A Simplified Patient-Centered Educational Tool for Improved Hearing-Aid Outcomes

Objectives: Reasons for non-use of hearing aids are varied, but many studies have suggested
that a lack of knowledge about how to use and/or take care of the hearing aids is a major
factor. This is not surprising given that other healthcare fields have reported that between
40-80% of information provided during a clinical appointment is forgotten by the patient
immediately after the appointment and almost half of what is remembered is not correct. The
long-term goal of this project is to improve the delivery of information during the
hearing-aid orientation, as better delivery of information will result in better hearing-aid
handling skills and thus better overall hearing-aid outcomes. To accomplish this goal, the
investigators propose to refine and evaluate the effectiveness of three forms of supplemental
hearing-aid-orientation tools, each of which was developed using established guidelines for
good patient-provider communication.

Plan: The purpose of the proposed application is to evaluate the relative effectiveness of
four forms of hearing-aid orientation provided to first time hearing-aid users, three of
which use some of the aforementioned strategies to enhance the standard of care. The four
forms of orientation will be: (1) the standard-of-care hearing-aid orientation; (2) the
standard of care plus provision a hearing-aid information guide (HAIG) (3) the standard of
care supplemented by an explanation of its content using the talk-back technique to confirm
patient understanding; and (4) the standard of care plus provision of a take-home hearing-aid
orientation DVD (HAO DVD). The content of the HAIG will be field tested and finalized
following input obtained via focus groups with clinical audiologists and first-time hearing
aid users.

Methods: For the field testing up to 16 clinical audiologists and 10 new hearing aid user
Veterans will be recruited to participate in focus groups during which they will view and
then be asked questions about the content of the HAIG. Information learned during these focus
groups will then be incorporated into the HAIG, at which time they will be ready for use in
the study. For the comparative effectiveness study, up to 468 hearing-impaired Veterans who
are about to become first-time hearing-aid users will be enrolled to participate in this
investigation. These individuals will be recruited from the VA Portland Health Care System's
Audiology and Speech Pathology Service (ASPS). Prior to receiving their hearing aids,
subjects will be enrolled in the study at the National Center for Rehabilitative Auditory
Research (NCRAR), and will conduct health literacy, manual dexterity and hepatic sensitivity,
visual acuity, and learning and memory assessments. They will then attend their hearing aid
fitting in the ASPS and will receive standard-of-care hearing-aid orientation. At the end of
that appointment, they will receive one of the four study interventions. Subjects will return
to the NCRAR 4-6 weeks after the hearing-aid-fitting appointment to complete the following
outcome measures: a knowledge and practical test regarding hearing-aid use and care, a
measure of self-efficacy, and a measure of hearing-aid outcomes. They also will be
interviewed so that the investigators can learn their opinions about the intervention. A
subset of the initial 50 participants enrolled into each study arm will attend a second
follow-up appointment 6 months after the fitting appointment so the investigators can examine
longer-term impacts of the hearing aid orientation interventions.

Inclusion Criteria:

Participants will be Veterans who are receiving hearing aids from the Audiology Clinic at
the VA Portland Health Care System and who have had no prior experience using hearing aids.
To be included in the study, participants will:

- Be approved and have plans to get bilateral hearing aid fitting at the VA Portland
Health Care System .

- Be able to read and converse in English.

Exclusion Criteria:

- Be younger than 50 years or older than 89 years of age.

- Have a documented diagnosis of neurological, cognitive, visual, or other mental
disorder, such as Alzheimer's disease, schizophrenia, current alcohol or substance
abuse, as determined by chart review that would interfere with study completion.