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Objectives: To explore the extent to which an international sample of adults with hearing loss experience and respond to stigma-induced identity threat; and the associations between experiences of hearing loss stigma, responses to hearing loss stigma (concealment of hearing loss), and hearing aid use., Design: Cross-sectional online survey comprising published questionnaires and multiple response questions designed to capture five of seven constructs of the Major and O'Brien model of stigma-induced identity threat. Multivariate modelling examined factors associated with hearing aid use and concealment of hearing loss., Study Sample: 331 adults (50+ years) with self-reported hearing loss, living in Australia, United Kingdom, or United States, participated., Results: Individuals with hearing loss associated hearing loss and hearing aids with negative stereotypes associated with ageing and disability; although, perceptions of modern hearing aids were positive overall. About 25% of participants did not disclose their hearing loss to anyone or in any situation; and hearing loss disclosure, in addition to attitudes towards hearing aids, stereotypical beliefs, and personal characteristics were associated with hearing aid use in multivariate modelling., Conclusions: One way in which we may be able to increase use of hearing aids is by explicitly asking about and addressing individuals' experiences of hearing loss stigma.

Objective: The aim of this study was to use Ecological Momentary Assessment (EMA) to capture how stigma-induced identity threat is experienced by adults with hearing loss and how they respond to such threats in daily life., Design and Study Sample: Twenty adults with hearing loss from 53 to 88 years (mean age of 69.4 years) completed a range of demographic and stigma questionnaires in the laboratory and, over a two-week period, answered daily EMA surveys., Results: A total of 633 EMA surveys were collected. Five participants reported 13 listening events in which they experienced stigma. These events were typically when conversing with family or friends who were aware of the adults' hearing loss., Conclusions: The number of individual stigma experiences captured by EMA were low, when viewed across a large number of social interactions. However, as a group, a quarter of the participants in this study experienced stigma over a two-week period, typically from others close to them. This suggests that stigma experiences may be a regular occurrence for some adults with hearing loss.

Objective: To investigate the perspectives and experiences of adults with hearing loss (HL), their family members, and hearing care professionals on how they respond to the stigma of HL and hearing aids (HAs)., Design: Qualitative descriptive approach using semi-structured interviews., Study Sample: Three participant groups were recruited, including 20 adults over the age of 50 years with HL, 20 family members who had a close relationship to the adults with HL, and 25 hearing care professionals., Results: Three themes described how adults with HL, family members, and hearing care professionals respond to the stigma of HL and HAs, namely: (1) some people tell others about their HL and HAs and some people don't; (2) telling or not telling depends on the situation; and (3) people deal with the stigma of HL and HAs in different ways., Conclusions: This study revealed a range of volitional responses to the stigma of HL and HAs. People affected by HL may not tell others about their HL and/or HAs because of the stigma, and these volitional responses are influenced by situational cues. Adults with HL and family members manage the stigma of HL and HAs in different ways and require a person-centred approach.

Objective: To develop a prototype of a decision aid to be used on a website for adults with hearing loss. Design: Development was guided by the International Patient Decision Aid Standards (IPDAS) and included a survey and think-aloud process., Study Sample: A total of 153 participants completed a survey about what to include in the decision aid (111 adults with hearing loss, 21 family members of adults with hearing loss, and 21 professionals). Six adults with hearing loss and six family members participated in a think-aloud process to provide feedback as they used an initial version of the decision aid., Results: In the survey, 26 of the 38 potential items were identified as being highest priority and were included in the initial version of the decision aid. This initial version was then tested in the think-aloud sessions and a prototype of a web-based version was developed based on participant responses related to: 1) information on the decision aid, 2) ease of use, 3) layout and orders of the items, 4) satisfaction, 5) areas for improvement (e.g., need for graphics)., Conclusions: The methodologies used in this study are recommended for developing decision aids for adults with acquired hearing loss.

Objective: To describe the application of the Behaviour Change Wheel (BCW) to the development of a family-centred intervention for families of children with hearing loss transitioning into early intervention., Design: The BCW was used in a mixed methods design to understand the gaps in family-centred service provision and to identify appropriate intervention functions and implementation options to address these gaps., Study Sample: Families and health professionals participated in different steps of the BCW., Results: The qualitative interviews revealed that families required individualised information and support. The quantitative and interview data suggested inconsistencies in the provision of information and support to some families. It was determined that administration of a needs assessment by the support professionals was the most appropriate target behaviour to address this issue. In the analysis of the professionals' capabilities, opportunities, and motivations for administration of a needs assessment, a resource limitation was identified, and therefore, a Minimum Data Set for a Needs Assessment Tool was developed to facilitate the assessment of families' needs during the transition period., Conclusions: This study provided an example of how the BCW could be successfully applied to the design of a family-centred intervention for families of children with hearing loss.

Objective: This study examines the interactional management of hearing difficulties and hearing aids (HAs) in real-life, video-recorded social interactions with adults with hearing loss (HL) and their families/friends., Design: 32 video-recordings in various social settings were analysed using Conversation Analysis., Study Sample: 20 adults with HL and their families/friends., Results: HL and/or HAs did not typically become explicit in conversation. When adults with HL' hearing difficulties did become explicit in the conversation, they were typically accompanied by laughter/humour. Sometimes the humour/laughter was initiated by the person with HL themselves (i.e. self-directed joking) but more frequently it was initiated by someone else within the conversation (i.e. a tease)., Conclusions: The findings display the management of the "to tell or not to tell" dilemma in practice, and how humour was often used to lighten the tension when "telling" about HL and/or HAs. The findings also highlight that not all humour is equal: there are different outcomes for adults with HL depending on who initiated the humour/laughter within the context of the interaction. This study highlights stigma-in-action - how stigma related to HL and/or HAs is occasioned and managed within real-life social interactions.

Objectives: To explore when and how stigma-induced identity threat is experienced by adults with hearing loss (HL) and their family members (affiliate stigma) from the perspectives of adults with HL, their family members, and hearing care professionals., Design: Qualitative descriptive methodology with semi-structured interviews., Study Sample: Adults with acquired HL ( n  = 20), their nominated family members ( n  = 20), and hearing care professionals ( n  = 25)., Results: All groups of participants believed that both HL and hearing aids were associated with stigma for adults with HL. Two themes were identified, specifically: (1) an association between HL and hearing aids and the stereotypes of ageing, disability, and difference; and (2) varied views on the existence and experience of stigma for adults with HL. Hearing care professionals focused on the stigma of hearing aids more than HL, whereas adult participants focused on stigma of HL. Family member data indicated that they experienced little affiliate stigma., Conclusions: Stigma-induced identity threat related to HL and, to a lesser extent, hearing aids exists for adults with HL. Shared perceptions that associate HL and hearing aids with ageing stereotypes were reported to contribute to the identity threat, as were some situational cues and personal characteristics.

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: 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.