Abstract
Background: The provision of individualised, goal-oriented hearing health care aligns with a person-centred approach to audiological rehabilitation and can be used to adopt the perspective of living well with hearing loss. Taking this approach ensures that we move beyond a deficit model in rehabilitation and include other aspects of living well with hearing loss, including social engagement and communicative functioning. The Ida Institute‘s Living Well Online tool utilises eHealth to assist clients in preparing for their audiology appointment by focusing on the communication situations which are most relevant and important to them and uses an active problem solving approach to assist clients in identifying solutions to their everyday communication difficulties. In this way, Living Well Online also assists audiologists in identifying client goals. This study aimed to explore how Living Well Online facilitated the provision of person-centred care in audiological rehabilitation, and specifically how it influenced the way in which audiologists communicated with clients in audiological appointments.
Methodology: Two audiologists and twenty-four clients with hearing loss participated in this study. Audiologists working across two private clinics invited clients to complete Living Well Online prior to their appointment. Audiology appointments were subsequently video-recorded to observe how the Living Well tool was utilised during the appointment, and clients and audiologists participated in an individual qualitative interview to investigate their perspective of Living Well Online and its use in appointments. Appointments were transcribed verbatim and analysed using conversational analysis. Interviews were transcribed and analysed using template analysis.
Results: Four participants completed Living Well Online prior to their appointment; the remaining 20 participants completing it within their appointment with the audiologist‘s assistance. Two of the twenty-four clients brought a family member with them to their appointment who also participated in completing the Living Well tool. Audiologists typically communicated to the client that the purpose of the tool was to focus the conversation on the client as a person, and to assist them in better understanding the client‘s individual hearing situations. Duration of discussion relating to Living Well Online ranged from 1:40 minutes to 16:16 minutes. Analysis of appointments suggested that clients who completed Living Well Online prior to their appointment typically had longer discussions and more active involvement in conversations than clients who completed the tool during the appointment. In addition, audiologists‘ use of open versus restrictive questions influenced the person-centredness of the communicative interaction, with the use of open questions providing clients with the opportunity to identify their own communication situations to discuss. Analysis of the client interviews revealed four themes of importance: client characteristics influenced tool use (e.g., the therapeutic relationship and experience with technology); client satisfaction with tool design (e.g., ease of use, presentation and workings of the website); process of using tool (e.g., belief that the tool should be used in session and helps the audiologist); and helpfulness of tool content (e.g., relatability to the client and social/emotional aspects of using the tool). Clinicians reported that the Living Well tool provided a framework to streamline goal setting and provided an important context to client communication difficulties.
Conclusions: Feedback from both clients and clinicians showed support for the use of Living Well Online within hearing health care appointments. Importantly, Living Well Online provided a context for clients and clinicians, focusing on communication and clients‘ participation in everyday life. Communication patterns of clinicians influenced the extent to which person-centred care was implemented in using the tool. Using the tool has implications for training audiologists, highlighting the importance of open-ended questions and the value of completing the tool prior to appointment attendance.