Title: The development and feasibility of m-health technologies to improve hearing aid use and benefit in first-time hearing aid users
Funder: Department of Health and Social Care

Abstract: Background Hearing loss affects not only the 1 in 6 of the UK population with hearing loss (11m) but also those with whom they communicate. Despite the introduction of digital hearing aids (HAs) in the NHS in 2000, HA non-use remains around 20%, with many wearing their HAs sub-optimally. Untreated hearing loss can lead to social withdrawal and isolation, depression, increased risk of dementia, and reduced quality of life. In addition to personal costs, there are also societal and economic costs. One explanation for non-use of HAs is that knowledge about them and the consequences of hearing loss is poor, with half the information given at the HA fitting appointment forgotten six weeks later. This proposal builds on a study that developed eight interactive multimedia videos (or reusable learning objects, RLOs) for first-time HA users, which were evaluated in a randomised controlled trial (n=203). Benefits included significantly improved practical HA skills, greater knowledge of HAs and communication, and greater use of HAs compared to those receiving standard clinical care. Furthermore, RLOs improved awareness and confidence using HAs, and were rated as highly useful. The RLOs, branded as C2Hear, are now freely available online but are currently a one size fits all solution. Aim: To further develop and refine a theoretically-driven personalised intervention for use with mobile technologies (mobile-enabled RLOs; m-RLOs). Research Plan: The three-phase research will repurpose the C2Hear RLOs into short bite-sized m-RLOs that are tailored to individuals needs, and incorporate greater user interactivity and self-evaluation. The development will be based on a recently developed comprehensive model of health behaviour change (COM-B). Phase 1 will identify the individualised components of the m-RLOs using (i) a theoretical approach based on the COM-B model to classify each m-RLO to a set of domains (e.g. knowledge, physical skills, social influences) necessary to facilitate hearing aid use, and (ii) an ecological approach using a Think Aloud analysis involving existing hearing aid users (n=15), using thematic analysis to identify key themes/words for assigning tags to each m-RLO. The end result will be a self-evaluation filter aid questionnaire. Phase 2 will develop the m-RLO tailored intervention incorporating the filter aid. Following a user-centred design a panel of hearing aid users (n=4) and the PPI panel will review and advise on aspects of usability, to ensure the m-RLOs are aligned to the end-users needs. Phase 3 will assess the feasibility of the m-RLO intervention in first-time hearing aid users using a mixed-methodology. Semi-structured interviews (n=15) will assess usability, delivery, accessibility, acceptability and adherence. Hearing aid use and knowledge, activities/participation, and self-efficacy will be assessed in 30 participants in their home setting over a 10-12 week period. This feasibility study of the m-RLO intervention will inform a future definitive multi-centre trial to assess the effectiveness of m-RLOs. Potential benefits to patients With increasing requirements for NHS services to cut costs, the time available for audiologists to deliver all the required information on hearing aids to ensure successful outcomes is reducing. Multimedia educational online support is an increasingly used method to support patients. IT literacy is rapidly increasing in the typical first-time hearing aid user age group (~70years). Therefore, the time is right to further develop and refine C2Hear into a personalised product with greater interactivity and self-evaluation in order to future proof the C2Hear RLO concept. In addition to the previously demonstrated benefits of C2Hear, we will assess whether the personalised approach increases self-efficacy and participation in social situations. Finally, this educational intervention will increase accessibility and patient choice, allowing first-time hearing aid users to acquire essential information on-the-go , wherever and whenever is desired.

Lay abstract: People with hearing loss struggle to hold conversations with others. This can be socially isolating and lowers quality of life. Hearing aids help overcome hearing loss. However, many people know little about them. Hearing aids can be difficult to use and do not give perfect hearing. Many hearing aids are therefore abandoned or underused. In the past, we have worked with hearing aid users to produce multimedia, interactive educational videos about how best to use hearing aids and to communicate well. We have shown that these videos improve patient s knowledge of hearing aids and communication. They have also increased hearing aid use and improved patient s confidence. Educational videos can be improved by tailoring them to the needs of each person. They can also be more easily accessed by running them on the internet. Mobile devices, such as smartphones and tablet computers, provide an ideal means to achieve this. This research aims to work with hearing aid users to adapt our existing educational videos for use with people s own mobile devices. We will then ask first-time hearing aid users to try out the videos on their own devices. After 10-12 weeks, we will speak to each user individually. We will ask questions about how they got on with them, what worked and what made a difference to them. Informed by the views of first-time hearing aid users, we plan to develop a larger study. This is to see whether our new educational videos, delivered through mobile devices, really make a difference to the lives of those affected by hearing loss. If they do, we plan to find out how and why. The overall study goal is to improve hearing aid use by helping hearing aid users to self-manage their condition. This is to lessen the negative effects linked to hearing loss.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: EAR