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

*Advances in Rehabilitation of Hearing Loss*

you need?

using.

tions, well-being)?

need to be overcome or addressed.

**6. The self-management plan**

5.How likely are you to keep track of changes in your condition (e.g., sudden

6.How likely are you to work with your hearing care provider to get the services

7.How do you manage the effect of your hearing loss on how you feel (e.g., emo-

8.How do you manage the effects of your hearing loss on your social life (e.g.,

9.How confident are you that you can self-manage your condition effectively?

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

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

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.

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

change in hearing, pain, hearing aids stop working)?

participate in activities, mix with other people)?

**48**

**Figure 7.**

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 the most from their purchase of hearing aids.

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


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

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

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 developed that addresses this gap.

Nearly every patient fitted with hearing aids in a clinic returns for several hours of additional follow-up care. Spread over the course of four or more years, these face-to-face visits with the clinician gobble up a lot of precious clinical time, but the additional time does not always result in favorable patient outcomes. For example, Bennett et al. [6] suggest the needs of adult hearing aid owners are not being adequately addressed during their follow-up appointments with an audiologist. According to their work, 90% of hearing aid owners demonstrated difficulty with basic hearing aid management tasks, such as inserting the device into the ear or properly cleaning it. They also reported that almost one-half of hearing aid owners did not receive enough practical help about their hearing aid use. Obviously, insufficient training and support can lead to poor outcomes and non-use of hearing aids. But just how widespread of a problem this poses is a question that warrants further analysis.

Rebecca Bennett of the Ear Sciences Centre at The University of Western Australia and her colleagues have addressed these apparent gaps in the informational and training needs of adults fitted with hearing aids. Using a research method called concept mapping, an approach previously used to study help seeking behaviors in adults with hearing loss, Bennett and her colleagues evaluated the opinions of both hearing aid owners and clinicians about their knowledge, skills and tasks required to use, handle, care and maintain hearing aids. Described by the researchers as hearing aid self-management skills, the main objective of their work is to better understand the key skills and attributes of adult hearing aid users, so that clinicians can deliver a better quality of care to individuals after they have been fitted with hearing aids.

In studies published in the peer reviewed journals, *American Journal of Audiology* and *Ear and Hearing*, Bennett and her colleagues identified more than 100 unique descriptors of the hearing aid management process that could be broken down into 6 separate concepts that influenced hearing aid use and quality of follow-up care: (1) working with your clinician, (2) communication strategies, (3) learning to come to terms with hearing aids, (4) hearing aid maintenance and repairs, (5) daily hearing aid use, and (6) advanced hearing aid knowledge.

Items 1–3 were classified as person-centered attributes, while items 4–6 were classified by the researchers are device-centered attributes. Hearing aid owners (24 of them participated in the study) indicated that all six concepts were similarly important, whereas clinicians (22 participated in the study) indicated that advanced hearing aid knowledge was less important to long-term success of the patient than the other five concepts.

Despite the on-going support offered to clients after they acquire hearing aids, they are often hesitant to seek help from their clinician, and instead engage in a myriad of helpful and unhelpful behaviors in response to problems that arise with their hearing aids. Previous positive and negative experiences with the clinic, clinician and significant other influenced these actions, highlighting the influential role of these individuals' in the success of the rehabilitation process. This data suggests that clinicians could improve hearing aid problem resolution by providing technical and emotional support, including to significant others by promoting client empowerment and self-management.

#### **8. The importance of a therapeutic relationship during follow-up care**

Hearing aid wearers who participated in the study noted the importance of an effective working relationship between hearing aid wearer and audiologist. Traits of a good therapeutic relationship with their audiologist, such as awareness,

**51**

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

The work of Bennett and colleagues cited previously serves as a reminder that successful long-term hearing aid use by patients has two distinct components: mastery of the device and independent problem-solving, self-management skills. To teach patients about these two components require audiologists possess both effective technical skills and interpersonal counseling skills. A careful reading of Bennett's work suggests clinicians need to excel at both: many clinicians focus too much of their attention on the technical aspects of the device at the expense of

Finally, it should be apparent that a clinician's role is much more than providing verbal instructions on how to handle and maintain hearing aids—one of the main topics covered during hearing aid follow-up appointments. It is equally important to establish whether patients have learned skills that allow for mastery of their device and self-managed problem-solving skills. Clinicians who are proficient at teaching patients both skills, especially in a changing market where patients might purchase hearing aids on-line, and then seek professional guidance, offer a professional service that cannot

Using Bennett et al.'s [6] work as a foundation, here are five tasks audiologists can do during routine follow-up appointments to ensure patients are getting the

1.Empowerment. Help patients recognize and independently solve communication problems. The process of empowerment can be facilitated by getting patients involved in decision making and supporting their treatment choices. The use of easy-to-understand, visually appealing decision aids that present patients with a range of treatment options and tips for independently solving common communication breakdowns can be used to help patient's feel empowered. We know, see https://www.ncbi.nlm.nih.gov/pubmed/21841487, for one example, that individuals who are given a range of treatment and hearing loss management choices are more likely to actively participate in the rehabili-

2.Avoid Information dumping. Convey technical information in ways that are easy for patients to understand. Provide them with concise printed materials that they can refer to after the appointment. Be sure that the instructional materials are easy to read, use pictures to reinforce key points and are branded

3.Considering breaking appointments into smaller chunks. To ensure patients understand all aspects of successful hearing aid use, consider bringing the patient back more often for follow-up appointments, or better yet, use Skype and other forms of video conferencing to relay information to the patient in smaller chunks. Utilize support personnel whenever possible in the follow-up care and support process to ensure your clinic operates efficiently. Allowing an audiology assistant to participate in the follow-up process is an effective way to break the monotony some patients experience when trying to learn from one instructor over a lengthy period. By getting an assistant involved in teaching patients some of the routine aspects of follow-up care, it frees the audiologist's

be duplicated by lower skilled technicians or machine learning algorithms.

understanding, knowledge and a willingness to help were valued by hearing aid owners. On the other hand, patient traits, like proactive, help seeking behavior, knowing when to ask questions to the clinician, being comfortable divulging personal information, and asking for help contributed to a strong working relationship

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

building a strong therapeutic relationship with the person.

most from their hearing aids over the next several years:

between patient and clinician.

tation process.

to your clinic.

schedule to see new patients.

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

understanding, knowledge and a willingness to help were valued by hearing aid owners. On the other hand, patient traits, like proactive, help seeking behavior, knowing when to ask questions to the clinician, being comfortable divulging personal information, and asking for help contributed to a strong working relationship between patient and clinician.

The work of Bennett and colleagues cited previously serves as a reminder that successful long-term hearing aid use by patients has two distinct components: mastery of the device and independent problem-solving, self-management skills. To teach patients about these two components require audiologists possess both effective technical skills and interpersonal counseling skills. A careful reading of Bennett's work suggests clinicians need to excel at both: many clinicians focus too much of their attention on the technical aspects of the device at the expense of building a strong therapeutic relationship with the person.

Finally, it should be apparent that a clinician's role is much more than providing verbal instructions on how to handle and maintain hearing aids—one of the main topics covered during hearing aid follow-up appointments. It is equally important to establish whether patients have learned skills that allow for mastery of their device and self-managed problem-solving skills. Clinicians who are proficient at teaching patients both skills, especially in a changing market where patients might purchase hearing aids on-line, and then seek professional guidance, offer a professional service that cannot be duplicated by lower skilled technicians or machine learning algorithms.

Using Bennett et al.'s [6] work as a foundation, here are five tasks audiologists can do during routine follow-up appointments to ensure patients are getting the most from their hearing aids over the next several years:


*Advances in Rehabilitation of Hearing Loss*

analysis.

fitted with hearing aids.

ing aid use, and (6) advanced hearing aid knowledge.

patient than the other five concepts.

erment and self-management.

Nearly every patient fitted with hearing aids in a clinic returns for several hours of additional follow-up care. Spread over the course of four or more years, these face-to-face visits with the clinician gobble up a lot of precious clinical time, but the additional time does not always result in favorable patient outcomes. For example, Bennett et al. [6] suggest the needs of adult hearing aid owners are not being adequately addressed during their follow-up appointments with an audiologist. According to their work, 90% of hearing aid owners demonstrated difficulty with basic hearing aid management tasks, such as inserting the device into the ear or properly cleaning it. They also reported that almost one-half of hearing aid owners did not receive enough practical help about their hearing aid use. Obviously, insufficient training and support can lead to poor outcomes and non-use of hearing aids. But just how widespread of a problem this poses is a question that warrants further

Rebecca Bennett of the Ear Sciences Centre at The University of Western Australia and her colleagues have addressed these apparent gaps in the informational and training needs of adults fitted with hearing aids. Using a research method called concept mapping, an approach previously used to study help seeking behaviors in adults with hearing loss, Bennett and her colleagues evaluated the opinions of both hearing aid owners and clinicians about their knowledge, skills and tasks required to use, handle, care and maintain hearing aids. Described by the researchers as hearing aid self-management skills, the main objective of their work is to better understand the key skills and attributes of adult hearing aid users, so that clinicians can deliver a better quality of care to individuals after they have been

In studies published in the peer reviewed journals, *American Journal of Audiology* and *Ear and Hearing*, Bennett and her colleagues identified more than 100 unique descriptors of the hearing aid management process that could be broken down into 6 separate concepts that influenced hearing aid use and quality of follow-up care: (1) working with your clinician, (2) communication strategies, (3) learning to come to terms with hearing aids, (4) hearing aid maintenance and repairs, (5) daily hear-

Items 1–3 were classified as person-centered attributes, while items 4–6 were classified by the researchers are device-centered attributes. Hearing aid owners (24 of them participated in the study) indicated that all six concepts were similarly important, whereas clinicians (22 participated in the study) indicated that advanced hearing aid knowledge was less important to long-term success of the

Despite the on-going support offered to clients after they acquire hearing aids, they are often hesitant to seek help from their clinician, and instead engage in a myriad of helpful and unhelpful behaviors in response to problems that arise with their hearing aids. Previous positive and negative experiences with the clinic, clinician and significant other influenced these actions, highlighting the influential role of these individuals' in the success of the rehabilitation process. This data suggests that clinicians could improve hearing aid problem resolution by providing technical and emotional support, including to significant others by promoting client empow-

**8. The importance of a therapeutic relationship during follow-up care**

Hearing aid wearers who participated in the study noted the importance of an effective working relationship between hearing aid wearer and audiologist. Traits of a good therapeutic relationship with their audiologist, such as awareness,

**50**


Beyond adjusting the acoustic parameters of hearing aids and assisting patients with the hands-on skills needed to use their hearing aids, there are an abundance of person-centered skills that are too often overlooked by clinicians, but desired by patients. The work of Bennett and her colleagues lays the groundwork for how knowledge, skills and tasks can be conveyed to patients in a meaningful way, thus enabling them to be independent, self-managers of their communication.

While clinical audiologists to shed light on new approaches to care, there are some things we can do to add value to the follow-up process.

In summary, the following types of services could be offered to help seekers who already own hearing devices:

	- Device customization and/or device mastery training, possibly delivered by a non-audiologist
	- Hearing loss self-management skills training
	- Customized treatment plan that focuses on "getting used to hearing aids"
