Hearing Health Care for Adults Priorities for Improving Access and Affordability (2016) / Chapter Skim
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6 Engaging a Wider Community: Awareness, Education, and Support
6 Engaging a Wider Community: Awareness, Education, and Support
Pages 235-286
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From page 235... ...
Attitudes and beliefs about hearing loss and the use of hearing health care services and technologies are explored from the perspectives of individuals and family members, employers and coworkers, and the general public, including the media. The chapter provides insights on the role of health literacy, the Internet, community-based support, and the built environment, such as public and private spaces that can be designed or altered to enhance acoustics and accessibility, and it also describes how these fac 235
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From page 236... ...
. Hearing loss has been associated with serious health comorbidities such as depression, anxiety, low self-esteem and insecurity, social isolation, stress, mental fatigue, cognitive decline and dementia, reduced mobility, falls, and mortality (see Chapter 2)
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From page 237... ...
. As discussed in Chapter 4, there are numerous reasons why individuals choose not to adopt or use hearing aids or choose not to seek hearing health care.
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. The specific attitudes and beliefs that are described converge and affect decisions about whether to be evaluated for hearing loss, to seek treatment, and to use hearing aids and hearing assistive technologies.
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Studies demonstrate that, among other factors, people with more positive attitudes and expectations are more likely to be empowered to take action and experience success with treatment options such as hearing aids and communication programs (Laplante-Lévesque et al., 2012b; Ng and Loke, 2015; van den Brink et al., 1996)
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From page 240... ...
. In addition to the FDA-mandated provision of user instructional brochures, some manufacturers and hearing health care professionals provide customized information on specific hearing aids and other technologies in order to better guide and educate consumers.
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From page 241... ...
Therefore, an individual diagnosed with hearing loss or using a hearing aid for the first time may require a more simplified explanation than an individual who has been managing hearing loss and using hearing aids for many years. An individual's hearing loss in and of itself may create unique communication challenges for patients, regardless of the health care setting.
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From page 242... ...
These specific measures also provide a simplified starting point for discussions between individuals and health care professionals about opportunities to improve health and well-being and may contribute to improved hearing health literacy. The American Heart Association and health care systems across the United States have leveraged specific health metrics through Know Your Numbers campaigns in order to educate individuals about diabetes and about risk factors for cardiovascular disease, such as obesity, high cholesterol, and high blood pressure.
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From page 243... ...
argued that testing speech recognition in the presence of noise offers four primary advantages, including • better alignment with the most common concern of people with hearing loss -- understanding speech in noisy or complex acoustic environments; • a more accurate assessment of the impact of hearing loss in real world settings; • informing the selection of the most appropriate hearing technology given individual needs; and • helping set expectations regarding hearing aids and their perfor mance in real-life situations. Box 6-1 provides examples of hearing tests that were designed to measure speech recognition in noise by presenting the listener with sentences or words in the presence of various types and levels of background noise.
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From page 244... ...
These standards serve as a point of comparison for dB SNR measures for people with hearing loss, and they can provide an assessment of the ability to understand speech in noisy environments.2 As part of a consultation with a hearing health care professional, these results -- along with the pure-tone audiogram, which is a measure of hearing acuity -- could provide a more comprehensive assessment of how individuals might function in real-life settings, which are frequently filled with background noise (e.g., restaurants, classrooms, offices with an open design, public transportation, sports arenas, gatherings of friends and family) , and how hearing technologies and auditory rehabilitation may be used to improve communication.
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From page 245... ...
Improving Information for Consumer Comparisons In order for consumers to obtain, process, and understand information relevant to hearing loss treatment options, easy-to-understand, evidencebased information needs to be readily available and presented by health care professionals following a diagnosis of hearing loss. Given the assortment of hearing aids and assistive technologies on the market, the decisions that individuals must make regarding which type of services or product will best meet their needs, preferences, and budgets can be overwhelming, and they are further complicated by marketing materials that do not meet health literacy standards.
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From page 246... ...
Ng and Loke (2015) hypothesized that factors such 1 Precontemplation No recognition of need for or interest in change • Severity of hearing loss 2 1 Contemplation Thinking about changing 5 • Self-perceived hearing loss Maintenance 5 2 • Expectations and attitude Ongoing practice of new • Demographics and healthier behavior socioeconomic status • Self-perceived benefits of treatment options • Overall satisfaction 4 3 3 4 Preparation Action Planning for change Adopting new habits • Type of hearing technologies and • Acceptance/adoption of services available hearing technologies and other • Support from others available treatment options • Availability of group consultations FIGURE 6-2 Transtheoretical model of behavior change.
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From page 247... ...
Following a diagnosis, some individuals may begin to wear hearing aids, use other assistive technologies, or participate in peer-support groups (maintenance phase) , while others may choose not to take action (returning to the precontemplation and contemplation stages)
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From page 248... ...
Chapter 4 and other sections throughout the report have described other mechanisms for empowering individuals to take a more active role in identifying and managing their hearing loss (e.g., mobile applications; over-the-counter wearable hearing devices; self-fitting hearing aids) with innovations developing in multiple areas.
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From page 249... ...
. Services provided include hearing aid fittings, mobility training, the installation of smoke alarm systems and doorbells designed for individuals with hearing loss, the provision of other assistive technologies such as telephones and alarm clocks, and instruction on how to use hearing aids and hearing assistive technologies.
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From page 250... ...
The use of peer-support groups may offer a valuable mechanism for community-based education and support, but further research is needed to establish efficacy and determine best practices. Advocacy organizations at the national and local levels can also play an important role in supporting those affected by hearing loss.
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In a 5-year follow-up, individuals with hearing loss -- both hearing aid users and those with untreated hearing loss -- relied more heavily on community services and nonspouse family or friend support, with increasing use seen by those with greater severity of hearing loss. The participants with hearing loss were more likely to report having low health status, having experienced a fall in the last year and having an impairment related to walking, vision, or cognition (Schneider et al., 2010)
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From page 252... ...
Health information from government agencies, national advocacy organizations, and health care systems offer a wealth of helpful information. However, reviews of the readability of hearing and hearing loss information on the Internet suggest that consumers would need between 9 and 14 years of education to comprehend the available information, representing a sizable mismatch when compared to average health
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From page 253... ...
Health literacy and usability are imperative design factors, especially when the target audiences are older adults with hearing loss and other populations that may have limited Internet access and computer literacy. Since an emphasis on health communications was announced as part of Healthy People 2010, the Department of Health and Human Services (HHS)
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From page 254... ...
Additionally, health care professionals need to be aware of the available online information sources and resources, and they should discuss the wide range of resources with their patients to ensure that people with hearing loss and their families are directed to reliable, evidenced-based information. THE ROLE OF COMMUNITIES Individuals and families are intrinsically woven into their communities, as is indicated in the social-ecological model.
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From page 255... ...
• Consumer Reports Hearing Aids Guide (www.consumerreports.org/cro/ hearing-aids/buying-guide.htm) • Mayo Clinic (www.mayoclinic.org/diseases-conditions/hearing-loss/basics/ definition/con-20027684)
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From page 256... ...
Equal Employment Opportunity Commission under Title I of the ADA between 1992 and 2003, Bowe and colleagues (2005) found that almost 9,000 complaints had been filed by individuals with some degree of hearing loss.
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suggest that stigma associated with hearing loss in the workplace has declined, perceived stigma is still a concern. Further reducing stigma, fostering a supportive environment in the workplace, and developing coping mechanisms and resilience among employees with hearing loss are crucial steps to eliminating discrimination, promoting broader support in the workplace, and enabling employees to remain in the workforce longer, if they so choose.
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For people with hearing loss, the availability of hearing aids and hearing assistive technologies, acoustics, and the connections to other communications systems (see Chapter 4) may mean the difference between participating in conversations and engaging with their surroundings and feeling isolated.
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Examples of communication services and technologies for individuals with hearing loss may include the following: • written materials, exchange of written notes, or the availability of note takers; • real-time, computer-aided transcription; • amplifiers and hearing aid–compatible telephones; • open and closed captioning, as well as closed captioning decoders; • various telecommunication systems (e.g., captioned telephones, video phones) ; • videotext screens and displays; • secondary auditory programs; and • other assistive technologies or systems.
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From page 260... ...
While this pairing requirement may be a limiting factor for those without hearing aids, hearing loops have been installed in a variety of public spaces, including theaters, museums, airports, sports arenas, classrooms and audi 7 Personal communication. Email to staff for the Committee on Accessible and Afford able Hearing Health Care for Adults from Daniel Fink, Quiet Areas in Restaurants.
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. In addition to the availability of hearing assistive technologies and services, the built environment can also be augmented to permit an optimal acoustic environment that benefits all individuals, regardless of hearing ability.
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Additional work in the arena of universal design and the built environment in terms of ameliorating the effects of hearing loss is also needed. PUBLIC EDUCATION AND AWARENESS Society is the all-encompassing level of the social-ecological model within which all other activities occur.
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From page 263... ...
. This shift may be a result of an increased awareness and acceptance of disabilities in recent decades; the aging of the baby boomer generation, which is experiencing and openly discussing chronic, age-related health conditions and focusing on living well; younger generations that tend to have more tolerant views of individual differences; and advances in technology that provide individuals with new hearing and communication options.
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. A general lack of understanding by the public can contribute to negative attitudes and can lead to stigma, which highlights the importance of public education efforts and campaigns that can reach diverse audiences through a variety of mechanisms.
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In all three cases, the character with permanent hearing loss adopted hearing aids, but there were no challenges with using the devices, there were no other accommodations or support needed, and the individual's hearing was restored completely by the hearing aid -- a combination of outcomes that is not very realistic. Despite many inaccuracies in the storylines studied, most characters denied the presence of their hearing loss and tried to hide it from their coworkers and friends -- a reaction that is common in real life (Foss, 2014)
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From page 266... ...
. Furthermore, a national study of health literacy found that individuals with lower health literacy are more likely to obtain health-related information from radio and television programs than individuals with higher levels of health literacy, who tend to seek information from written sources such as the Internet, newspapers, and magazines (Kutner et al., 2006)
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From page 267... ...
, and in audiology clinics and physician offices, thus reaching -- and possibly influencing -- large segments of the population. To better serve people with hearing loss, reduce stigma, and educate the public, the marketing for hearing aids and any hearing assistive technology should focus on individuals finding a solution that is effective, meets their needs, and helps them reconnect with family and friends, become more socially engaged, and continue to participate in their communities, rather than highlighting the ease with which an individual can hide his or her use of hearing aids or hearing assistive technologies.
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From page 268... ...
When a public awareness campaign is not feasible, advocacy organizations, government agencies, and other stakeholders often use smaller-scale efforts (e.g., videos, public service announcements, blogs) to educate the public about various public health topics and, in some cases, to reduce stigma.
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From page 269... ...
It also limits the opportunities to identify lessons learned that could be used to inform plans for future public awareness efforts. Advocacy organizations also play an important role in educating the public and supporting public education efforts.
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From page 270... ...
The availability of reliable, evidence-based information for consumers helps to reduce misperceptions and empower individuals with hearing loss to seek care and more openly discuss their hearing loss, the challenges it presents, and successful treatment stories with others. Given the current and expected number of individuals with hearing loss in the United States, advocacy organizations, government agencies, health care professionals, researchers, and industry need to collaborate in order to identify the best mechanisms for educating the public about hearing loss, the importance of hearing health, and what services and treatment options are available to people who live with hearing loss.
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org/#about-marquee • peak Up About Hearing Loss: http://www.asha.org/About/news/Speak-Up S About-Hearing-Loss • Turn it to the Left: http://www.turnittotheleft.org • Dangerous Decibels: http://www.dangerousdecibels.org • a Noisy Planet: http://www.noisyplanet.nidcd.nih.gov It's • Listen to Your Buds: http://www.asha.org/buds • How You Listen That Counts: http://www.hearingreview.com/2010/12/to-teens It's its-how-you-listen-that-counts • clearly defined goals, target audiences, messaging, milestones, and successes; • data and research to establish baselines of awareness and the misperceptions associated with hearing loss; • participation and involvement of targeted audiences throughout the planning and implementation phases to ensure that the messaging and education efforts are reaching their intended audiences, are culturally sensitive, and are making a difference; • coordination, collaboration, and partnerships to leverage limited resources, expand reach, and meet goals; and • short- and long-term evaluation plans to measure success, adjust ongoing initiatives, and target future efforts.
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From page 272... ...
predicted that the public stigma associated with hearing aids would vanish with the pervasive use of earpieces among the general public, and preliminary data suggest that Jackler's prediction may be coming to fruition. Since 1977, a series of studies have assessed the hearing aid effect, which is defined as "the assignment of negative attributes to individuals using hearing aids" (Rauterkus and Palmer, 2014, p.
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. Recent advances in hearing aids and hearing assistive technologies (described in Chapter 4)
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From page 274... ...
requirements, accommodations, and tools for successful interviews and hiring of people with hearing loss • The widespread installation and use of hearing assistive technologies in public spaces, as stipulated in the ADA • The development, evaluation, and implementation of design elements that can optimize acoustics in public spaces whenever possible, with an emphasis on universal design solutions • more positive portrayal of hearing loss and the use of hearing aids and A hearing assistive technologies in the media • The application and evaluation of social media to educate the public about hearing loss and the risks of noise-induced hearing loss • Positive messaging and themes in hearing technology marketing, with an emphasis on topics such as connecting with family and friends rather than on aesthetics and hiding the hearing aid or hearing assistive technology
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From page 275... ...
that explain hearing and related health concerns for adults of all health literacy levels, and address the breadth of services and technologies, includ ing their comparative effectiveness and costs; • Work through media, social marketing, and public education cam paigns to disseminate and evaluate key evidence-based messages about hearing and hearing health and to promote accuracy in media portrayals; • Implement and support a consumer-based metric to enable indi viduals to understand and track their communication abilities and hearing needs and a consumer-oriented format for audiogram and other hearing test results; • Adopt standardized terminology across manufacturers about the features and capabilities of hearing aids and hearing assistive tech nologies so that consumers and hearing health care professionals can make easy, clear, unambiguous comparisons; and • Develop and disseminate criteria that individuals and families can use to evaluate and compare hearing-related products and services. Goal 12: Promote Individual, Employer, Private-Sector, and C ommunity-Based Actions to Support and Manage Hearing Health and Effective Communication Recommendation 12: Individuals, families, community-based organi zations, advocacy organizations, employers, private-sector businesses, and government agencies (local, state, federal)
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From page 276... ...
National poll on hearing health: Results summary. http://www.asha.org/uploadedFiles/AARP-ASHA-National-Hearing-Health Health-Poll.pdf (accessed March 13, 2016)
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From page 277... ...
2011. Low health literacy and health outcomes: An updated systematic review.
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2007. A systematic review of health-related quality of life and hearing aids: Final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults.
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2014. Getting used to hearing aids from the perspec tive of adult hearing-aid users.
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2014. Factors associated with success with hearing aids in older adults.
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2012b. What makes adults with hearing impairment take up hearing aids or communication programs and achieve successful outcomes?
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2013. Why do people fitted with hearing aids not wear them?
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2015. The role of volunteer support in the com munity for adults with hearing loss and hearing aids.
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2014. The hearing aid effect in 2013.
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source=2&country=USA&series=&period= (accessed March 11, 2016)
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