Novel Approaches to Fostering Hearing Loss Self-Management in Adults

Over the course of the last 10 years, the field of audiology has experienced significant changes. Of course, technological advances are among these changes, including the development of increasingly intelligent, adaptable, and user-friendly hearing devices; cutting-edge diagnostic capabilities; and the widespread availability of electronic medical records. A benefit of these technological advances is the potential for automation. Automation of procedures not only saves valuable clinic time but it also allows for increased accessibility to hearing health care. Consider the upcoming new class of hearing aids designated by the passage of the Over-the-Counter Hearing Aid Act of 2017. These devices, designed to address mild-to-moderate age-related hearing loss, may address cost which is one barrier to hearing aid uptake by potentially driving costs down through market competition as well as removing the need for consultation with a physician or audiologist. Furthermore, as the quality and availability of automated diagnostic assessment improves, the need for audiologists in the booth for individuals with uncomplicated hearing loss will become obsolete. The future is upon us, and while these changes are exciting for some, they also bring about new challenges. Removing the audiologist from the service provision equation for some individuals leaves the patient in the driver's seat, and while patients are ultimately in charge of their health-related decisions, a great deal of variety exists regarding how successful patients are at self-managing their health.

Like diabetes, asthma, and arthritis, hearing loss is a chronic condition for which there is no cure. There is no magic bullet, no elixir, and no surgical procedure that will reverse it. And like other chronic health conditions, patients living with hearing loss must manage its symptoms on a daily basis. Fortunately, hearing health care providers have options to offer patients for hearing loss management: hearing aids, hearing-assistive technology, communication strategies, self-help groups, computerized auditory training … the list goes on. These various interventions are efficacious in those patients who successfully use them, but narrowing down the defining features associated with success has proven difficult. Indeed, in a systematic review of the literature, Knudsen et al[1] identified over 20 factors associated with hearing aid use among adults, with the most robust being age, hearing loss severity, perceived need for hearing intervention, and stigma. Thus, while we have an idea of modifiable factors related to hearing health care use (perceived need and stigma), as a field we have made little headway in the most effective ways to address these factors. Recently, researchers in the area of hearing health care have focused attention on chronic disease management models to guide their intervention efforts. An important aspect of chronic disease management is the concept of self-management. How do patients self-manage their symptoms? What barriers and facilitators exist to patient self-management? What makes a person successful at self-management? And importantly, how can health care providers foster self-management skills in patients with chronic health conditions, such as hearing loss?

This edition of Seminars in Hearing introduces the reader to the concept of hearing loss self-management, as effective self-management on the part of the patient, in part, is predictive of positive clinical outcomes for chronic health conditions. The first article, a review by Convery et al, discusses the Chronic Care Model, a framework utilized by researchers and practitioners in other areas of disease management (e.g., diabetes, asthma). The Chronic Care Model describes a patient-centered approach at improving the management and outcomes of chronic disease. Two core components of the Chronic Care Model are a collaborative relationship between the practitioner and the patient and self-management patient education. In their review, Convery et al make a case for applying the Chronic Care Model to audiology service provision, and describe how the Flinders Chronic Condition Management Program can assist with identifying patient self-management capabilities and areas where additional support on the behalf of the audiologist may be warranted.

The other papers in this edition each focus on a specific area of hearing loss self-management, describing how hearing health care providers and researchers are investigating different ways of increasing self-management skills of patients from diverse backgrounds. Reed et al compare the ability of users to self-program hearing aids provided in an over-the-counter hearing aid model to programs set by an audiologist. As the over-the-counter hearing aid service model gains popularity, studies that identify barriers and facilitators to effective self-programming will be essential. It behooves clinicians and researchers to invest in the success of patients who choose an over-the-counter device, as widespread failure with the over-the-counter devices poses a risk to the reputation of amplification devices and audiology as a field.

Suen et al discuss a novel service delivery model: that of community-based approaches for increasing hearing health care use in vulnerable populations, with the aim of reducing hearing health disparities. Highlighted are the opportunities for fostering hearing loss self-management in vulnerable populations through partnerships with community health workers and utilizing a community-based participatory design for outreach and education programs. Particularly important to consider when designing hearing intervention programs for understudied populations are their hearing health care needs, goals, and preferences. Incorporating end-users, communities, and health care workers who patients identify with increases the chance for success of hearing loss self-management education programs delivered.

The last two articles included in this edition discuss patient education programs designed to foster hearing loss self-management skills. My colleagues and I introduce The Hearing Loss Toolkit for Self-Management(c), consisting of modular patient education materials targeted toward new or prospective adult hearing aid users. The article describes the development and formative assessment of the Hearing Loss Toolkit(c), taking into consideration best-practice U.S. health literacy recommendations from both the Department of Health and Human Services and the Centers for Disease Control and Prevention. The Hearing Loss Toolkit(c) directly speaks to the Chronic Care Model in that it fosters self-management through delivering education that is person centered (e.g., takes into consideration the goals and preferences of the patient) and focuses on a collaborative approach to problem solving between the audiologist and the patient.

Finally, Ferguson et al provide a review on the cornerstones of adult audiologic rehabilitation: hearing devices, education, auditory and cognitive training, and motivational engagement. They further discuss the future of hearing loss self-management education through electronic and mobile-health applications. In their review, they provide a summary of outcomes from a series of reusable learning objects: short video clips focused on various self-management aspects of adjusting to and using hearing aids, entitled C2Hear. They additionally address the importance of appropriate outcomes to assess the benefits of aural rehabilitation and self-management for adults with hearing loss.

Taken together, I believe these five articles highlight the importance of understanding hearing loss self-management as the field of audiology continues to evolve. The works represent years of research, reiteration, and careful consideration of how hearing health care providers can remain relevant in the inevitable age of automation and alternative service provision models. I would like to take the opportunity to personally thank each of the contributors and let them all know how much I value them as colleagues and critics. Thank you! I hope you enjoy the edition.

• Reference

• 1 Knudsen LV, Öberg M, Nielsen C, Naylor G, Kramer SE. Factors influencing help seeking, hearing aid uptake, hearing aid use and satisfaction with hearing aids: a review of the literature. Trends Amplif 2010; 14 (03) 127-154