BAA MAGAZINE SUMMER 2017 DRAFT 4

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FEATURE Promoting Uptake of Rehabilitation Support for Hearing Loss CRYSTAL ROLFE Head of Local Engagement England- South East, Action on Hearing Loss Introduction One in six people in the UK has Hearing Loss (HL), a condition becoming more prevalent due to the ageing population (Davis et al., 2007). Untreated HL negatively affects physical and mental health, yet people with HL take on average 10–15 years to seek help, with only one in three acquiring a Hearing Aid (HA). There is evidence that this delay is due to: 1) people postponing seeking help; 2) barriers to accessing existing rehabilitation support, such as delays in referrals (Meyer and Hickson, 2012; Knudsen et al., 2010). While the role that hearing screening can play in increasing HA uptake has been documented (Davis et al., 2007), there has been no study comparing different methods of increasing uptake or identifying the barriers that intervention developers should focus on. As part of Action on Hearing Loss’s programme of work, we aim to encourage people to accept and address hearing loss. We carried out research with UCL as part of an MSc in Health Psychology. This study aimed to describe personal experiences of HL among UK adults and their views on possible intervention strategies to promote the uptake of rehabilitation support. Method Preliminary work: The Behaviour Change Wheel (Michie et al., 2011) was used to design eight hypothetical interventions across four workshops, involving a Patient Participation Group and an Expert Steering Group. Qualitative research: • Semi-structured, face-to-face qualitative interview design • 22 participants with HL, aged 66–88 • Interviews focused on participants’ experiences of seeking and gaining access to help, and their views on eight hypothetical interventions • Inductive thematic analysis to analyse verbatim transcripts Results Three themes were identified: From realisation to readiness Realisation: Most participants initially misattributed symptoms of HL to external factors, assessing their hearing capacity by using everyday sounds as objective indicators or by comparing their hearing to other people’s hearing. Encouraging people to monitor their hearing capacity against objective criteria, eg TV volume, a ticking clock, could raise awareness of HL and help people realise more quickly that they have symptoms. Readiness: The decision to seek support ultimately has to come from people themselves. Participants modified their environments and were only ready to seek help when they realised their HL could not be mitigated and would not remedy itself. Competing demands: Once a state of ‘readiness’ has been achieved, action was often delayed further because HL did not take priority over competing dayto-day demands. Family: An intervention based on encouraging family members to support people with HL to seek and prioritise support was mostly deemed acceptable. Yet, the way in which some participants’ families communicated concerns often led to resistance. Others thought family members reluctant to raise the topic of HL for fear of causing offence. Generally, however, participants were more offended by family members not raising the subject of suspected HL. Many felt that discussions initiated sensitively might have encouraged them to seek help. Others felt that speaking to people with HL could stimulate action. Healthcare professionals and screening: For many, offers of support from qualified healthcare professionals were important in making the journey to self-realisation. GPs were particularly trusted due to their expertise. Screening: Most participants said they would have attended a screening invitation. Screening was acceptable to most, with screening as a part of other health checks being deemed the most acceptable method. Self-screening, using tests available online or by phone, was less popular, as participants felt that professional involvement was important to validate and encourage acceptance of test results, and prompt further action. Combating social stigma identity: Some participants were reluctant to identify as a person with HL, associating HL with ageing, disability, and prosthetics. Many sought to hide HL from others for fear of disapproval or being treated differently. Visibility: There was a strong preference for hidden HAs. Some people felt pressure from others to conceal HAs. Half of participants identified interventions based on improving HA design as being most likely to have encouraged them to seek support for HL. Some however, felt that HA marketing aimed at increasing uptake by emphasising that the devices can be hidden, actually perpetuated stigma. Others felt that enhancing HA visibility could destigmatise HAs and HL. Creating norms: Some people delayed seeking help because they did not want to feel part of a minority group. They felt that raising awareness of the prevalence of HL and HAs would be beneficial. Making comparisons with celebrities and HAs were encouraging and boosted self-esteem by reducing stigma. Increasing the visibility of HL among everyday public figures with whom they could more easily identify, was also seen as helpful. Accessing appropriate rehabilitation support GPs: Did not raise the subject of HL but did refer onwards on request. Cost barrier: Many participants delayed seeking help because they had not realised that HAs on the NHS were free. Assess and fit: Although this service was welcomed, it did not make BAA MAGAZINE / SUMMER 2017 / 14
participants more likely to go ahead with getting HAs. Alternative rehabilitation: Some were more willing to use HAs if found in places not associated with disability, and available from everyday locations eg. high street shops. Therefore, promotion of alternative devices as a substitute for HAs was not beneficial, as it was seen as less effective and time consuming. Knowledge of benefits: Allowing people to experiment with HAs to appreciate the benefits may encourage people to get and use them. Limitations Limitations of this study are fully discussed in the paper but include that the study focused on those who had sought help; ideally, it would have recruited people experiencing early signs of HL, but it is difficult to recruit those who have not identified themselves as experiencing HL, so the data may not represent the views of those less willing to seek help. Next steps Action on Hearing Loss are working in a number of ways to address this issue: • Working on the task and finish groups for the Action Plan on Hearing Loss who are working towards filling the evidence gaps on hearing screening as a step towards securing a national hearing screening programme and promoting opportunistic screening. • Creating materials to encourage and support friends and families to initiate proactive discussions with people who may have unaddressed hearing loss. • Holding hearing screening events and promoting our hearing check. • We will be holding a webinar to bring together international experts from different disciplines to discuss methods to increase uptake of support for hearing loss, share evidence and create solutions. Conclusion There are several interventions which can be piloted, focusing on realisation. Awareness of the benefits of taking action and creating social norms are also important. If you would like to be involved in the webinar, please contact Crystal Rolfe for more information. References Davis, A., Smith, P., Ferguson, M., Stephens, D. and Gianopoulos, I. (2007). Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. National Coordinating Centre for Health Technology Assessment, University of Southampton. Knudsen, L.V., Öberg, M., Nielsen, C., Naylor, G. and Kramer, S.E. (2010). Factors influencing help seeking, hearing aid uptake, hearing aid use and satisfaction with hearing aids: A review of the literature. Trends in Amplification, 14(3), 127–154. Meyer, C. and Hickson, L. (2012). What factors influence help-seeking for hearing impairment and hearing aid adoption in older adults? International journal of audiology, 51(2), 66–74. Michie, S., van Stralen, M.M. and West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. Contact: Crystal Rolfe: crystal.rolfe@ hearingloss.org.uk Publication: Rolfe, C. and Gardner, B. (2016). Experiences of hearing loss and views towards interventions to promote uptake of rehabilitation support among UK adults. International Journal of Audiology, 55(11), 666673. Early Bird Allocation Almost Gone! On the Programme Sharing decisions in Tinnitus: Preference, Information and Approaches | Helen Pryce Audiologist Guided Internet-Based CBT for Tinnitus: Feasible, Acceptable and Effective | Eldre Beukes ANNUAL CONFERENCE 07.09.17 Thursday 7 September 2017 Sheffield Hallam University | City Campus Tickets from £75 Full details available at www.tinnitus.org.uk/btaconf2017 #BTAConf2017 NEW! Workshops ‘Practice guidance for tinnitus in adults’ ‘How we manage hyperacusis in children’ ‘Getting a support group from good to great’ ‘Eye movement desensitisation and reprocessing therapy & tinnitus’ ‘The relationship between tinnitus, hyperacusis & anxiety in children’ ‘Dealing with challenging support group members’ Round Table Q&A Tinnitus Toolkit: Person-Centered Care in Tinnitus Management | Cherilee Rutherford Evaluation of a Cognitive Model of Tinnitus Distress: Is it Accurate and is it Useful? | Lucy Handscomb Mobile Applications for Management of Tinnitus | Magda Sereda Shapiro Prize & Poster Competition BAA MAGAZINE / SUMMER 2017 / 15
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Page 3 and 4: Contents: General: 3 Editorial 4 Pr
Page 5 and 6: Power Your Senses Oticon NHS Study
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Page 23 and 24: FEATURE Development of the Spatial
Page 25 and 26: INFORMATION BAA Members - Education
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Page 29 and 30: INDUSTRY UPDATES The future is now:
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