A Simplified Patient Centered Educational Tool for Improved Hearing Aid Outcomes

描述(由申请人提供)： 尽管有证据表明，助听器对听力受损的人有好处，而且未经治疗的听力损失可能会产生负面后果，但许多人使用助听器的程度低于人们认为的最佳水平。研究表明，不能使用助听器是这个问题的根本原因。这种无能可能源于知识的缺乏或身体上的限制，如视力不佳或手动灵活。无论如何，研究表明，目前对助听器使用者进行助听器培训的过程(称为助听器定向，HAO)可能是不够的。认识到这一问题，我们的长期目标是通过开发使用既定原则进行良好的患者与提供者沟通的工具来改善HAO信息的交付。因此，这些工具将适用于三分之一的美国人，他们具有基本或低于基本的健康素养，以及与年龄相关的视力、灵巧度以及学习和记忆限制的个人。在这项研究中，将开发和评估三种工具：(1)针对个人助听器类型和设置的书面助听器信息指南(HAIG)；(2)带回家的助听器导向DVD(HAO DVD)；以及(3)回授技术，通过该技术，提供者可以确认患者理解并能够执行助听器管理任务(TBT)。使用有效性比较研究框架，本研究将比较这三种工具与护理标准(SOC)Hao的相对有效性。要检查的结果是管理和使用助听器的能力(主要结果)，关于助听器管理和使用的知识，助听器的自我效能，以及总体助听器结果(次要结果)。为此，即将成为首次助听器使用者的退伍军人将从波特兰退伍军人医疗中心的听力诊所招募。在参与者接受助听器之前进行的研究访问中，参与者将完成对健康素养、手动灵活性和肝脏敏感度、视觉敏感度以及学习和记忆的评估。这些衡量标准将被用作结果的潜在预测因素/协变量。参与者随后将在听力学诊所参加配戴助听器的预约，并将接受临床听力科医生的SOC Hao。在任命结束时，他们将被分配到四个学习部门中的一个，并将接受干预：(1)仅接受SoC，(2)SoC+HAIG，(3)SoC+Hao DVD，或(4)SoC+TBT。四周后，参与者将参加第二次研究访问，届时将使用经修订的助听器实用技能测试(Doherty&Desjardins，2012)来评估结果，以评估实际管理助听器的能力(主要结果衡量标准)，使用助听器探查回忆问卷(Reese&Smith，2006)来评估Hao知识，使用助听器听力康复自我效能衡量标准(West&Smith，2007)来评估助听器自我效能，以及使用国际助听器结果清单(Cox等，2000)来评估助听器的总体结果(次要结果衡量标准)。他们也将接受采访，我们可以了解他们对他们所接受的干预以及其他干预的看法。这个项目的长期目标是改进 好信息的传递。每一种建议的HAO工具都将产生比HAO目前的实践标准更好的助听器结果，因为它们是根据患者与提供者沟通的既定指南开发的。如果这是真的，这些工具可以很容易地过渡到临床环境中，为我们的退伍军人带来立竿见影的好处。这些信息将帮助我们确定应该进一步开发、评估和使用哪个工具(S)来创建HAO的最佳实践。

DESCRIPTION (provided by applicant): Despite evidence that hearing aids provide benefit for hearing-impaired individuals, and that untreated hearing loss can have negative consequences, many individuals use their hearing aids less than is considered optimal. Studies indicate that an inability to use the hearing aids, i part, underlies this problem. This inability may stem from a lack of knowledge or a physical limitation, such as poor vision or manual dexterity. Either way, studies indicate that the current process for teaching hearing-aid users about their hearing aids (known as hearing-aid orientation, HAO), may be inadequate. Recognizing this problem, our long-term goal is to improve the delivery of HAO information by developing tools that use established principles for good patient-provider communication. These tools will therefore be appropriate for the 1/3 of US individuals who have basic or below basic health literacy, and for individuals with age-related vision, dexterity, and learning and memory limitations. For this study, three tools will be developed and evaluated: (1) a written Hearing Aid Information Guide (HAIG) targeted to the individual's hearing-aid style and settings, (2) a take-home hearing-aid-orientation DVD (HAO DVD), and (3) the teach-back technique through which the provider can confirm the patient understands and can conduct hearing-aid-management tasks (TBT). Using a comparative effectiveness research framework, the study will compare the relative effectiveness of the three tools with the standard-of-care (SoC) HAO. Outcomes to be examined are the ability to manage and use hearing aids (primary outcome), knowledge about hearing-aid management and use, hearing-aid self-efficacy, and overall hearing-aid outcome (secondary outcomes). To this end, Veterans who are about to become first-time hearing-aid users will be recruited from the Portland VA Medical Center's Audiology Clinic. At a research visit that will take place prior to participants receiving their hearing aids, participants will complete assessments of health literacy, manual dexterity and hepatic sensitivity, visual acuity, and learning and memory. These measures will be used as potential predictors/covariates of outcome. Participants will then attend their hearing-aid-fitting appointment at the audiology clinic and will receive the SoC HAO from a clinical audiologist. At the end of that appointment, they will be assigned to one of the four study arms and will receive that intervention: (1) SoC alone, (2) SoC + HAIG, (3) SoC + HAO DVD, or (4) SoC + TBT. Four weeks later, participants will attend a second research visit at which outcomes will be assessed using the Practical Hearing Aid Skills Test-Revised (Doherty& Desjardins, 2012) to assess actual ability to manage hearing aids (primary outcome measure), the Hearing Aid Probed Recall Inventory (Reese & Smith, 2006) to assess HAO knowledge, the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (West & Smith, 2007) to assess hearing-aid self efficacy, and the International Outcome Inventory for Hearing Aids (Cox et al., 2000) to assess overall hearing-aid outcome (secondary outcome measures). They will also be interviewed to we can learn their opinions about the intervention they received, as well as the other interventions. The long-term goal of this project is to improve the delivery of HAO information. Each of the proposed HAO tools will result in better hearing-aid outcomes than the current standard of practice for HAO because they were developed using established guidelines for patient-provider communication. If this is true, the tools can be transitioned easily into the clinical environment, resulting in immediate benefits for our Veterans This information will help us determine which tool(s) should be further developed, evaluated, and used to create best practices for HAO.