Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study.

Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.

A randomised, controlled trial of clinically implementing online hearing support.

OBJECTIVE: The research-oriented objective of this study was to document the effectiveness of online support for hearing aid (HA) users compared with traditional support. DESIGN: This study is a randomised controlled trial with parallel group design. The research-oriented objectives were evaluated using the Hearing Handicap Inventory for the Elderly (HHIE) and the Communication Strategies Scale (CSS) at baseline and immediately postintervention. STUDY SAMPLE: Selected clients at five different clinics were randomised to an intervention group (n = 78) that took part in online hearing support and a control group (n = 58) that received standard care. RESULTS: The analyses (intention-to-treat) showed statistically significant improvements in the HHIE-total and Emotional subscale scores for the intervention group compared with the control group. The intervention group also showed significantly greater improvement in the CSS-total and Verbal and Nonverbal subscale scores. A subgroup analysis was performed including two groups: HA use <1 year and HA use >1 year. A statistically significant improvement was found for the HA users >1 year compared with HA use <1 year. CONCLUSIONS: It is effective to clinically include online hearing support for HA users when addressing self-perceived hearing difficulties and to sharpen communication strategy skills.

Development of the Communication and Acceptance Scale (CAS) for group aural rehabilitation.

OBJECTIVE: The aim of the current study was to develop a reliable instrument for the Active Communication Education (ACE) programme evaluating changes in communication strategies and the emotional consequences, knowledge and acceptance of hearing loss and to examine its reliability and face, content and construct validity. DESIGN: Semistructured interviews and questionnaires were conducted with participants and clinicians engaged in the ACE intervention. STUDY SAMPLE: The psychometric properties were evaluated in two phases for two samples of adults with hearing loss who participated in the ACE programme, including 61 and 41 participants, respectively. RESULTS: The final Communication and Acceptance Scale (CAS) contained 18 items, and the reliability of the overall scale (Cronbach's alpha 0.86) and the test-retest reliability (r = 0.89, p < 0.001) were good. The construct validity, evaluated with principal component analysis, suggested a five-factor solution explaining 72% of the variance. The questionnaire revealed statistically significant short- and long-term effects of the ACE programme. Both participants and clinicians found the questionnaire relevant, useful and easy to administer. CONCLUSION: The CAS questionnaire was found to be valid and reliable, but because of the low sample size, further analysis with a larger population is needed.

Experiences of an Internet-based aural rehabilitation (IAR) program for hearing aid users: a qualitative study.

OBJECTIVE: Internet interventions for hearing aid (HA) users have been shown to be effective in helping persons with hearing problems. As earlier research refers to objective data on these effects, little is known about how participants experience the Internet interventions subjectively. The aim of the present study was to explore participants' experiences of an Internet-based aural rehabilitation (IAR) program for HA-users, and to explore the possible subjective benefits of such a program. DESIGN: A qualitative exploratory design was implemented involving semi-structured telephone interviews. The interviews were transcribed and analysed using content analysis. STUDY SAMPLE: Interviews were conducted with 20 participants (9 men and 11 women) who had completed an IAR program for HA-users. The participants were 57-81 years old and had used HAs for 2-25 years. RESULTS: The results are organised in three main categories: general experiences associated with participating in the program, knowledge obtained from the program and perceived impact of taking part in the program. CONCLUSIONS: The overall results indicate positive experiences of the IAR program, and an overreaching theme of increased self-esteem was identified. The findings provide some valuable information for developers of future IAR programs.

International Outcome Inventory for Hearing Aids: Data From a Large Swedish Quality Register Database.

PURPOSE: The purpose of this study was to analyze a database of completed International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires obtained from over 100,000 clients fitted with new hearing aids in Sweden during the period of 2012-2016. Mean IOI-HA total scores were correlated with degree of hearing loss, unilateral versus bilateral fitting, first-time versus return clients, gender, and variation among dispensing clinics. The correlations with expectations, service quality, and technical functioning of the hearing aids were also analyzed. METHOD: Questionnaires containing the 7 IOI-HA items as well as questions concerning some additional issues were mailed to clients 3-6 months after fitting of new hearing aids. The questionnaires were returned to and analyzed by an independent research institute. RESULTS: More than 100 dispensing clinics nationwide take part in this project. A response rate of 52.6% resulted in 106,631 data sets after excluding incomplete questionnaires. Forty-six percent of the responders were women, and 54% were men. The largest difference in mean score (0.66) was found for the IOI-HA item "use" between return clients and first-time users. Women reported significantly higher (better) scores for the item "impact on others" compared with men. The bilaterally fitted subgroup reported significantly higher scores for all 7 items compared with the unilaterally fitted subgroup. Experienced users produced higher scores on benefit and satisfaction items, whereas first-time users gave higher scores for residual problems. No correlation was found between mean IOI-HA total score and average hearing threshold level (pure-tone average [PTA]). Mean IOI-HA total scores were found to correlate significantly with perceived service quality of the dispensing center and with the technical functionality of the hearing aids. CONCLUSIONS: When comparing mean IOI-HA total scores from different studies or between groups, differences with regard to hearing aid experience, gender, and unilateral versus bilateral fitting have to be considered. No correlation was found between mean IOI-HA total score and degree of hearing loss in terms of PTA. Thus, PTA is not a reliable predictor of benefit and satisfaction of hearing aid provision as represented by the IOI-HA items. Identification of a specific lower fence in PTA for hearing aid candidacy is therefore to be avoided. Large differences were found in mean IOI-HA total scores related to different dispensing centers.

A multicentre study evaluating the effects of the Swedish ACE programme.

OBJECTIVE: This study investigated the effects of a modified Swedish version of an interactive group education programme, the Active Communication Education (ACE) programme, in five Swedish regions. This study also explored whether the pre- and post-programme outcomes differed with regard to region, age, gender, hearing loss (HL) or the attendance of significant others (SOs). DESIGN: An intervention study with between- and within-group measurements was applied. STUDY SAMPLE: Seventy-seven individuals with hearing impairments and a mean age of 73.9 years (SD = 9.8) from five different regions in Sweden participated in this study. RESULTS: Statistically significant short- and long-term effects on communication strategy use, activity and participation were observed. The ACE programme was most effective for older individuals, women and participants with more severe HL. Individuals who attended with an SO tended to use better communication strategies. No regional differences were observed. The qualitative results indicated that the programme increased individuals' ability to cope and restored their social identities. CONCLUSIONS: The ACE programme is effective, is recommended for implementation in clinical settings and is considered an alternative or additional treatment to hearing aid rehabilitation. Additional studies that include younger individuals and a control group are recommended.

The initial evaluation of an Internet-based support system for audiologists and first-time hearing aid clients.

OBJECTIVES: Audiologists provide professional contact and support between appointments to clients with hearing impairment using telephone and e-mail, but more advanced and flexible technological platforms are also possible. The present study aimed to evaluate the clinical application of an Internet-based support system for audiologists and their first-time hearing aid clients. DESIGN: An Internet-based support system developed by Månsson et al. (2013) for psychologists and their clients was adapted for audiologic purposes. Three audiologic clinics in Sweden tested the support system with their clients. STUDY SAMPLE: Twenty-three clients managed by four audiologists used and evaluated the support system. In addition, five of the clients and all four audiologists were interviewed and their responses were analyzed using content analysis. RESULTS: The clients and the audiologists reported positive experiences and overall satisfaction but audiologists reported that the support system did not address the needs of all clients. More positive experiences and greater satisfaction with the support system were associated with reductions on self-reported consequences of hearing loss and positive hearing aids outcomes. CONCLUSIONS: An Internet-based support system can be used in audiologic rehabilitation. Both audiologists and clients recognized the system's potential value to offer an online support to the provision of audiologic services.

Internet Interventions for Hearing Loss.

PURPOSE: The purpose of the two studies presented in this research forum article was to develop audiological rehabilitation programs for experienced hearing aid users and evaluate them in online versions. In this research forum article, the differences between the two studies are discussed. METHOD: Two randomized controlled trials (RCTs) were performed evaluating the efficacy of online rehabilitation, including professional guidance by an audiologist. In each RCT, the effects of the online programs were compared with the effects measured in a control group. RESULTS: The results from the first RCT showed a significant increase in activity and participation for both groups with participants in the intervention group improving more than those in the control group. At the 6-month follow-up, after the study, the significant increase was maintained; however, amounts of increase in the two groups were no longer significantly different. The results from the second RCT showed significant increase in activity and participation for the intervention group, although the control group did not improve. CONCLUSIONS: The results from the RCTs provide evidence that the Internet can be used to deliver rehabilitation to hearing-aid users and that their problems are reduced by the intervention; however, the content of the online rehabilitation program requires further investigation.

The Process of Developing an Internet-Based Support System for Audiologists and First-Time Hearing Aid Clients.

BACKGROUND: In audiologic practice, complementary information sources and access to the clinician between appointments improve information retention and facilitate adjustment behaviors. An Internet-based support system is a novel way to support information sharing and clinician access. PURPOSE: This research forum article describes the process of developing an Internet-based support system for audiologists and their first-time hearing aid clients. METHOD: The iterative development process, including revisions by 4 research audiologists and 4 clinical audiologists, is described. The final system is exemplified. CONCLUSION: An Internet-based support system was successfully developed for audiologic practice.

Hearing Care for Older Adults: Beyond the Audiology Clinic.

Purpose: The purpose of this article was to highlight the importance of hearing health care beyond the clinic for older people with impaired hearing. Method: To emphasize factors affecting the success of audiologic rehabilitation for older people and to describe practical clinical and community-based strategies to promote successful hearing health care. Result: Older people are not always aware of the extent of their hearing loss, they may not always expect to benefit from using a hearing aid, and they often have low self-efficacy for managing to learn to use hearing aids. Increased knowledge and support from other health professionals, family caregivers and significant others could optimize older peoples' participation in everyday activities. Conclusion: Further work is needed to develop new interventions for older people with impaired hearing and to increase collaboration with general practitioners as well as other health-care professionals.

Exploring the Effects of the Narrative Embodied in the Hearing Aid Fitting Process on Treatment Outcomes.

OBJECTIVES: There is strong evidence from other fields of health, and growing evidence in audiology, that characteristics of the process of intervention as perceived by the client (embodied narratives) can have significant effects on treatment outcomes, independent of the technical properties of the intervention itself. This phenomenon deserves examination because studies of technical interventions that fail to take account of it may reach erroneous conclusions and because clinical practice can put such effects to therapeutic use. The aim of this study was to test the idea that embodied narratives might affect outcomes in hearing aid fitting. This was achieved by carrying out experiments in which technical (acoustic) differences between alternative hearing aid fittings were absent, while providing test subjects with a strong contrast between the processes apparently applied to derive the fittings being compared. Thus, any effects of contrasting narratives could be observed, free of acoustical confounds. The hypothesis was that narrative effects would be observed. DESIGN: A balanced crossover design was used, in which subjects received and evaluated two bilateral hearing aid fittings in succession. Subjects were deceived as to the true identical content of the hearing aid fittings being compared, but encouraged to believe that one fitting process was "interactive" and the other was "diagnostic" in character. Two almost identical experiments were undertaken: one with 24 experienced adult hearing aid users and another with 16 adult first-time users. Each hearing aid fitting was worn at home for 2 weeks, after which self-report outcome measures (Hearing Aid Performance Questionnaire, Hearing Handicap Inventory for the Elderly, and International Outcome Inventory for Hearing Aids) were administered. After the second test period, a short preference questionnaire was also completed. RESULTS: Twenty of the 24 experienced users showed a clear preference for one or the other fitting, and their self-report scores reflected these preferences. Effect sizes were comparable with those typically observed for true acoustical contrasts. No order effect was seen in this group. In contrast, 13 of the 16 first-time users preferred the second fitting. Trends in the self-report measures were similar for this group but weaker than for the experienced users. In both groups, the reasons given for subjects' preference were predominantly related to sound, despite there being no acoustical differences. CONCLUSIONS: This study suggests that the narrative embodied in a given fitting process can have a substantial effect on the perceived benefit of the treatment, independent of any acoustical differences, at least for experienced users. For first-time users, acclimatization seems to overshadow the purely narrative effect of any fitting process. In the future, research study designs should include steps to avoid narrative effects when technical parameters of hearing aids are the intended object of study. In clinical practice, the narrative is part of the therapeutic context, and one may design it for maximum beneficial effect.

Short- and long-term effects of the modified swedish version of the Active Communication Education (ACE) program for adults with hearing loss.

BACKGROUND: In Sweden, there is a lack of evidence-based rehabilitation programs for hearing loss. The Active Communication Education program (ACE) has successfully been used in Australia and was translated and evaluated in a Swedish pilot study. The pilot study included 23 participants (age 87 yr). No statistically significant effects were found, but the qualitative assessments indicated that this population found the program to be beneficial. The participants requested more focus on the psychosocial consequences of hearing loss, and the modules in the original ACE program were modified. PURPOSE: The aim of this study was to explore the effects of a modified Swedish version of the ACE program in a population aged 39-82 yr old. RESEARCH DESIGN: Design was a between-group and within-group intervention study. STUDY SAMPLE: The participants were recruited from the hearing health clinic in Linköping during 2010 and 2012. A total of 73 participants agreed to undergo the ACE, and 67 (92%) completed three or more sessions. INTERVENTION: The ACE program consists of five weekly 2 hr group sessions with 6 to 10 participants per group. DATA COLLECTION AND ANALYSIS: The outcomes were measured before initiation of the program, 3 wk after program completion, and 6 mo after program completion and included communication strategy use, activity and participation, health-related quality of life, and anxiety and depression. In addition, outcomes were measured after program completion using the International Outcome Inventory-Alternative Interventions, a modified version of the Client Oriented Scale of Improvement, and qualitative feedback was obtained about the response to the program and actions taken as a result of participation. The treatment effects were examined using repeated-measures analyses of variance. RESULTS: Statistically significant effects were found for communication strategy use, activity and participation, and psychosocial well-being. Statistically significant effects were found for gender and degree of hearing loss, indicating that women and those with mild hearing loss significantly improved communication strategies. CONCLUSIONS: It is suggested that the program be implemented as part of regular audiological rehabilitation and offered in an early stage of rehabilitation.

A preliminary evaluation of the active communication education program in a sample of 87-year-old hearing impaired individuals.

BACKGROUND: Previous research suggests that audiological rehabilitation for older adults could include group communication programs in addition to hearing aid fitting or as an alternative to hearing aid fitting for those people who do not wish to proceed with hearing aids. This pilot study was a first attempt to evaluate a Swedish version of such a program, Active Communication Education (ACE), which had been developed and previously evaluated in Australia (Hickson et al, 2007a). PURPOSE: The aim of the study was to explore the use of the ACE program in an older-old population of people aged 87 yr in Sweden. RESEARCH DESIGN: A within-subject intervention study. STUDY SAMPLE: The participants were recruited from the Elderly in Linköping Screening Assessment (ELSA), a population-based study of the functional abilities of all inhabitants of the city of Linkoping aged 85 yr in 2007. Participants who responded to the hearing related items in the ELSA study were approached for this study; 29 people agreed to undertake ACE, and 23 (79%) completed three or more sessions. INTERVENTION: The ACE program consists of five weekly 2 hr group sessions with six to ten participants per group. DATA COLLECTION AND ANALYSIS: Self-report measures of communication strategy use, activity and participation, health-related quality of life, and depression were obtained preprogram, 3 wk postprogram, and 6 mo postprogram. Within-group changes and effect sizes were calculated. In addition, outcomes were measured postprogram using the International Outcome Inventory-Alternative Interventions (IOI-AI; Noble, 2002) and a modified version of the Client Oriented Scale of Improvement (COSI; Dillon et al, 1997; Hickson et al, 2007b), and qualitative feedback was obtained. RESULTS: The effect size of ACE was small (0.03-0.27), and, in the sample of 23 included in this pilot study, differences in pre- and postprogram assessments were not statistically significant. Results from the IOI-AI and the modified COSI indicated that these elderly participants found the program to be beneficial, and 90% stated that the course had increased their ability to deal with hearing loss and the problems it creates. CONCLUSIONS: This preliminary investigation indicates the potential benefits of ACE for older adults, and further research is needed with larger numbers of participants in different age groups to draw conclusions about the effectiveness of the ACE program for a general Swedish population.

A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users.

OBJECTIVE: Previous research shows that the internet can be used in the rehabilitation of hearing-aid users. By further developing the online program, it might be possible to foster behavioral changes that will positively affect hearing-aid users. DESIGN: A randomized controlled study with two groups of participants. The intervention group underwent a five-week online intervention while the control group was referred to a waiting list. Questionnaires were used as outcome measures. STUDY SAMPLE: Seventy-six experienced hearing-aid users participated in the study, ranging in age from 26 to 81 years (mean 69.3 years). RESULTS: The findings showed significant improvements in the intervention group after the intervention, measured by the hearing handicap inventory for the elderly. The effects were maintained and improved at the follow-up. Furthermore, the results indicated that the participants in the intervention group improved at two items of the international outcome inventory for hearing aids, and the effects were partly maintained at the follow-up. Finally, significant improvements in the domain of psychosocial wellbeing were found at the follow-up. CONCLUSIONS: This study provides further evidence that the internet can be used to deliver intervention of rehabilitation to hearing-aid users.

Internet-based hearing screening using speech-in-noise: validation and comparisons of self-reported hearing problems, quality of life and phonological representation.

OBJECTIVES: For the last decade a host of different projects have been launched to allow persons who are concerned about their hearing status to quickly and at a low cost test their hearing ability. Most often, this is carried out without collecting complementary information that could be correlated with hearing impairment. In this two-part study we first, present the development and validation of a novel Internet-based hearing test, and second, report on the associations between this test and phonological representation, quality of life and self-reported hearing difficulties. DESIGN: Cross-sectional study. SETTING: An opportunity sample of participants was recruited at the Stockholm central station for the first study. All parts of the second study were conducted via the Internet, with testing and self-report forms adapted for online use. PARTICIPANTS: The first part of the study was carried out in direct contact with the participants, and participants from the second study were recruited by means of advertisements in newspapers and on webpages. The only exclusion criterion was that participants had to be over 18 years old. Most participants were between 60 and 69 years old. There were almost an equal number of men and women (total n=316). OUTCOME MEASURES: 48 participants failed the Internet-based hearing screening test. The group failing the test reported more problems on the Amsterdam Inventory of Auditory Disability. In addition, they were found to have diminished phonological representational skills. However, no difference in quality of life was found. CONCLUSIONS: Almost one in five participants was in need of contacting their local hearing clinic. This group had more complaints regarding tinnitus and hyperacusis, rated their own hearing as worse than those who passed, and had a poorer capability of generating accurate phonological representations. This study suggests that it is feasible to screen for hearing status online, and obtain valid data.

Internet access and use in adults with hearing loss.

BACKGROUND: The future rehabilitation of adults with hearing loss is likely to involve online tools used by individuals at home. Online tools could also be useful for people who are not seeking professional help for their hearing problems. Hearing impairment is a disability that increases with age, and increased age is still associated with reduced use of the Internet. Therefore, to continue the research on online audiological rehabilitative tools for people with hearing loss, it is important to determine if and to what extent adults with hearing loss use the Internet. OBJECTIVE: To evaluate the use of the Internet and email in a group of adults with hearing loss and to investigate if their use of Internet and email differed between genders, among different age groups, and how it compared with the general population in Sweden. METHODS: Questionnaires containing multiple-choice questions about Internet access, email use, and educational level were mailed to individuals with hearing loss, who were registered as patients at a hearing aid clinic. Out of the 269 invited participants, 158 returned a completed questionnaire, which was a response rate of 58.7%. RESULTS: The results showed that 60% (94/158) of the participants with hearing loss used computers and the Internet. The degree of hearing loss in the group of participants did not explain the level of Internet usage, while factors of age, gender, and education did (P<.001). More men than women used the Internet (OR 2.54, 95% CI 1.32-4.91, P<.001). Use of the Internet was higher in the youngest age group (25-64 years) compared to the oldest age group (75-96 years, P=.001). A higher usage of the Internet was observed in the participants with hearing loss, especially the elderly, when compared with the general population of Sweden (OR 1.74, 95% CI 1.23-3.17, P=.04). CONCLUSIONS: We conclude that the use of computers and the Internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden, but that this use is even higher in specific age groups. These results are important for the future work in developing and evaluating rehabilitative educational online tools for adults with hearing loss.

Hearing help-seeking and rehabilitation: perspectives of adults with hearing impairment.

OBJECTIVE: This study investigated the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. DESIGN: Individual semi-structured interviews were completed. STUDY SAMPLE: In total, 34 adults with hearing impairment in four countries (Australia, Denmark, UK, and USA) participated. Participants had a range of experience with hearing help-seeking and rehabilitation, from never having sought help to being satisfied hearing-aid users. RESULTS: Qualitative content analysis identified four main categories ('perceiving my hearing impairment', 'seeking hearing help', 'using my hearing aids', and 'perspectives and knowledge') and, at the next level, 25 categories. This article reports on the densest categories: they are described, exemplified with interview quotes, and discussed. CONCLUSIONS: People largely described hearing help-seeking and rehabilitation in the context of their daily lives. Adults with hearing impairment rarely described clinical encounters towards hearing help-seeking and rehabilitation as a connected process. They portrayed interactions with clinicians as isolated events rather than chronologically-ordered steps relating to a common goal. Clinical implications of the findings are discussed.

Factors influencing help seeking, hearing aid uptake, hearing aid use and satisfaction with hearing aids: a review of the literature.

OBJECTIVES: This descriptive summary of the literature provides an overview of the available studies (published between January 1980 and January 2009) on correlates of help-seeking behavior for hearing loss, hearing-aid uptake, hearing-aid use, and satisfaction with the device. METHODS: Publications were identified by structured searches in Pubmed and Cinahl and by inspecting the reference lists of relevant articles. The articles covered different stages that a person with hearing impairment may go through: prior to hearing aid fitting, the period covering the fitting and the period post hearing aid fitting. Inclusion of articles occurred according to strict inclusion and exclusion criteria. Data were extracted by two independent researchers. Thirty-nine papers were included that identified 31 factors examined in relation to the four outcome measures. These covered personal factors (e.g., source of motivation, expectation, attitude), demographic factors (e.g., age, gender) and external factors (e.g., cost, counseling). Only two studies covered the actual fitting process. There was only one factor positively affecting all four outcome variables. This was self-reported hearing disability. The vast majority of studies showed no relationship of age and gender with any of the outcome domains. DISCUSSION AND CONCLUSION: Whereas research of the last 28 years yielded valuable information regarding relevant and irrelevant factors in hearing aid health care, there are still many relevant issues that have never been investigated in controlled studies. These are discussed.

Development and initial validation of the 'Clinical Global Impression' to measure outcomes for audiological rehabilitation.

PURPOSE: The aim of this study was to develop and validate an interview instrument for assessing outcome following hearing aid fitting based on clinical global impressions. METHOD: The Audiological Rehabilitation Clinical Global Impression (AR-CGI) was developed and used in a telephone interview in two separate samples. The first sample (N=69) consisted of hearing aid owners who had participated in two intervention studies, and the second sample consisted of hearing aid owners receiving regular services from a hearing clinic (N=21). Following the semi-structured telephone interview, participants were categorised into three categories: successful, successful with some limitations or unsuccessful. RESULTS: A vast majority were categorised as successful (80% of the intervention sample and 71% of the clinical sample). Those categorised as successful were found to differ from those categorised as less successful in terms of age and self-reported hearing aid use, depressed mood and residual participation restriction, but they did not differ in terms of degree of hearing loss. CONCLUSIONS: It is suggested that the brevity and usefulness of the AR-CGI makes it a potential tool for further use in audiological settings.