What factors are associated with infant hearing aid use? A parent survey using the Theoretical Domains Framework

Figures & data

Table 1. Definitions of the domains of the TDF.

Domain	Definition
D1 Knowledge	An awareness of the existence of something
D2 Skills	An ability or proficiency acquired through practice
D3 Social/professional role and identity	A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting
D4 Beliefs about capabilities	Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use
D5 Optimism	The confidence that things will happen for the best or that desired goals will be attained
D6 Beliefs about consequences	Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation
D7 Reinforcement	Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus
D8 Intentions	A conscious decision to perform a behaviour or a resolve to act in a certain way
D9 Goals	Mental representations of outcomes or end states that an individual wants to achieve
D10 Memory, attention and decision processes	The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives
D11 Environmental context and resources	Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour
D12 Social influences	Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours
D13 Emotion	A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event
D14 Behavioural regulation	Anything aimed at managing or changing objectively observed or measured actions

Note. Definitions as described in Cane et al. (Cane, O'Connor, and Michie 2012).

Table 2. Reliabilities.

TDF domain	Cronbach’s alpha	95% CI	Interpretation
Beliefs about capabilities	0.67	0.51 to 0.79	Acceptable
Beliefs about consequences	0.84	0.76 to 0.90	Good
Behavioural regulation	0.77	0.65 to 0.85	Good
Environmental context and resources	0.69	0.56 to 0.80	Acceptable
Emotion	0.49	0.24 to 0.68	Poor
Goals	0.80	0.69 to 0.87	Good
Intentions	0.90	0.83 to 0.95	Excellent
Knowledge	0.71	0.57 to 0.81	Good
Memory, attention and decision processes	0.73	0.61 to 0.83	Good
Optimism	−0.17	−0.98 to 0.31	Unacceptable
Skills	0.81	0.71 to 0.88	Good
Social influences	0.47	0.22 to 0.65	Poor
Social/professional role and identity	0.85	0.77 to 0.91	Good

Note: Interpretation of Cronbach’s alpha is based on Kline (Kline 1999).

Table 3. Participant characteristics and demographic information.

Parent Characteristics	n (%)
Relationship to child
Mother	53 (95)
Father	2 (4)
Guardian	1 (2)
Primary caregiver
Yes	44 (79)
Equally shared with other caregiver	11 (20)
No	1 (2)
Primary HA manager^a
Yes	48 (86)
Equally shared with other caregiver	7 (13)
No	1 (2)
Ethnicity
White British	48 (86)
Mixed White & Asian	2 (4)
Asian or Asian British Indian	1 (2)
Other Asian or Asian British Background	1 (2)
Black or Black British African	1 (2)
Chinese	1 (2)
White Irish	1 (2)
Other Mixed Background	1 (2)
Experience of deafness/hearing loss
None	28 (50)
Participant HL	6 (11)
Immediate family members with HL	10 (18)
Other	12 (21)
Education level
Secondary education (educated to age 16)	3 (5)
Sixth form or college education	5 (9)
Vocational education	11 (20)
University education (undergraduate degree)	20 (36)
University education (postgraduate degree)	16 (29)
University education (doctoral degree)	1 (2)
Annual household income^b
Less than £10,000	2 (4)
£10,000 - £19,999	3 (5)
£20,000 - £29,999	9 (16)
£30,000 - £39,999	6 (11)
£40,000 - £49,999	9 (16)
£50,000 - £59,999	4 (7)
£60,000 – £69,999	7 (13)
£70,000 or more	13 (23)
Child Characteristics	n (%)	Mean (SD) Min-Max
Child age (months)		18.43 (9.15) 4-36
Age HL confirmed (months)		1.91 (3.12) 0-21
Degree of HL in better hearing ear
Mild	5 (9)
Moderate	24 (43)
Severe	18 (32)
Profound	5 (9)
No HL	4 (7)
Amplification
Bilateral BTE	44 (79)
Unilateral BTE	2 (4)
Bilateral BCHD (non-surgical)	3 (5)
Unilateral BCHD (non-surgical)	7 (13)
Age of amplification (months)^c		3.35 (3.66) 1-21
Adjusted hearing aid use		74.80 (26.93) 8.33-100
Additional needs
Yes	15 (27)
No	41 (73)
Primary mode of communication
Spoken language	39 (70)
Sign supported spoken language	6 (11)
Bimodal bilingual^d	6 (11)
Sign language	2 (4)
Other^e	3 (5)

Note. HA = hearing aids. HL = hearing loss. BTE = behind the ear hearing aid. BCHD = Bone conduction hearing device on a soft band. ^aParent/guardian who spends the most amount of time managing their child’s hearing aids. ^bAnnual household income missing for three participants. ^cAge of amplification missing for two participants. ^dEqual use of sign and spoken language. ^eMakaton, Onbody sign, Nonverbal.

Figure 1. Mean TDF Domain Scores and 95% Confidence Intervals.

Note. Lower mean domain scores indicate more of a barrier to infant hearing aid use.

Figure 2. Correlations and 95% Confidence Intervals Between Adjusted Hearing Aid Use and TDF Domains.

Cane, J., D. O'Connor, and S. Michie. 2012. “Validation of the Theoretical Domains Framework for Use in Behaviour Change and Implementation Research.” Implementation Science: IS 7 (1):37. https://doi.org/10.1186/1748-5908-7-37.

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Kline, P. 1999. The Handbook of Psychological Testing. 2nd ed. London: Routledge.

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