Intervention decision making in audiological rehabilitation

Laplante-Levesque, Ariane (2010). Intervention decision making in audiological rehabilitation PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

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Author Laplante-Levesque, Ariane
Thesis Title Intervention decision making in audiological rehabilitation
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2010-08
Thesis type PhD Thesis
Open Access Status Other
Supervisor Louise Hickson
Linda Worrall
Total pages 221
Total colour pages 4
Total black and white pages 217
Subjects 11 Medical and Health Sciences
Formatted abstract
Hearing impairment, a prevalent chronic health condition, is associated with reduced quality of life. Rehabilitation interventions such as hearing aids and communication programs are effective, but their uptake and outcomes are suboptimal. Shared decision making, or the involvement of both the client and the clinician in all decisional steps, has been advocated for people with chronic health conditions. This thesis investigated the application of shared decision making to the rehabilitation of adults with acquired hearing impairment. Mixed methods research (qualitative and quantitative) was framed within a prospective design. In total, 153 adults aged over 50 with acquired hearing impairment seeking help for the first time participated. Four studies were conducted to investigate: 1) the experiences of adults with acquired hearing impairment with shared decision making; 2) the factors they report as influencing their intervention decisions; 3) the significant predictors of their intervention decisions; and 4) the significant predictors of their intervention uptake and outcomes. Each participant met with the audiologist who used shared decision making and a decision aid to offer intervention options: hearing aids, communication programs (group or individual), and no intervention. Participants considered the intervention options for at least one week before making their intervention decisions.

Studies one and two used a qualitative methodology. Individual interviews were conducted with 22 participants purposefully chosen to represent a wide range of decision making perspectives and experiences. The interviews were audio recorded, transcribed, and analysed with content analysis. Study one identified the participants’ experiences with shared decision making. The results were organised into an evidence-based model of shared decision making for adults with acquired hearing impairment. Participants described decision making by its actors, processes, and dimensions and highlighted two themes: my story and trust. The themes convey that adults with acquired hearing impairment wish clinicians to listen to their experiences and preferences and to be trustworthy.

Study two identified the factors that participants reported as influencing their intervention decisions: 1) convenience; 2) expected adherence and outcomes; 3) financial costs; 4) hearing disability; 5) nature of intervention; 6) other people’s experiences, recommendations, and support; and 7) preventive and interim solution. All factors were a positive influence for a particular intervention for some participants and a negative influence for the same intervention for other participants.

Studies three and four used a quantitative approach and, more specifically, multivariate analysis (logistic and linear regression) to identify unique predictors when all other variables were held constant. Study three investigated the predictors of intervention decisions in 139 participants. The majority of the sample opted for hearing aids (54%) whilst 24% of the sample opted for communication programs and 22% opted for no intervention. Seven predictors were identified: 1) application for subsidised hearing services (participants more likely to choose hearing aids and less likely to choose communication programs); 2) hearing impairment (hearing aids more likely and no intervention less likely); 3) communication self-efficacy (hearing aids less likely); 4) powerful others locus of control (hearing aids less likely); 5) hearing disability perceived by others and self (hearing aids more likely); 6) perceived communication program effectiveness (communication programs more likely); and 7) perceived suitability of individual communication program (hearing aids less likely and communication programs more likely).

Whilst study three identified the predictors of intervention decisions (i.e., the intervention participants intended to take up), study four investigated the predictors of intervention uptake 6 months later and of hearing aid and communication program outcomes 3 months after intervention completion. Almost a quarter (24%) of the 153 participants did not take up the intervention they intended to. Seven intervention uptake predictors were identified: 1) application for subsidized hearing services (participants more likely to obtain hearing aids and less likely to pursue no intervention); 2) higher socio-economic status (no intervention less likely); 3) communication self-efficacy (hearing aids less likely); 4) contemplation stage of change (no intervention less likely); 5) hearing disability perceived by others and self (communication programs less likely); 6) perceived communication program effectiveness (communication programs more likely); and 7) perceived suitability of individual communication program (hearing aids less likely and communication programs more likely). Intervention outcomes (benefit, composite outcomes, and reduction in self-reported hearing disability) were obtained for 91 of the 94 participants who completed an intervention and six predictors of successful intervention outcomes were identified: 1) higher socio-economic status; 2) higher initial self-reported hearing disability; 3) lower precontemplation stage of change; 4) higher action stage of change; 5) lower chance locus of control; and 6) higher hearing disability perceived by others and self.

In summary, these four studies underline the importance of a client-centred and trusting approach to decision making with adults with acquired hearing impairment. More specifically, clinicians should discuss self-reported hearing disability and stages of change to successfully help adults with acquired hearing impairment make decisions that result in intervention uptake and successful outcomes.
Keyword Hearing impairment
Shared decision making
Health uptake
Health outcomes
Aural rehabilitation
Hearing aids

Document type: Thesis
Collections: UQ Theses (RHD) - Official
UQ Theses (RHD) - Open Access
 
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Created: Wed, 17 Nov 2010, 06:11:44 EST by Ms Ariane Laplante-levesque on behalf of Library - Information Access Service