Cultural competence in NHS hearing aid clinics: a mixed-methods case study of services for Deaf British sign language users in the UK

BACKGROUND

This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers.

METHODS

This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels.

RESULTS

Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness.

CONCLUSION

This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS.

Tele-Audiology in India: Current and Future Trends in Knowledge, Attitude, and Practice Among Audiologists

Background and Objectives

The COVID-19 pandemic has led to widespread use of telepractice in hearing health care services. In this study, we investigated the knowledge, attitude, and practice (KAP) of tele-audiology among Indian audiologists. The current study is based on tele-practice guidelines recommended by the Indian Speech and Hearing Association for tele-audiology services in India.

Subjects and Methods

An internet-based KAP questionnaire survey was performed among 108 audiologists. The questionnaire included 33 items categorized under the following domains: demographic information and KAP of tele-audiology. Of the 108 audiologists included in the study, 38 admitted to the practice of tele-audiology previously and during the COVID-19 pandemic (tele-practitioners), and 70 respondents had no experience of tele-audiology (non-telepractitioners).

Results

Overall higher scores were observed with regard to the knowledge domain, and a mixed attitude regarding tele-practice was observed among audiologists. Most respondents acknowledged the advantages of tele-audiology in clinical practice. However, audiologists were hesitant to utilize this technology owing to the challenges associated with tele-practice.

Conclusions

Despite adequate awareness and a positive attitude, a gap is observed between available knowledge and its actual application/utilization in tele-audiology. Tele-audiology practice was limited to counseling, hearing impairment treatment, and troubleshooting tips for hearing aids. Evidence-based practices to perform diagnostic test battery in tele-mode, hands-on training to run diagnostic test battery/rehabilitation using a tele-mode approach, and greater understanding of the technical requirements for tele-practice may result in a positive perception and encourage tele-audiology practice among audiologists. Specialized training and regular continuing education programmes are important to promote tele-audiology services in clinical practice.

Impact of COVID-19 pandemic on audiology practice: A scoping review

Background

COVID-19 has significantly impacted the professional practice of health care professionals including audiological practice. Audiologists had to adopt to changes and modify their practice to deal with the pandemic. Reasonable published work has been seen since the onset of the pandemic, depicting impact on the audiology practice across the globe in different practice settings and contexts. The present scoping review was carried out to explore the impact of COVID-19 pandemic on audiology practice and the challenges faced.

Material & methods

A literature search was carried out to identify the studies exploring the impact of COVID-19 pandemic on audiology practice. Three electronic databases namely Scopus, PubMed/Medline, and Cochrane Library were searched using keywords. After title and abstract screening, suitable studies were identified.

Results

Of the total 172, nine studies focusing on impact of COVID-19 pandemic on audiology practice COVID-19, published between January 2020 to June 2021 were included. Overall, the COVID-19 pandemic and the subsequent restrictions, caused changes in routine clinical practices in audiology. These changes were with respect to stringent infection control measures, mode of service delivery, changes in routines with reduced services or prioritizing services. Challenges included issues with remote services, experience, and support.

Conclusion

The present review reveals the changes in audiology practice during COVID –19 and challenges encountered by audiologists. These findings would help in better planning of audiology practice in the post pandemic world.

Noise pollution in hospitals - A study of public perception

Introduction:

Hospitals are categorized under silent zone, but noise pollution in this setup is inevitable. The noise in hospitals may have adverse effects on the patients, caregivers and professionals working in hospitals.

Aim:

The aim of the study was to determine awareness of public regarding noise pollution in hospitals, its health effects and mitigation measures.

Method:

The present study was an internet-based questionnaire survey. The questionnaire consisted of a common Section-I for all participants and an additional Section-II for participants of the study who were Audiologists. Descriptive statistical analysis was done on the acquired data.

Results:

174 completed questionnaires were received and analysed, out of which 108 were general public and 66 were Audiologists. The data analysis revealed that the public is aware of the presence of noise in hospitals, some of its overt health effects and measures that can be taken to control the noise pollution in hospitals. Only 22.7% Audiologists who participated in the study were aware of the more technical aspects like permissible noise level in hospitals and their response was similar to that of the general public.

Conclusion:

Though the public is aware of some of the basic facts related to noise in hospitals, there is a need to create public awareness and to train Audiologists regarding hearing conservation program in hospital setups.

An examination of clinical uptake factors for remote hearing aid support: a concept mapping study with audiologists

OBJECTIVE

To develop a conceptual framework around the factors that influence audiologists in the clinical uptake of remote follow-up hearing aid support services.

DESIGN

A purposive sample of 42 audiologists, stratified according to client-focus of either paediatric or adult, were recruited from professional associations in Ontario, Canada, as members of the six-step, participatory-based concept mapping process. Analyses included multidimensional scaling and hierarchical cluster analysis.

RESULTS

Six main themes emerged from this research according to overall level of importance: (1) technology and infrastructure; (2) audiologist-centred considerations; (3) hearing healthcare regulations; (4) client-centred considerations; (5) clinical implementation considerations; and (6) financial considerations. Subthemes were identified at the group-level and by subgroup. These highlight the importance of TECH factors (accessible Technology, Easy to use, robust Connection, and Help available), as well as the multi-faceted nature of the perceived attitudes/aptitudes across stakeholders.

CONCLUSION

Findings can be utilised in tailored planning and development efforts to support future research, knowledge dissemination, best-practice protocol/guideline development, and related training to assist in the clinical uptake of remote follow-up hearing aid support services, across variable practice contexts.

Adults' cochlear implant journeys through care: a qualitative study

Background

Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices.

Method

Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed.

Results

One hundred forty-three data-capture events disclosed 2 themes: 1) “The burden of hearing loss and the impact of Cochlear Implants”, and 2) “Professional Support and Practice, and HCPs Roles and Responsibilities”.

Conclusions

Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.

Audiologists' preferences in programming cochlear implants: A preliminary report

Background: There is little data available addressing how clinical audiologists handle cochlear implant (CI) programming between device manufacturers and make decisions on related services, particularly in the United States. Objectives: This study sought to understand the techniques and settings professionals use with their patients, how they approach bimodal fitting, which tests they use to evaluate patient and device performance, and their overall preferences of (re)habilitative options. Methods: A questionnaire was developed and distributed to CI audiologists throughout the United States electronically. Results: All respondents reported either always or almost always using Cochlear's default signal processing strategy in contrast to the 64% reported for Med-El and 40% for Advanced Bionics. A trend of less use of electrically evoked stapedial reflex threshold (eSRT) than electrically evoked compound action potentials (eCAP) for objective measures was revealed. Higher likelihood of performing speech recognition tests in quiet than in noise was revealed. Preferences for bimodal fitting trend toward using a partner company's hearing aid, although preferences were comparable in adopting four types of hearing aid formulas surveyed in the questionnaire. Conclusions: These data confirm high variability among audiologists' CI programming practices, and documenting these differences is an important step to understanding how to best treat patients.

Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists

Background

Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one’s quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients.

Aim

The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus.

Method

Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified.

Results

The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants’ years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus.

Conclusion

The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Management of occupational noise induced hearing loss in the mining sector in South Africa: Where are the audiologists?

OBJECTIVE

This study was conducted to explore the scope of practice for occupational audiologists in the mining industry and the audiologists' involvement in hearing conservation programmes in South African mines. Additionally, this study investigated the mining industry's role in the audiologists' involvement, and assessed the audiologists' levels of preparedness for working in occupational audiology.

METHODS

In-depth, qualitative telephone and face-to face interviews were conducted with seven occupational audiologists involved in the management of occupational, noise-induced hearing loss (ONIHL) in the South African mining sector. Snowball sampling was utilized to recruit possible participants for this study. Data were analysed using inductive thematic analysis.

RESULTS

The following themes were identified: scope-context misalignment, juniorization of the experts, audiologists are important... but for what?, and limited training in occupational audiology.

CONCLUSIONS

Our evidence highlights important gaps in HCPs in South Africa. The fact that the audiologists responsible for the management of ONIHL are only minimally and peripherally involved may play a significant role in the lack of progress reported in the management of ONIHL in the South African mining sector.

Knowledge and Perceptions of Teleaudiology Among Audiologists: A Systematic Review

Background and Objectives

The knowledge and perception of teleaudiology among audiologists will determine the acceptance and success of teleaudiology practice. This systematic review was conducted to review the published literature on knowledge and perceptions of teleaudiology application among audiologists.

Materials and METHODS

Five studies exploring knowledge and perceptions of teleaudiology application among audiologists published in the English language up to May 2017 were included.

RESULTS

Positive attitudes was observed across the studies regarding acceptance towards application of teleaudiology. The most common sources of knowledge were on the job, graduate studies, and continuing education programs. The major barriers to the uptake of application of teleaudiology were in terms of limitations in infrastructure, reimbursement, and licensure.

Conclusions

The study sheds light on the existing knowledge and perceptions of teleaudiology applications among audiologists. This will help in improving the existing teleaudiology services as well as overcome the challenges faced.