RESUMEN
OBJECTIVE: When we evaluate the success of a hearing aid fitting, or the effectiveness of new amplification technology, self-report data occupy a position of critical importance. Unless patients report that our efforts are helpful, it is difficult to justify a conclusion that the intervention has been successful. Although it is generally assumed that subjective reports primarily reflect the excellence of the fitted hearing aid(s) within the context of the patient's everyday circumstances, there is relatively little research that assesses the validity of this assumption. In previous work, we have reported some contributions of the service delivery setting (private practice versus public health) to self-report outcomes. The purpose of the present investigation was to assess the relative contributions of patient variables (such as personality and hearing problems) and amplification variables (such as soft sound audibility, gain and maximum output) to self-reports of hearing aid fitting outcomes. DESIGN: A cross-sectional survey of 205 patients was conducted with cooperation of eleven Audiology clinics. All subjects were recruited when they were seeking new hearing aids. Before the hearing aid fitting, measurements of personality and response bias were made, as well as measures of hearing problems and expectations about amplification. At the fitting, traditional verification data were measured including sound field thresholds, preferred gain for conversation, and maximum output. Six months after the fitting, a set of 12 standardized self-report outcomes was completed. Analyses concerned: (1) the associations among personality, response bias, and self-reports about hearing problems that are available before the hearing aid fitting, and (2) the associations of these precursor variables, and fitting verification data, with self-report data assessing the outcome of hearing aid provision. RESULTS: Self-reports of hearing problems, sound aversiveness, and hearing aid expectations obtained before the fitting were found to be more closely related to the strength of certain personality traits than to audiometric hearing loss. Response bias also was associated with personality variables. Analyses of the collection of outcome measures produced a set of three components that were interpreted as a Device component, a Success component, and an Acceptance component. The Device component was construed as reflecting characteristics of the hearing aid whereas the two other components were construed as reflecting attributes of the wearer. The Success and Acceptance components were each significantly associated with several personality traits, but the Device component was not associated with personality. Variables available before the fitting accounted for 20 to 30% of each outcome component whereas amplification variables measured to verify the fitting accounted for only 10% on only one component. CONCLUSIONS: As reported in previous research, personality is associated with self-report outcome data. However, if practitioners utilize existing measures of hearing problems at the prefitting stage, separate personality data will not yield additional leverage in prediction of long-term fitting outcomes. Traditional fitting verification data as measured in this study, proved minimally useful in prediction of long-term outcomes of the fitting. A large proportion of variance in self-report fitting outcomes has yet to be accounted for. Finally, it appears that certain types of questionnaires might be more appropriate for research evaluating new amplification devices, whereas a different questionnaire approach might be optimal for evaluating intervention effectiveness in a clinical context.
Asunto(s)
Audífonos/normas , Trastornos de la Audición/terapia , Personalidad , Ajuste de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Trastornos de la Audición/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. DESIGN: The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. RESULTS: Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. CONCLUSIONS: These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.
Asunto(s)
Audífonos/psicología , Hospitales de Veteranos , Satisfacción del Paciente , Práctica Privada , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , VeteranosRESUMEN
OBJECTIVE: Evidence indicates that elderly hearing-impaired people who use amplification live happier, healthier, and longer lives than those who do not. Nevertheless, only a small fraction (approximately 23%) of hearing-impaired adults actually seek and use hearing aids. This study explored the personalities of hearing aid seekers in an attempt to determine whether those who seek hearing aids are systematically different from the general population. DESIGN: In this cross-sectional survey, self-report data were obtained from 230 older adults with bilateral, symmetrical, sensorineural, mild to moderately severe hearing impairment. Subjects were representative of patients served either in a publicly funded hospital-based system (VA) or in a free-standing private practice system (PP). All subjects were seeking new hearing aids. Subjects completed a comprehensive personality questionnaire (NEO-Five-Factor Inventory) as well as questionnaires determining locus of control and preferred coping strategies. RESULTS: Individuals who seek amplification are not simply a random sample of the general population and presumably not a random sample of the hearing-impaired population. Compared with the typical adult, hearing aid seekers tended to be more pragmatic and routine-oriented and probably less imaginative in coming up with novel approaches to dealing with a complex problem such as hearing impairment. These individuals also were found to feel relatively more personally powerful in dealing with life's challenges. Further, hearing aid seekers reported using social support coping strategies less frequently than their non-hearing-impaired peers. In addition, there were significant differences in personality patterns between hearing aid seekers in the PP and VA systems. Differences noted in the personality traits of Openness and Neuroticism might be a useful guide to selecting treatment approaches and expectations for patients in each setting. Additional differences in Agreeableness imply that patients in the private practice system were more trusting than those in the general population, whereas this was not seen for patients in the public health VA system. One interpretation of this finding is that hearing-impaired individuals who are more suspicious and cynical are reluctant to try amplification in the PP system. This observation underscores the need to improve the public image of hearing health care to increase the uptake of hearing aids in general. CONCLUSIONS: Although individual hearing aid seekers display personality characteristics within the range of normal, this study suggested that they are not simply a random sample of the general population. Possible explanations are offered for significant personality differences, and potential clinical relevance is noted for some effects. The data also point to a need to improve the public image of hearing health care in the PP system.
Asunto(s)
Audífonos , Pérdida Auditiva Sensorineural/psicología , Personalidad , Adaptación Psicológica , Anciano , Actitud Frente a la Salud , Estudios Transversales , Femenino , Audífonos/psicología , Pérdida Auditiva Sensorineural/rehabilitación , Hospitales de Veteranos , Humanos , Control Interno-Externo , Masculino , Aceptación de la Atención de Salud , Determinación de la Personalidad , Práctica Privada , Encuestas y Cuestionarios , Estados UnidosRESUMEN
The Abbreviated Profile of Hearing Aid Benefit (APHAB) is a self-report questionnaire that is used to quantify the impact of a hearing problem on an individual's daily life. In this investigation, the relationships were explored between typical clinical audiometric data and the four subscale scores of the APHAB administered in the unaided (without-amplification) condition. Sixty subjects provided APHAB scores, audiograms, and speech recognition data. Analyses revealed significant relationships between audiometric data and each of the three APHAB subscales that reflect speech communication (EC, RV, and BN). None of these subscales was significantly more strongly related to any specific audiological variable. However, the pattern of associations between audiometric variables and subscale scores was consistent with predictions based on item content for subscales EC and RV, but not for BN. As predicted, no relationship was found between audiometric data and scores for the Aversiveness subscale (AV). Even for the subscales with the strongest associations, differences in audiometric data could be used to explain half or less of the variance in self-report data.