The experiences of telepractice nurses undertaking a vocational audiological rehabilitation program.

OBJECTIVE: In response to modest outcomes in the field of vocational audiological rehabilitation, we examined the mechanism by which a group of workers with hearing challenges engaged with such a program. DESIGN: Telepractice nurses with hearing challenges participated in a four-session, online course teaching evidence-based communication strategies. Using multiple case study methodology, we collected ethnographic interviews, surveys, and discussion-forum comments before, during, and after the program. We applied grounded theory to these data sources to develop an across-case model of nurses' engagement with the strategies presented. STUDY SAMPLE: Twelve female nurses made up the study's twelve cases. RESULTS: Nurses undertook a problem-solving process in response to the presented strategies. They evaluated strategies based on perceived benefits and obstacles to implementation. Nurses took steps to incorporate promising strategies into their unique work contexts', but not all completed the problem-solving process required to do so. CONCLUSIONS: Participants needed to problem solve to implement course strategies in the workplace. This process was effortful and not always successful. We conclude that future interventions in the field of vocational audiological rehabilitation may benefit workers by actively supporting their problem-solving processes.

Increasing telephone accessibility for workers with hearing loss: a scoping review with recommendations.

OBJECTIVE: A scoping review was undertaken to identify strategies which increase telephone accessibility for workers with hearing loss. DESIGN: The scoping review protocol outlined by the Joanna Brigg's Institute was used. Terms relating to hearing loss, telephones, and management strategies were searched in CINAHL, MEDLINE, and Web of Science. An additional hand search was also conducted for two journals and two publications from consumer organisations as they were known to publish relevant articles. Inclusion and exclusion criteria were applied to the resulting 1086 texts. Strategies from the selected texts were organised into categories through thematic analyses.Study sample: Eighty-four texts were included in the review. RESULTS: The effective telephone strategies fall into the following categories: amplifying the telephone signal, reducing background noise, listening to the telephone through both ears, accessing text-based supports to understanding telephone speech, using Internet-based telephony, optimising mobile phones, improving telephone skills and communication strategies, and requesting accommodation in the workplace. CONCLUSION: Strategies exist by which the telephone can be made more accessible to workers with hearing loss. These have the potential to benefit both workers and their employers.

Reported benefits of peer support group involvement by adults with hearing loss.

OBJECTIVE: The purpose of this study was to better understand the benefits of self-help group involvement by adults with hearing loss. DESIGN: A secondary content analysis of interview transcripts of participants from a previous study on the impact of stigma on help-seeking was carried out. STUDY SAMPLE: Ten members (aged 55-76 years) of self-help groups for persons with hearing loss in the United States of America and Canada participated in the interviews. RESULTS: Three themes describing the benefits of self-help group participation emerged: (1) Practical and accessible information about hearing loss; (2) Social belonging leading to personal transformation; and (3) A new and mutually beneficial direction. CONCLUSIONS: The findings are discussed in relation to the "helper therapy principle", as well as group audiological rehabilitation.

Representations of workers with hearing loss in Canadian newspapers: a thematic analysis.

OBJECTIVE: Participation in the labour force with a hearing impairment presents a number of challenges. This study describes how Canadian newspapers represent workers with hearing loss. DESIGN: Taking a critical framing theory approach, thematic analysis was performed through coding relevant articles, abstracting and hierarchically categorising themes. STUDY SAMPLE: Seven English-language Canadian newspapers were searched for publications between 1995 and 2016. Twenty-six articles met our criteria: discussing paid workers with hearing loss who used English rather than sign language on the job and making reference to workers' competence. RESULTS: We identified a global theme, Focussing on a good worklife or focussing on a limited worklife, composed of three organising themes (1) Prominent individuals struggle, take action, and continue despite hearing loss, (2) Workers with hearing loss in the community create their best day themselves, and (3) Workers with hearing loss, as a generalised whole, are portrayed as either competent or limited. CONCLUSIONS: The dominant framing portrays individual workers as ingenious, determined, and successful. Negative framings were predominantly generalisations to these workers as a group. To generate more positive framings, professionals can build relationships with consumer groups and, when contacted by the media, direct journalists to interview workers with hearing loss.

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

BACKGROUND: Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. PURPOSE: Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. RESEARCH DESIGN: A cross-sectional approach was used to obtain online and paper-based concept ratings. DATA COLLECTION AND ANALYSIS: Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. RESULTS: There was a significant difference in the mean ratings for clients and clinicians for the concepts understanding and meeting client needs, conveying device information by clinician, supporting choices and shared decision making, and factors in client readiness. Three concepts-understanding and meeting client needs, conveying device information by clinician, and supporting choices and shared decision making-were rated as more important by clients than by clinicians. One concept (ie, factors in client readiness) was rated as more important by clinicians than by clients. CONCLUSIONS: The concepts rated as most important by clients and clinicians are consistent with components of several existing models of client-centered and patient-centered care. These concepts reflect the clients' perception of the importance of their involvement in the decision-making process. A preliminary model of client-centered care within the hearing aid uptake process and implications for clinical audiology are described.

Psychometric properties of the self-efficacy for situational communication management questionnaire (SESMQ).

OBJECTIVES: Perceived self-efficacy (PSE) is one's beliefs in one's capabilities to organize and execute the courses of action required to manage prospective situations. In audiologic rehabilitation, PSE could influence a person with hearing loss' activity limitations, participation restrictions, and response to audiologic rehabilitation. This article reports the psychometric properties of the Self-Efficacy for Situational Communication Management Questionnaire (SESMQ), developed to measure PSE for managing communication in adults with acquired hearing loss. DESIGN: The SESMQ contains 20 situations that are rated on two scales (hearing ability and PSE). Respondents rate how well they can hear from 0 (not well at all) to 10 (very well) and their degree of confidence in managing communication in the situation, or PSE, from 0 (not confident at all) to 10 (very confident). Total scores on each scale can range from 0 to 200, with higher scores indicating greater hearing ability or PSE. Psychometric properties were determined using data collected from The National Centre for Audiology (London, Canada) and the Communication Disability Centre at The University of Queensland (Brisbane, Australia). Participants were 338 adults aged 50 to 93 years with an average high-frequency pure-tone hearing loss in the better ear of 46 dB HL; 157 of the participants owned hearing aids. RESULTS: A two-factor solution was found to be optimal for the SESMQ, with hearing ability accounting for 46.4% of the variation and confidence accounting for 11.6% of the variation in SESMQ scores. Test-retest reliability on a subset of 40 participants resulted in intraclass correlation coefficients of 0.94 for the SESMQ, 0.93 for the hearing ability scale, and 0.94 for the confidence scale, The SESMQ and its scales exhibited high internal consistency, with Cronbach's α of 0.94 for the SESMQ, 0.93 for the hearing ability scale, and 0.94 for the confidence scale. Participants scored lower on the hearing scale items (92.6, SD = 37.1), on average, than on the PSE scale items (123.0, SD = 37.9). SESMQ hearing ability scores were significantly associated with duration of hearing loss, and duration of hearing aid ownership. Only the hearing ability scale of the SESMQ was negatively associated with hearing loss when controlling for age. SESMQ hearing ability and confidence scores were negatively associated with consequences of hearing loss and negative beliefs and attitudes toward hearing loss and its consequences. CONCLUSIONS: The results support the SESMQ as an informative measure of PSE specific to communication for adults with hearing loss. The SESMQ may prove useful in both research and clinical practice.

Social identity management strategies used by workers with acquired hearing loss.

OBJECTIVES: There is a paucity of knowledge about social identity-management by persons with hearing loss. The objective of the study was to gain an understanding from the perspective of the participants, the ways in which workers with acquired hearing loss manage their identity in the workplace. PARTICIPANTS: Twelve persons with acquired hearing loss, who were gainfully employed in a variety of settings and occupations in three Canadian cities, participated in audio-recorded semi-structured interviews. METHODS: A secondary qualitative analysis was conducted on transcripts of interviews collected in a previous study on factors that influence disclosure of hearing loss in the workplace. A qualitative descriptive research paradigm was adopted and content analyses were used to extract pertinent information from verbatim transcripts. RESULTS: Participants described a range of identity-management strategies enacted in the workplace. Five recurrent themes emerged as important considerations in the Art of Identity Management in the workplace: 1. Managing the situation, 2. Having a buddy system, 3. Feeling comfortable, 4. Using personal resources, 5. It gets easier with time. CONCLUSIONS: Social identity-management is a complex process. Although persons with acquired hearing loss experience different challenges from other persons with invisible stigmas, similarities in the range of social identity-management strategies employed were evident in our findings. In addition, the social cognitive learning model of disclosure appears to be relevant to the experiences of our participants. The implications of the findings emphasize the importance of all stakeholders working collaboratively to address the issues of the growing population of workers with hearing loss.

Assessing communication accessibility in the university classroom: towards a goal of universal hearing accessibility.

Measures of accessibility typically focus on the physical environment and aspects relating to getting into and out of spaces. The transient sound environment is less well characterized in typical accessibility measures. Hearing accessibility measures can be based upon physical indices or functional assessment. The physical measures are indices that use signal-to-noise ratios to evaluate audibility while the functional assessment tool adopts universal design for hearing (UDH) principles derived from principles of universal design. The UDH principles include (1) Optimization of the hearing environment for all; (2) Optimization of interactions between persons and objects to promote better hearing in an environment; (3) Optimization of opportunities for people to have multiple choices of interactions with one another; (4) Optimization of opportunities for people to perform different activities in and across environments; (5) Optimization of opportunities for people to have safe, private, and secure use of the environment while minimizing distraction, interference, or cognitive loading; and (6) Optimization of opportunities for people to use the environment without extra steps for hearing access during preparatory, use and/or after use phases. This paper compares the two approaches using case examples from post-secondary classrooms in order to describe the potential advantages and limitations of each.

The standpoint of persons with hearing loss on work disparities and workplace accommodations.

OBJECTIVES: The perspectives of persons who live and work with hearing loss were sought to examine workplace accommodation challenges and strategies. PARTICIPANTS: A convenience sample of seven older adults with hearing loss participated in in-depth interviews. METHODS: A systematic grounded theory approach informed the study design and analysis. Categories of facilitators and challenges in the data were identified through axial coding and clustering. Core categories of social processes emerged through constant comparison and theoretical sampling of the data to reveal the actions and interactions used to negotiate or implement adaptations or workplace accommodations. RESULTS: Persons with hearing loss use a realm of strategies to live and work with a hearing loss. Social processes used to navigate the challenges to working with hearing loss and to manage optimal work performance included: self-accommodation, self-advocacy, self-management of hearing loss, and lobbying. CONCLUSIONS: Success in overcoming work disparities for persons with hearing loss requires individuals to take control of identifying their needs within the workplace and at home, and to negotiate for specific accommodations. These strategies and processes draw attention to the need for a repository on contextualized workplace accommodation strategies for improving communication and hearing in the workplace. Further to this a best practice guide for use by workers, employers, and work rehabilitation and health care workers is indicated.

Innovations in workplace accessibility and accommodation for persons with hearing loss: using social networking and community of practice theory to promote knowledge exchange and change.

BACKGROUND: Despite widespread availability of assistive technology and the role of occupational therapists and audiologists in workplace health, little is known about how these groups influence the health of workers with hearing loss. OBJECTIVE: Based on a previously conducted study, this paper explores the need for networking and community of practice theory to promote knowledge sharing and use between occupational therapists, audiologists, educators, regulators, workers, and employers. METHODS: Five occupational therapists and five audiologists participated in in-depth interviews. Grounded theory was used to investigate the processes that hinder or support these professionals in addressing the accommodation needs of and workplace accessibility for workers with hearing loss. RESULTS: Constraints to addressing the needs of workers with hearing loss included: lack of knowledge about professional practice processes, lack of networking, lack of knowledge on current research, and lack of knowledge on the realm of expertise of audiologists by occupational therapists and of occupational therapists by audiologists. CONCLUSIONS: Innovations in workplace practice in hearing loss require engagement of occupational therapists, audiologists, and employers in knowledge transfer, networking, and learning. This column introduces two theories that may guide the use and development of evidence, knowledge, and expertise toward innovations in hearing work practice.

Factors in client-clinician interaction that influence hearing aid adoption.

The influence of client-clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider-patient interaction on health outcomes. The purpose of this study was to identify factors in the client-clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client-clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client-clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction.

Factors that influence disclosure of hearing loss in the workplace.

OBJECTIVE: The objective of the study was to identify factors that lead individuals to conceal or disclose their hearing loss in the workplace. DESIGN: A qualitative research paradigm called qualitative description was selected to address this issue. STUDY SAMPLE: Twelve people who had an adult onset hearing loss, and were gainfully employed, participated in audio-recorded semi-structured interviews designed to probe issues related to disclosure of hearing loss. A photo elicitation interview technique was employed during the interviews. Content analyses were used to extract pertinent information from verbatim transcripts. RESULTS: Five recurring themes emerged as important considerations in relation to this topic: (1) perceived importance of the situation; (2) perceived sense of control; (3) community affiliation; (4) burden of communication; and (5) coexisting issues related to hearing loss. CONCLUSIONS: The findings are discussed in relation to other concealable stigmatizing traits, stigma-theory, and social-cognitive theory. The clinical implications of these findings are discussed, with particular emphasis placed on worker self-efficacy.

Stigma: a negative and a positive influence on help-seeking for adults with acquired hearing loss.

There are stigmas associated with many chronic health conditions that emerge in adulthood. People who present manifestations of hearing loss are often perceived by others to be cognitively diminished, less able, and socially incompetent. In order to avoid being identified as a member of a stigmatized group, individuals with hearing loss may choose not to seek health services or fail to comply with recommended treatments. The purpose of this study was to better understand how stigma impacted upon the help-seeking activities of adults with an acquired hearing loss. Ten people who had hearing loss, and were members of peer-support groups participated in audio-recorded semi-structured interviews. Verbatim transcripts were analysed using thematic analyses. Analyses revealed that lasting decisions about hearing loss management were made following 'critical junctures', when the negative stress found in the respondent's social and physical environment far outweighed positive energy, or when the positive energy found in the respondent's environment far outweighed the negative stress. The time course development of these processes is described.

Exploring hearing aid use in older women through narratives.

This study explored experiences surrounding hearing aid use and non-use in older women with hearing loss. A narrative approach was used to gain an in-depth understanding of the meaning and contextual issues that impact upon the adaptation process of older adults and their transitions in using hearing devices. Four women over the age of sixty who were identified as being consistent hearing aid users took part in three face-to-face interviews. Wengraf's (2001) biographic-narrative-interview guiding framework was used to gather data in this study. Data were analyzed both holistically and thematically from a phenomenological perspective to identify the meaning and essence of the participants' experiences. The results revealed an overarching theme of meaningful participation in life situations and events that were linked to purposeful use and non-use of hearing aids. Barriers and facilitators related to participation, which in turn affect hearing aid use and acceptance, were uncovered. The results of this study have implications for audiologic research, and practice.

Towards a comprehensive approach for managing transitions of older workers with hearing loss.

Demographic and legislative trends suggest that many older workers may remain at work past the traditional retirement age. This extended work trajectory poses new challenges and opportunities for workers with acquired hearing loss as they age. Workplaces require a new approach to enable transitions of older workers with hearing loss to remain safe and productive. A review of the literature on older workers, those with hearing loss, and strategies used to accommodate them suggests that individualized and piecemeal approaches are predominant. While universal design represents a fresh ideology that may help create more accessible and usable products and environments, its application to improve workplaces for older workers with hearing loss is limited. This paper proposes that occupational science be integrated with knowledge in hearing sciences, accessibility, and usability to assist with the transitions faced by older workers with hearing loss. A more comprehensive approach including the following three key components will be posited to examine the nexus of aging, hearing loss and work: (1) the use of an occupational perspective, along with concepts in hearing sciences to examine hearing demands and improve hearing access; (2) the use of contextual processes to promote physical and social change, and (3) the inclusion of Universal Design for Hearing (UDH) considerations as stakeholders develop more hearing friendly workplaces.

Impact of hearing loss in the workplace: raising questions about partnerships with professionals.

The number of adults with hearing loss who continue to work later in life is growing. Persons with hearing loss are generally unaware of the role that audiologists, occupational therapists, and vocational rehabilitation counsellors might play in the assessment of the workplace environment and appropriate accommodations. Three narratives of adults with hearing loss are used to demonstrate the gaps in accessing information, technology and services needed to maintain optimal work performance and productivity. The lack of recognition of the multidimensional needs of older workers with hearing loss and the lack of timely coordination of services led to all three persons acting alone in trying to access services and supports. In two of the three cases the impact of the hearing loss resulted in further unexpected losses such as the loss of employment and the loss of a worker-identity. There is an urgent need for partnering with persons who are hard of hearing to develop new strategies for knowledge exchange, more thorough assessment of hearing demands and modifications in the workplace, and interdisciplinary approaches to service specific to the needs of hard of hearing persons.