AU Bankaitis's Audiology Blog

All of us are all too-familiar with the math; in the United States, approximately one out of every three adults over the age of 60 has hearing loss, while more than 50% of individuals over the 85 have a hearing loss.¹ Recent estimates indicate that 3.8 million or 14.2% of American 50-years of age and older with hearing loss wear hearing aids. For patients 50 years and older in the United States with hearing loss, one  in seven individuals have obtained a hearing aid, and for adults of working age (ages 50-59), the rate of hearing aid acquisition declines to less than one in 20.² There are thought to be several causes for this low rate of hearing aid acquisition among adults, including a lack of reimbursement, high prices and stigma.

Like many medical conditions, successful intervention requires adults with acquired hearing loss to change their thinking and behaviors with respect to their disability. This may involve taking the necessary steps to seek professional help for an evaluation, accepting the need and the use of amplification, and/or completing some type of rehabilitation program. Over the past several years, research has attempted to uncover the reason for a lack of hearing aid uptake among adult non-users. Various health behavior change (HBC) models  have been used to describe the process of coming to terms with an acquired hearing loss and taking the necessary steps to ameliorate it. Manchaiah³ provides an overview of many of these HBC models as they relate to hearing healthcare and the provision of hearing aids.  Recently, Laplante-Levesque, Hickson & Worrall⁴ conducted research on the validity of a well-known four-stage HBC model. Their recent work in this area suggests that hearing impaired adults can be reliably categorized into one of the four stages shown in the Figure 1 continuum.

Figure 1: A simple four-stage health behavior change model

The Sudden Jolt

Motivational interviewing is a tool clinicians can use to evaluate the HBC stage an individual may be in during their consultation and spark behavior changes by tapping into their inner drives. Rather than relying on coercion, pressure and promises, effective motivational interviewing relies on thoughtful, irrational questions. According to Dr. Michael Pantalon⁵ at the Yale School of Medicine, who is a leading authority on motivational interviewing techniques, irrational questions are what seem to trigger meaningful dialogue that often results in behavior changes. If you are trying to jolt patients into action, try asking your patients these two questions during the initial hearing evaluation:

1.         “On a scale of 1 to 10, one being the worst and ten being the best, how would you rate your overall hearing ability?”

After you receive an answer to this question, the follow-up question you can ask is,

2.         “Why didn’t you choose a higher number?”

According to Dr. Pantalon, this second, irrational question often catches many people off guard.  The first question asks them to quantify their perception of the problem, while the second requires a more detailed explanation that is likely to take patients out of their comfort zone as they explain why a higher number was not chosen. It is during this process that patients can get on the path to behavior change.

Palmer and colleagues⁶ provide us with some insight on how question 1 above can be adapted in your clinic. Their results showed that 16% of study participants rated themselves an 8-10, 31% rated themselves between a 6-7, and 53% provided a rating between 1 and 5. Their result, moreover, showed approximately 80% of participants with a rating between 1 and 5 obtained amplification, while less than 20% of participants with a self-rating of 8 to 10 obtained hearing aids. The big opportunity, however, seems to rest with those that have a self-rating of 6 to 7, as about 50% of the time this group failed to obtain hearing aids at the time of the evaluation.

The Gentle Nudge

If the two questions listed above provide the sudden jolt that leads to behavior change, perhaps the gentle nudge to improved communication rests with Unitron’s Flex:trial instrument. Flex:trial is a tool, along with motivational interviewing techniques’ that may result in greater uptake of hearing aids for patients who are contemplating taking action for their hearing disability.

Unitron’s Flex:trial program allows patients to try the level of amplification that is deemed most appropriate for them by their practitioner during the initial consultation.  By allowing a patient to use the Flex:trial devices for an extended period of time in the comforts of home (using the fitting software you can select a trial time between 1-day and 1-month), while they experience the benefits of a customized solution in real-world listening conditions. A customizable trial device is a convenient and risk-free way of helping the patient make an affirmative decision to obtain hearing aids. For patients that decide to obtain amplification after the trial, the Flex:trial device is swapped out for the exact model of instruments that are purchased by the patient.

Here is how the combination of motivational interviewing and use of Unitron’s Flex:trial could work; during the routine evaluation you ask the first question.  Let’s say your patient responds to the first question with a response of 6 or 7. Patients that classify themselves in this range are likely to have a substantial hearing loss, but are still contemplating any behavior changes. These patients may be best described as “fence-sitters,” and need a gentle nudge into action. An extended at-home trial with Flex:trial may be in order.

Given the relatively poor acceptance of hearing aids by the millions of Americans who could benefit from them, the combination of motivational interviewing techniques and an in-home trial of a fully customizable device (Unitron’s Flex:trial) offer the ambivalent non-user the best avenue to improved communication and a higher quality of life. For the clinician this combination of technology and thoughtful questioning is likely to translate into a more efficient and productive business. The Flex:trial business solution program will be launched at the upcoming AudiologyNOW event in Anaheim, California. To learn more visit the Unitron booth at the AudiologyNOW expo or contact me at brian.taylor@unitron.com

Brian Taylor, Au.D. is the Director of Practice Development & Clinical Affairs for Unitron and the Editor of Audiology Practices, the quarterly publication of the Academy of Doctors of Audiology. Brian also serves on the advisory board for the Better Hearing Institute and is a frequent contributor to Audiology Online. During the first decade of his career, he practiced clinical audiology in both medical and retail settings. Since 2004, Dr. Taylor has held a variety of management positions within the industry in both the United States and Europe. He has published over 30 articles and book chapters on topics related to hearing aids, diagnostic audiology and business management. Brian has authored two text books Fitting and Dispensing Hearing Aids and Consultative Selling Skills for Audiologists, both published by Plural, Inc.

References

1. www.hearingloss.org Downloaded February 27, 2013
2. Chien, W. & Lin, F, (2013). Prevalence of hearing aid use among older adults in the United States. Arch Intern Med. 172, 3, 292-293.
3. Manchaiah, V.K. (2012). Health behaviour change in hearing healthcare: A discussion paper. Audiological Research. 2, e4, 12-16
4. Laplante-Levasque, A., Kickson, L., Worrall, L. (2013). Stages of change in adults with acquired hearing impairment seeking help for the first time: Application of the transtheoretical model in audiologic rehabilitation. Ear and Hearing. (published-ahead-of-print).
5. Pantalon. M. (2011). Instant Influence. Little, Brown Co. New York.
6. Palmer, C. et al. (2009). Relationship between self-perception of hearing ability and hearing aid purchase. Journal of the American Academy of Audiology. 20, 6, 341-348.