Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
J Med Internet Res. 2020 Sep 22;22(9):e17927. doi: 10.2196/17927.
Hearing aid (HA) use is known to improve health outcomes for people with hearing loss. Despite that, HA use is suboptimal, and communication issues and hearing-related activity limitations and participation restrictions often remain. Web-based self-management communication programs may support people with hearing loss to effectively self-manage the impact of hearing loss in their daily lives.
The goal of the research is to examine the short- and long-term effects of a web-based self-management SUpport PRogram (SUPR) on communication strategy use (primary outcome) and a range of secondary outcomes for HA users aged 50 years and older.
Clients of 36 HA dispensing practices were randomized to SUPR (SUPR recipients; n=180 HA users) and 34 to care as usual (controls; n=163 HA users). SUPR recipients received a practical support booklet and online materials delivered via email over the course of their 6-month HA rehabilitation trajectory. They were encouraged to appoint a communication partner and were offered optional email contact with the HA dispensing practice. The online materials included 3 instruction videos on HA handling, 5 videos on communication strategies, and 3 testimonial videos. Care as usual included a HA fitting rehabilitation trajectory only. Measurements were carried out at baseline, immediately postintervention, 6 months postintervention, and 12 months postintervention. The primary outcome measure was self-reported use of communication strategies (3 subscales of the Communication Profile for the Hearing Impaired [CPHI]). Secondary outcome measures included self-reported personal adjustment to hearing loss (CPHI); use, satisfaction and benefit of HAs and SUPR (use questionnaire; International Outcome Inventory for Hearing Aids [IOI-HA], Alternative Interventions [IOI-AI]); recommendation of HA dispensing services; self-efficacy for HA handling (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids [MARS-HA]); readiness to act on hearing loss (University of Rhode Island Change Assessment adapted for hearing loss [URICA-HL]); and hearing disability (Amsterdam Inventory for Auditory Disability and Handicap [AIADH]).
Linear mixed model analyses (intention to treat) showed no significant differences between the SUPR and control group in the course of communication strategy use (CPHI). Immediately postintervention, SUPR recipients showed significantly higher self-efficacy for advanced HA handling than the controls, which was sustained at 12 months (MARS-HA; mean difference immediately postintervention: 5.3, 95% CI 0.3 to 10.4; P=.04). Also, SUPR recipients showed significantly greater HA satisfaction than controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.09 to 0.5; P=.006), which was sustained at 12 months, and significantly greater HA use than the controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.02 to 0.5; P=.03), which was not sustained at 12 months.
This study provides ground to recommend adding SUPR to standard HA dispensing care, as long-term, modest improvements in HA outcomes were observed. Further research is needed to evaluate what adjustments to SUPR are needed to establish long-term effectiveness on outcomes in the psychosocial domain.
ISRCTN77340339; http://www.isrctn.com/ISRCTN77340339.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2016-015012.
助听器（HA）的使用已被证明可以改善听力损失患者的健康结果。尽管如此，HA 的使用仍不理想，沟通问题以及与听力相关的活动限制和参与限制仍然存在。基于网络的自我管理沟通计划可能会支持听力损失患者有效地管理日常生活中的听力损失影响。
该研究的目的是检查基于网络的自我管理支持计划（SUPR）对沟通策略使用（主要结果）和一系列次要结果的短期和长期影响，这些结果针对的是 50 岁及以上的 HA 用户。
36 个 HA 调配实践的客户被随机分配到 SUPR（SUPR 接受者；n=180 HA 用户）和 34 个对照组（常规护理；n=163 HA 用户）。SUPR 接受者在他们的 6 个月 HA 康复轨迹中通过电子邮件收到实用支持手册和在线材料。他们被鼓励任命一名沟通伙伴，并可选择与 HA 调配实践进行电子邮件联系。在线材料包括 3 个关于 HA 处理的教学视频、5 个关于沟通策略的视频和 3 个证词视频。常规护理仅包括 HA 适配康复轨迹。测量在基线、干预后立即、干预后 6 个月和干预后 12 个月进行。主要结果测量是自我报告的沟通策略使用情况（听力障碍者沟通概况[CPHI]的 3 个分量表）。次要结果测量包括自我报告的个人听力损失适应情况（CPHI）；HA 和 SUPR 的使用、满意度和收益（使用问卷；国际助听效果问卷[IOI-HA]、替代干预[IOI-AI]）；HA 调配服务的推荐；HA 处理自我效能感（助听器听力康复自我效能测量表[MARS-HA]）；听力损失行动准备（为听力损失改编的罗得岛大学变化评估[URICA-HL]）；听力残疾（阿姆斯特丹听力障碍和障碍问卷[AIADH]）。
线性混合模型分析（意向治疗）显示，在沟通策略使用方面，SUPR 和对照组之间没有显著差异（CPHI）。干预后立即，SUPR 接受者的高级 HA 处理自我效能感明显高于对照组，这一结果在 12 个月时仍保持（MARS-HA；干预后立即的平均差异：5.3，95%CI 0.3 至 10.4；P=.04）。此外，SUPR 接受者在干预后立即表现出比对照组更高的 HA 满意度（IOI-HA；0.3，95%CI 0.09 至 0.5；P=.006），这一结果在 12 个月时仍保持，并且在干预后立即表现出比对照组更高的 HA 使用量（IOI-HA；0.3，95%CI 0.02 至 0.5；P=.03），但这一结果在 12 个月时不再保持。
本研究为建议在 HA 调配护理中添加 SUPR 提供了依据，因为观察到 HA 结果的长期、适度改善。需要进一步研究以评估对 SUPR 进行哪些调整，以在心理社会领域的结果方面建立长期效果。
ISRCTN77340339；http://www.isrctn.com/ISRCTN77340339。
国际注册报告标识符（IRRID）：RR2-10.1136/bmjopen-2016-015012。
