A home education program for older adults with hearing impairment and their significant others: A randomized trial evaluating short- and long-term effects Do increases in patient activation result in improved self-management behaviors? Applying the COM-B behaviour model and behaviour change wheel to develop an intervention to improve hearing-aid use in adult auditory rehabilitation Beyond hearing aid fitting: improving communication for older adults Reduced hearing, ownership, and use of hearing aids in elderly people in the UK–the MRC Trial of the Assessment and Management of Older People in the Community: a cross-sectional survey Framework for design and evaluation of complex interventions to improve health
This paper addresses the development and effectiveness of a home education program . The program , design ed for hearing-impaired elders and their significant others ( SO ) , deals with communication strategies and speech reading . Participants were r and omly assigned to a training group ( hearing aid fitting + home education program ) or a control group ( hearing aid fitting ) . The training group included 24 hearing-impaired subjects and 24 SO 's . Controls were 24 affected individuals and 22 SO 's . Question naires addressing emotional response , communication strategies and the IOI-HA , IOI-AI and IOI-SO were used . A repeated measures analysis of variance was applied to test group differences between pre , post , and 6-months follow-up measures . Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only ( p < 0.05 ) . No group difference on ‘ emotional response ’ was found . IOI-AI and IOI-SO demonstrated favorable attitudes towards the program . Follow-up measures showed improved quality of life and satisfaction in the training group , while a decrease was observed among the controls ( p < 0.05 ) . Some effects differed between first-time and experienced hearing aid users . Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation OBJECTIVE The purpose of this study is to determine whether patient activation  is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes in health behavior . STUDY METHODS To obtain variability in activation and self-management behavior , a controlled trial with chronic disease patients r and omized into either intervention or control conditions was employed . In addition , changes in activation that occurred in the total sample were also examined for the study period . Using Mplus growth models , activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes . DATA SOURCES Survey data from the 479 participants were collected at baseline , 6 weeks , and 6 months . PRINCIPAL FINDINGS Positive change in activation is related to positive change in a variety of self-management behaviors . This is true even when the behavior in question is not being performed at baseline . When the behavior is already being performed at baseline , an increase in activation is related to maintaining a relatively high level of the behavior over time . The impact of the intervention , however , was less clear , as the increase in activation in the intervention group was matched by nearly equal increases in the control group . CONCLUSIONS Results suggest that if activation is increased , a variety of improved behaviors will follow . The question still remains , however , as to what interventions will improve activation Abstract Objectives : To introduce a psychological model of behaviour ; the COM-B model and describe how this has been used in combination with the behaviour change wheel ( BCW ) in developing an intervention which aims to promote regular , long-term use of hearing aids by adults with acquired hearing loss . Design : Qualitative structured interview study using the COM-B model to identify the determinants of behavioural planning on the part of audiologists ; a potentially important factor in encouraging long-term hearing-aid use . Study sample : Ten audiologists drawn from a r and om sample of five English audiology departments . Results : The analysis suggests that behavioural planning might be more likely to occur if audiologists ’ psychological capability , physical and social opportunity , and reflective and automatic motivation were addressed . This analysis forms the basis of an intervention design , using the BCW , to encourage behavioural planning by audiologists and subsequent hearing-aid use by people with hearing loss . Conclusions : The COM-B model and BCW can be applied successfully in the context of audiology to analyse the behaviour of both people with hearing loss and professionals working with them , supplying information that is being used in intervention design . The effectiveness of the intervention will be tested in a clinical trial Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids , and many do not choose to wear hearing aids . Two group communication education programs aim ed at such older people are described . The ‘ Keep on Talking ’ program has a health promotion focus , and is aim ed at maintaining communication for older adults living in the community . An experimental group ( n=120 ) attended the program , and a control group ( n = 130 ) received a  communication assessment but no intervention . Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills . At the follow-up evaluation at 1 year , 45 % of the experimental group , compared to 10 % of the control group , had acted to improve their communication skills . The ‘ Active Communication Education ’ program focuses on the development of problem-solving strategies to improve communication in everyday life situations . Preliminary outcomes have been assessed on a small scale ( n=14 ) to date . It is concluded that communication programs represent an important adjunct to , or supplement for , the traditional approach that focuses on hearing aid fitting BACKGROUND Reduced hearing in elderly people is important because it is disabling and potentially treatable . We aim ed to assess the prevalence of reduced hearing in elderly people and levels of ownership of hearing aids and use . METHODS We have done a cross-sectional survey of people aged at least 75 years in 106 family practice s in the UK . We obtained self-reported data on hearing difficulties for 32,656 people and gave 14,877 a whispered voice test ( response rate 78 % ) . FINDINGS 2537 ( 8 % ) of 32,656 participants reported a lot of difficulty hearing and 13,630 ( 42 % ) a little or a lot of difficulty . 3795 ( 26 % ) of 14877 participants who completed the whispered voice test ( 95 % CI 23 - 29 ) failed the test , the proportion rising sharply with age . Following wax removal , 343 passed a retest , leaving 3452 ( 23 % , 20 - 26 ) who failed the test , even after wax removal if present . 998 ( 46 % ) of 2180 people wearing a hearing aid at the time of testing failed the whispered voice test . More than half the people who failed the test did not own a hearing aid . 2200 ( 60 % ) of 3846 people who owned a hearing aid said they used it regularly . Level of use was strongly related to perceived benefit . INTERPRETATION Reduced hearing is common and provision of hearing aids inadequate in elderly people . Many people who own a hearing aid do not use it regularly , and even when wearing their aid many still have socially disabling levels of hearing loss . A major source of morbidity in elderly people could be alleviated by improvements in detection and management of reduced hearing R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community
Background The consequences of poorly managed hearing loss can be ameliorated with hearing aid use but rates of use are sub-optimal .
The impact of audiologist behaviour on subsequent use , particularly over the long term , is unknown .
Purpose This study aim ed to describe the role of the behaviour change wheel in developing an intervention to introduce and embed particular clinical behaviours into adult hearing aid fitting consultations , within the framework of the Medical Research Council guidance on complex interventions .