in personal and work situations. Different personal and work situations are discussed and employees are encouraged to introduce difficulties that they encounter in their personal or work lives. The counselling focuses on the themes of empowerment, demands and capacities, the complexity of communication, hearing loss and relationships, and acceptance of the hearing loss.

Baseline characteristics

The following variables were used to describe the study characteristics at baseline: gender, age, educational level, work sector, duration of the hearing impairment, use of hearing aids, and the degree of the hearing loss. The degree of hearing loss was derived from the patient files and was described as the mean pure tone average at 1000, 2000 and 4000 Hz, averaged across ears with a five to one weighting favouring the better ear (binaural hearing impairment, BHI).

Self-perceived listening effort (listening effort) and auditory work demands were assessed using the Amsterdam Checklist for Hearing and Work (section 2) [14]. This checklist assesses the occurrence of six hearing-related job activities (to detect sounds, to distinguish sounds, to communicate in quiet, to communicate in noise, to localize sounds, and to be exposed to loud sounds) and the effort that these activities take. We calculated a sum score of these six questions. The listening effort score can vary between 0 and 18 and the auditory demands score can vary between 0 and 48. Higher scores represent more listening effort and/or higher auditory work demands.

Outcome measures

Communication strategies (CS) & personal adjustments (PA)

CS and PA were assessed using the CPHI [18]. The domain CS consists of the scales maladaptive behaviour, verbal coping, and non-verbal coping. Questions include communication strategies that can be used to cope with hearing loss, such as to dominate conversations (maladaptive behaviour), to ask for a repeat twice (verbal coping), and to watch person’s face (non-verbal coping). The domain PA consists of the scales self-acceptance, acceptance of hearing loss, and stress and withdrawal. Questions include feelings, attitudes, and self-concept that have an effect on interpersonal relationships, such as to feel embarrassed to ask for repeat (self-acceptance), to have difficulties to admit the hearing problem to others (acceptance of hearing loss), and to withdraw from social talks because of hearing loss (stress and withdrawal). Responses are given on a 5-point scale and the scores for CS and PA consist of the sum score of the scales. Higher scores represent more adequate CS and PA.

Need for recovery (NFR)

We assessed the NFR using the NFR scale from the Questionnaire on the Experience and Evaluation of Work 2.0 (QEEW 2.0) [28]. This scale includes six statements with four response categories that assess indicators of fatigue, such as reduced concentration or feeling exhausted at the end of a working day. The sum score is converted to a scale score (percentage of the maximum score) that ranges from 0 to 100, with a higher score denoting higher levels of NFR.

Statistical analysis

Descriptive data are provided for the measurements at T₀ and T₁ at the case level. Change scores are calculated (post-score minus pre score) and visualized in scatterplots. For employees of both AC’s, we present median scores and the range of the change scores.

Results

At AC1, 4 employees of 3 different training groups were eligible for inclusion. They all completed the questionnaire at T₀ and T₁. At AC2, 9 employees of 3 different training groups were eligible for inclusion. Of these employees, 4 were excluded, because the follow-up questionnaire was not completed. The other 5 employees completed the questionnaire at T₀ and T₁. The baseline characteristics are presented in Table 2. The employees, 6 females and 3 males, were aged between 49 and 64 and worked 20 to 60 h per week in various professions. Their degree of hearing loss was mild to moderate and except for one employee, they were all hearing aid users.

Table 2. Baseline characteristics of the included employees at two audiological centres (AC1 and AC2), including demographic, hearing-related, and work-related characteristics.

	Age	Gender	BHI in dB HL	Hearing loss since	Hearing aids	Educational level	Profession	Working hours per week	Auditory work demands	Listening effort
AC1
1	58	female	37.2	6–10 years	Yes	University	Team leader	32	15	13
2	58	male	56.6	6–10 years	Yes	General secondary	Entrepreneur	60	18	17
3	52	male	55.0	2–5 years	Yes	General secondary	Draftsman	32	9	10
4	64	female	44.1	>10 years	Yes	Intermediate vocational	Harvest worker	20	18	15
AC2
5	50	female	59.4	2–5 years	Yes	Higher vocational	HR employee	36	15	9
6	59	female	56.4	>10 years	Yes	Intermediate vocational	Doctor’s assistant	28	20	14
7	58	male	38.6	0–1 year	No	General intermediate	Mason	40	14	5
8	49	female	45.0	>10 years	Yes	General secondary	Admin. Assisstant	32	10	8
9	56	female	45.3	6–10 years	Yes	University	Nurse	40	19	10

BHI: Binaural Hearing Impairment and is calculated by averaging the pure tone thresholds at 1000, 2000 and 4000 Hz favouring the better ear.

The outcomes are summarised in Table 3, Figure 1, and Figure 2. Before the communication training, the CS score ranged from 50 to 70 at AC1 and from 38 to 70 at AC2. After the communication training, the CS score ranged from 62 to 75 at AC1 and 56 to 76 at AC2. Without considering clinical or statistical significance, the CS score was more favourable after the communication training in 3 of the 4 employees of AC1 and all employees of AC2. Change scores ranged from -6 to 12 at AC1 and from 1 to 25 at AC2 (positive change scores represent improvement).

Figure 1. Scatterplot of the communication strategies (CS) scores before (T₀) and directly after (T₁) a communication group-training at AC1 (n = 4) and AC2 (n = 5). Dots above the diagonal represent improvement in the communication strategies.

Figure 2. Scatterplot of the personal adjustments (PA) score at before (T₀) and directly after (T₁) the communication training at AC1 (n = 4) and AC2 (n = 5). Dots above the diagonal represent improvement in personal adjustments.

Table 3. Communication strategies, personal adjustments, and need for recovery before (T₀) and after (T₁) participation of employees participating in a communication group-training at two audiological centres. Questionnaire scores before and after the training are provided as well as the questionnaire change scores.

	Communication strategies			Personal adjustments			Need for recovery
	T0	T1	Change score	T0	T1	Change score	T0	T1	Change score
AC1
1	68	75	7^a	46	58	12^a	44	50	6
2	70	64	−6	40	35	−5	33	33	0
3	60	62	2^a	51	50	−1	50	39	−11^a
4	50	62	12^a	29	32	3^a	39	67	28
AC2
5	52	66	14^a	52	56	4^a	72	61	−11^a
6	45	61	16^a	23	47	24^a	61	39	−22^a
7	38	63	25^a	39	38	−1	44	78	34
8	55	56	1^a	37	54	17^a	44	33	−11^a
9	58	76	18^a	46	59	13^a	39	39	0

^aCompared to the score at T_0, a more favourable score was obtained at T₁.

Before the communication training, the PA score ranged from 29 to 51 at AC1 and from 23 to 52 at AC2. After the communication training, the PA score ranged from 32 to 58 at AC1 and 38 to 59 at AC2. A more favourable PA score was observed in 2 of the 5 employees of AC1 and in 4 of the 5 employees of AC2. Change scores ranged from -5 to 12 at AC 1 and from -1 to 24 at AC2 (positive change scores represent improvement).

Before the communication training, the NFR score ranged from 33 to 50 at AC1 and 39 to 72 at AC2. After the communication training, the NFR score ranged from 33 to 67 at AC1 and from 33 to 78 at AC2. The NFR score was more favourable in 1 of the 4 employees of AC1 and in 3 of the 5 employees of AC2. Change scores ranged from -11 to 28 at AC1 and from -22 to 34 at AC2 (negative change scores represent improvement).

Discussion

The aim of this study was to describe the CS, PA, and NFR of employees with hearing loss before and directly after participating in a communication group-training. The results suggest that most employees used more adequate CS after the group-training and that their PA remained relatively stable or improved. There seems to be a difference between the two centres. For both centres, no clear trend towards a decrease in the NFR was observed.

The observed improvement r CS is in line with the systematic review that concluded that a communication group-training potentially provides better use of CS in (non-working and/or working) adults [10]. However, this finding contrasts with the results of earlier studies that investigated the effect of aural rehabilitation strategies on employees with hearing loss [8,25]. This difference is likely to be explained by the differences between the provided interventions. In contrast to the earlier studies [8,25], a substantial part of the trainings described in this study focussed on encouraging employees to reflect on their communication needs and encouraged to use CS in their lives. Also, although the intensity of the counselling was not described in these earlier studies, it can be assumed that this intensity was lower than in the current study. Therefore, our results suggest that a communication group-training might be effective for improving the CS used by employees with hearing loss.

Regarding the PA, the scores remained relatively stable or improved, although there seems to be a slight difference between the two centres. The PA score of a greater number of employees improved at AC2 compared to AC1 and the improvement accomplished was also greater at AC2. The PA change scores differed from -5 to 12 at AC1 and from -1 to 24 at AC2 with positive scores representing improvement. Especially the change scores of the employees at AC2 seem to be higher than the mean improvement of 4.78 which was reported in a previous study evaluating the effect of aural rehabilitation strategies, including sensory management interventions, perceptual training, and/or individual instruction or counselling [25].

The difference between the two centres in the effect of the communication group-training on PA might be explained by differences in the contents of the trainings. The training of AC2 is more intensive than the training of AC1, respectively 22 h versus 10.5 h. Also, the individual sessions of AC2 before and after the group-training does not take place at AC1. Another difference lies in the homogeneity of the participants. At AC1, employees participated in the training together with non-working participants, often elderly, whereas at AC2 only employees participated. Lastly, the counselling focussed on PA themes at AC2, such as acceptance of hearing loss and empowerment, whereas this focus was less strong at AC1. Our results suggest that greater improvement in PA might be achieved with higher training intensity, including only participants that have a job, and including counselling that specifically focuses on PA themes, such as empowerment and acceptance of hearing loss.

For the employees of both centres, no trend towards a decrease in the NFR was observed. This might imply that the NFR of employees with hearing loss does not improve after a communication group-training. Although the sample size of our study was too small to rule out a true effect, our study adds to the body of evidence that current rehabilitation strategies might fail to reduce the difficulties encountered at work by most employees with hearing loss [8,13,25,27]. Potentially, a greater effect on the NFR might be accomplished when there is more focus on work adjustments, such as improving room acoustics and adjusting work schedules. There is a great need for standards or guidelines describing appropriate rehabilitation services supporting employees with hearing loss.

Although we believe that employees with hearing loss might benefit from a communication group-training, suggestions can be given that might improve current practices. First, we suggest including a thorough assessment of the impact of hearing loss on work performance in the diagnosis of employees with hearing loss. The NFR scale, CPHI, and the Amsterdam Checklist for Hearing and Work might be helpful, although these instruments need to be validated in a population of employees with hearing loss [25]. Also, making accommodations in the workplace has been described to be a complex and ongoing process that requires conscious attention and effort [21]. Therefore, we suggest that employees are supported to start or continue an ongoing dialogue with their employer and colleagues about the challenges that they encounter at work and the strategies that might be helpful. A group-setting might be appropriate for this purpose. The employees in this study were encouraged to bring their significant others, but might also be specifically encouraged to bring their employer and/or their colleagues. Also, the effect of a communication group-training might be greater if the duration is longer than 6 or 11 weeks or if a group-training is followed by individual counselling sessions. This should be investigated by future research in larger samples of employees with hearing loss.

Besides the need for improving current rehabilitation services, the accessibility of multidimensional services is also under pressure. We found that only 13 employees were eligible for inclusion in a period of 15 months which shows that a communication group-training has not been common practice for employees with hearing loss at the two included centres. This might be an effect of the COVID-19 pandemic since most group-trainings were cancelled or delayed. However, in line with two earlier Dutch studies that reported that counselling services were only provided to a minority of the employees with hearing loss [8,25], our finding might also reflect that a multidimensional approach including counselling is not commonly provided to employees with hearing loss, at least not in a group setting.

In conclusion, the results show that it is still challenging to effectively reduce the work difficulties that are encountered by employees with hearing loss. Especially with regard to the PA, differences between the centres were observed, which points out a need for standards or guidelines for appropriate rehabilitation services supporting employees with hearing loss. Suggestions for improvement are provided and should be investigated by future research in a larger population.

Acknowledgements

We thank Libra Revalidation and Audiology and Adelante Audiology and Communication for participating in this study.

Disclosure statement

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

Additional information

Funding

No funding was received for conducting this study.