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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.

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: 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.

Introduction: Communication is an area of health and functioning that is profoundly affected by dementia. While it is known that people living with dementia and their care partners experience disruptions to daily activities and social engagement, detailed knowledge about the lived impact of dementia-related communication changes is lacking. This study sought an in-depth understanding of the lived experience of dementia-related communication changes and the associated impact, needs, and strategies., Methods: As part of an overarching participatory design study, a qualitative (interpretive description) exploration was undertaken with people living with dementia and their care partners. Data from semi-structured interviews were analysed using thematic analysis., Results: We interviewed 13 people living with dementia and 21 care partners and drew three themes and 10 subthemes from the interviews. The first theme illustrates how dementia changes communication which in turn changes life; the second captures the impact of changes on people living with dementia and care partners emotionally and in the context of relationships; and the third describes some positive and constructive ways of moving forward with dementia-related communication changes., Conclusions: Interventions to enhance function, participation, and wellbeing for people living with dementia and their care partners need to encompass support for communication changes. There is a need to ensure that people living with dementia feel dignified and respected during communication, and that care partners and inclusive communities are educated, trained, and supported to facilitate communication., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study aimed to explore the perceptions and experiences of adults with hearing impairment (HI), their significant others (SOs), and clinicians regarding the use and provision of wireless microphone systems (WMS). A qualitative descriptive methodology was used, with a total of 43 participants across three groups: (1) 23 adults with HI who used WMS; (2) 7 SOs of adults who used WMS; and (3) 13 clinicians who provided WMSs to adults with HI. Participants completed an individual semi-structured in-depth interview to explore their experiences, with the data analysed using thematic analysis. The analysis revealed five themes encompassing the perceptions and experiences of WMSs: (1) with experience and clear expectations, users believe that WMS can make a difference; (2) the trial and decision-making process is important; (3) clients' experiences using WMS; (4) issues with WMS and technology; and (5) users require ongoing training and support to use WMS. These findings highlight the complexities of providing and using WMS with adults with HI. However, clients, SOs, and clinicians all reported that, with appropriate experience, expectations, training, and support, WMS can make a real difference in listening and communicating in different situations. There is also an opportunity to involve SOs more throughout the rehabilitation process.

Purpose: Assessing the unique needs of each family following the diagnosis of a hearing loss is central to the delivery of family-centered hearing health care. Therefore, the aim of this study was to develop a Minimum Data Set (MDS) that could be used in the design of a needs assessment tool for families of children with hearing loss transitioning to early intervention., Method: A list of potential items for the MDS was prepared. In a two-round electronic Delphi study in Australia, hearing researchers ( N = 15 in Round 1; N = 9 in Round 2), clinicians, and professionals working in early intervention for children with hearing loss ( N = 85) were asked to review the potential items and to rate the importance of items using a Likert scale., Results: Consensus was reached on 32 main items to be included in the MDS across six categories, including informational support (13 items), professional support (five items), peer support (one item), skills and knowledge (seven items), financial support (three items), and methods of information provision (three items). Eight optional items that could be considered for inclusion in the MDS were also identified., Conclusions: The proposed MDS could support hearing professionals in identifying families' needs in order to provide individualized information and support. Future research is needed to conduct a pilot study to evaluate the needs assessment tool in terms of usability, feasibility, and therapeutic effects.

Introduction: Newborn hearing screening is essential for early identification of hearing loss to decrease the adverse effects of hearing loss. The objective of this study was to determine the prevalence of hearing loss and risk factors of congenital hearing loss in newborns., Methods: In this analytical case-control study, a hearing screening test was performed for all newborns aged 3-14 days., Results: Of 5,500 newborns evaluated, 24 newborns had hearing loss. The prevalence of hearing loss was 4.36 per 1,000. Of 24 hearing-impaired newborns, 15 had bilateral hearing loss (BHL) (62.5%) and nine had unilateral hearing loss (UHL) (37.5%). Among the neonates with hearing loss, the prevalence of hearing loss was higher (77.8%) in the right ear. The main risk factors identified in this study were low gestational age ( P =0.001), hospitalization in the neonatal intensive care unit (NICU) ( P =0.008), exposure to ototoxic drugs ( P =0.001), gestational diabetes  P =0.01), craniofacial anomalies ( P =0.01), convulsion ( P =0.03), consanguineous marriage of parents ( P =0.001), low birth weight ( P =0.01), and hyperbilirubinemia ( P =0.001)., Conclusion: The prevalence of hearing loss was higher in the right ear than in the left ear. NICU stay, use of ototoxic drugs, low gestational age (<35 weeks), gestational diabetes, craniofacial anomalies, convulsion, consanguineous marriage of parents, low birth weight, and hyperbilirubinemia were significant risk factors for congenital hearing loss in studied newborns., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sabbagh et al.)

This study aimed to explore and compare families' and professionals' perspectives on the implementation of family-centered care (FCC) (Moeller, Carr, Seaver, Stredler-Brown, & Holzinger, 2013) during the period between diagnosis of hearing loss (HL) and enrollment in early intervention (EI). A convergent mixed-methods study incorporating self-report questionnaires and semistructured in-depth interviews was used. Seventeen family members of children with HL and the 11 professionals who support these families participated in this study. The results suggested that the services engaged during the transition period partially adhered to the principles of FCC, including the provision of timely access to EI services and provision of emotional and social support. However, areas for improvement identified include strengthening family/professional partnerships, shared decision-making processes, collaborative teamwork, program monitoring, and consistency in the provision of information and support. Qualitative and quantitative research findings also indicated a lack of consistency in service provision during the transition period., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Prior to developing a successful eHealth intervention, it is important that we explore stakeholders' capacity to adapt to eHealth., Objective: To explore what factors influence the use eHealth services from the perspectives of families of children with hearing loss and professionals who support families as they transition into early intervention., Methods: A qualitative study incorporating semi-structured in-depth interviews was conducted with families (n = 17) and professionals (n = 11). Interview topic guides were developed based on the COM-B model of behaviour change to explore barriers and facilitators related to capability, opportunity, and motivation., Results: The COM-B model captured several factors that may influence the use eHealth interventions for families of children with hearing loss. The capability factors included computer literacy and familiarity with social media. The opportunity factors were access to online resources, reliable Internet, and affordable equipment. Professionals' and families' preferences and a culture of face-to-face services were also identified as barriers for using eHealth. The motivation factors included families' and professionals' confidence in using technology and beliefs that there were benefits (e.g., saving travel) associated with using eHealth services. In contrast, beliefs that eHealth may be difficult to set up and not able to replace in-person communication identified as barriers to families and professionals adopting eHealth interventions., Conclusion: Findings of this study indicated that implementation of an eHealth intervention could be facilitated by addressing the barriers in stakeholders' capabilities, opportunities (e.g., equipment and social support), and motivation (e.g., negative beliefs about eHealth) before developing eHealth services., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Families of children with hearing loss must make a number of decisions during the transition from diagnosis of hearing loss to enrolment in early intervention and thus require a wealth of information and support. This study aimed to investigate families' needs during this period and explore how these needs might differ for families of children with hearing loss who have additional disabilities., Methods: An exploratory qualitative study incorporating semistructured in-depth interviews and thematic analysis was used. A total of 28 participants from two groups were involved: (a) family members of children with hearing loss (n = 17) and (b) professionals who support these families during the transition period from diagnosis of hearing loss to enrolment in early intervention (n = 11)., Results: Analysis of qualitative data revealed four major themes: (a) families require information that meet their specific needs; (b) families require supportive professionals to "walk the journey" with them; (c) some families want to connect with other families who "are in the same boat"; and (d) professional support needs differ for children with hearing loss who have additional disabilities., Conclusions: Families and professionals in this study identified a wide range of family needs during the transition to early intervention. The results highlighted the importance of providing individualized services and considering families' needs when providing family-centred services., (© 2019 John Wiley & Sons Ltd.)

Background and Objectives: Conductive hearing loss is common among children and adults. This study aims at comparing the results of conductive hearing loss in summer and autumn., Subjects and Methods: Puretone audiometry and tympanometry tests were done for all patients who referred to the Iranian-based audiology center of Imam Khomeini Hospital in Ahvaz. Data on the patients with conductive or mixed hearing loss were analyzed. The impacts of season, age, and etiology of the disease were analyzed on the patients who visited the audiology clinic due to the conductive hearing loss in summer and autumn., Results: One hundred and fifty nine patients in summer and 123 patients in autumn had conductive or mixed hearing loss. Their age ranged from four to 82 years, with the average age of 35. The percentage of the patients, with acute otitis media and chronic otitis media (COM), who visited this clinic, was significantly higher than those with middle ear problems. COM and mastoid surgeries rate was higher in summer than autumn among adults., Conclusions: There is no relationship between season and middle ear diseases between children and juveniles, but COM and mastoid problems are more common in summer among adults visiting this clinic. Most of the patients had mild conductive hearing loss and bilateral middle ear impairments.

Introduction: Audiology students should possess clinical competence and skills. To achieve this, their clinical skills must be properly assessed. The Objective Structured Clinical Examination (OSCE) is a standard and fair examination of clinical competence. The goal of this study is to devise a checklist of OSCE examination criteria and study their validity and reliability for assessing the clinical competence of Audiology students., Methods: Among the various procedures in which audiology students should possess demonstrated competence, 10 specific skills were selected and checklists were prepared. Faculty members of university's Audiology Department were consulted to determine the validity of the checklists. Subsequently, the examination was administered to all 14 fourth-year audiology students in their final semester of study at Ahvaz Jundishapur University of Medical Sciences. The examination consisted of three question stations and seven procedure stations. Each station was managed by two examiners who independently used a checklist to score each student's performance in a given procedure. To determine reliability, the Spearman test was used., Results: The correlation between each examiner's scores of students at question stations was 0.908. The correlation between each examiner's scores at procedure stations was 0.857 (p=0). The site of lesion test had the highest correlation (0.948) and immittance audiometry had the lowest correlation (0.585)., Conclusion: The prepared checklists had good validity and reliability and can be used to evaluate the clinical competence of audiology students in their final semester of study.