Current process in hearing-aid fitting appointments: An analysis of audiologists’ use of behaviour change techniques using the behaviour change technique taxonomy (v1)

Figures & data

Figure 1. Patient and audiologist component behaviours that interact and may contribute to long-term hearing-aid use (adapted from Barker et al, 2016).

Table 1. Demographic information about participants, and details regarding consultation type and length.

	Audiologists	Patients
Gender ratio female/male	8:1	2:7
Experience in post (years)	Mean = 8.3 (range 1.5–17)
AQP/non-AQP services*	3:2
New/existing hearing-aid use		8:2
Binaural/monaural fitting		5:5
Consultation details
Scheduled appointment length (minutes)	Binaural: 2 consults = 45, 3 consults = 60Monaural: 4 consults = 30, 1 consult = 45
Duration of patient contact (minutes)	Mean binaural = 49 (range 42–54)Mean monaural = 37 (range 29–48)
Additional time spent preparing for consultation (minutes)	Mean = 7 (range 5–10)
Time spent completing electronic patient record (minutes)	Mean = 8 (5–10)

*The AQP scheme was introduced as part of the National Health Service (NHS) agenda for increasing patient choice. In essence, AQP providers are independent providers contracted to provide specified services.

Table 2. The 16 clusters and 93 individual behaviour change techniques of the taxonomy (Michie et al, 2013).

Cluster name	Behaviour change technique name	Code
Goals and planning	Goal-setting (behaviour)	1.1
	Problem-solving	1.2
	Goal-setting (outcome)	1.3
	Action-planning	1.4
	Review behaviour goal(s)	1.5
	Discrepancy between current behaviour and goal	1.6
	Review outcome goal(s)	1.7
	Behavioural contract	1.8
	Commitment	1.9
Feedback and monitoring	Monitoring of behaviour by others without feedback	2.1
	Feedback on behaviour	2.2
	Self-monitoring of behaviour	2.3
	Self-monitoring of outcome(s) of behaviour	2.4
	Monitoring outcome(s) of behaviour by others without feedback	2.5
	Biofeedback	2.6
	Feedback on outcome(s) of behaviour	2.7
Social support	Social support (unspecified)	3.1
	Social support (practical)	3.2
	Social support (emotional)	3.3
Shaping knowledge	Instruction on how to perform a behaviour	4.1
	Information about antecedents	4.2
	Re-attribution	4.3
	Behavioural experiments	4.4
Natural consequences	Information about health consequences	5.1
	Salience of consequences	5.2
	Information about social and environmental consequences	5.3
	Monitoring of emotional consequences	5.4
	Anticipated regret	5.5
	Information about emotional consequences	5.6
Comparison of behaviour	Demonstration of the behaviour	6.1
	Social comparison	6.2
	Information about othersʼ approval	6.3
Associations	Prompts/cues	7.1
	Cue signalling reward	7.2
	Reduce prompts/cues	7.3
	Remove access to the reward	7.4
	Remove aversive stimulus	7.5
	Satiation	7.6
	Exposure	7.7
	Associative learning	7.8
Repetition and substitution	Behavioural practice/rehearsal	8.1
	Behavioural substitution	8.2
	Habit formation	8.3
	Habit reversal	8.4
	Overcorrection	8.5
	Generalization of target behaviour	8.6
	Graded tasks	8.7
Comparison of outcomes	Credible source	9.1
	Pros and cons	9.2
	Comparative imagining of future outcomes	9.3
Reward and threat	Material incentive (behaviour)	10.1
	Material reward (behaviour)	10.2
	Non-specific reward	10.3
	Social reward	10.4
	Social incentive	10.5
	Non-specific incentive	10.6
	Self-incentive	10.7
	Incentive (outcome)	10.8
	Self-reward	10.9
	Reward (outcome)	10.10
	Future punishment	10.11
Regulation	Pharmacological support	11.1
	Reduce negative emotions	11.2
	Conserving mental resources	11.3
	Paradoxical instructions	11.4
Antecedents	Restructuring the physical environment	12.1
	Restructuring the social environment	12.2
	Avoidance / reducing exposure to cues for the behaviour	12.3
	Distraction	12.4
	Adding objects to the environment	12.5
	Body changes	12.6
Identity	Identification of self as role model	13.1
	Framing/reframing	13.2
	Incompatible beliefs	13.3
	Valued self-identity	13.4
	Identity associated with changed behaviour	13.5
Scheduled consequences	Behaviour cost	14.1
	Punishment	14.2
	Remove reward	14.3
	Reward approximation	14.4
	Rewarding completion	14.5
	Situation-specific reward	14.6
	Reward incompatible	14.7
	Reward alternative behaviour	14.8
	Reduce reward frequency	14.9
	Remove punishment	14.10
Self-belief	Verbal persuasion about capability	15.1
	Mental rehearsal of successful performance	15.2
	Focus on past success	15.3
	Self-talk	15.4
Covert learning	Imaginary punishment	16.1
	Imaginary reward	16.2
	Vicarious consequences	16.3

Table 3. Use of behaviour change techniques (BCTs) across nine hearing-aid fittings.

Cluster (theme)	BCTTv1 code	BCT name	Definition	Total number of uses across all consultations	Median number of uses within a fitting consultation (range)
Goals and planning	1.1	Goal-setting (behaviour)	Set or agree a goal in terms of the behaviour to be achieved.	26	3 (0–5)
	1.4	Action-planning	Prompt detailed planning of performance of the behaviour (must include at least one of context, frequency, duration, and intensity).	5	1 (0–1)
Social support	3.2	Social support (practical)	Advise on, arrange or provide practical help for performance of the behaviour.	34	4 (1–7)
Shaping knowledge	4.1	Instruction on how to perform a behaviour	Advise on or agree on how to perform the behaviour.	124	17 (5–22)
Natural consequences	5.1	Information about health consequences	Provide information about health consequences of performing the behaviour.	37	4 (0–8)
	5.3	Information about social and environmental consequences	Provide information about social and environmental consequences of performing the behaviour.	60	7 (1–11)
	5.6	Information about emotional consequences	Provide information about emotional consequences of performing the behaviour.	1	0 (0–1)
Comparison of behaviour	6.1	Demonstration of the behaviour	Provide an observable sample of the performance of the behaviour.	56	6 (2–11)
Repetition and substitution	8.1	Behavioural practice or rehearsal	Prompt practice or rehearsal of the performance of the behaviour one or more times in a context or at a time when the performance may not be necessary in order to increase habit and skill.	45	4 (1–11)
	8.7	Graded tasks	Set easy-to-perform tasks, making them increasingly difficult, but achievable, until behaviour is performed.	5	0 (0–2)
Antecedents	12.5	Adding objects to the environment	Add objects to the environment in order to facilitate performance of the behaviour.	23	2 (1–4)

Table 4. Examples of consequences of hearing-aid use cited by audiologists.

BCT	Nature of information	Total number of uses	Number of audiologists	Example
Information about health consequences	Positive	13	7	‘obviously because of the tinnitus hopefully it will help bring in the sounds in from around you to dull that down’
	Neutral	10	4	‘You’ll initially find that you’ll be able to hear your own voice a bit more as the sound’s coming in through the microphones’
	Negative	14	7	‘Your own voice as well sir may sound a little bit strange’
Information about social and  environmental consequences	Positive	12	6	‘A lot of people say the television volume does go down er, so hopefully if that’s an issue you might find that the volume's going down and it will make everyone happy, no-one's complaining about the volume’
	Neutral	20	7	‘initially you are going to be more aware of particularly higher pitched noises so things like the oven timer when it beeps or when you can hear a clock ticking’
	Negative	28	6	‘certain things might sound a bit sharper and more obtrusive than you’d normally think’

Barker F., Atkins L. & de Lusignan S. 2016. Applying the COM-B behaviour model and Behaviour Change Wheel to develop an intervention to improve hearing aid use in adult auditory rehabilitation. Int J Audiol, [Epub ahear of print]. DOI: 10.3109/14992027.2015.1120894.

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Michie S., Richardson M., Johnston M., Abraham C., Francis J. et al. 2013. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med, 46, 81–95.

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