Keywords
hearing aid satisfaction - EMA - retrospective report
Overall hearing aid (HA) satisfaction depends upon the individually weighted improvements
one perceives with HA treatment. An individual's interpretation of HA satisfaction
could considerably vary, and people may use different criteria when judging whether
they are satisfied with the HA.[1] For example, one might think about comfort of fit, streaming possibilities/connectivity,
speech understanding, or different aspects of sound quality. Moreover, certain situations
may be given more weight than others based on frequency of occurrence, importance,
severity of hearing difficulty, recency, or relationship to the present,[2] which can bias the overall HA satisfaction rating.
We developed the hearing-related lifestyle questionnaire (HEARLI-Q)[3] that asks participants to rate 23 everyday listening situations on frequency of
occurrence, importance to hear well, difficulty to hear, and HA satisfaction. The
HEARLI-Q situations are grouped in seven listening task categories: speech communication
(two people, more than two people, and through device), focused listening (live sounds,
through media device), and nonspecific (monitoring surroundings and passive listening),
as defined by the Common Sound Scenarios (CoSS) framework.[4] In a study where the HEARLI-Q was administered four times (days 1, 2, 15, and 29),
we found that experienced HA users' responses were reliable across short (day 1 vs.
day 2) and longer (day 1 vs. day 15 or 29) time spans.[3] Nonetheless, HEARLI-Q is a retrospective questionnaire and, as such, is at risk
of being subject to memory bias.[5]
[6] Ecological Momentary Assessment (EMA), on the other hand, relies on participants
repeatedly reporting in their momentary listening environment, reducing memory bias.[7] Because of this, EMA has gotten recent traction in audiology community to evaluate
HAs in real life.[8] However, to achieve a balance between getting high-quality data and minimizing participant
burden, EMA in hearing research is normally not administered for longer periods than
four weeks, although on most occasions, the period is shorter and more likely to fall
within one to two weeks. This means that situations that occur less frequently than
the EMA period may not be represented. Moreover, since EMA requires participants to
answer in the moment, some situations may be unsafe (e.g., when driving) or inappropriate
(e.g., in the middle of an important meeting) to report in. Consequently, certain
situations are underrepresented in EMA.[9]
[10] Participants may also be less likely to interact with the EMA application in a moment
that is already challenging[11] and these situations are often the most interesting when evaluating HAs.
One way to include assessments of those challenging situations in EMA is to ask participants
to rate HA performance based on a short retrospective period.[12]
[13]
[14]
[15] For example, Wu et al.[15] asked their participants to answer EMA-prompted Glasgow Hearing Aid Benefit Profile
(GHABP) questionnaire every 1.5 hours based on the last 1.5 hours for one week. The
authors compared these EMA ratings to the ones obtained by the standard retrospective
GHABP to assess outcomes of two different HAs. While both EMA-based (in situ) GHABP
and retrospective GHABP showed a significant difference between the two HAs on the
satisfaction subscale, only the EMA-based GHABP was significantly different on benefit
and residual disability subscales.
Recently, we conducted a study where we utilized both HEARLI-Q and EMA based on the
same questions and response alternatives to investigate the effect of a “positive
focus” intervention on HA satisfaction and benefit.[16] Similar to Wu et al.,[15] we observed comparable effects on HA satisfaction between retrospective and in situ
questionnaires, where participants who were asked to focus on positive listening experiences
for two weeks after HA fitting had higher ratings relative to the control group. Although
it was not the aim of the study to compare HA satisfaction ratings between questionnaires,
EMA ratings tended to be higher than HEARLI-Q ratings. In other words, although both
questionnaires were sensitive to detect a difference due to the intervention, when
evaluating HA performance, the satisfaction rating itself may be over/underestimated
depending on the type of questionnaire utilized.
In the current study, we set out to investigate how HA satisfaction ratings on the
HEARLI-Q scale compare with HA satisfaction measured on the same scale implemented
in an EMA trial. The goal was to compare both, the overall HA satisfaction as well
as CoSS listening task-specific HA satisfaction. In case any significant discrepancies
were observed, we investigated what drove these inconsistencies in ratings. The overarching
aim was to learn how the two types of assessments can complement each other to give
a holistic view of HA experience.
Methods
Ethical clearance for conducting the study was obtained from the Research Ethics Committee
of the Capital Region of Denmark (case no. H-18056647). The data in the current work
were collected during August to November 2021.
Participants
Twenty-one HA users with mild-moderate hearing losses were enrolled in the study (6
females, 15 males with an average age of 66 years; standard deviation [SD]: 7 years).
All the participants were experienced HA users (>1 year), smartphone users, and fluent
in Danish. Twenty participants reported to use their HAs all day, whereas one reported
to use it sporadically. Ten participants were retired at the time of the study. Exclusion
criterion was severe cognitive impairment that would preclude the ability to perform
the necessary tasks, as judged by the audiologist who did the recruiting. The participants
were recruited through an internal database of participants via phone or e-mail. They
were informed about the study orally and in writing. Before the trial commenced, the
participants gave their informed consent in writing.
Study Design
The participants were asked to download and install the MyHearingExperience app (Lenox
UG, Herrsching, Germany), which is available for iOS and Android, on their own smartphones.
Each participant was provided with a unique study log-in code for the app and instructed
to fill out the HEARLI-Q available in the app, on the day of the initial log-in. Starting
the day after, the participants were prompted to answer an EMA questionnaire every
two hours between 9:00 a.m. and 9:00 p.m. over seven days. That is, the total number
of prompts was 49. The EMA questionnaire remained available from the initial prompt
until the participant completed it or the next questionnaire was prompted (2 hours
later or next morning for the 9:00 p.m. questionnaire). The EMA questionnaire asked
the participants to indicate their location, listening task (same categories as in
the HEARLI-Q), and noisiness of the situation. Further, the participants were asked
to rate the frequency of occurrence, importance to hear well, hearing difficulty,
and HA satisfaction in the situation on the same scale as HEARLI-Q. The specific EMA
questions and response alternatives are outlined in [Supplementary Table S1] (available in online version only). The full HEARLI-Q questionnaire can be found
in the [Supplementary Materials] of Lelic et al.[3]
The participants wore their own HAs throughout the trial period and all the ratings
were based on their experiences with own devices.
Data Analysis
Based on 1,000 simulations of HEARLI-Q HA satisfaction data with mean = 3.4 and SD = 0.6,
21 participants would enable difference detection of 0.5 scale points with power of
approximately 80% using mixed-effects linear regression. The mean and SD were taken
from existing internal HEARLI-Q data.
Mixed-effects linear regression with random intercept for participant was conducted
to analyze predictors of HA satisfaction ratings within each of the two methods. The
dependent variable was HA satisfaction, and the covariates were frequency of occurrence,
importance to hear well, and difficulty to hear.
For comparison between methods, the overall HEARLI-Q HA satisfaction rating was calculated
by averaging the satisfaction ratings of individual situations, as described in Lelic
et al.[3] HEARLI-Q HA satisfaction ratings were further averaged for each of the seven CoSS
task categories. To ensure that the results of EMA and HEARLI-Q could be directly
compared and analyzed in the same statistical model, EMA overall and CoSS task-specific
HA satisfaction ratings were also calculated by averaging the ratings within each
individual.
Repeated measures analysis of variance (ANOVA) was conducted to compare the overall
and CoSS task-specific HA satisfaction ratings between HEARLI-Q and EMA. For those
CoSS task categories where there were significant differences between HEARLI-Q and
EMA, further analyses were done to understand what these differences can be attributed
to. Specific details of these analyses are reported in results/[Supplementary Material] (available in online version only). Correlation between the HEARLI-Q and EMA HA
satisfaction ratings was analyzed using Pearson's correlation.
The dependent variables subjected to ANOVA were visually inspected to ensure that
they fit an approximate normal distribution. If not, the ladder of powers was applied
to transform the data. The residuals for all the mixed-effects linear regression analyses
were visually inspected for normality.
All the statistical analyses were done in Stata (v. 15, StataCorp, College Station,
TX).
Results
Ecological Momentary Assessment Compliance and Location/Listening Task Distribution
Across Reports
The total number of collected reports was 845. EMA compliance was on average 82% (SD:
15%; submitted reports/prompted reports). Participants responded on average within
21 minutes of the prompt ([Supplementary Fig. S1], available in online version only). Most of the reports were filled in home environment
without conversation/focused listening activity, followed by one-on-one conversation
and focused listening (media; [Supplementary Fig. S2], available in online version only).
Hearing Aid Satisfaction, Hearing Aid Use, and Predictors of Hearing Aid Satisfaction
The entire range of the HA satisfaction scale was used in both EMA and HEARLI-Q, although
most responses were in the moderate-very satisfied range (87% responses in EMA and
72% of responses in HEARLI-Q). In HEARLI-Q, two participants indicated they do not
wear their HAs when “Passive listening—Hearing sounds of nature.” In the EMA questionnaire,
82 reports attributed to 16 participants were submitted while they were not wearing
their HAs—63 of those reports were in “situation without a conversation or focused
listening,” eight reports were in “conversation with one person,” two reports were
in “conversation with several people,” one report was in “conversation over phone
or another technical device,” and two reports were in “focused listening (media)”
situation.
Hearing difficulty was an independent predictor of HA satisfaction in both questionnaires,
where satisfaction decreased with increased hearing difficulty ([Table 1]).
Table 1
Mixed-effects linear regression results for hearing-related lifestyle questionnaire
and Ecological Momentary Assessment
|
HEARLI-Q
|
EMA
|
|
Dependent variable
|
Independent variable
|
Coefficient (95% CI)
|
p
|
Coefficient (95% CI)
|
p
|
|
HA satisfaction
|
Occurrence (reference: ∼2 times a year)
|
|
|
|
|
|
Monthly
|
0.09 (−0.08, 0.27)
|
0.29
|
−0.04 (−0.41, 0.33)
|
0.83
|
|
Weekly
|
0.12 (−0.07, 0.31)
|
0.22
|
0.03 (−0.29, 0.35)
|
0.86
|
|
Daily
|
0.11 (−0.08, 0.31)
|
0.25
|
0.11 (−0.22, 0.43)
|
0.52
|
|
Importance (reference: not important)
|
|
|
|
|
|
A little important
|
−0.14 (−0.73, 0.45)
|
0.64
|
−0.01 (−0.20, 0.19)
|
0.95
|
|
Moderately important
|
−0.02 (−0.59, 0.55)
|
0.95
|
−0.05 (−0.31, 0.21)
|
0.70
|
|
Very important
|
0.07 (−0.52, 0.66)
|
0.81
|
0.07 (−0.20, 0.34)
|
0.62
|
|
Extremely important
|
0.37 (−0.06, 0.68)
|
0.19
|
0.18 (−0.13, 0.50)
|
0.25
|
|
Hearing difficulty (reference: not difficult)
|
|
|
|
|
|
A little difficult
|
−0.87 (−1.12, −0.63)
|
<0.001
|
−0.56 (−0.69, −0.42)
|
<0.001
|
|
Moderately difficult
|
−1.16 (−1.47, −0.84)
|
<0.001
|
−0.93 (−1.16, −0.71)
|
<0.001
|
|
Very difficult
|
−1.94 (−2.49, −1.40)
|
<0.001
|
−1.47 (−1.79, −1.15)
|
<0.001
|
|
Extremely difficult
|
−2.09 (−2.71, −1.48)
|
<0.001
|
−2.66 (−2.97, −2.36)
|
<0.001
|
Abbreviations: CI, confidence interval; EMA, Ecological Momentary Assessment; HA,
hearing aid; HEARLI-Q, hearing-related lifestyle questionnaire.
Note: Significant p-values are shown in bold.
Comparison of Hearing Aid Satisfaction Ratings
The overall HA satisfaction was rated 3.4 ± 0.6 in HEARLI-Q and 3.5 ± 0.4 in EMA (F
1,20 = 2.06, p = 0.17). The overall HA satisfaction ratings were positively correlated between the
two questionnaires (r = 0.58, p < 0.01). Comparison of HA satisfaction ratings for individual CoSS task categories
is presented in [Fig. 1]. Not all the participants contributed with ratings for “Speech Communication—Through
Device” and “Focused Listening—Live Sounds” in either of the questionnaires, although
the number of contributing participants was lower in EMA than HEARLI-Q for both CoSS
task categories. Eighteen participants contributed with HA satisfaction ratings for
“Focused Listening—Through Media” in EMA. HA satisfaction was significantly higher
in EMA for “Speech Communication—One Person” (F
1,20 = 7.88, p = 0.01) and “Speech Communication—Several People” (F
1,20 = 5.38, p = 0.03). There was not a significant difference between the two questionnaires for
“Speech Communication—Through Device” (F
1,9 = 0.04, p = 0.84), “Focused Listening—Live Sounds” (F
1,9 = 0.31, p = 0.59), “Focused Listening—Through Media” (F
1,17 = 3.85, p = 0.07), or “No Conversation/No Focused Listening” (F
1,20 = 3.93, p = 0.06).
Fig. 1 Mean and 95% confidence intervals for hearing aid satisfaction ratings in HEARLI-Q
and EMA by CoSS task category. The number of contributing participants is indicated
below each error bar. Significant differences are denoted by asterisk (*). CoSS, Common
Sound Scenarios; EMA, Ecological Momentary Assessment; HEARLI-Q, hearing-related lifestyle
questionnaire.
Reasons for Higher Hearing Aid Satisfaction Ratings in Ecological Momentary Assessment
How do Occurrence and Hearing Difficulty Compare between Hearing-Related Lifestyle
Questionnaire and Ecological Momentary Assessment?
[Fig. 2] shows occurrence, hearing difficulty, and HA satisfaction ratings for the two CoSS
task categories where HA satisfaction was rated higher in EMA than HEARLI-Q. For both
categories, speech communication in quiet in HEARLI-Q was rated similarly to EMA on
occurrence, hearing difficulty, and HA satisfaction. On the other hand, when comparing
the EMA ratings to HEARLI-Q ratings for situations where there was some background
noise, occurrence was lower, hearing difficulty was higher and HA satisfaction was
lower in HEARLI-Q (all ps < 0.001; [Supplementary Table S2] for detailed statistics; available in online version only). The situations in the
“noise” category for HEARLI-Q were combined based on visual inspection of the data
showing similar contrasts to EMA for the individual situations.
Fig. 2 Mean and 95% confidence intervals of occurrence, hearing difficulty, and HA satisfaction
ratings in HEARLI-Q and EMA for “Speech Communication—One Person” and “Speech-Communication—Several
People” CoSS task categories. The x-axes show the questionnaire type: HEARLI-Q (quiet) indicates speech communication
in quiet and HEARLI-Q (noise) is a group of the remaining situations in that category
with some background noise. The left y-axis shows the labels for occurrence ratings and the right y-axis shows the labels for hearing difficulty and HA satisfaction ratings. CoSS, Common
Sound Scenarios; EMA, Ecological Momentary Assessment; HA, hearing aid; HEARLI-Q,
hearing-related lifestyle questionnaire.
Are Difficult Listening Situations with Disturbing Background Noise Captured in Ecological
Momentary Assessment?
To assess whether difficult listening situations with disturbing background noise
are captured in EMA, EMA ratings for situations where there was no noise were compared
with the ones where nondisturbing and disturbing background noise was present ([Fig. 3]). Hearing difficulty was rated significantly higher in situations where disturbing
background noise was present (p < 0.001 for communication with one and p = 0.03 for communication with several), and HA satisfaction was lower in these situations
(all ps < 0.001; see [Supplementary Table S3], available in online version only, for detailed statistics). Neither hearing difficulty
nor HA satisfaction ratings in situations with disturbing background noise were significantly
different from the ratings in “HEARLI-Q (noise)” presented in [Fig. 2] (detailed statistics can be seen in [Supplementary Table S4], available in online version only). However, although represented in EMA, these
difficult and less satisfactory situations with disturbing background noise were reported
by only 10 participants in “Speech Communication—One Person” and 12 participants in
“Speech Communication—Several People.”
Fig. 3 Mean and 95% confidence intervals of occurrence, hearing difficulty, and HA satisfaction
ratings in EMA according to the indicated level of noisiness for “Speech Communication—One
Person” and “Speech Communication—Several People” categories. The left y-axis shows the labels for occurrence ratings and the right y-axis shows the labels for hearing difficulty and HA satisfaction ratings. For plotting
purposes, an average rating for occurrence, hearing difficulty, and HA satisfaction
for each participant was taken, such that each person contributes equally to the summary
statistic. N indicates the number of participants that contributed to the summary statistics.
EMA, Ecological Momentary Assessment; HA, hearing aid.
How do Hearing Aid Satisfaction Ratings Compare between Hearing-Related Lifestyle
Questionnaire and Ecological Momentary Assessment when Only Frequently Occurring Situations
are Analyzed?
When comparing only those situations where participants indicated the occurrence to
be daily or weekly, there was not a significant difference in HA satisfaction ratings
between the two questionnaires (β = −0.06 [95% confidence interval, CI: −0.24, 0.12],
p = 0.53, mixed-effects linear regression). Hearing difficulty was, however, still
lower in EMA (β = −0.26 [95% CI: −0.44, −0.07], p < 0.01, mixed-effects linear regression). These effects were mainly attributed to
“Speech Communication—One Person,” “Speech Communication—Several People,” and “No
Conversation/No Focused Listening.” Detailed statistics for individual CoSS task categories
are presented in [Supplementary Table S5] (available in online version only). In [Fig. 4], it can be seen that hearing difficulty ratings were well below moderate.
Fig. 4 Comparison of hearing difficulty and HA satisfaction ratings within individual CoSS
task categories between HEARLI-Q and EMA when only those HEARLI-Q situations where
occurrence was daily/weekly were considered. Means and 95% confidence intervals are
plotted. N indicates the number of participants that contributed to the summary statistics.
CoSS, Common Sound Scenarios; EMA, Ecological Momentary Assessment; HA, hearing aid;
HEARLI-Q, hearing-related lifestyle questionnaire.
How do Hearing Difficulty Ratings in Hearing-Related Lifestyle Questionnaire Compare
between Frequently and Infrequently Occurring Situations?
HEARLI-Q hearing difficulty ratings for daily/weekly situations were significantly
lower than HEARLI-Q hearing difficulty ratings when including all the listening situations
or when comparing to listening situations that occur more seldom than on a weekly
basis (frequent vs. all situations: β = 0.24 [95% CI: 0.06, 0.43], p = 0.01; frequent vs. infrequent situations: β = 0.54 [95% CI: 0.34, 0.74], p < 0.001, mixed-effects linear regression). See [Fig. 5] and [Supplementary Table S6] (available in online version only) for detailed statistics within individual CoSS
task categories.
Fig. 5 Comparison of HEARLI-Q hearing difficulty ratings between frequent situations (occurring
on daily or weekly basis), all situations, and infrequent situations (occurring more
seldom than on weekly basis) within individual CoSS task categories. Means and 95%
confidence intervals are plotted. N indicates the number of participants that contributed to the summary statistics.
CoSS, Common Sound Scenarios; HEARLI-Q, hearing-related lifestyle questionnaire.
Discussion
The results of the current study indicate that the overall HA satisfaction ratings
are similar between the retrospective HEARLI-Q and in situ EMA. On the other hand,
when comparing the HA satisfaction ratings within individual CoSS task categories,
it is evident that ratings are higher in EMA for in-person conversations.
Although EMA has clear advantages over retrospective questionnaires, it is also known
that certain situations might be underrepresented, specifically those pertaining to
social interactions and noisy environments.[9]
[10] In fact, the distribution of listening environments where participants filled out
EMA questionnaires points to easier/more familiar listening situations, such as in
home environments while not participating in a conversation or focused listening,
followed by one-on-one conversations and media listening. This is in line with auditory
reality patterns shown in previous EMA studies.[9]
[17]
[18]
[19] Moreover, the EMA data in the current work show that difficult situations with disturbing
background noise, while represented, are seen less frequently. From EMA data alone,
it is unclear whether those more challenging listening situations occurred less frequently,
or participants did not fill out the questionnaire in those moments. However, when
comparing the situations that only occur on daily or weekly basis, the HA satisfaction
ratings between the two questionnaires were comparable. Additional analysis revealed
that hearing difficulty ratings increased with decreased occurrence in HEARLI-Q. Hence,
lower occurrence of difficult listening situations seems to be driving the discrepancy
in HA satisfaction ratings between the HEARLI-Q and EMA.
Then, if more difficult listening situations occur less frequently, the likelihood
of capturing them in time-limited EMA is lower. And, if it is true that people spend
most time in easier/more familiar listening situations, and this is what is reflected
in EMA, then EMA alone may well be sufficient to accurately model the dynamics of
one's daily life. It has been shown that when a question pertains to a frequent behavior,
participants are less likely to have detailed representation of each event in their
memory, but rather these are grouped into one global representation without specific
traits related to those events.[20] In this case, EMA has a clear advantage over HEARLI-Q because nuances of those frequent
episodes would be detected. However, better understanding of the less frequent and
more difficult listening situations could give relevant insights into where improvements
in hearing care can be made. This in turn could lead to people spending time in situations
that they otherwise avoid.
Two previous studies compared retrospective questionnaire responses about HA satisfaction
and benefit to EMA. In a study investigating real-life benefit from “noise management”
processing, Andersson et al.[21] compared SSQ-12 ratings with EMA. The authors found that EMA data were able to provide
insights into more specific listening environments where participants experienced
benefit. Wu et al.,[15] on the other hand, compared retrospective GHABP scores with those captured by EMA
for two HAs. They found that GHABP-EMA was significantly different between the two
HAs on all the subscales, in comparison to the retrospective questionnaire where only
the satisfaction subscale showed a significant difference. Authors of both studies
discuss their findings in light of EMA being more sensitive to detect differences
in HA performance. We have shown that both HEARLI-Q and EMA are sensitive to detect
effect of the applied intervention on HA satisfaction,[16] and as such, we do not consider one method to be superior to the other in this aspect
but rather want to discuss their potential of complementing each other. For example,
“Focused Listening—Live Sounds” was rated by 13 participants in EMA, whereas only
one participant in HEARLI-Q indicated such situations to occur on daily or weekly
basis. This is potentially a consequence of the trial period when the country was
just starting to open again during coronavirus disease 2019 and the participants presumably
started to attend more live events, which is reflected in EMA. When rating in HEARLI-Q,
on the other hand, they reflected on the past year that did not have many such events.
Similarly, all the 21 participants indicated that they experience “Speech Communication—Over
Device” on daily/weekly basis in HEARLI-Q, but this situation was reported by only
nine participants in EMA. This is a situation that typically does not last very long
and hence is less likely to be captured by a 2-hour sampling scheme, or even if the
prompt does align with the event, it may be considered inappropriate to fill out an
EMA questionnaire. As such, it is not surprising that speech communication over device
is underrepresented in EMA. In the two examples of live sounds and communication over
device, we captured complementary information about participants' everyday lives that
we would not have with either of the two questionnaires alone.
It is promising that HEARLI-Q and EMA paint a similar picture: HA satisfaction ratings
are highly correlated between the two questionnaires and hearing difficulty is the
key predictor of HA satisfaction in both questionnaires. It is also noteworthy that
the two questionnaires offer balancing information. When rating HA satisfaction in
HEARLI-Q, two participants indicated that they do not wear their HAs when “Passive
listening—Hearing sounds of nature.” In EMA, conversely, there were many more situations
where participants indicated they do not wear their HAs. In this aspect, EMA offers
a more refined insight into day-to-day dynamics and how people use their devices.
While it is likely that people do not always take their HAs off in those situations,
with EMA, we can see how often people tend to take their HAs off and when. It is also
true that participants are likely to give a more accurate rating of the current situation
in EMA, as they are basing it on their experience right now and not relying on their
memory. In contrast, when filling out the HEARLI-Q, one gets a description of the
situation to assess but still must remember a real-life situation that matches the
questionnaire item. That process might overemphasize negative experiences as those
are more memorable and more salient than positive experiences when doing retrospective
reports.[22] For example, we observed a borderline significant contrast in HA satisfaction ratings
for “No Conversation/No Focused Listening” category, where there was a tendency of
HA satisfaction to be higher in EMA. These types of situations without conversation/focused
listening could include vacuum cleaning, washing dishes, operating machinery, etc.
In other words, noisy situations where one would need to stop the activity to answer
an EMA questionnaire. As such, these situations might be underrepresented. On the
other hand, when filling out the HEARLI-Q, the participant is likely to think back
to situations that stand out (e.g., of higher hearing difficulty). That is, we potentially
have a slight overestimation of hearing difficulty in HEARLI-Q and a slight underrepresentation
of hearing difficulty in EMA, with the truth lying somewhere in between.
It may not always be possible to administer both in situ and retrospective questionnaires
to get insights from both angles. One way to overcome the limitation of EMA not capturing
infrequently occurring or especially difficult situations can be overcome by asking
participants to seek out and report in those types of situations that are relevant
for the research questions, as done in Lelic et al.[11] or ask for EMA ratings based on a short retrospective period.[12]
[13]
[14]
[15] HEARLI-Q can also be administered more frequently in a longitudinal fashion, such
that participants do not need to think too far back, and this to an extent can reduce
the amount of guessing and estimation related to long reference periods.[23]
[24]
While providing meaningful insights into how retrospective and in situ satisfaction
ratings compare, it should be noted that the results here most likely depend on the
EMA sampling scheme. In the current study, we allowed participants to answer the EMA
questionnaire anytime between two consecutive prompts and this potentially allowed
for more selection bias than studies that may keep the prompt open for e.g., up to
15 minutes. That is, some situations may appear to “not occur” because they were inconvenient
to report in the moment of the prompt and when the participant was able to answer,
they were in a completely different situation. The sampling scheme employed in this
study is also a likely reason for the high compliance rate. Further, the results of
this study are based on experienced HA users. Although it has been previously shown
that HEARLI-Q and aggregated EMA responses are stable over time[3]
[25] in this population, expectedly HA satisfaction ratings may vary with time in new
HA users as they get used to their devices.[26] Thus, we may see a different contrast in satisfaction ratings within and between
the two questionnaires depending on the time of administration, relative to HA fitting,
when considering new HA users.
Conclusion
The overall satisfaction ratings are similar between HEARLI-Q and EMA. The satisfaction
ratings for one-on-one and group conversations are, on the other hand, higher in EMA.
Lower occurrence of difficult listening situations seems to be the key driver of discrepancies
in HA satisfaction ratings between the two questionnaires. The advantage of EMA is
that it provides insight into an individual's day-to-day life and is less prone to
memory bias than HEARLI-Q. HEARLI-Q, on the other hand, can capture those difficult
situations that occur infrequently or are inconvenient to report in the moment. The
high correlation between the two questionnaires is promising because it may not always
be feasible to administer both types of questionnaires. In this case, HEARLI-Q can
provide a reasonable assessment of HA satisfaction. Otherwise, when possible, administering
HEARLI-Q and EMA in combination has the potential to give a complementary and more
holistic view of HA satisfaction.
Disclaimer
Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American
Academy of Audiology.
