Maximizing Participant Engagement, Participation, and Retention in Cohort Studies Using Digital Methods: Rapid Review to Inform the Next Generation of Very Large Birth Cohorts.

BACKGROUND: Many current research needs can only be addressed using very large cohorts. In such studies, traditional one-on-one phone, face-to-face, or paper-based engagement may not be feasible. The only realistic mechanism for maintaining engagement and participation at this scale is via digital methods. Given the substantial investment being made into very large birth cohort studies, evidence for optimal methods of participant engagement, participation, and retention over sustained periods without in-person contact from researchers is paramount. OBJECTIVE: This study aims to provide an overview of systematic reviews and meta-analyses evaluating alternative strategies for maximizing participant engagement and retention rates in large-scale studies using digital methods. METHODS: We used a rapid review method by searching PubMed and Ovid MEDLINE databases from January 2012 to December 2019. Studies evaluating at least 1 e-engagement, participation, or retention strategy were eligible. Articles were screened for relevance based on preset inclusion and exclusion criteria. The methodological quality of the included reviews was assessed using the AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews 2) measurement tool, and a narrative synthesis of the data was conducted. RESULTS: The literature search yielded 19 eligible reviews. Overall, 63% (n=12) of these reviews reported on the effectiveness of e-engagement or participation promotion strategies. These evaluations were generally not conducted within very large observational digital cohorts. Most of the contributing reviews included multipurpose cohort studies (with both observational and interventional elements) conducted in clinical and research settings. Email or SMS text message reminders, SMS text messages or voice notifications, and incentives were the most commonly used design features to engage and retain participants. For parental outcomes, engagement-facilitation interventions influenced uptake and behavior change, including video feedback, goal setting, and intensive human facilitation and support. Participant-stated preferences for content included new knowledge, reminders, solutions, and suggestions about health issues presented in a clear, short, and personalized way. Perinatal and postpartum women valued self-monitoring and personalized feedback. Digital reminders and multiple SMS text messages were specific strategies that were found to increase adherence to medication and clinic attendance, respectively. CONCLUSIONS: This review adds to the growing literature evaluating methods to optimize engagement and participation that may apply to large-scale studies using digital methods; it is promising that most e-engagement and participation promotion strategies appear to be effective. However, these reviews canvassed relatively few strategies, suggesting that few alternative strategies have been experimentally evaluated. The reviews also revealed a dearth of experimental evidence generated within very large observational digital cohort studies, which may reflect the small number of such studies worldwide. Thus, very large studies may need to proactively build in experimental opportunities to test engagement and retention approaches to enhance the success of their own and other large digital contact studies.

The cognitive and psychosocial effects of auditory training and hearing aids in adults with hearing loss.

PURPOSE: Our study assessed the efficacy of the simultaneous use of hearing aids and auditory training for improving cognition and psychosocial function in adults with hearing loss, and the relationships between hearing loss, speech perception and cognition. PARTICIPANTS AND METHODS: A 40-person (aged 50-90 years) pilot study in Melbourne, Australia, was conducted. Participants with hearing impairment completed the Geriatric Depression Scale-Short Form, questions about social activity participation, a wide range of cognitive tasks and a speech perception test at baseline, 3 and 6 months. Participants underwent auditory training for 6 months and used hearing aids for 3 months. RESULTS: Correlations and structural equation modeling suggested that several cognitive domains were associated with speech perception at baseline, but only the Incongruent Stroop cognition measure was associated with hearing loss. Hearing aid use reduced problems with communication, but there were no significant improvements in speech perception, social interaction or cognition. The effect of hearing aids and auditory training for improving depressive symptoms was significant with a moderate to large effect size (Cohen's d=0.87). CONCLUSION: The small sample size and a relatively high rate of attrition meant that this study was underpowered. However, baseline results suggested relationships between hearing loss, speech perception and cognition, and the hearing intervention provided evidence of reduced depressive symptoms. A full-scale, randomized hearing loss intervention and a longer neuroim-aging study with cognitive outcomes measured in the short term as well as after several years of hearing aid use are needed.

Hearing Aid Use in Older Adults With Postlingual Sensorineural Hearing Loss: Protocol for a Prospective Cohort Study.

BACKGROUND: Older adults with postlingual sensorineural hearing loss (SNHL) exhibit a poor prognosis that not only includes impaired auditory function but also rapid cognitive decline, especially speech-related cognition, in addition to psychosocial dysfunction and an increased risk of dementia. Consistent with this prognosis, individuals with SNHL exhibit global atrophic brain alteration as well as altered neural function and regional brain organization within the cortical substrates that underlie auditory and speech processing. Recent evidence suggests that the use of hearing aids might ameliorate this prognosis. OBJECTIVE: The objective was to study the effects of a hearing aid use intervention on neurocognitive and psychosocial functioning in individuals with SNHL aged ≥55 years. METHODS: All aspects of this study will be conducted at Swinburne University of Technology (Hawthorn, Victoria, Australia). We will recruit 2 groups (n=30 per group) of individuals with mild to moderate SNHL from both the community and audiology health clinics (Alison Hennessy Audiology, Chelsea Hearing Pty Ltd). These groups will include individuals who have worn a hearing aid for, at least, 12 months or never worn a hearing aid. All participants would be asked to complete, at 2 time points (t) including baseline (t=0) and follow-up (t=6 months), tests of hearing and psychosocial and cognitive function and attend a magnetic resonance imaging (MRI) session. The MRI session will include both structural and functional MRI (sMRI and fMRI) scans, the latter involving the performance of a novel speech processing task. RESULTS: This research is funded by the Barbara Dicker Brain Sciences Foundation Grants, the Australian Research Council, Alison Hennessy Audiology, and Chelsea Hearing Pty Ltd under the Industry Transformation Training Centre Scheme (ARC Project #IC140100023). We obtained the ethics approval on November 18, 2017 (Swinburne University Human Research Ethics Committee protocol number SHR Project 2017/266). The recruitment began in December 2017 and will be completed by December 2020. CONCLUSIONS: This is the first study to assess the effect hearing aid use has on neural, cognitive, and psychosocial factors in individuals with SNHL who have never used hearing aids. Furthermore, this study is expected to clarify the relationships among altered brain structure and function, psychosocial factors, and cognition in response to the hearing aid use. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617001616369; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001616369 (Accessed by WebCite at http://www.webcitation.org/70yatZ9ze). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/9916.

Investigating the Impact of Hearing Aid Use and Auditory Training on Cognition, Depressive Symptoms, and Social Interaction in Adults With Hearing Loss: Protocol for a Crossover Trial.

BACKGROUND: Sensorineural hearing loss is the most common sensory deficit among older adults. Some of the psychosocial consequences of this condition include difficulty in understanding speech, depression, and social isolation. Studies have shown that older adults with hearing loss show some age-related cognitive decline. Hearing aids have been proven as successful interventions to alleviate sensorineural hearing loss. In addition to hearing aid use, the positive effects of auditory training-formal listening activities designed to optimize speech perception-are now being documented among adults with hearing loss who use hearing aids, especially new hearing aid users. Auditory training has also been shown to produce prolonged cognitive performance improvements. However, there is still little evidence to support the benefits of simultaneous hearing aid use and individualized face-to-face auditory training on cognitive performance in adults with hearing loss. OBJECTIVE: This study will investigate whether using hearing aids for the first time will improve the impact of individualized face-to-face auditory training on cognition, depression, and social interaction for adults with sensorineural hearing loss. The rationale for this study is based on the hypothesis that, in adults with sensorineural hearing loss, using hearing aids for the first time in combination with individualized face-to-face auditory training will be more effective for improving cognition, depressive symptoms, and social interaction rather than auditory training on its own. METHODS: This is a crossover trial targeting 40 men and women between 50 and 90 years of age with either mild or moderate symmetric sensorineural hearing loss. Consented, willing participants will be recruited from either an independent living accommodation or via a community database to undergo a 6-month intensive face-to-face auditory training program (active control). Participants will be assigned in random order to receive hearing aid (intervention) for either the first 3 or last 3 months of the 6-month auditory training program. Each participant will be tested at baseline, 3, and 6 months using a neuropsychological battery of computer-based cognitive assessments, together with a depression symptom instrument and a social interaction measure. The primary outcome will be cognitive performance with regard to spatial working memory. Secondary outcome measures include other cognition performance measures, depressive symptoms, social interaction, and hearing satisfaction. RESULTS: Data analysis is currently under way and the first results are expected to be submitted for publication in June 2018. CONCLUSIONS: Results from the study will inform strategies for aural rehabilitation, hearing aid delivery, and future hearing loss intervention trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT03112850; https://clinicaltrials.gov/ct2/show/NCT03112850 (Archived by WebCite at http://www.webcitation.org/6xz12fD0B).