MICA: Understanding and alleviating hearing disability: A cognitive-behavioural model of miscommunication in everyday conversation

到2050年，全球将有25亿人患有听力损失，其中大部分是老年人。未经治疗的听力损失与随年龄增长的认知能力下降有关，这可能是因为听力损失在社交孤立中所起的作用。交谈困难是最常见的听力损失问题，但目前使用助听器治疗并不能充分解决这一问题。有一个明显的和未得到满足的需求，即了解听力损失的老年人为什么以及如何在对话中遇到问题。有了这样的理解，更好的治疗将成为可能，提高听力损失患者的社会参与度。在这个节目中，我们将深入解释日常对话中如何发生错误沟通，以及人们如何应对这些错误。也就是说，我们将揭开听力损失患者在日常对话中经历的基本误听与限制他们生活质量的情感(因此也是社会)后果之间的联系。这一结果将为限制这些错误沟通并通过生命周期促进更大健康的治疗提供灵感。对话不仅仅是一种完美的信息交换；最常见的情况是，它实际上是一个逐渐达成相互理解的过程。语言很重要，但行为也很重要：时机、手势、凝视、面部表情和附带的信号(“嗯”)。我们将重点放在日常对话中尚未得到充分解决的三个关键方面--特别是对于听力损失的人。首先，当沟通不畅时，交谈的伙伴通常会调整他们的行为或说话方式，以克服障碍。因此，不只是听力损失的人会经历后果。第二，流畅的交谈依赖于对说话机会的快速理解、表述和预测。如果其中任何一个进展得太慢，结果就是一个瓶颈，其中一个会被排除在对话之外。第三，对话环境(例如，声学环境、对话类型、团队组成)会影响人们的沟通方式，以及他们如何应对困难。这意味着没有单一的通用机制在起作用，也没有单一的解决方案。在以前的工作中，我们已经确定了一系列不同的沟通行为及其潜在功能。最重要的是，我们初步发现，对于听力受损的人和没有听力损失的人来说，上述所有方面的运作方式都不同。因此，我们提出了一系列全面的研究，以揭示对话中发生的心理过程和行为，重点是听力损失如何影响沟通失误的发生和谈判。最终的结果将是一个概念性的模型，通过一系列解释机制将听力损失本身与社会后果联系起来。为了创建这样一个模型，我们将应用多种方法，所有依赖于自然对话，以不同的方式阐明关键方面。我们将通过深入的访谈和调查，制定出沟通不畅的范围和情感代价。我们将通过新的移动评估技术来量化现实世界中沟通失误的发生和影响。我们将通过最先进的实验室测量来确定导致和遵循错误沟通的特定行为模式。我们将测试在什么时间限制下会发生沟通错误。该模型将结合所有这些洞察力，涵盖沟通失误的感知、心理、行为和情感方面。这种模式提供的深入理解将启发新颖的、个性化的听力康复和支持无问题交流的技术。通过这样做，它将促进在老龄化人口中保持社会参与，改善数百万老年人的心理健康、就业前景和生活质量。

By 2050 there will be 2.5 billion people worldwide with hearing loss, mostly of older age. Untreated hearing loss is linked to greater cognitive decline with age, possibly because of the role hearing loss plays in social isolation. Difficulty engaging in conversation is the most often-reported problem of hearing loss, but currently treatment with hearing aids does not adequately fix this. There is a clear and unmet need for understanding why and how older adults with hearing loss experience problems in conversation. With such understanding, better treatments will become possible, improving the social participation of people with hearing loss. In this programme we will develop an in-depth explanation of how miscommunications happen in everyday conversation, and how people behave in response to them. That is, we will unravel the connections between the basic mishearings experienced by those with hearing loss in everyday conversation and the emotional (and hence social) consequences that limit their quality of life. The results will provide inspiration for treatments that limit these miscommunications and promote greater health through the lifespan. Conversation is much more than an exchange of perfect messages; most often it is actually a gradual process of coming to mutual understanding. Words matter, but so does behaviour: timing, gesture, gaze, facial expression, and incidental signals ("uh-huh"). We focus on three key aspects of everyday conversation that have not yet been adequately addressed - especially for people with hearing loss. The first is that when miscommunication occurs, conversational partners typically adjust how they behave or speak, to overcome the obstacle. Hence it is not only the person with hearing loss who experiences consequences.The second is that flowing conversation depends on very rapid comprehension, formulation, and prediction of opportunities to speak. If any of these go too slowly, the result is a 'bottleneck', and one is left out of the conversation.The third is that conversational context (e.g., acoustical environment, type of conversation, group composition) affects the way people communicate, and how they respond to difficulty. This means there is no single universal mechanism in action, nor a single solution.In previous work we have identified a diverse array of communication behaviours and their potential functions. Crucially, we found initial signs that all the above aspects operate differently for people with vs. without hearing loss.We therefore propose a comprehensive series of studies to reveal the mental processes and behaviours that take place in conversation, focussing on how hearing loss affects the occurrence and negotiation of miscommunication. The final result will be a conceptual 'model' linking hearing loss itself to social consequences through a chain of explanatory mechanisms.In order to create such a model, we will apply multiple approaches, all relying on natural conversation, to illuminate key aspects in different ways. We will map out the scope and emotional cost of miscommunication through in-depth interviews and surveys. We will quantify the occurrences and effects of miscommunication in the real world through novel mobile assessment techniques. We will identify the specific patterns of behaviour that lead to and follow from miscommunication through state-of-the-art laboratory measurements. We will test under what time constraints miscommunication happens. The model will combine all these insights to span perceptual, mental, behavioural and emotional aspects of miscommunication. The in-depth understanding provided by this model will inspire novel, personalised hearing rehabilitations and technologies to support problem-free communication. By so doing, it will advance the maintenance of social engagement in an ageing population, improving mental health, employment prospects, and quality of life for millions of older adults.