A Simplified Patient-Centered Educational Tool for Improved Hearing-Aid Outcomes
Condition: Hearing Loss
MeSH terms: Hearing Loss
Study type: Interventional

Summary: 
      Hearing loss is the second most prevalent service-connected disability among Veterans.
      Hearing aids are the most common technological intervention for hearing loss. The VA,
      therefore, spends a considerable amount of money on them. Despite these expenditures, there
      are some Veterans who do not use their hearing aids successfully. Research has demonstrated
      that this inconsistent use may be related to a patient's inability to effectively take care
      of, and use, hearing aids. The proposed investigation will compare the effectiveness of three
      different tools for enhancing the educational efforts (hearing-aid orientation) typically
      provided by clinical audiologists when dispensing hearing aids. Each of these educational
      tools were developed using established methods for improving patient-provider communication.
      The investigators hypothesize that the use of these tools will result in better hearing-aid
      outcomes for Veteran patients than using the current standard-of-care procedures.
    

Detailed description: 
      Objectives: Reasons for non-use of hearing aids are varied, but many studies have suggested
      that a lack of knowledge about how to use and/or take care of the hearing aids is a major
      factor. This is not surprising given that other healthcare fields have reported that between
      40-80% of information provided during a clinical appointment is forgotten by the patient
      immediately after the appointment and almost half of what is remembered is not correct. The
      long-term goal of this project is to improve the delivery of information during the
      hearing-aid orientation, as better delivery of information will result in better hearing-aid
      handling skills and thus better overall hearing-aid outcomes. To accomplish this goal, the
      investigators propose to refine and evaluate the effectiveness of three forms of supplemental
      hearing-aid-orientation tools, each of which was developed using established guidelines for
      good patient-provider communication.

      Plan: The purpose of the proposed application is to evaluate the relative effectiveness of
      four forms of hearing-aid orientation provided to first time hearing-aid users, three of
      which use some of the aforementioned strategies to enhance the standard of care. The four
      forms of orientation will be: (1) the standard-of-care hearing-aid orientation; (2) the
      standard of care plus provision a hearing-aid information guide (HAIG) (3) the standard of
      care supplemented by an explanation of its content using the talk-back technique to confirm
      patient understanding; and (4) the standard of care plus provision of a take-home hearing-aid
      orientation DVD (HAO DVD). The content of the HAIG will be field tested and finalized
      following input obtained via focus groups with clinical audiologists and first-time hearing
      aid users.

      Methods: For the field testing up to 16 clinical audiologists and 10 new hearing aid user
      Veterans will be recruited to participate in focus groups during which they will view and
      then be asked questions about the content of the HAIG. Information learned during these focus
      groups will then be incorporated into the HAIG, at which time they will be ready for use in
      the study. For the comparative effectiveness study, up to 468 hearing-impaired Veterans who
      are about to become first-time hearing-aid users will be enrolled to participate in this
      investigation. These individuals will be recruited from the VA Portland Health Care System's
      Audiology and Speech Pathology Service (ASPS). Prior to receiving their hearing aids,
      subjects will be enrolled in the study at the National Center for Rehabilitative Auditory
      Research (NCRAR), and will conduct health literacy, manual dexterity and hepatic sensitivity,
      visual acuity, and learning and memory assessments. They will then attend their hearing aid
      fitting in the ASPS and will receive standard-of-care hearing-aid orientation. At the end of
      that appointment, they will receive one of the four study interventions. Subjects will return
      to the NCRAR 4-6 weeks after the hearing-aid-fitting appointment to complete the following
      outcome measures: a knowledge and practical test regarding hearing-aid use and care, a
      measure of self-efficacy, and a measure of hearing-aid outcomes. They also will be
      interviewed so that the investigators can learn their opinions about the intervention. A
      subset of the initial 50 participants enrolled into each study arm will attend a second
      follow-up appointment 6 months after the fitting appointment so the investigators can examine
      longer-term impacts of the hearing aid orientation interventions.
    

Intervention name(s): Hearing-Aid Informational Guide; Hearing-Aid DVD; Teach-back Technique; Standard of Care
Intervention type(s): Other; Other; Behavioral; Other
Intervention description(s): Printed take-home guide on hearing aids; Take-home DVD about hearing aids; Counseling/Educational session using the teach-back technique to review information about their hearing aids; standard of care hearing-aid orientation as provided by clinical audiologist
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: hearing aids; counseling; outcomes assessment (health care); rehabilitation