Institute for Matching Person & Technology
Webster, NY
Associate Professor of Physical Medicine and Rehabilitation
University of Rochester Medical Center
Rochester, NY
Larry Medwetsky, Ph.D., CCC-A
Vice President of Audiology
Rochester Hearing and Speech Center
Rochester, NY
D. Robert Frisina, Ph.D.
Director
International Center for Hearing and Speech Research
Rochester Institute of Technology/National Technical Institute for the Deaf
Rochester, NY
Introduction:
Hearing aids are the most common device used by persons with hearing loss to improve their hearing ability. Of the entire population of individuals with hearing loss, estimated to be some 30 million people in the USA (as of 2005), only 20% choose to obtain hearing aid amplification. Importantly, of those seeking hearing aid amplification, one year after purchase, some 15% no longer wear their hearing aids on a consistent basis. A lack of congruence between degree of hearing loss, preparedness to use hearing aid amplification and realized benefits associated with hearing aid use, exists.
In addition to hearing aids, individuals with hearing loss can be fit with many other useful listening products. Assistive technology (AT) for hearing can be defined as "any item, piece of equipment, or product system¡K used to increase, maintain, or improve functional capabilities of individuals with disabilities". (Technology Related Assistance of Individuals with Disabilities Act of 1988 (P.L. 100 819) p. 3, see Appendix 1).
A tool which accurately provides information regarding how clients react to their hearing loss and how they will likely react going forward, and one that defines and clarifies hearing expectations, would be an important addition to the hearing rehabilitative process. It would allow us to match technology with people and help them move toward a better state of readiness for aural rehabilitation.
To better understand factors serving as barriers to realization of benefit, a study was conducted to address the affect of personality and temperament traits on: (1) predispositions to using a hearing aid; (2) the derivation of benefit from hearing aid use; and (3) whether these can be predicted (Scherer, Frisina, and Medwetsky, in review).
Methods:
211 adults consecutively evaluated and fitted with hearing aids at the Rochester Hearing and Speech Center (Rochester, NY) were enrolled in the study from 2001 through 2003. Each patient had a full audiologic evaluation and was determined to have hearing loss of an appropriate degree and type to benefit from hearing aid amplification. Study participants had not previously worn hearing aids.
The Hearing Technology Predisposition Assessment (HTPA) was developed for this study (by Scherer and Medwetsky) to help ensure an appropriate match between the person and their hearing aids, or other hearing technology (e.g., assistive listening devices, cochlear implant, etc). The HTPA was based in part on Scherer & Frisina¡¦s previous work (1994, 1998) and incorporates the ¡§Matching Person and Technology¡¨ model (Scherer, 1991). The Matching Person and Technology model had multiple validation studies with different populations and technology use situations (e.g., Scherer & Craddock, 2002).
The development and validation of the HTPA progressed according to the standard practice of measure development (Scherer, 1995) as follows:
- Concept definition and clarification,
- Draft of items and response scales,
- Pilot testing, and
- Determination of measure quality and usefulness
- Current Status(11 items). Consumer subjective ratings of functional capabilities, Sample items:
- Dexterity and the ability to manipulate small objects
- Physical strength/stamina
- Social and recreational involvement
- Emotional well-being
- Dexterity and the ability to manipulate small objects
- Personal and Psychosocial (29 items). These items profile an individual's personal and psychosocial characteristics including support and assistance from family members. Sample items:
- I am a socially active person
- I feel confident
- I am easy going
- I accomplish what I set out to do
- I am satisfied with what I am able to do
- I find it easy to adjust to change and to new things
- I like to know as much as possible about things I use
- I like to be busy and have a lot going on
- I want to participate more fully in conversations
- I am a socially active person
- Expectations (baseline) or realizations (follow-up forms) (10 items). The Realizations form uses the same items as the Expectations form (future, but the wording is changed to reflect what has actually been realized by the patient). It is an analysis of prediction of anticipated benefit/realized benefit from hearing aid use. Sample items:
- I am confident I know how to use this device and its various features.
- This device will fit well with my accustomed routine.
- The supports, assistance and accommodations exist for successful use of this device.
- I will feel comfortable (and not self conscious) using this device around friends.
- I will feel comfortable (and not self conscious) using this device around the community.
- I am confident I know how to use this device and its various features.
Prior to the hearing aid fitting, subjects were asked to complete the HTPA and identify up to three specific listening goals they hoped to be achieved by the hearing aid fitting. Upon completion of the hearing aid fitting process (approximately 45 days after the date of initial fitting) they were asked to rate how well these goals had been met. Ratings were comprised of a three point rating scale (1 = no improvement; 2 = some improvement; 3 = much improvement).
Also at approximately the 45-day follow-up, participants were asked to rate their satisfaction on an 11 point rating scale, regarding their new hearing aids. The scale ranged from 0 (Not satisfied) to 10 (Very satisfied), thus, encompassing an 11 point range. The mean satisfaction rating was 7.8 out of a total possible score of 10 (very satisfied).
Participants completed the HTPA again at 3-months and 6-months post-fitting. Of the 211 individuals enrolled in the study, 176 completed all baseline measures and 168 completed the 3- and 6- month follow-up measures. Participants ranged in age from 34-89, with a mean age of 70.5 years (S.D. = 12.27). The reliability of the scales was statistically calculated and they were found to be very good.
A score of 50 on the Expectations of Hearing Technology Benefit scale means the individual expects maximum benefit (10 items X maximum score of 5 points = 50). The scoring is the same for the Realizations of Hearing Technology Benefit. The mean scores obtained at the various times of assessment are as follows:
Expectations = 39.81
Realizations (3-months) = 39.63
Realizations (6-months) = 40.09
At first glance, the HTPA seems to indicate that what patients ultimately derive (see Realizations, above) is similar to their expectations. However, if the HTPA is truly to be a useful instrument one must look not at group statistics, but how well it is able to provide individual information. Therefore, a correlation analysis examining the predictability of the benefits as a function of expectations was conducted.
When the 40 personal and psychosocial items (current status and personal/psychosocial items) were statistically analyzed for their ability to predict benefit, the results showed that the more positively respondents scored relative to their personal and psychosocial characteristics, the more favorably they viewed their realizations of benefit from hearing aid use. Thus, it appears that personality and temperament traits do predispose people to the realization of benefit from hearing aid use and realization of benefit and, importantly, this has been confirmed statistically.
For example, if a respondent scored positively on the current status items, the more likely it is that a positive realization of benefit will occur, but if the score was negative, then realization of benefit was less likely.
A particular individuals profile on the HTPA informs the audiologist of the degree of desired social activity, motivation for hearing technology use, whether or not other illnesses or physical challenges exist and the persons general outlook on life. Since these are all associated with later realization of benefit, this information is useful in assessing which intervention might best optimize results and perceived benefit, such as counseling, aural rehabilitation classes, the involvement of significant others, etc.
Note, the results obtained were on individuals who kept their hearing aids. Had the HTPA Realizations forms been completed on the few individuals who returned their hearing aids, the results would potentially have been even more enlightening regarding negative correlations and predictors of unlikely successes.
Summary:
Although physical aspects of hearing loss result in a range of hearing capability and outcomes that audiologists know a great deal about, as well as the technologies that are most apt to benefit individuals, personal aspects of hearing loss have historically received less attention.
Research suggests that helping individuals develop an emotional readiness to using hearing technologies is important in encouraging individuals to adopt hearing aids and other technologies achieve favorable outcomes.
Until the personal and psychosocial aspects of hearing loss are addressed more adequately, it is likely we will continue to see only 20% of those in need of some form of hearing amplification obtain it, and 15% no longer wearing their hearing aids on a consistent basis after one year.
In this era of emphasis on evidence-based practice, the use of a resource such as the new Hearing Technology Predisposition Assessment (HTPA) to assist in clinical and program outcomes, organize information about the needs of a particular individual, and provide insights into those factors that contribute to (or detract from) the use of the desired technology and perceived benefits from its use. With such insights, the hearing professional can diagnose and intervene in potential or existing problem areas through counseling, aural rehabilitation classes, the involvement of significant others, etc., and, thus, better ensure that the use of the technology will enhance the users feelings of being connected and quality of life. The inclusion of an instrument such as the HTPA into the audiology practice may help audiologists achieve greater customer satisfaction and likely reduce refunds/exchanges.
Finally, we welcome professionals interested in the HPTA to review the three appendices at the end of this paper (see appendix one, two and three) to view the HTPA in its entirety. The third appendix is a contact form, should the audiologist require or desire additional information.
Acknowledgments:
Funding for the reported research was made possible by a grant from Atlantic Philanthropies. Some material in this article has been adapted from:
Scherer, M.J. (2004). Connecting to Learn: Educational and Assistive Technology for People with Disabilities. Washington, DC: American Psychological Association Books. This book reports the experiences of individuals with hearing loss from childhood through adulthood, in elementary, secondary and postsecondary education and beyond, as they have incorporated technology use in their education, vocation, and day-to-day lives.
Appendix:
View: Comparing Devices for Expectations of Benefit
View: Hearing Technology Predisposition Assessment
View: Hearing Technology Predisposition Assessment (HTPA), Request for Updates and Revised Versions
References:
Pape, T.LB., Kim, J. & Weiner, B. ( 2002). The shaping of individual meanings assigned to assistive technology: a review of personal factors. Disability and Rehabilitation, 24 (1/2/3), 5-20.
Pollard, R. Q (1996). Professional psychology and deaf people: The emergence of a discipline. American Psychologist, 51 (4), 389-396.
Scherer, M. J. (2005). Living in the State of Stuck: How Technology Impacts the Lives of People with Disabilities, Third Edition. Cambridge, MA: Brookline Books.
Scherer, M.J. (2004). Connecting to Learn: Educational and Assistive Technology for People with Disabilities. Washington, DC: American Psychological Association Books.
Scherer, M.J. (1996). Outcomes of assistive technology use on quality of life. Disability and Rehabilitation, 18(9), 439-448.
Scherer, M.J. (1995). A model of rehabilitation assessment. In L. Cushman and M. Scherer (Eds), Psychological Assessment in Medical Rehabilitation (pages 3-23). Washington, DC: American Psychological Association Books.
Scherer, M.J. (1991). The Matching Person & Technology (MPT) Model Manual, First Edition. Webster, NY: The Institute for Matching Person & Technology, Inc.
Scherer, M.J. & Craddock, G. (2002). Matching Person & Technology (MPT) assessment process. Technology & Disability, 14(3), 125 ¡V 131.
Scherer, M.J. & Frisina, D.R. (1998). Characteristics associated with marginal hearing loss and subjective well-being among a sample of older adults. Journal of Rehabilitation Research and Development, 35(4), 420-426.
Scherer, M. J. & Frisina, D. R. (1994). Applying the Matching People with Technologies Model to individuals with hearing loss: What people say they want--and need--from assistive technologies. In M. J. Scherer (Ed.), Technology & Disability: Deafness and Hearing Impairments, 3(1), 62-68.
Scherer, M.J., Frisina, D.R. & Medwetsky, L. (in review). Predicting Realization of Benefit from Hearing Aid Use
Schirmer, B.R. (2001). Psychological, Social, and Educational Dimensions of Deafness. NY: Allyn & Bacon.
Thomas, A.J. (1985). Acquired Hearing Loss: Psychological and Psychosocial Implications. San Diego: Academic Press.
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Marcia J. Scherer, Ph.D., MPH, FACRM
Dr. Scherer is a Fellow of the American Psychological Association in Applied Experimental and Engineering Psychology; Evaluation, Measurement, and Statistics; and Rehabilitation Psychology. She is Director, Institute for Matching Person & Technology, and Sr. Research Associate, International Center for Hearing and Speech Research (a joint program of the University of Rochester and National Technical Institute for the Deaf/Rochester Institute of Technology) and Associate Professor of Physical Medicine and Rehabilitation, University of Rochester Medical Center. Dr. Scherer is also author of the new book, Connecting To Learn: Educational and Assistive Technology for People with Disabilities. She has written other books and many research articles on psychological aspects of technology use.
Larry Medwetsky, Ph.D., CCC-A
Dr. Larry Medwetsky graduated with a Ph.D. in Speech and Hearing Sciences in 1994 from the Graduate Center, City University of New York. Dr. Medwetsky is presently the Vice President of Audiology at the Rochester Hearing and Speech Center, where he has been employed for over 13 years. He has published and presented on many different topics with a special focus on underlying speech perception processes and deficits in both normal hearing and hearing impaired populations as well as examining barriers to accessing hearing related services among individuals with hearing loss.
D. Robert Frisina, Ph.D
Dr Frisina graduated with a PH.D. in Audiology and Psychology from Northwestern University. He is presently Director of the International Center for Hearing and Speech Research at Rochester Institute of Technology where he has served as the Founding Director of the National Institute for the Deaf , Sr. VP, and Secretary of RIT. He currently serves as Principal Investigator of an NIH research-supported multi-institutional program on age-related hearing loss.
