Poost-Foroosh Laya, Jennings Mary Beth, Cheesman Margaret F
National Centre for Audiology, Western University, London, ON, Canada.
Li KaShing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
J Am Acad Audiol. 2015 Mar;26(3):247-59. doi: 10.3766/jaaa.26.3.5.
Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth.
Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions.
A cross-sectional approach was used to obtain online and paper-based concept ratings.
Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts.
There was a significant difference in the mean ratings for clients and clinicians for the concepts understanding and meeting client needs, conveying device information by clinician, supporting choices and shared decision making, and factors in client readiness. Three concepts-understanding and meeting client needs, conveying device information by clinician, and supporting choices and shared decision making-were rated as more important by clients than by clinicians. One concept (ie, factors in client readiness) was rated as more important by clinicians than by clients.
The concepts rated as most important by clients and clinicians are consistent with components of several existing models of client-centered and patient-centered care. These concepts reflect the clients' perception of the importance of their involvement in the decision-making process. A preliminary model of client-centered care within the hearing aid uptake process and implications for clinical audiology are described.
尽管临床上已认识到获得性听力损失的不良影响，但只有一小部分能从中受益的成年人使用助听器。助听器的采用情况已根据与客户相关及与助听器技术相关的因素进行了研究。客户与临床医生之间的互动对购买助听器决策的影响尚未得到深入探讨。
比较来自加拿大各地的近期收到助听器推荐的成年人样本（客户）和听力保健专业人员（临床医生）对影响助听器购买决策的客户 - 临床医生互动因素的重要性评级。
采用横断面方法获取在线和纸质概念评级。
参与者为43名成年人（年龄范围45 - 85岁），他们在参与前3个月内首次收到助听器推荐。来自各种临床环境、开具或配发助听器的54名听力学家和20名听力仪器从业者完成了概念评级任务。该任务由122个项目组成，这些项目是通过先前研究中的概念映射生成的，结果确定了八个可能影响助听器购买决策的概念。参与者根据5点李克特量表对“每个人购买助听器决策中各陈述的重要性”进行评级，从1 = 极不重要到5 = 极其重要。对于初始数据分析，每个参与者对每个概念中包含的每个项目的评级进行平均，以提供每个概念总体重要性评级的估计值。使用多变量方差分析比较客户与临床医生的平均重要性评级。还比较了各个陈述的评级，以调查概念内重要性评级的方向性。
在理解和满足客户需求、临床医生传达设备信息、支持选择和共同决策以及客户准备因素等概念方面，客户和临床医生的平均评级存在显著差异。客户认为理解和满足客户需求、临床医生传达设备信息以及支持选择和共同决策这三个概念比临床医生认为的更重要。临床医生认为客户准备因素这一概念比客户认为的更重要。
客户和临床医生认为最重要的概念与现有的几种以客户为中心和以患者为中心的护理模式的组成部分一致。这些概念反映了客户对其参与决策过程重要性的认知。描述了助听器采用过程中以客户为中心的护理的初步模型及其对临床听力学的启示。
