Focusing on positive listening experiences improves hearing aid outcomes in experienced hearing aid users

Figures & data

Figure 1. The study flow. HA : Hearing Aid; IOI-HA: International Outcome Inventory for Hearing Aids; HEARLI-Q: Hearing-Related Lifestyle Questionnaire; COSI: Client Oriented Scale of Improvement; EMA: Ecological Momentary Assessment.

Table 1. EMA questions and response alternatives.

Item	Instruction/question	Response alternatives
Location	Choose the category that best fits the place where you are now:	Inside (home environment) Inside (public place) Outside Transport (car, train, etc.)
Listening Task	Choose the category that best fits the situation you are in:	Conversation with one person Conversation with several people Conversation over a phone or another technical device Focused listening (live) Focused listening (media) Situation without a conversation or focused listening
Hearing Difficulty	How difficult is it for you to hear in this situation?	Not difficult Slightly difficult Moderately difficult Very difficult Extremely difficult
Hearing Aid Satisfaction	How satisfied are you with your hearing aids in this situation?	I am not wearing my hearing aids Not satisfied Slightly satisfied Moderately satisfied Very satisfied Extremely satisfied

Table 2. Comparison of baseline characteristics between the two groups.

Variable	Control	Positive focus	P-value
Age (mean ± SD)	64 ± 8	68 ± 7	.26
# female	3	3	.89
# non-Widex own hearing aids	1	1	.94
Hearing aid experience (median [range])	12.5 [1–53] years	13 [1–37] years	>.99
Hearing Loss (mean ± SD)^+	44 ± 9.8 dB	44 ± 9.0 dB	.95
BFI (mean ± SD)
Extroversion	3.2 ± 0.6	3.3 ± 0.8	.90
Agreeableness	4.1 ± 0.4	4.2 ± 0.5	.78
Conscientiousness	3.8 ± 0.6	4.2 ± 0.4	.11
Neuroticism	2.3 ± 0.7	1.8 ± 0.5	.09
Openness	3.5 ± 0.6	3.6 ± 0.6	.70
HEARLI-Q (mean ± SD)
Hearing-related lifestyle	58.2 ± 7.9	63.2 ± 9.4	.20
Hearing demand	36.5 ± 12.9	46.1 ± 10.6	.08
Hearing difficulty	1.5 ± 0.3	1.5 ± 0.7	.82
Hearing aid satisfaction	3.1 ± 0.5	3.5 ± 0.6	.16
Hearing aid satisfaction (mean ± SD)	6.9 ± 1.2	7.7 ± 1.0	.10
IOI-HA (mean ± SD)^#	24.2 ± 3.3	29.5 ± 1.9	<.001*
EMA
Compliance (mean ± SD)^	82 ± 17 %	83 ± 15 %	.90
Location (% of reports)	Inside (home): 58% outside: 19% inside (public): 17% transport: 6%	Inside (home): 58% outside: 22% inside (public): 15% transport: 5%	.66
Listening task (% of reports)	Passive: 36% conversation with 1: 23% focused media: 19% conversation with >1: 14% focused live: 5% Mobile conversation: 3%	Passive: 34% conversation with 1: 24% focused media: 19% conversation with >1: 16% focused live: 4% Mobile conversation: 3%	.94
Hearing aid satisfaction (mean ± SD)	3.5 ± 0.7	3.6 ± 0.8	.18
Expectation (median [range])	3 [2–4]	3 [2–4]	.33

⁺Hearing loss was calculated as mean hearing loss across all the audiometric frequencies (250, 500, 1000, 2000, 4000, 8000 Hz) in the better hearing ear. ^#The two individual IOI-HA items that were not significantly different were items 1 (usage of the hearing aids) and 5 (residual participation restrictions). ^Compliance was calculated as: (all responses/expected responses) *100. The number of expected responses was 49. *Significant difference.

Figure 2. The average number of submitted positive reports per participant, per day.

Figure 3. Two weeks post-fitting hearing aid outcome scores on the four scales. The EMA satisfaction ratings were averaged within each individual prior to box plot visualisation, in order to give each participant the same weight. The significant differences are indicated by *(p <.05) and **(p <.01).

Table 3. Regression analyses results.

Dependent variable	Independent variable	Coefficient	95% CI	P-value	R^2
Overall Satisfaction	Group (PF or Control)	1.00	−0.06, 2.06	.06	0.14
IOI-HA total (conventional)	Group (PF or Control)	5.43	1.23, 9.64	.01*	0.52
	IOI-HA (baseline)	0.20	−0.38, 0.78	.49
IOI-HA total (recoded)	Group (PF or Control)	5.65	1.44, 9.86	.01*	0.52
	IOI-HA (baseline)	0.22	−0.33, 0.76	.44
Satisfaction (HEARLI-Q)	Group (PF or Control)	0.42	0.08, 0.77	.02*	0.45
	Hearing Demand	0.00	−0.01, 0.02	.87
	Hearing Difficulty	−0.44	−0.76, −0.14	<.01*
Satisfaction (EMA)	Group (PF or Control)	0.34	0.09, 0.60	<.01*	0.57
	Hearing Difficulty	−0.42	−0.56, −0.29	<.001*
COSI (degree of change)	Group (PF or Control)	1.12	0.40, 1.85	<.01*	0.36
	HA Expectation (2 VS 1)	0.71	−0.32, 1.73	.18
	HA Expectation (3 VS 1)	0.64	−0.44, 1.72	.25
	HA Expectation (4 VS 1)	−0.21	−2.36, 1.94	.85
COSI (final ability)	Group (PF or Control)	1.20	0.28, 2.12	.01*
	HA Expectation (2 VS 1)	1.55	−0.34, 3.43	.11
	HA Expectation (3 VS 1)	1.32	−0.61, 3.24	.18
	HA Expectation (4 VS 1)	−2.39	−6.02, 1.25	.20

HA – Hearing Aids. The control group was the reference group in all the analyses. The “HA expectation” variable in COSI analyses was coded as: 1 = “no real help at all”, 2 = “some help but not very much”, 3 = “great help”, and 4 = “I would expect this hearing aid to return my hearing to normal”. HA expectation = 1 was the reference category. Both, the conventional and recoded IOI-HA (Leijon et al. 2021) totals are reported. It can be seen that recoding the ordinal IOI-HA responses to interval scale responses does not make a difference for the outcome of these data. The significant effects are indicated by an asterisk (*) in the P-value column.

Figure 4. COSI ratings at the second visit. The median of COSI ratings was calculated within each individual prior to box plot visualisation, in order to give each participant the same weight. The significant differences are indicated by *(p <.05) and **(p <.01).

Table 4. Correlation analyses between the number of submitted positive experiences and hearing aid outcome ratings.

Variable	Rho	P-value
Overall Satisfaction	0.08	.83
IOI-HA	0.41	.21
Satisfaction – HEARLI-Q	0.31	.35
Satisfaction - EMA	0.21	.54
COSI – degree of change	0.61	<0.05*
COSI – final ability	0.15	.67

Significant correlation is indicated by an asterisk (*) in the P-value column.

Table 5. Participant responses to “How did it go with the trial?” at the exit interview.

How did it go with the trial?
Control Group	Positive Focus Group
I cannot always answer the question the moment it pops up.	A good study. Good idea with a reminder. Was not at all cumbersome to answer every two hours.
Went ok, sometimes worried that I missed the pop ups. Did not look at my phone all the time. Did not have the sound turned on the phone.	A little stressful with the reminders, it was not always that I could reply.
Really well. Much better than last time I participated.	It all worked out as it should. Questionnaires were fine. I could not always answer right when I was prompted. I could not come up with many good situations because hearing aid was very comparable to own.
It went well, but because I could not receive questionnaires for a few days, I had to restart the iPhone. I was not aware of that, and it would have been good to know.	Very nice. Hearing aids are unbelievably comfortable to wear. I could not notice that I have them on. I could well report positive feedback at first, but I think I started repeating myself because I got into the same situations every day.
It has gone very well. There may be some situations that do not quite fit into the categories that were in the app.	It went really well. The directional effect is very good. The speech became very clear and background noise was attenuated really well.
A painless process. Easy to understand.	It went fine. It was fun. A little in doubt how much I should write in the text.
It went fine. A more comprehensive experience, but I got closer to the real world.	A 3D sound experience when the whole thing works.
No problems. The app was easy enough to handle. Sometimes I could not answer the prompt exactly when I was prompted.	It went well. It seemed like there were problems with directionality at first, but I got used to it.
Flawless. Reasonable to answer the questions and the prompts.	Fantastic. I have enjoyed every single day.
It went well. I set my own alarm to remind me to answer questionnaires.	Very well. It went so well that I booked a time to purchase them.
	Surprised how good the hearing aid is. Focusing on the positives was a new experience. I usually notice what does not work. When I put on hearing aids I almost hear normally. Sounds very natural to me.

The responses that were related to hearing aids are depicted in bold text. The responses are translated from Danish.

Leijon, A., H. Dillon, L. Hickson, M. Kinkel, S. E. Kramer, and P. Nordqvist. 2021. “Analysis of data from the international outcome inventory for hearing aids (IOI-HA) using Bayesian item response theory.” International Journal of Audiology 60 (2): 81–88. doi:10.1080/14992027.2020.1813338.

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