**5. Helping patients become better self-managers of their condition**

Self-management skills for adults with hearing loss is defined as the patient independently demonstrating the following behaviors: (1) Active participation in the goal setting and treatment planning process, (2) Adherence to an agreed upon treatment plan, (3) Ability to recognize and manage changes in condition or treatment plan, and (4) Use of proactive coping strategies when communication becomes challenging or treatment plan falls short of expectations. When audiological rehabilitative is viewed through the lens of improving hearing loss self-management skills, the provision of a hearing device from the audiologist is not necessarily needed.

When audiologists improve the self-management skills of adults with hearing loss, several benefits are likely to occur: Individuals, who can effectively selfmanage their condition, are less likely to show up unannounced in the clinic looking for additional help, they are more likely to keep their scheduled appointments and to experience improved outcomes. All of which help a practice operate more efficiently.

It is likely that many adults with hearing loss, regardless of where they purchased hearing devices, will benefit from becoming better self-managers of their condition. If a primary role of audiology is to guide patients through the process of becoming better self-managers, the necessary services provided by the audiologists can probably be placed into one of these three categories: (1) Information gathering and exploratory dialog, (2) Goal setting and treatment planning, and (3) Monitoring progress and assessing outcomes. The foundational skills needed to perform that services are motivational interviewing, shared decision making, and other types of skills directly related to communication and counseling. It is a positive development, for example, to see collaborations between audiology and psychology that are encouraging the use of these skills.

To customize a hearing loss self-management plan for these individuals, Convery et al. [4] developed a self-management interview process centered around assessing the patient's knowledge of their condition and treatment options, actions that can be taken to improve or cope with their condition and coping strategies for difficult communication challenges. In their iteration of a self-management in-take process, they asked patients and audiologist to work together to complete a self-management interview. In this process, the audiologist asks the following questions to the patient:


*Advances in Rehabilitation of Hearing Loss*

prescriptive target is being matched

• Care and maintenance of devices

support of these device mastery skills.

• Expectations of initial use of devices

• Insert and removal of hearing aids from ears

Any service delivered by an audiologists that depends on the patient's interaction with their hearing devices can be placed in the device mastery skills category,

• Customization of device performance using real ear measures to ensure a

• Basic orientation—how to use features and accessories of devices

• Pairing device to mobile device and adjustment of SFHAs with app

be taught via YouTube videos or a smartphone-enabled app.

• Auditory training exercises that include use of hearing devices during the

Note that many of the components of device mastery are addressed in the user manual of the hearing device. In addition, many of these device mastery skills can

Once a device mastery plan has been customized for the individual (and when

As we peer into the future, SFHAs are likely to become easier to use for a larger segment of the population. As SFHA technology becomes easier to use and meshes seamlessly with smartphones and Bluetooth-enabled devices, it is also likely that the user instruction manual will become more interactive. It is safe to assume that many of the device mastery skills listed above could be replaced by smartphone-enabled apps that help a patient troubleshoot problems associated with their hearing devices. Thus, audiologists should be poised to provide device mastery services to individuals that require face-to-face intervention, perhaps scheduled across several

Hearing loss self-management skills refer to the knowledge and skills people use to manage—as independently as possible—the effects of hearing loss on all aspects of their lives. Moving beyond device mastery skills, teaching individuals to actively identify challenges and solve problems associated with their hearing loss describes the term self-management. For audiologists, providing self-management skills training could be an opportunity to offer a tangible service that stands apart from

Given the movement toward more over-the-counter purchases of hybrid hearing devices, it is imperative that audiologists have some tangible services, valued by the marketplace, that fall under the rubric of hearing loss self-management skills. Beyond successfully using hearing aids, hearing loss self-management skills

permitted by state regulations) audiologists should consider the use of a welltrained, competent non-audiology assistant to deliver all or part of the patient

**4.5 Device mastery skills**

including:

training

service appointments.

the delivery of a device.

**4.6 Self-management skills**

**46**


In addition to asking for responses from patients, the audiologist rated on a 1–8 scale their professional judgment as to patient's ability to complete these tasks. The purpose of the rating and the interview was to individualize the self-management plan. Clinicians should be cautious about utilizing this interview format, as research is still being gathered on how it might apply to persons with hearing loss, especially those who have attempted to self-direct their care. However, responses to these interview questions could form the basis for a customized self-management treatment plan used with anyone in need of help, regardless of where they purchased their devices or what type of devices they are using.

The patient's responses to the interview can be used to create a plan with the goal of assisting the patient become an independent self-manager of his condition. The plan can focus on improving one of the three components of self-management: (1) Knowledge of condition and treatment options, (2) Actions that improve the patient's condition, and (3) Psychosocial issues resulting from the hearing loss that need to be overcome or addressed.

### **6. The self-management plan**

The results of the self-management interview can be used to create a customized self-management plan for the patient. The objective of the self-management plan is to guide the patient toward becoming an independent communicator. **Figure 5** shows one example of a self-management plan for one older adult.


**49**

*Audiology's Third Pillar: Comprehensive Follow-Up Care and Counseling for Those Who Choose…*

The self-management plan, depicted in **Figure 7**, is an iterative process, which means that it is likely to change over time. Therefore, at least once a year the audiologist and patient sit down together and update the plan by modified goals and communication strategies. The main point is that a major focus is on the individual with hearing loss and not the mastery of devices, thus any patient who purchased their devices elsewhere are still a prime candidates to benefit from the provision of

As experienced audiologists know, a substantial number of patients struggle with "getting used to hearing aids." The term, "getting used to hearing aids" can mean many different things, but for our purposes, it refers to a patient's ability to become a successful hearing aid user, which typically entails a bit of a learning curve as patients learn how to both use the hearing aids and listen to new sounds for the first in several years. If we all agree that successful use is involves full time hearing aid use, as well as some combination of good satisfaction and benefit in real-world listening situations, it is incumbent upon audiologists to help patients get

Dawes et al. [5] examined some of the factors associated with getting used to hearing aids. According to their work, there are seven factors that moderate a

• Provision of information about how hearing aids works and the self-manage-

Clinical audiologists can use this list of moderators to build a treatment plan that result in a patients becoming a successful wearer. By evaluating each of the seven components and devising a plan to improve shortcomings, the audiologist is directly

For each of the seven factors that moderate successful hearing aid use listed above, the audiologist can customize a plan. This process starts by asking one or two questions about each of these factors and devising a strategy for improving it. For example, for the factor of determination to be a successful user, the audiologist could ask some frank questions about exactly how determined a patient is to do what it takes to be successful. For those lacking determination, a strategy could be

*DOI: http://dx.doi.org/10.5772/intechopen.88224*

self-management skills training from an audiologist.

**7. More on hearing aid follow up care**

the most from their purchase of hearing aids.

• Acceptance of hearing loss

• Consistent use of hearing aids

• Encouragement from others

developed that addresses this gap.

ment process

• Gradually build up to full time use

• Determination to become a successful user

• Good relationship with the audiologist

contributing to an outcome that is more likely to be successful.

**7.1 Customizing a "Getting Used to It" treatment plan**

patient's ability to get used to their devices, which include:

#### **Figure 7.**

*An example of a customized self-management plan, which is an iterative process.*

*Audiology's Third Pillar: Comprehensive Follow-Up Care and Counseling for Those Who Choose… DOI: http://dx.doi.org/10.5772/intechopen.88224*

The self-management plan, depicted in **Figure 7**, is an iterative process, which means that it is likely to change over time. Therefore, at least once a year the audiologist and patient sit down together and update the plan by modified goals and communication strategies. The main point is that a major focus is on the individual with hearing loss and not the mastery of devices, thus any patient who purchased their devices elsewhere are still a prime candidates to benefit from the provision of self-management skills training from an audiologist.
