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Objective: This study aimed to gather opinions and establish consensus among audiologists and patients on supporting individuals with mental health concerns in audiology settings., Design: Utilising a modified electronic Delphi survey, a panel of 25 experts engaged in three rounds of data collection over 12 weeks. Participants provided open-text responses in Round 1 describing "clinical practices that can be employed to support to patients presenting with mental health concerns", and the research team combined these with relevant clinical practices from literature searches. In subsequent rounds, panellists then rated their level of agreement with the combined list of statements; individually (Round 2) and again after seeing the panel's collated responses (Round 3)., Study Sample: Panel experts included 11 patients (adults with hearing loss; M age 73.8 years) and 14 audiologists (with M 11.8 years of experience working in audiology)., Results: Consensus was met for 123 items categorised into: Detection, Education, Effective Communication, Provision of Emotional Support, Personal Qualities and Attitudes of the Audiologist, Interventions, Connecting the Patient to Additional Support Services, Normal Processes that are Especially Important in these Cases, and Organisational Considerations., Conclusions: The study highlights the diversity of approaches audiologists can employ to support patients with mental health concerns.

Purpose: (1) To understand the impact of adult cochlear implantation on the partner relationship, as perceived by adult cochlear implant (CI) recipients and their intimate partners. (2) To generate a conceptual framework for guiding future research and clinical adult cochlear implantation interventions., Method: Concept mapping, a participatory, mixed-method approach, was used for data collection, analysis and interpretation. Participants attended sessions to generate, sort and rate statements describing the changes in their relationship due to cochlear implantation. Participants included 15 CI recipients (mean age: 51.6 years; SD: 8.2) and 12 partners (mean age: 50.9 years; SD: 8.2)., Results: Five concepts emerged from the data, describing changes in the partner relationship following cochlear implantation: (1) Social Interactions , (2) Partner Involvement , (3) Communication , (4) Emotional Adjustment , and (5) Relationship Intimacy . The concept Relationship Intimacy was rated the highest in positivity and importance. Findings also underscored improved social interactions, communication dynamics, and emotional adjustment., Conclusions: The Relationship Intimacy cluster emerged as pivotal, highlighting its essential role in improving post-implantation relationships. CI recipients experienced enhanced autonomy, while partners' roles evolved regarding assistance and support. The diverse effects of implantation on partner relationships highlight the importance of adopting a patient- and family-centered approach to audiological intervention.

Purpose: The aim of this study was to investigate the perspectives of Australia-based hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use., Method: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants ( M age = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia., Results: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy., Conclusion: Low consumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology., Supplemental Material: https://doi.org/10.23641/asha.25619808.

Aim : Best-practice in audiological rehabilitation takes a holistic client- and family-centred approach and considers hearing care in the context of personal well-being. Hearing loss not only impairs the ability to hear, but can also compromise the ability to communicate, thus negatively impacting both social and emotional well-being. Hearing care professionals play a key role in fostering their client's well-being. This paper aims to provide evidence-based recommendations to ensure inclusion of social-emotional well-being in audiologic rehabilitation clinical practice. Methods : A review of current research and expert opinion. Results : This guide proposes a 5-step plan which includes: identifying the client's social-emotional well-being; including family members in audiological rehabilitation; incorporating social-emotional needs and goals in an individualized management plan; relating identified hearing needs and goals to rehabilitation recommendations; and using counselling skills and techniques to explore and monitor social-emotional well-being. Each component of the 5-step plan is discussed and clinical considerations are presented. Conclusion : These comprehensive recommendations provide guidance to hearing care professionals looking to ensure clients' social-emotional well-being are considered throughout the rehabilitation journey.

Objective: We aimed to explore (i) what adults with hearing difficulties want and need from hearables, which we defined as any non-medical personal sound amplification product, and (ii) what hearing care professionals think about hearables., Design: This was an exploratory, qualitative study conducted using separate focus groups with adults with hearing difficulties and audiologists. Data were analysed inductively using reflexive thematic analysis., Study Sample: Participants were 12 adults with hearing difficulties and 6 audiologists., Results: Adults with hearing difficulties expressed desire for trustworthy information and support, described evaluating hearables and other devices according to diverse personal criteria, and expressed willingness to vary their budget according to product quality. Audiologists expressed views that hearables are an inferior product but useful tool, that it is not necessarily their role to assist with hearables, that hearables are a source of uncertainty, and that the provision of hearables by audiologists is not currently practical., Conclusion: Adults with hearing difficulties may have complex reasons for considering hearables and may desire a high level of clinical support in this area. Ongoing research into the efficacy and effectiveness of hearables is needed together with research into effective strategies to incorporate hearables into clinical practice.

Objectives: The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol., Design: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews)., Results: Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants., Conclusions: The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Empowerment is the process through which individuals with hearing-related challenges acquire and use knowledge, skills and strategies, and increase self-efficacy, participation, and control of their hearing health care, hearing solutions, and everyday lives. The aim was to refine and validate the Empowerment Audiology Questionnaire (EmpAQ), a hearing-specific measure of empowerment. This was achieved through (1) refinement via Rasch analysis (study 1), and (2) traditional psychometric analysis of the final survey structure (study 2)., Design: In study 1, 307 adult hearing aid owners completed the initial empowerment measure (33 items) online. To inform an intended item reduction, Rasch analysis was used to assess a range of psychometric properties for individual items. The psychometric properties included analysis of individual items (e.g., response dependency, fit to the polytomous Rasch model, threshold ordering) and the whole EmpAQ (e.g., dimensionality). Item reduction resulted in a 15-item version (EmpAQ-15) and a short-form 5-item version (EmpAQ-5), validated using modern (Rasch), and traditional (Classical Test Theory) psychometric analysis (study 2). In study 2, 178 adult hearing aid owners completed the EmpAQ-15 and EmpAQ-5, alongside 5 questionnaires to measure related constructs. These included two hearing-specific questionnaires (Social Participation Restrictions Questionnaire and Self-Assessment of Communication), two general health-related questionnaires (Patient Activation Measure and World Health Organization Disability Assessment Schedule 2.0), and a general empowerment questionnaire (Health Care Empowerment Questionnaire). Modern (Rasch) and traditional psychometric analysis techniques (internal consistency, construct validity, and criterion validity) were used to assess the psychometric properties of the EmpAQ-15 and EmpAQ-5., Results: Rasch analysis of the initial 33-item measure of empowerment identified 18 items with high response dependency, poor fit to the Rasch model, and threshold disordering, which were removed, resulting in a long-form (EmpAQ-15) hearing-specific measure of empowerment. A short-form (EmpAQ-5) version was developed for use in the clinic setting. Validation of the two EmpAQ measures using Rasch analysis showed good item fit to the Rasch model, appropriate threshold targeting, and the existence of unidimensionality. Traditional psychometric evaluation showed that both questionnaires had high internal consistency and positive correlations with the hearing-specific questionnaires. However, in contrast with our hypotheses, correlations with general health questionnaires were stronger than with hearing-specific questionnaires; all questionnaires were correlated with the EmpAQ and in the direction hypothesized. Taken together, these findings support the construct validity of the EmpAQ-15 and EmpAQ-5., Conclusions: The EmpAQ-15 and EmpAQ-5 are the first self-report measures to be developed specifically for the measurement of empowerment. The EmpAQ-15 and EmpAQ-5 were found to meet the Rasch model criteria for interval-level measurements. Traditional psychometric evaluation supports the construct validity of both measures. The EmpAQ measures have the potential to be used in both research and clinical practice to evaluate empowerment along the hearing journey. The next stage of this research will be to further validate these measures by assessing their responsiveness, minimal clinically important difference, and clinical interpretability in a clinical population., (Copyright © 2023 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Purpose: While the impact of paediatric cochlear implantation on parents and siblings are recognised, limited evidence exists regarding the effect of paediatric cochlear implantation on the entire family life (e.g., routine interactions, family activities). This study aimed to describe the impact of paediatric cochlear implantation on family life as perceived by parents, using concept mapping., Materials and Methods: Parents of paediatric cochlear implant (CI) recipients ( n  = 29) participated in this concept mapping study to generate, group, and rate statements regarding the impact of paediatric cochlear implantation on family life., Results: In total, 99 unique statements described the impact of paediatric cochlear implantation on family life. The concept map revealed six concepts, namely (i) Financial Outlay and Supports ; (ii) Education and Therapy ; (iii) Responsibilities and Sacrifices ; (iv) Extended Family and Community ; (v) Spouses and Siblings and (vi) Achievements and Enrichments ., Conclusions: This study highlights the multiple areas of family life affected by paediatric cochlear implantation. To improve patient-and-family-centered care, these factors must be considered during pre-operative and successive counselling of paediatric CI recipients and their families.

Objective: To conduct the first phases in the development of a self-report measure of empowerment on the hearing health journey, specifically, item generation and content evaluation of the initial pool of items generated., Design: A content expert panel survey and cognitive interviews were conducted. Descriptive statistics were obtained for the quantitative data, and the cognitive interviews were analysed using thematic analysis., Study Sample: Eleven researchers and clinicians participated in the content expert surveys. Sixteen experienced hearing aid users participated in the cognitive interviews, recruited from the USA and Australia., Results: The items underwent five iterations based on feedback from the survey and interview data. This resulted in a set of 33 quality-tested potential survey items that were rated highly for relevance (mean = 3.96), clarity (mean = 3.70) and fit to dimensions of empowerment (mean = 3.92) (scale 0-4, where 4 was the maximum rating)., Conclusions: Involving stakeholders in item generation and content evaluation increased relevance, clarity, fit to dimension, comprehensiveness, and acceptability of the items. This preliminary version of the 33-item measure underwent further psychometric refinement (Rasch analysis and traditional classical test theory testing) to validate it for clinical and research use (reported separately).

Objective: To assess non-medical amplification devices in adults with mild-to-moderate hearing loss, and the impact of device features on outcomes., Design: A prospectively registered systematic review., Study Sample: Ten studies evaluating personal sound amplification products (PSAPs), and four evaluating smartphone amplification applications (or apps). Devices were classified as "premium" or "basic" based on the number of compression channels (≥16 or <16, respectively)., Results: Meta-analyses showed that premium PSAPs improved speech intelligibility in noise performance compared to unaided, whereas basic PSAPs and smartphone apps did not. Premium PSAPs performed better than basic hearing aids. Premium hearing aids performed better than premium and basic PSAPs, smartphone apps, and basic hearing aids. Although data could not be pooled, similar findings were also found for quality of life, listening ability, cognition, feasibility, and adverse effects., Conclusions: Premium PSAPs appear to be an effective non-medical amplification device for adults with mild-to-moderate hearing loss. Given the overlap in features available, it may be that this is a key consideration when drawing comparisons between devices, rather than the device being named a PSAP or hearing aid. Nevertheless, the extent to which PSAPs are effective without audiological input remains to be determined.

Background: Chronic tinnitus during childhood/adolescence can be associated with impaired quality of life. Guidelines for managing paediatric tinnitus recommend assessment and interventions are often based upon the experiences and opinions of guideline committee members., Objective: To examine patient response tools used for the assessment and management of childhood tinnitus and how interventions had been evaluated., Design: A structured scoping review (i) identifying and critically appraising patient response measures (PRMs) assessing tinnitus in children/adolescents, and (ii) critically appraising evidence supporting reported interventions. Original papers written in English, involving paediatric participants ≤19 years, reporting (i) application of established PRMs to assess the experience of chronic tinnitus or (ii) application and evaluation of tinnitus interventions were included., Study Sample: Papers written in English, identifying, or assessing the experience of chronic tinnitus (>3 months) as a primary complaint during childhood/adolescence in participants ≤19 years of age using a PRM and studies evaluating the application of non-pharmaceutical interventions for tinnitus in children/adolescents., Results: Six studies involving the assessment of tinnitus during childhood/adolescence using a PRM were identified and evaluated. Three established (previously named, described, and published) PRMs were applied of which none were developed specifically for children/adolescents. Three behavioural tinnitus interventions and three combination intervention strategies (coupling of psychological intervention with sound enrichment) had been applied to and evaluated within paediatric populations., Conclusions: Although clinicians are seeing children/adolescents with tinnitus, they are evaluating and managing children's distress without appropriate PRMs, and little evidence exists to support clinical interventions.

Objective: To explore the utilisation, safety, cost, and patient outcomes of delivering tele-audiology services during the COVID-19 pandemic., Design: A national cross-sectional self-report online survey asking participants to reflect on interactions with hearing services between April and October 2020. Data were analysed using descriptive statistics. The COM-B model of behaviour change guided survey creation and the presentation of a subset of the results., Study Sample: 249 Australia-based hearing healthcare clinicians (age range 23-74 years; 162 female)., Results: Clinicians reported an increase in the use of tele-audiology services, with key drivers relating to keeping their patients safe and keeping businesses running. Clinicians generally viewed the provision of tele-audiology services as successful and resulting in improved patient outcomes. Overall, clinicians were highly motivated to provide tele-audiology services, and they expressed being confident in their knowledge and understanding of tele-audiology service delivery. Barriers to providing tele-audiology services included concerns about the reliability of the results obtained from remote assessments, as well as concerns around information security and privacy issues., Conclusions: Clinicians' motivations to use tele-audiology services appeared to be driven by their desire to maintain COVID-safe practices during the pandemic and by the COVID-driven increase in availability of funding for tele-audiology services.

Background: Shigella sp. are enteric pathogens which causes >125 million cases of shigellosis annually. S. sonnei accounts for about a quarter of those cases and is increasingly prevalent in industrialising nations. Being an enteric pathogen, S. sonnei benefits from outcompeting gut commensals such as Escherichia coli to establish itself and cause disease. There are numerous mechanisms that bacterial pathogens use to outcompete its rivals including molecules called colicins. A Type 6 Secretion System (T6SS) was recently described as contributing to E. coli killing in S. sonnei., Methods: We used Bulk Phenotyping of Epidemiological Replicates (BPER) which combined bacterial Genome Wide Association Studies (bGWAS) and high throughput phenotyping on a collection of S. sonnei surveillance isolates to identify the genetic features associated with E. coli killing and explore their relationship with epidemiological behaviour. We further explored the presence of colicins and T6SS components in the isolates using genomics, laboratory experimentation, and proteomics., Findings: Our bGWAS analysis returned known and novel colicin and colicin related genes as significantly associated with E. coli killing. In silico analyses identified key colicin clusters responsible for the killing phenotype associated with epidemiologically successful sub-lineages. The killing phenotype was not associated with the presence of a T6SS. Laboratory analyses confirmed the presence of the key colicin clusters and that killing was contact-independent., Interpretation: Colicins are responsible for E. coli killing by S. sonnei, not a T6SS. This phenotype contributes to shaping the observed epidemiology of S. sonnei and may contribute to its increasing prevalence globally. BPER is an epidemiologically relevant approach to phenotypic testing that enables the rapid identification of genetic drivers of phenotypic changes, and assessment of their relevance to epidemiology in natural settings., Funding: Biotechnology and Biological Sciences Research Council, Biotechnology and Biological Sciences Research Council Doctoral Training Partnership studentship, Wellcome Trust, Medical Research Council (UK), French National Research Agency., Competing Interests: Declaration of interests Authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

There are many examples of remote technologies that are clinically effective and provide numerous benefits to adults with hearing loss. Despite this, the uptake of remote technologies for hearing healthcare has been both low and slow until the onset of the COVID-19 pandemic, which has been a key driver for change globally. The time is now right to take advantage of the many benefits that remote technologies offer, through clinical, consumer, or hybrid services and channels. These include greater access and choice, better interactivity and engagement, and tailoring of technologies to individual needs, leading to clients who are better informed, enabled, and empowered to self-manage their hearing loss. This article provides an overview of the clinical research evidence-base across a range of remote technologies along the hearing health journey. This includes qualitative, as well as quantitative, methods to ensure the end-users' voice is at the core of the research, thereby promoting person-centered principles. Most of these remote technologies are available and some are already in use, albeit not widespread. Finally, whenever new technologies or processes are implemented into services, be they clinical, hybrid, or consumer, careful consideration needs to be given to the required behavior change of the key people (e.g., clients and service providers) to facilitate and optimize implementation., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Objective: To canvas the views of Australia-based hearing healthcare clinic owners/managers and reception staff regarding the utilisation, experiences and perspectives of providing tele-audiology services during the COVID-19 pandemic., Design: A national prospective self-report survey was completed online. Data were analysed using descriptive statistics., Study Sample: Twenty-one clinic owners/managers (M age 54.43 years, 15 female) and 58 reception staff (M age 42.88 years, 49 female) from Australia-based hearing clinics., Results: Clinic owners/managers reported an increase in use of tele-audiology services as compared to pre-COVID-19. Reception staff reported providing more advice and support to clients over the phone. Both clinic owners/managers and reception staff indicated key barriers to providing tele-audiology services to include concerns about their clients' digital and technological literacy and the perception that in-the-clinic appointments deliver better client outcomes than tele-audiology appointments., Conclusions: The increased utilisation of tele-audiology services observed appears to be largely influenced by COVID-19 related factors (e.g. maintaining client and staff safety and increased funding). It is therefore possible that utilisation of tele-audiology service may drop once the threat of the pandemic has subsided. Perceived barriers relating to clients' digital literacy and the effectiveness of tele-audiology services require attention to safeguard the future of tele-audiology service delivery in Australia.

Objective: To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being., Design: This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model., Study Sample: Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated., Results: Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice., Conclusions: Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being.

Objective: The purpose of this study was to explore whether self-reported mental wellbeing (anxiety, depression and loneliness) in audiologists has changed over the course of the COVID-19 pandemic and to examine possible factors contributing to audiologists' current state of mental wellbeing. Design: Two cross-sectional surveys were distributed at two different time points during the COVID-19 pandemic screening for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3). Study sample: 117 audiologists from around the world. Results: Findings demonstrated that over the course of the COVID-19 pandemic audiologists' levels of depression decreased, levels of anxiety were low and stable, whilst levels of loneliness were stable and high. Younger age was associated with lower levels of mental well-being. Responses to open text questions suggests that audiologists could be supported through development of clear and consistent guidelines on COVID-19 workplace restrictions, allowing for more workplace flexibility and providing mental health support through employee assistance programs. Conclusions: The rates of anxiety, depression and loneliness observed highlight the continued need for mental health and workplace interventions to support audiologists throughout the COVID-19 pandemic and the subsequent recovery period.

Background: This study aimed to describe available evidence of cochlear implantation delivery arrangements in adults and the outcomes by which these service models are measured., Methods: Scoping review of English language, primary studies conducted on adults (≥18 years) with ten or more subjects, published between January 2000 and June 2022, which assessed the effects of delivery arrangements of cochlear implantation were included. MEDLINE, EMBASE, CINAHL Plus, AMED, PsycINFO, LILACS, KoreaMed, IndMed, Cochrane CRCT, ISRCTN registry, WHO ICTRP and Web of Science were systematically searched. Included studies had to have a method section explicitly measure at least one of the Cochrane Effective Practice and Organization of Care (EPOC) outcome category. Criteria for systematic reviews and delivery arrangement category based on EPOC taxonomy was included in data extraction. Data was narratively synthesized based on EPOC categories., Results: A total of 8135 abstracts were screened after exclusion of duplicates, of these 357 studies fulfilled the inclusion criteria. Around 40% of the studies investigated how care is delivered, focusing on quality and safety systems. New care pathways to coordinate care and the use of information and communication technology were emerging areas. There was little evidence on continuity, coordination and integration of care, how the workforce is managed, where care is provided and changes in the healthcare environment. The main outcome measure for various delivery arrangements were the health status and performance in a test., Conclusion: A substantial body of evidence exists about safety and efficacy of cochlear implantation in adults, predominantly focused on surgical aspects and this area is rapidly growing. There is a lack of evidence on aspects of care delivery that may have more impact on patients' experience such as continuity, coordination and integration of care and should be a focus of future research. This would lead to a better understanding of how patient's view CI experience, associated costs and the value of different care models., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ebrahimi-Madiseh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: This study describes the development of an intervention to increase the frequency of audiologists' asking about and providing information regarding mental wellbeing within adult audiology services., Design: The Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed., Results: A multifaceted intervention was developed to change audiologists' behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing, (2) providing general information on the mental wellbeing impacts of hearing loss, and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources., Conclusion: This study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work., (© 2023. The Author(s).)

Objective: To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being., Design: A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change)., Study Sample: Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3)., Results: Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss., Conclusion: Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Objective: To examine willingness to consider and to pay for various one-to-one telehealth appointments and online group training/information sessions amongst hearing service clients interested in future telehealth., Design: Online survey exploring telehealth usage and attitudes more broadly., Study Sample: One-hundred-and-sixty-eight (39.8%) of the 422 survey respondents who answered the question were interested in future hearing-related telehealth. Data were analysed for the 148 providing demographic information., Results: At least some respondents were interested in each type of one-to-one appointment (∼30-60% for most types) and group training/information session (∼30-50% for most types). Some inconsistent associations were found between willingness to consider individual appointment types and a metropolitan location, younger age, and female gender. Associations with having a hearing device fitted may have been influenced by the different needs of those without devices. Younger respondents were more likely to consider a wide range of appointment types. Being younger was associated with an interest in 7 of the 9 different group session types. The acceptable price range was AUD$30-$86 (USD$22-$62) ( n  = 129) for one-to-one appointments and AUD$47-$103 (USD$34-$73) for three group sessions ( n  = 99)., Conclusions: Despite additional communication needs, hearing service clients have a strong interest in a range of individual and group telehealth services.

Objective: To understand the nature of mental health discussions in audiological rehabilitation, specifically, the types of conversations, when and how they are initiated, and the participant factors associated with discussing mental health., Design: A cross-sectional descriptive survey including quantitative (multiple choice) and qualitative (free-text) questions regarding mental health discussions between audiologists and clients., Study Sample: A convenience sample of 118 Australian audiologists working in adult audiological rehabilitation., Results: The majority of participants (95.8%) reported having engaged in discussions with clients about mental illness and health at some point throughout their career. The frequency of these discussions varied across participants: 7% rarely discuss, 50% discuss occasionally, 30% discuss with about half their clients and 13% have discussions with most clients. Many participants (85.6%) reported that clients would initiate these conversations, most often via disclosing the impacts of hearing loss on clients' lives., Conclusions: Most audiologists will encounter clients with mental health concerns, and many will engage in conversations about psychological symptoms, therefore, training audiologists to recognise and address verbal and non-verbal cues regarding mental health may help to promote person-centred care and potentially improve outcomes.

Objectives: Psychological factors, such as mental illness, mental health, attitudes, emotions, and coping styles, are known to impact the success of audiological rehabilitation. However, evidence suggests that audiologists are not sufficiently addressing client psychological factors. Psychologically informed practice, implemented in other healthcare professions, is a framework that guides clinicians in addressing both the physical and psychological factors of a condition throughout rehabilitation. Psychologically informed practice may also be an appropriate framework to improve client outcomes in audiology. The objectives of this study were (1) to determine the barriers and facilitators to audiologists addressing client mental health, psychological symptoms, emotions, and feelings, and (2) to determine audiologists' preparedness and willingness to implement aspects of psychologically informed practice in audiological rehabilitation., Design: A cross-sectional survey was conducted with a convenience sample of 118 Australian clinical audiologists (83.1%, n = 98 female) working in adult audiological rehabilitation., Results: Most participants (91.5%) reported at least one barrier to discussing mental health with clients, with the most common being insufficient knowledge and skills in mental health (39.8%). Applying the COM-B model of behavior change, audiologists reported that factors related to motivation were primarily facilitators, and factors related to opportunity (e.g., lack of time) and capabilities (e.g., insufficient knowledge) were barriers to discussing client mental health. Many participants (83.1%) reported willingness to incorporate a clear protocol, including when and how to refer to psychological services, within audiological rehabilitation., Conclusions: Audiologists were generally motivated to incorporate psychologically informed practice into audiological rehabilitation; however, lack of knowledge and organizational barriers would need to be overcome. The insights gained in this study provide a foundation for developing a viable approach to psychologically informed practice, which may ultimately encourage audiologists to engage in person-centered care more actively., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To explore factors influencing postoperative experiences of adult cochlear implant (CI) recipients, determine the impact of each factor, and conceptualize recipients' postoperative journey., Study Design: Participatory mixed methods; concept mapping., Setting: Tertiary care (private and public)., Patients: Ninety-three participated in the brainstorming activity. Eighty-nine completed the sorting tasks (96% retention rate): CI recipients (n = 44), significant others (n = 13), CI audiologists (n = 14) and surgeons (n = 5), CI clinics' administration staff (n = 5) and managers (n = 3), and CI manufactures' clinical support staff (n = 5)., Interventions: Rehabilitative (CIs)., Main Outcome Measures: Statements were generated and rated by participants. Similarity of grouping of the statements informed the matrices used for cluster analysis to form concepts., Results: Eighty-seven unique statements described the factors influencing adapting to, use, and maintenance of CIs after implantation. These were grouped, and five concepts were identified: financial considerations, complications, device usability and durability, device programming and adaptation, and patient motivation and supports. Although statements within the concepts financial considerations and complications were negatively rated, statements within the concepts device programming and adaptation, and patient motivation and supports were mostly rated as having positive influence in patients' postoperative journey. The concept device usability and durability contained both negatively and positively rated statements., Conclusions: Postoperative experience of adult CI recipients is a multifaceted journey with several challenges to address to improve services. Although support from and connection with family and clinicians, and simplicity of using a CI device facilitated the experience, medical and surgical complications, durability, and cost of maintaining the device challenged the postoperative experience., Competing Interests: The authors disclose no conflicts of interest. The authors would like to thank the Ear Science Institute Australia for a partial scholarship to the first author to support parts of this project., (Copyright © 2022, Otology & Neurotology, Inc.)

Purpose: Online reviews have become increasingly common for consumers to share their experiences about products and to assist potential consumers with decision making. The current study was aimed to understand the hearing aid user experience from online consumer reviews using qualitative analysis., Method: The study used a qualitative thematic analysis to analyze open text responses from consumers leaving hearing aid reviews on the http://www.HearingTracker.com website. One thousand three hundred seventy-eight online consumer hearing aid reviews (open-text responses) were extracted and analyzed., Results: Three domains emerged within the data set, containing 11 themes and 136 subthemes. Domain one (Clinical Processes) contained two themes: Hearing Assessment and Hearing Aid Acquisition. Domain two (The Device) contained five themes: Function, Performance, Physical, Device Management, and Maintenance. Domain three (The Person) contained four themes: Satisfaction, Quality of Life, Personal Adjustment, and Knowledge. The themes gave an understanding that there were a contribution of factors that formed part of a consumers hearing aid user experience., Conclusions: Hearing aid users described a range of positive, negative, and neutral descriptions online about their hearing aid user experience and gave advice to fellow hearing aid users helping clinicians improve their hearing aid fitting skills in practice. These findings have implications to future product development as well as service delivery model in terms of developing strategies for fostering patient-centered audiological practice.

Objective: To explore the lived experience of social challenges and emotional distress in relation to hearing loss and the coping mechanisms employed to manage them., Design: Two focus groups and two one-on-one semi-structured interviews were conducted during February 2020. Transcripts were first inductively analysed to identify experiential categories of social and emotional difficulty, and then deductively analysed using Leventhal's self-regulation model to identify how individuals conceptualised these experiences and the coping mechanisms employed to manage them., Study Sample: Adults with hearing loss and self-reported emotional distress due to their hearing loss ( n  = 21) and their significant others ( n  = 9)., Results: Participants described their social and emotional experiences of hearing loss in terms of negative consequences (social overwhelm, fatigue, loss, exclusion), identity impact (how they perceive themselves and are perceived by others), and emotional distress (frustration, grief, anxiety, loneliness, and burdensomeness). While many participants described a general lack of effective coping strategies, others described employing coping strategies including avoidance (helpful and unhelpful), controlling the listening environment, humour, acceptance, assertiveness, communication repair strategies, and accepting support from significant others., Conclusion: Many participants described a lack of effective coping strategies and tended to rely on avoidance of social interaction,deepening their isolation and loneliness.

Objective: The aim of the study was to examine the mental well-being of audiologists in the midst of the COVID-19 pandemic., Design: A cross-sectional online survey was conducted during the COVID-19 pandemic, between 23 June and 13 August 2020. A self-report survey included screening measures for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3)., Study Sample: 239 audiologists from around the world., Results: The prevalence of psychological distress was 12.1% (subscales for anxiety 16.3% and depression 10.4%), and loneliness 32.2%. Depression and loneliness were higher in those participants self-reporting perceived job insecurity, with psychological distress (anxiety and depression) higher in those from South Africa. Accessibility to Employee Assistance Programs (EAPs) appears to be a protective factor., Conclusions: Well-being interventions, such as EAPS, are needed to support audiologists during challenging times like the COVID-19 pandemic.

Objective: To determine the attitudes of audiologists towards telehealth and use of telehealth for the delivery of ear and hearing services pre-, during- and post- the COVID-19 pandemic, and to identify the perceived effects of telehealth on services and barriers to telehealth., Design: An online survey distributed through the International Society of Audiology and member societies., Study Sample: A total of 337 audiologists completing the survey between 23 June and 13 August 2020., Results: There was a significant increase in the perceived importance of telehealth from before (44.3%) to during COVID-19 (87.1%), and the use of telehealth previous (41.3%), current (61.9%) and expected use of telehealth (80.4%). Telehealth was considered adequate for many audiology services, although hearing assessment and device fitting by telehealth received least support. Matters related to timeliness of services and reduction of travel were reported as the main advantages, but relationships between practitioners and clients may suffer with telehealth. Important barriers were technologies related to the client or remote site; clinic-related items were moderate barriers, although more clinician training was a common theme provided through open-ended responses., Conclusion: The COVID-19 pandemic has resulted in audiologists having a more positive attitude towards and greater use of telehealth, but with some reservations.

Objective: This study surveyed the effects of the COVID-19 pandemic on the audiology workplace., Design: The study used a cross-sectional survey design for audiologists across the globe ( n  = 337) using an online survey (June-August 2020) focussing on changes to the workplace during the pandemic., Results: Participants represented varied work settings and audiology services. Only a third (31.5%) provided psychosocial support, which may be important during the pandemic, as part of their services. Almost all (97%) audiologists reported changes to their workplace, with 76.4% reporting reduced caseloads during the COVID-19 pandemic. When rating their current and anticipated work conditions, 38.7% reported reduced working hours although only 13.8% anticipated reduced working hours in 6-months' time. Audiologists ranked services such as access to hearing assessment, hearing device adjustment and maintenance, and general audiological support as being more important during the pandemic than services such as psychosocial, emotional and tinnitus support., Conclusions: The COVID-19 pandemic has resulted in significant disruptions to audiological practice that highlights the need to adapt and incorporate new audiological practices including telehealth, to ensure patients have continued access to care and clinics remain sustainable during the ongoing COVID-19 pandemic and recovery phase.

Objective: To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices., Design: A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis., Study Sample: Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting., Results: Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians' ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss., Conclusions: These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.

Cybersecurity is an ever-present problem for organizations, but organizational science has barely begun to enter the arena of cybersecurity research. As a result, the "human factor" in cybersecurity research is much less studied than its technological counterpart. The current manuscript serves as an introduction and invitation to cybersecurity research by organizational scientists. We define cybersecurity, provide definitions of key cybersecurity constructs relevant to employee behavior, illuminate the unique opportunities available to organizational scientists in the cybersecurity arena (e.g., publication venues that reach new audiences, novel sources of external funding), and provide overall conceptual frameworks of the antecedents of employees' cybersecurity behavior. In so doing, we emphasize both end-users of cybersecurity in organizations and employees focused specifically on cybersecurity work. We provide an expansive agenda for future organizational science research on cybersecurity-and we describe the benefits such research can provide not only to cybersecurity but also to basic research in organizational science itself. We end by providing a list of potential objections to the proposed research along with our responses to these objections. It is our hope that the current manuscript will catalyze research at the interface of organizational science and cybersecurity., Competing Interests: Conflict of interestThe authors have no known conflicts of interest to disclose., (© The Author(s) 2021.)

Purpose: Audiology clinical guidelines recommend the use of mental health screening tools; however, they remain underutilized in clinical practice. As such, psychological concerns are frequently undetected in adults with hearing loss. This study aimed to better understand audiology clinic staff's perspectives (including audiologists, audiometrists, reception staff, and clinic managers) on how to improve detection of poor mental health by (a) exploring the role of audiology clinic staff in detecting psychological concerns in adults with hearing loss and (b) investigating the appropriateness, acceptability, and usability of several screening tools in an audiology setting., Method: Eleven audiology clinic staff ( M age = 33.9 ± 7.3, range: 25-51 years) participated in a semistructured focus group. First, participants discussed the role of audiology clinic staff in detecting psychological difficulties in adults with hearing loss, including current practices and needs for improving practices. Second, participants discussed the appropriateness, acceptability, and usability of nine standardized mental health screening tools commonly used in wider health care settings., Results: Audiology clinic staff described their role in being aware of, and detecting, psychological difficulties, as well as their part in promoting an understanding of the link between hearing loss and mental health. Participants described the need to provide support following detection, and highlighted barriers to fulfilling these roles. The use of mental health screening tools was considered to be client and context specific. The language used within the screener was identified as an important factor for its acceptability by audiology clinic staff., Conclusions: Audiology clinic staff acknowledged that they have an important role to play in the detection of psychological difficulties and identified the core barriers to using screening tools. Future research may explore the possibility of developing a mental health screening tool specific to the unique experiences of adults with comorbid hearing loss and mental health concerns., Supplemental Material: https://doi.org/10.23641/asha.16702501.

Purpose: This study aimed to (a) identify participant factors associated with hearing aid review (HAR) appointment attendance, (b) investigate whether the completion of self-report survey identifying hearing aid-related problems affects HAR appointment attendance, and (c) investigate whether hearing aid problems and hearing aid management deficiencies are adequately addressed during HAR appointments., Method: A prospective cohort study of adult hearing aid owners recruited from a single hearing clinic in Western Australia. Potential participants were invited to an annual HAR appointment via postal letter. The invitation included a paper-based self-report survey evaluating either (a) hearing aid problems, (b) hearing aid management skills, or (c) hearing aid outcomes, depending on which intervention/control group the potential participants were assigned to, and a reply paid addressed envelope. Two months later, potential participants were sent all three paper-based self-report surveys, irrespective of whether they had attended or not attended an HAR appointment., Results: (a) There was no significant difference in gender or source of funding for hearing services between HAR appointment attendees and nonattendees. HAR nonattendees lived a greater distance from their clinic and were younger than attendees. (b) Survey completion did not influence HAR appointment attendance rates. (c) A significant reduction in individuals' self-reported hearing aid problems was recorded following the attendance at the HAR appointment. No significant changes in hearing aid management skills or overall hearing aid outcomes were detected., Conclusions: Long travel distances may be a barrier to attendance at review appointments. HAR appointments appear to be effective in improving hearing aid problems.

Purpose: Hearing loss causes emotional distress and can contribute to the development of psychological difficulties, yet emotional and psychological issues are not addressed within current audiology services. The purpose of this study was to use focus groups with consumer and community representatives to explore how we might improve the provision of support for clients experiencing emotional and psychological issues in relation to their hearing loss., Participants: Adults with hearing loss ( n = 19) and their significant others ( n = 9), as well as 10 hearing health care professionals ( n = 4 hearing health care clinicians, n = 4 reception staff, and n = 2 clinical managers), participated in consumer and community engagement focus groups., Method: Consumer and community representatives were tasked with (a) identifying the stakeholders involved in supporting adults experiencing emotional or psychological difficulties on account of their hearing loss, (b) describing the behaviors undertaken by each stakeholder group, and (c) selecting target behavior(s) that could optimally form the basis of an intervention program to improve the quality and frequency of support provided to people experiencing emotional and psychological problems in the audiology setting., Results: Participants identified 12 stakeholder groups involved in supporting adults with hearing loss experiencing emotional and psychological problems. The three behaviors voted by participants to be the most promising for a behavioral intervention included the clinician (a) asking about, (b) providing information on, and (c) delivering therapeutic intervention for emotional and psychological well-being within audiological service provision., Conclusion: Consumer and community stakeholder representatives indicate a general desire for hearing health care clinicians to deliver support for the emotional and psychological issues that arise relating to hearing loss.

Objectives and importance of study: Interventions are needed to help general practitioners (GPs) better support clients living with age-related hearing loss. This project canvassed stakeholder views regarding how GPs might better support people with hearing loss., Study Type: A group concept-mapping approach was used to identify enablers to improving the way in which GPs could support people with age-related hearing loss., Methods: Concept-mapping techniques were used to gather the perspectives of GPs (n = 7), adults with hearing loss (n = 21), and professionals working with GPs (n = 4) in Australia. Participants generated statements in response to the question, "What would enable GPs to better support people with hearing loss?" Participants then grouped and ranked these statements via an online portal., Results: Five concepts were identified: 1) making hearing assessment part of routine care; 2) asking questions and raising concerns; 3) listening with empathy and respect; 4) having knowledge and understanding; 5) being connected to expert hearing professional networks. Statements contained within all five concepts were deemed to be highly beneficial in this context, with no individual concept identified to be more or less beneficial than any of the other four concepts., Conclusions: A wide range of hearing-specific and general communication approaches were identified that could potentially help GPs to better support their adult patients with age-related hearing loss., Competing Interests: None declared.

Importance: The prevalence of hyperacusis and its relationship with mental and general health is unknown in a nonclinical sample. Therefore, we aimed to determine the prevalence of hyperacusis and its relation with hearing, general and mental health in a population-based study., Study Design: Prospective population-based study., Material and Methods: This study uses data from the Busselton Healthy Ageing Study (BHAS). A sample of 5,107 eligible inhabitants aged 45 to 70 years completed a detailed questionnaire and a clinical assessment. A positive answer to "Do you consider yourself sensitive or intolerant to everyday sounds" was used to indicate hyperacusis. Logistic regression was used to examine the association between hearing, mental and general health factors, and hyperacusis., Results: Of 5,107 participants, 775 (15.2%) reported hyperacusis. The majority of participants with hyperacusis reported an occasional effect on daily life (72.0%). Being female, older in age, having a lower income, physical or mental health difficulties, more severe hearing loss, and tinnitus were all associated with the presence of hyperacusis. Individuals who experience hearing impairment, poorer general or mental health have a higher possibility of hyperacusis having an effect on their daily life., Conclusions: In this community population-based cohort study, we found a prevalence of hyperacusis of 15.2%. Individuals with hearing loss, mental health problems, and lower physical health have a higher possibility of experiencing effects on their daily life associated with their hyperacusis. Unravelling the relationship between hyperacusis hearing, general and mental health can be of major importance for a better understanding of the condition and its consequences., Level of Evidence: 2 Laryngoscope, 131:E2887-E2896, 2021., (© 2021 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To explore the publicised opinions of consumers actively participating in online hearing aid reviews., Design: A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership)., Study Sample: 1378 online consumer hearing aid reviews., Results: Six clusters within two domains were identified. The domain Device Acquisition included three clusters: Finding the right provider, device and price-point; Selecting a hearing aid to suit the hearing loss; Attaining physical fit and device management skills. The domain Device Use included three clusters: Smartphone streaming to hearing aids ; Hearing aid adjustment using smartphone; and Hearing in noise ., Conclusions: Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.

Purpose Online reviews have been used by hearing aid owners to share their experiences and to provide suggestions to potential hearing aid buyers, although they have not been systematically examined. The study was aimed at examining the hearing aid consumer reviews using automated linguistic analysis, and how the linguistic variables relate to self-reported hearing aid benefit and satisfaction ratings. Method The study used a cross-sectional design. One thousand three hundred seventy-eight consumer hearing aid reviews (i.e., text response to open-ended question), self-reported benefit and satisfaction ratings on hearing aids in a 5-point scale with meta-data (e.g., hearing aid brand, technology level) extracted from the Hearing Tracker website were analyzed using automated text analysis method known as the Linguistic Inquiry and Word Count. Results Self-reported hearing aid benefit and satisfaction ratings were high (i.e., mean rating of 4.04 in a 5-point scale). Examining the association between overall rating and the key linguistic variables point to two broad findings. First, the more people were personally, socially, and emotionally engaged with the hearing device experience, the higher they rated their hearing device(s). Second, a minimal occurrence of clinic-visit language dimensions points to factors that likely affect benefit and satisfaction ratings. For example, if people mention paying too much money (money), their overall ratings are generally lower. Conversely, if people write about their health or home, the ratings were higher. There was no significant difference in linguistic analysis across different hearing aid brands and technology levels. Conclusions Hearing aid consumers are generally satisfied with their hearing device(s), and their online reviews contain information about social/emotional dimensions as well as clinic-visit related aspects that have bearing toward hearing aid benefit and satisfaction ratings. These results suggest that the natural language used by consumers provide insights on their perceived benefit/satisfaction from their hearing device.

Purpose The purpose of this study was to explore the current practices and training requirements for supporting clients experiencing psychosocial concerns in the audiology setting, from the perspectives of audiology clinicians, managers, and reception staff. Method Convenience sampling was used to recruit audiologists, reception staff, and clinic managers ( N = 13, M age = 32.2 ± 8.1, range: 25-47 years, 11 female) through a large hearing services provider in Western Australia. A semistructured focus group was used to elicit participant views regarding current experiences relating to clients who express psychosocial concerns in the audiology setting, familiarity with psychosocial interventions, and training requirements for delivery of psychosocial interventions in the audiological setting. Results Twenty-four subthemes were identified across six themes: (1) awareness of psychosocial well-being, (2) the role of others, (3) identifying client's psychosocial needs, (4) managing client's psychosocial needs, (5) barriers to providing psychosocial support, and (6) broadening audiological services to include psychosocial support. Conclusions Participants reported an awareness of their clients' psychosocial challenges within the audiology setting, yet they described uncertainty in how best to respond in providing support and whether this was within their scope of practice. A majority of audiology staff expressed desire and motivation to broaden the scope of their service in order to better address their clients' hearing loss-related psychosocial needs.

Purpose The study examined psychologically meaningful language dimensions (i.e., social and emotional dimensions, health dimensions, and personal concerns) within online consumer reviews on hearing health care services using an automated textual analysis approach. Method Nine thousand six hundred twenty-two consumer reviews of hearing health care services, including an open-ended question (i.e., free text response to the prompt "share details of your own experience at this place") and an overall rating (on a 5-point scale ranging from "very good" to "very poor") were extracted from Google.com from 40 different cities across the United States. In addition, some metadata about the cities (i.e., region, population size, median age, percentage of older adults) were also recorded. Text responses were analyzed using the automated Linguistic Inquiry and Word Count software for selected language dimensions. The language dimensions of online hearing health care reviews were descriptively compared with language dimensions observed in the natural language of typical bloggers. Language dimensions from free text responses were correlated with quantitative overall experience ratings. Results Automated linguistic analysis showed that consumer reviews on hearing health care services had higher social processes, positive emotions, hearing, health, money, and work, and lower negative emotions and time-awareness when compared to typical bloggers. Examining the association between overall experience rating and the language dimensions revealed two broad findings. First, higher engagement of consumers in terms of social processes, positive emotions, hearing, and work dimensions was related to higher experience ratings. Second, higher engagement of consumers in terms of negative emotions, time awareness, and money was related to lower experience ratings. Conclusions Online reviews contain information about various dimensions (i.e., social and emotional dimensions as well as personal concerns) that have bearing toward the way in that they rate their health care experiences. Automated linguistic analysis of consumer reviews appears helpful in identifying gaps in service delivery that may influence consumer experience.

Objective The aim of this study was to examine experiences of hearing health care services as described in online consumer reviews. Design This study used a cross-sectional design. Online consumer reviews about hearing health care services generated from Google.com to an open-ended question "Share details of your own experience at this place" and perceived overall experience (indicated on a 5-point rating scale: "very good" to "very poor") were extracted from 40 different cities across the United States. The open text contributed a text corpus of 9,622 unique consumer reviews. These responses were analyzed with the cluster analysis approach using an open-source automated text analysis software program, IRaMuTeQ, to identify key themes. Association between clusters and consumer experience ratings as well as consumer metadata (percentage of older adults in the city, region) were examined using the chi-square analysis. Results The majority of consumers appeared satisfied with their hearing health care services, with nearly 95% of consumers reporting "very good" and "good" on the global experience scale. The analysis of text responses resulted in seven clusters within two domains. Domain 1 (Clinical Processes) included the three clusters: administration processes, perceived benefits, and device acquisition. Domain 2 (Staff and Service Interactions) included the four clusters: clinician communications, staff professionalism , customer service, and provider satisfaction . Content relating to administration processes was associated with overall rating regarding the hearing health care service experience. Consumer's reviews relating to administration processes mostly described negative experiences, and these participants were more inclined to provide poorer overall experience ratings. In addition, city characteristics (i.e., percentage of older adults, region) had bearing toward what elements of hearing health care services are highlighted more in the consumer reviews. Conclusions Consumers comment on a variety of elements when describing their experiences with hearing health care services. Experiences reported in most clusters were generally positive, although some concerns in the "clinical process" are associated with lower satisfaction. Employing patient-centered strategies and ensuring patients have good experiences in the areas of concern may help improve both patient experience and their satisfaction. Supplemental Material https://doi.org/10.23641/asha.16455924.

Objectives The aim of this study was to generate a conceptual framework describing which aspects of children and adolescents' lives are affected by chronic tinnitus. Design Views and experiences of 32 participants from two participant groups informed this study: (a) a tinnitus group, consisting of adults who had experienced tinnitus during childhood and/or adolescence and primary carers of children/adolescents with tinnitus, and (b) a clinicians' group, consisting of clinicians who provided care for children/adolescents with tinnitus. Participants produced statements describing aspects of children/adolescents' lives that may be affected by chronic tinnitus. Key concepts were identified through the processes of sorting the statements and rating them for degree of associated impact. Result Participants identified 118 unique aspects of the lives of children/adolescents who may be affected by chronic tinnitus. These were clustered into four concepts: (a) emotional well-being, (b) academic performances, (c) social/relationa, and (d) auditory/cognitive processing. At a group level, participants rated the impact of tinnitus as above a slight degree but below a moderate degree of impact. However, individual participant's ratings indicated a range of perceived impact for each statement. Conclusions The experience of chronic tinnitus during childhood and adolescence extends beyond the mere perception of sound. The perception of tinnitus may impact a child's emotional well-being, academic performances, social/relational, and auditory/cognitive processing. The impact of tinnitus in one aspect of a child's life may influence other aspects of their life. While at a group level, participants regarded the impact of tinnitus as "somewhat more than mild" to "less than moderate"; individual participant's ratings indicate that the impact from chronic tinnitus may be highly individual and highlighted the importance of individual assessment and management. Clinically, tinnitus management during childhood and adolescence may be improved if clinicians consider the impact and manifestation of tinnitus within each child's daily life and tailor tinnitus education and management strategies accordingly.

Objectives: To generate a conceptual framework describing what is done to reduce the impact of chronic tinnitus on the lives of children and adolescents., Design: Views and experiences of 32 adults from two participant groups informed this concept mapping study: (i) a tinnitus group (adults who experienced tinnitus during childhood/adolescence, and primary carers of children/adolescents with tinnitus) and (ii) a clinicians' group (clinicians who provided care for children/adolescents with tinnitus). Participants produced statements describing what is done to reduce the impact of chronic tinnitus on the lives of children and adolescents who experience it. Through grouping and rating processes, they identified key concepts and inferred their associated benefit., Results: The participants generated 102 unique statements across four concepts: (1) Education, Support, and Counselling ; (2) Support from Parents and Teachers ; (3) Clinical Assessments and Management ; and (4) Self-Management Techniques . Many statements highlighted the need for child-friendly and patient-centred care. Adults with personal experience of childhood tinnitus tended to perceive many of the statements as more beneficial than did the clinician group., Conclusions: Although many children will develop management strategies to assist them with their tinnitus, both the adults who experienced tinnitus as children and their parents valued strategies involving clinical care, knowledge, and expertise. Participants from the tinnitus group perceived a greater degree of benefit associated with strategies from all four clusters than the clinicians' group. However, both groups perceived the greatest degree of benefit as being associated with activities and strategies within the Education, Support, and Counselling and the Clinical Assessments and Management clusters. Both groups identified that recognising the occurrence of tinnitus for children and adolescents, acknowledging the potential for associated distress, and initiating clinical care provide the nexus of effective management. Addressing the concerns and needs of parents was also perceived as valuable; hence, approaching the management of tinnitus during childhood and adolescence from a family-centred care framework is recommended., Competing Interests: All authors have no conflict of interest to declare., (Copyright © 2021 Susan Tegg-Quinn et al.)

Shigellosis is a diarrheal disease caused mainly by Shigella flexneri and Shigella sonnei Infection is thought to be largely self-limiting, with short- to medium-term and serotype-specific immunity provided following clearance. However, cases of men who have sex with men (MSM)-associated shigellosis have been reported where Shigella of the same serotype were serially sampled from individuals between 1 and 1,862 days apart, possibly due to persistent carriage or reinfection with the same serotype. Here, we investigate the accessory genome dynamics of MSM-associated S. flexneri and S. sonnei isolates serially sampled from individual patients at various days apart to shed light on the adaptation of these important pathogens during infection. We find that pairs likely associated with persistent infection/carriage and with a smaller single nucleotide polymorphism (SNP) distance, demonstrated significantly less variation in accessory genome content than pairs likely associated with reinfection, and with a greater SNP distance. We observed antimicrobial resistance acquisition during Shigella carriage, including the gain of an extended-spectrum beta-lactamase gene during carriage. Finally, we explored large chromosomal structural variations and rearrangements in seven (five chronic and two reinfection associated) pairs of S. flexneri 3a isolates from an MSM-associated epidemic sublineage, which revealed variations at several common regions across isolate pairs, mediated by insertion sequence elements and comprising a distinct predicted functional profile. This study provides insight on the variation of accessory genome dynamics and large structural genomic changes in Shigella during persistent infection/carriage. In addition, we have also created a complete reference genome and biobanked isolate of the globally important pathogen, S. flexneri 3a. IMPORTANCE Shigella spp. are Gram-negative bacteria that are the etiological agent of shigellosis, the second most common cause of diarrheal illness among children under the age of five in low-income countries. In high-income countries, shigellosis is also a sexually transmissible disease among men who have sex with men. Within the latter setting, we have captured prolonged and/or recurrent infection with shigellae of the same serotype, challenging the belief that Shigella infection is short lived and providing an early opportunity to study the evolution of the pathogen over the course of infection. Using this recently emerged transmission scenario, we comprehensively characterize the genomic changes that occur over the course of individual infection with Shigella and uncover a distinct functional profile of variable genomic regions, findings that have relevance for other Enterobacteriaceae ., (© Crown copyright 2021.)

Bloodstream infections caused by nontyphoidal Salmonella are a major public health concern in Africa, causing ~49,600 deaths every year. The most common Salmonella enterica pathovariant associated with invasive nontyphoidal Salmonella disease is Salmonella Typhimurium sequence type (ST)313. It has been proposed that antimicrobial resistance and genome degradation has contributed to the success of ST313 lineages in Africa, but the evolutionary trajectory of such changes was unclear. Here, to define the evolutionary dynamics of ST313, we sub-sampled from two comprehensive collections of Salmonella isolates from African patients with bloodstream infections, spanning 1966 to 2018. The resulting 680 genome sequences led to the discovery of a pan-susceptible ST313 lineage (ST313 L3), which emerged in Malawi in 2016 and is closely related to ST313 variants that cause gastrointestinal disease in the United Kingdom and Brazil. Genomic analysis revealed degradation events in important virulence genes in ST313 L3, which had not occurred in other ST313 lineages. Despite arising only recently in the clinic, ST313 L3 is a phylogenetic intermediate between ST313 L1 and L2, with a characteristic accessory genome. Our in-depth genotypic and phenotypic characterization identifies the crucial loss-of-function genetic events that occurred during the stepwise evolution of invasive S. Typhimurium across Africa.

Objective: To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss., Design: A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other., Study Sample: An international sample of 65 audiologists., Results: Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility., Conclusions: Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Background: A deeper knowledge of tinnitus is essential in order to better manage and treat tinnitus and its effects. Most studies to date are based on small samples and/or conducted in clinical settings. In this study we assessed the associations between tinnitus, general and mental health, hearing status and demographics in a large population cohort study., Materials and Methods: The Busselton Healthy Aging Study recruited people born between 1946 and 1964. Data were collected between 2010 and 2015. Logistic regression was used to examine the associations between tinnitus and its effect on daily life, age, gender, hearing, self-reported mental and general health, and doctor diagnosed health conditions., Results: Of 5107 participants, 1154 (22.6%) reported experiencing tinnitus. Of those, 32.4% reported that their tinnitus had an occasional effect on their daily lives, while for a further 8.9% the effect on their daily life was frequent or constant. The odds ratio for having a SF12-PCS was (OR 1.02 (95%CI 1.01-1.03). Furthermore, individuals who experience their tinnitus as having an effect on their daily life, have an increased risk of having a lower general health (OR 1.04 (95%CI 1.02-1.03)) than those without tinnitus. Higher levels of depression, anxiety and stress, as well as doctor diagnosed depression, were all significant risk factors for tinnitus. There were statistically significant worse hearing thresholds related to the presence of tinnitus., Conclusion: The outcomes raise the question for clinicians and researchers whether addressing the mental and general health of individuals will influence the presence or burden of tinnitus., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss., Design: Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss., Study Sample: A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists., Results: Overall, participants rated all of the approaches highly on both benefit and likelihood of use ; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales., Conclusions: Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

Purpose There is a well-established relationship between hearing loss and psychological symptoms. To ensure audiological rehabilitation is provided appropriately for older adults with comorbid psychological symptoms, a greater understanding of their preferences and experiences is needed. This study sought to understand experiences of hearing loss and audiological rehabilitation from the perspective of older adults with comorbid psychological symptoms (e.g., depression, anxiety, psychosis). Design A qualitative study using in-depth semistructured interviews was conducted with older adults who had attended audiological rehabilitation within the last year and scored above established cutoffs on measures of depression, anxiety, and psychosis. A thematic analysis generated themes that related to participants' experiences of hearing loss and audiological rehabilitation. Results Participants included 14 older adults (eight men and six women) with an average age of 70.5 years ( SD = 4.45, range: 64-80) who received hearing aids or a cochlear implant. Three major themes emerged from the analysis of participant interviews. " The cumulative impact of hearing loss and psychological symptoms" theme describes the two-way, additive relationship between hearing ability and psychological symptoms. "The experience of loss throughout hearing loss and audiological rehabilitation" captures subjective losses, the impact they have, and how participants cope with them. In contrast, "The experience of gain throughout hearing loss and audiological rehabilitation" describes the participants' reported gains, their related impacts, and coping strategies. Conclusions The experiences of participants revealed that the presence of comorbid psychological symptoms can influence the experience of hearing loss and audiological rehabilitation. These findings have implications for how audiological rehabilitation is provided to ensure optimal outcomes for adults with hearing loss and comorbid psychological symptoms. Supplemental Material https://doi.org/10.23641/asha.12985955.

Objectives: To enhance understanding of the lived experience of tinnitus during childhood/adolescence from the reflections of adults who experienced tinnitus during childhood/adolescence and the perceptions of primary carers and clinicians who care for children/adolescents who experience it. Secondly to develop a conceptual framework to better describe the experience of chronic tinnitus during childhood/adolescence and to guide approaches to assessment and management., Design: Using a concept mapping approach, participants from two stakeholder groups generated statements describing what chronic tinnitus sounds and feels like to children/adolescents who experience it. Participants subsequently grouped and rated the statements to reveal key concepts. The first stakeholder group consisted of adults who had experienced chronic tinnitus as a child/adolescent and parents of children or adolescents who are experience chronic tinnitus. The second stakeholder group consisted of clinical professionals who provide care for children/adolescents experiencing chronic tinnitus., Results: Participants identified 102 different descriptions of what chronic tinnitus sounds and feels like to children/adolescents, across five concepts: 1) Sounds of tinnitus; 2) Descriptions of tinnitus; 3) Perceptions of tinnitus; 4) Emotional responses to tinnitus and 5) Physical responses to tinnitus., Conclusions: The experience of chronic tinnitus during childhood/adolescence is heterogenous and multifaceted. It may involve the perception of sound, emotions and physiological sequalae. How a child/adolescent experiences their tinnitus will be influenced by the interplay between the sound they perceive, the number of accompanying senses involved and their interpretation of the sound. As well as the emotions and physical effects they experience., (Copyright © 2020 Elsevier B.V. All rights reserved.)