Development of a self-report measure of empowerment along the hearing health journey: a content evaluation study.

OBJECTIVE: To conduct the first phases in the development of a self-report measure of empowerment on the hearing health journey, specifically, item generation and content evaluation of the initial pool of items generated. DESIGN: A content expert panel survey and cognitive interviews were conducted. Descriptive statistics were obtained for the quantitative data, and the cognitive interviews were analysed using thematic analysis. STUDY SAMPLE: Eleven researchers and clinicians participated in the content expert surveys. Sixteen experienced hearing aid users participated in the cognitive interviews, recruited from the USA and Australia. RESULTS: The items underwent five iterations based on feedback from the survey and interview data. This resulted in a set of 33 quality-tested potential survey items that were rated highly for relevance (mean = 3.96), clarity (mean = 3.70) and fit to dimensions of empowerment (mean = 3.92) (scale 0-4, where 4 was the maximum rating). CONCLUSIONS: Involving stakeholders in item generation and content evaluation increased relevance, clarity, fit to dimension, comprehensiveness, and acceptability of the items. This preliminary version of the 33-item measure underwent further psychometric refinement (Rasch analysis and traditional classical test theory testing) to validate it for clinical and research use (reported separately).

Refinement and Validation of the Empowerment Audiology Questionnaire: Rasch Analysis and Traditional Psychometric Evaluation.

OBJECTIVES: Empowerment is the process through which individuals with hearing-related challenges acquire and use knowledge, skills and strategies, and increase self-efficacy, participation, and control of their hearing health care, hearing solutions, and everyday lives. The aim was to refine and validate the Empowerment Audiology Questionnaire (EmpAQ), a hearing-specific measure of empowerment. This was achieved through (1) refinement via Rasch analysis (study 1), and (2) traditional psychometric analysis of the final survey structure (study 2). DESIGN: In study 1, 307 adult hearing aid owners completed the initial empowerment measure (33 items) online. To inform an intended item reduction, Rasch analysis was used to assess a range of psychometric properties for individual items. The psychometric properties included analysis of individual items (e.g., response dependency, fit to the polytomous Rasch model, threshold ordering) and the whole EmpAQ (e.g., dimensionality). Item reduction resulted in a 15-item version (EmpAQ-15) and a short-form 5-item version (EmpAQ-5), validated using modern (Rasch), and traditional (Classical Test Theory) psychometric analysis (study 2). In study 2, 178 adult hearing aid owners completed the EmpAQ-15 and EmpAQ-5, alongside 5 questionnaires to measure related constructs. These included two hearing-specific questionnaires (Social Participation Restrictions Questionnaire and Self-Assessment of Communication), two general health-related questionnaires (Patient Activation Measure and World Health Organization Disability Assessment Schedule 2.0), and a general empowerment questionnaire (Health Care Empowerment Questionnaire). Modern (Rasch) and traditional psychometric analysis techniques (internal consistency, construct validity, and criterion validity) were used to assess the psychometric properties of the EmpAQ-15 and EmpAQ-5. RESULTS: Rasch analysis of the initial 33-item measure of empowerment identified 18 items with high response dependency, poor fit to the Rasch model, and threshold disordering, which were removed, resulting in a long-form (EmpAQ-15) hearing-specific measure of empowerment. A short-form (EmpAQ-5) version was developed for use in the clinic setting. Validation of the two EmpAQ measures using Rasch analysis showed good item fit to the Rasch model, appropriate threshold targeting, and the existence of unidimensionality. Traditional psychometric evaluation showed that both questionnaires had high internal consistency and positive correlations with the hearing-specific questionnaires. However, in contrast with our hypotheses, correlations with general health questionnaires were stronger than with hearing-specific questionnaires; all questionnaires were correlated with the EmpAQ and in the direction hypothesized. Taken together, these findings support the construct validity of the EmpAQ-15 and EmpAQ-5. CONCLUSIONS: The EmpAQ-15 and EmpAQ-5 are the first self-report measures to be developed specifically for the measurement of empowerment. The EmpAQ-15 and EmpAQ-5 were found to meet the Rasch model criteria for interval-level measurements. Traditional psychometric evaluation supports the construct validity of both measures. The EmpAQ measures have the potential to be used in both research and clinical practice to evaluate empowerment along the hearing journey. The next stage of this research will be to further validate these measures by assessing their responsiveness, minimal clinically important difference, and clinical interpretability in a clinical population.

Conversation success in one-to-one and group conversation: a group concept mapping study of adults with normal and impaired hearing.

OBJECTIVE: The concept of conversation success is undefined, although prior work has variously related it to accurate exchange of information, alignment between interlocutors, and good management of misunderstandings. This study aimed (1) to identify factors of conversation success and (2) to explore the importance of these factors in one-to-one versus group conversations. DESIGN: Group concept mapping method was applied. Participants responded to two brainstorming prompts ("What does 'successful conversation' look like?" and "Think about a successful conversation you have taken part in. What aspects of that conversation contributed to its success?"). The resulting statements were sorted into related clusters and rated in importance for one-to-one and group conversation. STUDY SAMPLE: Thirty-five adults with normal and impaired hearing. RESULTS: Seven clusters were identified: (1) Being able to listen easily; (2) Being spoken to in a helpful way; (3) Being engaged and accepted; (4) Sharing information as desired; (5) Perceiving flowing and balanced interaction; (6) Feeling positive emotions; (7) Not having to engage coping mechanisms. Three clusters (1, 2, and 4) were more important in group than in one-to-one conversation. There were no differences by hearing group. CONCLUSIONS: These findings emphasise that conversation success is a multifaceted concept.

Understanding patient empowerment along the hearing health journey.

OBJECTIVE: Related to the hearing health journey, this study aimed to: (i) explore how empowerment manifests itself from individuals' first awareness of hearing loss through to hearing aid fitting and then to becoming an active hearing aid user, (ii) identify points when the different dimensions of empowerment are most relevant, and (iii) conceptualise empowerment. DESIGN: A semi-structured interview study was conducted, followed by a template analysis of the data. STUDY SAMPLE: Adult hearing aid users from Sweden (n = 8) and Australia (n = 10) who had worn hearing aids for between 6 and 36 months. RESULTS: The themes that emerged from the transcripts were knowledge, skills and strategies, participation, self-efficacy, and control. CONCLUSIONS: This study conceptualises empowerment along the hearing health journey as the process through which individuals with hearing-related challenges acquire and use knowledge, skills, and strategies, and increase self-efficacy, participation, and the feeling of control of their hearing health care, hearing solutions, and everyday lives. There are not specific points along the hearing health journey where any dimension is uniquely relevant, instead, each dimension is a dynamic component at all stages.

Selecting Scenarios for Hearing-Related Laboratory Testing.

For hearing aid users to experience everyday benefit from their hearing aids, research, development, and fitting of hearing aids must be performed using evaluation methods that are indicative of everyday performance. These evaluations can take place both in peoples' ordinary lives and in laboratory settings. For the results of laboratory testing to be ecologically valid, the selected test scenarios must capture the essence of everyday listening. The present article discusses the selection of these laboratory test scenarios in three parts. Part 1 reviews prior research on the selection of everyday listening situations for laboratory testing and discusses realistic test scenarios as important research tools. Part 2 presents findings from an ecological momentary assessments study in which 19 experienced hearing aid users reported real-time auditory reality data, including their current listening activity and their current sound environment. Participants categorized their listening situations according to the common sound scenarios framework and rated how often each situation occurred, how important it was to hear well, and how difficult it was to hear in the situation. These ratings made it possible to filter the data according to three criteria (occurrence, importance, and difficulty). The filtered data could potentially be used for selecting laboratory test scenarios. Part 3 uses the data from Part 2 and data from the studies reviewed in Part 1 to broadly explore the test scenarios that various selection criteria lead to. Further, implementation of test scenarios in the laboratory, and the strengths and limitations of data collection methods for investigating auditory reality are briefly discussed. The article concludes with a summary of the collected study.

Having versus doing: The roles of moral identity internalization and symbolization for prosocial behaviors.

Moral identity has been identified as a consistent predictor of prosocial behavior, but the specific relationship and predictive strength of its two dimensions, internalization ("having") and symbolization ("doing"), are less clear. The current article explores this through two self-report studies. In study 1 (N = 228) a series of hierarchical regression analyses showed that, for three out of four domains of prosocial behavior, symbolization was the only significant predictor, and that its strength differed across outcomes. Building on these results, Study 2 (N = 299) proposed that the observed vs. anonymous nature of prosocial behavior could account for these differences. Unexpectedly, symbolization predicted both public and private behaviors, whereas internalization generally did not. Significant interactions between internalization and symbolization were also observed. These findings are discussed in relation to their theoretical implications and future moral identity research.

Sexual dimorphism in the human brain: evidence from neuroimaging.

In recent years, more and more emphasis has been placed on the investigation of sex differences in the human brain. Noninvasive neuroimaging techniques represent an essential tool in the effort to better understand the effects of sex on both brain structure and function. In this review, we provide a comprehensive summary of the findings that were collected in human neuroimaging studies in vivo thus far: we explore sexual dimorphism in the human brain at the level of (1) brain structure, in both gray and white matter, observed by voxel-based morphometry (VBM) and diffusion tensor imaging (DTI), respectively; (2) baseline neural activity, studied using resting-state functional magnetic resonance imaging (rs-fMRI) and positron emission tomography (PET); (3) neurochemistry, visualized by means of neuroreceptor ligand PET; and (4) task-related neural activation, investigated using fMRI. Functional MRI findings from the literature are complemented by our own meta-analysis of fMRI studies on sex-specific differences in human emotional processing. Specifically, we used activation likelihood estimation (ALE) to provide a quantitative approach to mapping the consistency of neural networks involved in emotional processing across studies. The presented evidence for sex-specific differences in neural structure and function highlights the importance of modeling sex as a contributing factor in the analysis of brain-related data.