Title: Development and feasibility of a behavioural intervention to improve the beneficial use of hearing technology for adults with hearing loss
Funder: Department of Health and Social Care

Abstract: BACKGROUND Hearing loss is the 5th leading cause of years lived with disability (YLD) worldwide. Within an ageing population, this represents a leading (and growing) global burden of disease1. More than 11 million people in the UK have a significant hearing loss, the prevalence and severity of which increases with age (41.7% of 50+ and 71.1% of 70+ year olds2).Hearing technologies that provide amplification such as hearing aids can be life-changing for people with hearing loss, but it can take time to get used to them. Hearing aids are the standard clinical management option to improve communication and quality of life3 for people with hearing loss. However, the non-use (3-23%)3 or sub-optimal use (up to 40%)4 of hearing aids is high. Reasons for this are often dependent on the individuals' recognition of their loss as well as the level of support offered to them5. Untreated hearing loss is associated with difficulties in communication3 that can result in reduced employment and economic productivity6, poorer social engagement7, social isolation8,9, declines in physical and mental health10, reduced independence11, increased falls12, hospitalisation10, and an increased risk of developing dementia13,14.The NHS is the largest supplier of hearing aids in the UK (1.2million per year), with approximately 400,000 provided to first-time users. Hearing aid non-use results in unnecessary waste of NHS funds, yet the largest cost is for those with hearing loss who continue to experience poor quality of life.RESEARCH AIMS, METHOD & TIMELINE In order to improve the beneficial use of hearing technologies for adults with hearing loss, this research will: (Months 1-6): Identify how factors associated with the use of hearing technologies operate at the level of human behaviour using validated methodologies and the latest science in health behaviour change15,16. (Months 7-21): Develop a digital behavioural intervention designed to improve the use of hearing technologies for adults with hearing loss, guided by health behaviour change theory and techniques16,17 and developed using a person-based approach18. (Months 20-48): Generate knowledge about the feasibility of a future multicentre pragmatic RCT of intervention effectiveness and cost-effectiveness for first-time hearing aid users in the NHS. IMPACT & DISSEMINATION This research will develop research capacity and generate new IP through: A conceptual framework of how behaviours can be linked to beneficial use of hearing technologies. A digital behavioural intervention to improve the beneficial use of hearing technologies for adults with hearing loss, developed using a person-based approach. Feasibility data to inform a multicentre pragmatic trial of intervention effectiveness and cost-effectiveness for first-time NHS hearing aid users, a key research recommendation of NICE5. If feasible, a expression of interest to the NIHR Health Technology Assessment programme to support the future trial. Research findings will be widely disseminated using conventional (peer reviewed scientific publications) and novel engagement strategies (infographics, blogs, vlogs and sketchnotes), in collaboration with the patient and public involvement representatives.Finally, we will hold a spotlight event upon project completion to celebrate the achievements of the research and fully-engage the key stakeholders.

Lay abstract: The problem Positive healthcare outcomes rely on patients' following the recommendations of their healthcare professionals. There are a range of available hearing technologies designed to help people with hearing loss hear sounds they would otherwise miss, such as hearing aids. Hearing aids are provided free of charge by the NHS to improve communication, social participation and health-related quality of life. But the non-use (up to 23%) or irregular use (up to 40%) of hearing aids by NHS patients is high. If left untreated, hearing loss leads to difficulties in communication which can affect daily life. Problems include; difficulties communicating at work, social isolation, poorer physical and mental health, reduced independence, increased falls, increased hospitalisation, and an increased risk of developing dementia. More than 11 million people in the UK have a hearing loss. Hearing loss is more common and becomes more severe as people get older. It affects 42% of adults aged over 50 years old, and 71% of adults aged over 70 years old. As the average age of the UK population rises, the burden of hearing loss will continue to increase year-on-year.The solution The use of hearing technologies is a healthy behaviour, similar to taking medications as prescribed by a doctor. The National Institute for Health and Care Excellence (NICE) state that patients in the NHS should be provided with additional tools to support and improve hearing aid use. Researchers in health psychology have provided ways to guide the development of tools to help patients begin and continue to use healthy behaviours. These tools provide patients with the capability, opportunity and motivation they need to perform healthy behaviours, such as using their hearing aids when they would benefit from doing so.To improve the use of hearing technologies to benefit adults with hearing loss, I will: Identify how individuals' behaviours are linked to their use of hearing technologies. Ask patients which behaviours they would most like help to change. Develop an online tool with patients to improve the use of hearing technologies. Ask patients what they think about the tool and how helpful it is for them. Carry out a study to identify the possibility and cost of a future clinical trial to measure all of the benefits to patients who receive NHS hearing aids for the first time. Make the results of the research widely available to patients, clinicians and researchers using scientific articles, newsletters, blogs, videos and pictures. Throughout the project I will work alongside patients, other researchers and clinicians to ensure that the results are relevant to patients and the NHS. Patients will help develop the tool, analyse the results, and design the study, so that it is easy for future patients take part in the clinical trial.

Research activity codes: 6.3 MEDICAL DEVICES;6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: EAR