DESIGN CONSIDERATIONS FOR INTERNET- DELIVERED SELF-MANAGEMENT PROGRAMS FOR ADULTS WITH HEARING IMPAIRMENT

Transcription

1 DESIGN CONSIDERATIONS FOR INTERNET- DELIVERED SELF-MANAGEMENT PROGRAMS FOR ADULTS WITH HEARING IMPAIRMENT Jill Preminger University of Louisville- USA

2 Disclosures - Jill Preminger Relevant Financial Relationships Salaried professor in the University of Louisville, Department of Otolaryngology- Head and Neck Surgery & Communicative Disorders Research reported here funded by National Institute on Deafness and Other Communication Disorders National Organization on Hearing Research University of Louisville School of Medicine Relevant Nonfinancial Relationships Guest Editor American Journal of Audiology Research Forum on Internet & Audiology 2014 & 2015 Member, Phonak Patient and Family Centered Care Expert Circle Member, Program Committee, Third International Meeting on Internet & Audiology Member, ASHA Special Interest Group: Aural Rehabilitation and its Instrumentation Member, ASHA committee on Clinical Research, Implementation Science, and Evidence- Based Practice (CRISP)

3 RATIONALE Why deliver self management programs over the internet for adults with hearing impairment?

4

5 Recommended Actions 1. Improve population-based information on hearing loss and hearing health care 2. Develop and promote measures to assess and improve quality of hearing health care services 3. Remove FDA s regulation for medical evaluation or waiver of that evaluation prior to hearing aid purchase 4. Empower consumers and patients in their use of hearing health care 5. Improve access to hearing health care for underserved and vulnerable populations 6. Promote hearing health care in wellness and medical visits for those with concerns about their hearing 7. Implement a new FDA device category for over-the-counter wearable hearing devices 8. Improve the compatibility and interoperability of hearing technologies with communications systems and the transparency of hearing aid programming 9. Improve affordability of hearing health care by actions across federal, state, and private sectors 10. Evaluate and implement innovative models of hearing health care to improve access, quality, and affordability 11. Improve publicly available information on hearing health 12. Promote individual, employer, private sector, and community-based actions to support and manage hearing health and effective communication

6 Pharmaceuticals and medical devices cannot always provide definitive solutions for chronic health conditions or meet the specific needs and preferences of every individual. Similarly, for individuals with hearing loss, hearing aids cannot unequivocally address the multifaceted challenges of living with hearing loss, such as the hearing loss itself, communication difficulties, changes in quality of life and possible comorbidities. Like other chronic health conditions, hearing loss requires a holistic, individual-centered approach to care that blends both medical and non-medical solutions, such as auditory rehabilitation.

7 DESIGN CONSIDERATIONS Based on evidence in regards to: Group Auditory Rehabilitation Role of Communication Partners in Auditory Rehabilitation Self-Management

8 Group Auditory Rehabilitation for People with Hearing Impairment Participants Experienced HA users (> 3 months) years of age At least a 20 on the Hearing Handicap Inventory for the Elderly - A measure of Self- Reported Hearing Disability Auditory Rehabilitation Program Sessions: 1 x week for 4 to 6 weeks, 60 to 90 minutes each week 4 to 8 participants per session Evaluation A number of questionnaires Within 2-weeks before program, within 2-weeks after program, 6-months after program Preminger JE, Ziegler CH. Can auditory and visual speech perception be trained within a group setting? American journal of audiology. 2008;17(1): Preminger JE, Yoo JK. Do group audiologic rehabilitation activities influence psychosocial outcomes? American journal of audiology. 2010;19(2): Preminger JE. Should significant others be encouraged to join adult group audiologic rehabilitation classes? Journal of the American Academy of Audiology. 2003;14(10):545-55

9 6 Auditory Rehabilitation Participant Groups: per group 1. Control: No group AR 2. Speech perception training: auditory only and auditory visual training in quiet and in noise in a group setting 3. Speech perception training + psychosocial exercises: Same training as above + 30 minute discussions about life with hearing impairment (attitudes, feelings, impact on relationships) 4. Communication strategies: anticipatory & repair strategies, opportunity for practice 5. Communication strategies + psychosocial exercises 6. Information + psychosocial exercises: lectures about audiograms, communication model, HA features, hearing assistance technologies 7. Same as group 5 & 6 with Communication Partners

10 Effect Size and 95% Confidence Interval Reduction in selfreported disability from baseline to post AR follow-up Measure of clinical efficacy Small Med Large

11 Small Med Large

12 Small Med Large

13 Small Med Large

14 Small Med Large

15 Small Med Large

16 Small Med Large

17 SELF MANAGEMENT FRAMEWORK Self-management is defined as the tasks that individuals must undertake to live with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions. Adams K, Greiner AC and Corrigan JM (eds) The 1 st annual crossing the quality chasm summit a focus on communities. Washington, D.C: The National Academic Press, 2004.

18 Education Educate about condition and management (e.g. understanding hearing loss, epidemiology, treatment options, strategy option, outcomes, psychosocial aspects) Skills Problem Solving Decision Making Utilizing Resources Partnership with HHC Provider Taking Action Monitoring of condition with feedback to the patient Self-Tailoring Learn basic problem-solving skills: problem definition, generation of possible solutions (from self, friends, peers, coaches), solution implementation, evaluation of results Select a communication strategy based on a particular problem Learn to find HHC information on the internet, how to access a coach, find support group Learn to participate in shared-decision making Develop a short-term action plan, learn how to change behaviors, selecting strategies that are realistic and ones which the participant is confident she/he can implement Monitor and review ability: Self-reported communication ability, Self-reported disability Acquire knowledge, learn decision making, and problem solving Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7 Pearce G, Parke HL, Pinnock H, Epiphaniou E, Bourne C, Sheikh A, et al. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility. Journal of health services research & policy

19 Mechanism Promoting Self-Efficacy Practical support with adherence Easy access to advice or support when needed Training/Rehearsal to communicate with healthcare professionals Training/Rehearsal for everyday activities Training/Rehearsal for practical self-management Training/Rehearsal for psychological strategies Social Support Reminders, texts, phone calls, prompts Ask the audiologist, coaching Learn to talk about rehabilitation options, how to promote shared decision making Learn and practice communication strategies Learn to use a hearing assistance technology; information about HAs Practice relaxation techniques, practicing problem solving From peers, from communication partners Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7 Pearce G, Parke HL, Pinnock H, Epiphaniou E, Bourne C, Sheikh A, et al. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility. Journal of health services research & policy

20 P What was offered in Group AR Skills Education Problem Solving Decision Making P Utilizing Resources Partnership with HHC provider Taking Action P PP P Monitoring of condition with feedback to the patient Self-Tailoring Educate about condition and management (e.g. understanding hearing loss, epidemiology, treatment options, strategy option, outcomes, psychosocial aspects) Learn basic problem-solving skills: problem definition, generation of possible solutions (from self, friends, peers, coaches), solution implementation, evaluation of results Select a communication strategy based on a particular problem Learn to find HHC information on the internet, how to access a coach, find support group Learn to participate in shared-decision making Develop a short-term action plan, learn how to change behaviors, selecting strategies that are realistic and ones which the participant is confident she/he can implement Monitor and review ability: Self-reported communication ability, Self-reported disability Acquire knowledge, learn decision making, and problem solving Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7 Pearce G, Parke HL, Pinnock H, Epiphaniou E, Bourne C, Sheikh A, et al. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility. Journal of health services research & policy

21 P What was offered in Group AR Mechanism P Promoting Self-Efficacy C. Practical support with adherence D. Easy access to advice or support when needed E. Training/Rehearsal to communicate with healthcare professionals F. Training/Rehearsal for everyday activities F. Training/Rehearsal for P P Reminders, texts, phone calls, prompts Ask the audiologist, coaching Learn to talk about rehabilitation options, how to promote shared decision making Learn and practice communication strategies Learn to use a hearing assistance technology; practical self-management information about HAs G. Training/Rehearsal for Practice relaxation techniques, practicing problem psychological strategies solving F. Social Support From peers, from communication partners P P Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7 Pearce G, Parke HL, Pinnock H, Epiphaniou E, Bourne C, Sheikh A, et al. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility. Journal of health services research & policy

22 IF GROUP AUDITORY REHABILITATION CAN SUCCESSFULLY PROMOTE SELF- MANAGEMENT, WHY OFFER IT OVER THE INTERNET?

23 1. Because it works!

24 Self-Reported Hearing Disability Online Auditory Rehabilitation reduces hearing disability in experienced hearing aid users Hearing Handicap Inventory T0 T1 T2 Evaluation Time Intervention Control Thorén ES, Oberg M, Wänström G, Andersson G, Lunner T. A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users. Int J Audiol Jul;53(7)

25 Educational videos may increase hearing aid usage in new hearing aid users Specifically in sub-optimal users those who were wearing their hearing aids less time than recommended Ferguson M, Brandreth M, Brassington W, Leighton P, Wharrad H. A Randomized Controlled Trial to Evaluate the Benefits of a Multimedia Educational Program for First-Time Hearing Aid Users. Ear Hear. 2015

26 2. Because few audiologists offer group Auditory Rehabilitation

27 3. Because the internet is an ideal delivery system for self-management programs

28 RATIONALE Why deliver self management programs over the internet for adults with hearing impairment?

29

30 Recommended Actions 1. Improve population-based information on hearing loss and hearing health care 2. Develop and promote measures to assess and improve quality of hearing health care services 3. Remove FDA s regulation for medical evaluation or waiver of that evaluation prior to hearing aid purchase 4. Empower consumers and patients in their use of hearing health care 5. Improve access to hearing health care for underserved and vulnerable populations 6. Promote hearing health care in wellness and medical visits for those with concerns about their hearing 7. Implement a new FDA device category for over-the-counter wearable hearing devices 8. Improve the compatibility and interoperability of hearing technologies with communications systems and the transparency of hearing aid programming 9. Improve affordability of hearing health care by actions across federal, state, and private sectors 10. Evaluate and implement innovative models of hearing health care to improve access, quality, and affordability 11. Improve publicly available information on hearing health 12. Promote individual, employer, private sector, and community-based actions to support and manage hearing health and effective communication

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32 The Solution? Hearing Screenings In the community Over the telephone Over the internet

33 But the follow-up rate following failed hearing screening is poor Follow-up after failed telephone hearing screening: Australia Number contacted 193 Percent who followed up Percent (of number contacted) who obtained a hearing aid Number/Percent 36% 7% Follow-up after failed telephone hearing screening: United States Number contacted 390 Percent who followed up Percent (of number contacted) who obtained a hearing aid Number/Percent 27% 8% Meyer C, Hickson L, Khan A, Hartley D, Dillon H, Seymour J. Investigation of the actions taken by adults who failed a telephone-based hearing screen. Ear Hear. 2011;32(6):720-3 Watson CS, Kidd GR, Preminger JE, Miller JD, Maki DP, Crowley A. Characteristics of 40,000 calls to the National Hearing Test. The Journal of the Acoustical Society of America. 2015;138(3):1830

34 We can apply internet Auditory Rehabilitation to adults with unaddressed hearing impairment Continuum of internet auditory rehabilitation Can we increase HA uptake in adults with unaddressed HI using principles of health psychology? Educational videos may increase hearing aid usage in new hearing aid users Online AR reduces hearing disability in experienced hearing aid users

35 How can we increase the number of individuals who visit an audiologist after a failed hearing screening? Health Psychology Health Belief Model Individuals who took up hearing aids were significantly more ready for change than individuals who did not, and they had more favorable attitudes measured by the HBQ in the form of higher severity, benefits and cues to action scores. In addition, self-efficacy and benefits were significant predictors of whether or not an individual acquired hearing aids. HBQ = Health Belief Questionnaire The Health Belief Model Saunders GH, Frederick MT, Silverman SC, Nielsen C, Laplante-Levesque A. Health behavior theories as predictors of hearing-aid uptake and outcomes. Int J Audiol. 2016:1-10.

36 Health Belief Model As applied to hearing impairment this model suggests that individuals will visit an audiologist and take-up hearing aids if they believe that their hearing problems are severe the benefits of the AR outweigh the barriers they have the ability to implement the recommended treatment (self-efficacy) they receive social support from family members or encouragement from a physician (cue to action)

37 Experiences that would motivate a hearing aid purchase 2071 non-owners of hearing aids A RECOMMENDATION FROM A HEARING CARE PROFESSIONAL I TRUST 18% A PLACE TO EVALUATE OR TRY HEARING AIDS WITHOUT FEELING PRESSURE TO BUY ONE THE FIRST VISIT KNOWING THAT UNAIDED HEARING LOSS CAN CONTRIBUTE TO OR EXACERBATE OTHER HEALTH ISSUES (MEMORY LOSS, ETC.) 19% 20% A POSITIVE RECOMMENDATION FROM MY DOCTOR 20% A HEARING TEST THAT MAKES IN CLEAR TO ME THAT I NEED ONE 36% HAVING INSURANCE THAT WILL COVER SOME/MORE OF THE COST 51% 0% 10% 20% 30% 40% 50% 60% Abrams HB, Kihm J. An Introduction to MarkeTrak IX: A New Baseline for the Hearing Aid Market. Hearing Review. 2015;22(6):16

38 EHIMA. Trends derived from the EuroTrak databases (Germany, United Kingdom and France)

39 With an internet based self-management program we can address the factors of the HBM

40 With an internet based self-management program we can address the factors of the HBM

41 With an internet based self-management program we can address the factors of the HBM

42 With an internet based self-management program we can address the factors of the HBM Watch a video of a couple using a hearing aid with a remote mic in a restaurant Take a quiz Based on the quiz, receive informational content in written form Ask an audiologist questions via video chat Watch another video of a couple successfully using the technology

43 THANK YOU Thanks also to: Ann Rothpletz, University of Louisville Elisabet Thorén, Eriksholm Research Center

44 BARRIERS & FACILITATORS FOR IMPLEMENTATION

45 Will the technology get used? Develop and evaluate technologies with input from all stakeholders Users (patients) Clinicians Family members Managers (Healthcare delivery systems) Participatory Development Assessment is a part of development User acceptance, satisfaction, adoption Impact of ehealth technology on: quality of health care, benefits, effectiveness, cost

46 Persuasive System Design (for user led intervention) Increased interaction with a clinician More frequent intended usage (more actively engaged with the technology) More frequent updates, reminders More extensive employment of dialogue support Offer praise Offer rewards Offer reminders Give suggestions

47 Acceptance of internet-based hearing healthcare among adults who fail a hearing screening This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants acceptance of IHHC (Phase 2). Training group participants attended an instructional class on existing IHHC websites. The control group received no training. Study sample: Twenty-seven adults (age mean = 72) who failed a hearing screening Acceptance of internet-based hearing healthcare, Rothpletz, Moore & Preminger IJA 2016

48 PTAM: Patient technology acceptance model HCK (Healthcare Knowledge), IS (Information Seeking Preferences), SE (Computer Aelf-Efficacy), ANX (Computer Anxiety), CA (Computer Affect), PU (Perceived Usefulness), PE (Perceived Ease of Use), SN (Social Norm) IU (Intention to Use).

49 Baseline scores

50 Training group: Significant increases