A Randomized Controlled Trial Evaluating the Active Communication Education Program for Older People with Hearing Impairment

Objective: To evaluate the effectiveness of the Active Communication Education (ACE) program for older people with hearing impairment and to investigate factors that influence response to the program. The ACE is a group program that runs for 2 hr per week for 5 wk. Design: In this double-blinded, randomized, controlled trial, 178 older people with, on average, mild to moderate hearing impairment were randomly allocated to one of two groups. Approximately half had been fitted with hearing aid/s in the past. One group (N = 78) undertook a placebo social program for the first 5 wk, followed by the ACE program. They were assessed before the social program, immediately after it, and then again immediately post-ACE. The other group (N = 100) undertook the ACE program only and were assessed before and after ACE. In addition, 167 participants were reassessed 6 mo after completing ACE. Assessments were all self-report and included two sets of measures: 1) those administered both before and after the program—the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, the Ryff Psychological Well-Being Scale, the Short-Form 36 health-related quality of life measure; and 2) those administered postprogram only—the Client Oriented Scale of Improvement, the International Outcome Inventory—Alternative Interventions, and a qualitative questionnaire. All assessments were conducted by a researcher blinded to participants' group membership. The relationships between participant response to the ACE program and a number of client-related factors were also investigated. These factors were the participants' age, gender, hearing loss, hearing aid use, attitudes to hearing impairment (as measured using the Hearing Attitudes to Rehabilitation Questionnaire) and the involvement of significant others. Results: For those participants who completed the social program initially, significant improvements were found on the Quantified Denver Scale of Communicative Function and on the Mental Component Score of the Short-Form 36 only, when pre- and postprogram scores were compared. For those who completed the ACE program, there were significant pre-to-post improvements on the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, and the Ryff Psychological Well-Being Scale. These improvements after ACE were maintained at 6 mo. Higher scores on the Hearing Attitudes to Rehabilitation Questionnaire before the ACE program were associated with greater positive change on a number of the pre-post program measures. Using the Client Oriented Scale of Improvement, 75% of participants reported some improvement on the primary goal they wished to achieve with the ACE. Positive outcomes were also recorded with the International Outcome Inventory–Alternative Interventions. Conclusions: This research study provides evidence for the effectiveness of the ACE program and indicates that such communication programs have an important place in the audiological rehabilitation of older adults. They should be considered as an alternative or a supplement to traditional interventions such as hearing aid fitting.