Gomez Rachel, Habib Alia, Maidment David W, Ferguson Melanie A
National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom.
Nottingham Audiology Services, Nottingham University Hospitals National Health Service Trust, Queens Medical Centre, Nottingham, United Kingdom.
Ear Hear. 2022 May/Jun;43(3):921-932. doi: 10.1097/AUD.0000000000001143.
To identify patient-reported barriers and facilitators to using smartphone-connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed.
A single-center, prospective, observational study. Eight hearing aid users (new = 1, existing = 7; mean age = 71.75 years, SD = 5.23, range = 65 to 81 years) were identified through convenience sampling from 44 participants who took part in a 7-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, preset, and customized programmes. Participants were assigned to one of two focus groups following trial of the app.
Focus group transcripts were thematically analyzed and underpinned by the COM-B (Capability, Opportunity, Motivation-Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique Taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators. Capability: The app increased participants' knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use. Opportunity: Perceived smartphone norms (i.e., acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers. Motivation: The ability to control hearing aid settings in any listening situation (e.g., to reduce noise) empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The app also reduced hearing aid-related and self-stigma, and the ability to self-adjust hearing aids benefitted both participants and communication partners. It was the adjustability and interaction afforded by the app that empowered users, rather than the hearing aid technology itself. Perceived beliefs and knowledge about digital literacy skills, and specifically abilities to use a smartphone, were perceived to be barriers in this typically older population, particularly when they compared themselves to younger generations. Using the Behavior Change Technique Taxonomy (version 1), behavior change techniques that could be used by audiologists to address these barriers included enablement, goal setting, reframing perceptions toward technology, and addressing patient educational needs.
Smartphone-connected hearing aids, when used in their everyday lives, were viewed positively by participants across a range of domains, empowering them and enabling hearing loss self-management. Audiologists should consider smartphone-connected hearing aid candidacy for all who have access to smartphones and are willing to use one. Use of the BCW has identified that modifiable barriers to using smartphone-connected hearing aids exist. Audiologists could use these evidence-based behavior change techniques to support patients in adopting and using these technologies to successfully self-manage hearing loss. Overall, by reframing smartphone technologies as a tool to remain connected with society, smartphone-connected hearing aids could shift the power of managing hearing loss from clinician to patient.
通过行为改变轮（BCW）来识别患者报告的使用与智能手机连接的助听器的障碍和促进因素，以了解相关体验以及如何解决这些问题。
一项单中心、前瞻性观察性研究。通过便利抽样从44名参与者中确定了8名助听器使用者（新使用者 = 1名，现有使用者 = 7名；平均年龄 = 71.75岁，标准差 = 5.23，年龄范围 = 65至81岁），这些参与者参与了由一款原型应用程序控制的与智能手机连接的助听器的为期7周的评估。该应用程序允许用户手动控制诸如增益、降噪和麦克风方向性等设置、预设程序和定制程序。在试用该应用程序后，参与者被分配到两个焦点小组之一。
对焦点小组的记录进行了主题分析，并以COM - B（能力、机会、动机 - 行为）模型和理论领域框架为基础，以识别使用与智能手机连接的助听器（目标行为）的障碍和促进因素。将主题映射到BCW可以使用行为改变技术分类法（第1版）来识别听力学家在临床实践中可以实施的行为改变技术，以解决这些障碍和促进因素。能力：该应用程序增加了参与者对助听器控制的了解，鼓励他们使用该应用程序来改善听力损失的自我管理。然而，使用该应用程序的障碍包括认为自己缺乏使用与智能手机连接的助听器所需的数字素养技能，以及因决定使用哪些控制而导致认知负担增加。机会：感知到的智能手机规范（即使用智能手机的可接受场合）和不同的聆听环境既是促进因素也是障碍。动机：在任何聆听情况下控制助听器设置的能力（例如降低噪音）使用户能够成功地自我管理听力损失，从而增强信心并更多地参与日常生活。该应用程序还减少了与助听器相关的耻辱感和自我耻辱感，并且自我调节助听器的能力使参与者和交流伙伴都受益。赋予用户权力的是该应用程序提供的可调节性和交互性，而不是助听器技术本身。在这个通常年龄较大的人群中，对数字素养技能，特别是使用智能手机的能力的感知信念和知识被视为障碍，尤其是当他们将自己与年轻一代进行比较时。使用行为改变技术分类法（第1版），听力学家可以用来解决这些障碍的行为改变技术包括赋能、目标设定、重塑对技术的认知以及满足患者的教育需求。
与智能手机连接的助听器在日常生活中使用时，在一系列领域中得到了参与者的积极评价，赋予了他们权力并实现了听力损失的自我管理。听力学家应考虑为所有能够使用智能手机且愿意使用的人推荐与智能手机连接的助听器。使用BCW已确定存在使用与智能手机连接的助听器的可改变障碍。听力学家可以使用这些基于证据的行为改变技术来支持患者采用和使用这些技术以成功地自我管理听力损失。总体而言，通过将智能手机技术重新定义为与社会保持联系的工具，与智能手机连接的助听器可以将管理听力损失的权力从临床医生转移到患者手中。
