Lecture 3: Hearing Impairments PDF

Lecture 3: Hearing Impairments ------------------------------ **Learning objectives:** - Describe some determinants and consequences of hearing impairments - Describe primary, secondary and tertiary prevention of hearing impairment - Understand the relevance of applying health behavior...

Lecture 3: Hearing Impairments ------------------------------ **Learning objectives:** - Describe some determinants and consequences of hearing impairments - Describe primary, secondary and tertiary prevention of hearing impairment - Understand the relevance of applying health behavior change models when designing and implementing interventions - Understand how to design and perform a cluster randomized controlled trial **Introduction to hearing impairment** **Hearing impairment** is a disability. Living with a disability can influence quality of life and years of life lost. This all can be captured in **DALY** ( Disability-Adjusted Life Year). This is the **YLD** (Years Lived with Disability) added onto the **YLL** (Years of Life Lost). Sense organ diseases are one of the most prevalent chronic diseases worldwide, with 43.5 millions YLDs in 2019. The prevalence of disabling hearing loss is 430 million (1:20) in 2019 worldwide, and is thought to grow to 700 million (1:14) in 2050. In the **Netherlands**, 1.3 million people experience hearing loss. We **measure hearing loss** by an audiometry test. It measures the softest sounds a person can hear at different frequencies, where results are plotted in an audiogram, showing the hearing threshold per ear. An individual wears headphones and listens to various tones, and indicate when they hear this sound. Symptoms of high-frequency hearing loss can be: - The struggle to understand women's or children's voices - You stopped hearing birds chirping - Words starting or ending with *s, h, f,* or *th* are harder to hear - When people talk, you can hear them talking, but not understand them **Prevention in hearing impairment: Primary, secondary and tertiary** *Primary prevention* Some **causal factors** in hearing loss can be **prenatal** (genetics and intrauterine infections), **perinatal** (lack of oxygen, prematurity, low birth weight etc.), in **childhood and adolescence** (chronic otitis media or other infections). However, when looking at **adulthood** or **lifespan factors**, multiple factors can be a cause, such as lifestyle with smoking, drugs, noise, or NCDs (non-communicable diseases) like diabetes or hypertension. The older you get, the likelier you will get hearing loss. To prevent hearing loss in the Netherlands, multiple interventions are in action. Think about **prenatal care** in pregnant women, the protection against noise and ototoxic chemicals at work (**Dutch Working Conditions Legislation**) and reducing recreational noise exposure by **using ear protection**. The Netherlands Hearing Health Foundation creates awareness, education, online tools, research and stakeholder collaboration. For young adults there is Oorcheck.nl, Prevention of hearing loss in the music sector and the hearing module at Testjeleefstijl.nu. "Iets minder is de Max" and "Help ze niet naar de Tuut" are also collaborative interventions. Outside the Netherlands there are also multiple collaborations to prevent hearing loss, such as the National institute for Occupational Safety and Health (hearing Consevation Program; Buy Quiet, Quiet-by-design; Safe in sound excellence etc.) *Secondary prevention:* Secondary is mostly focused on screening at a you age. Think about neonatal screening, or screening at primary school. Adults are able to 'self-screen', by using 'De Nationale Hoortest' website or use the 'hearWHO' from the World Health Organization. *Tertairy prevention* The impact of hearing impairment in adults can be great. By influencing their **communication**, consequences can be seen in social participation and in the **work** setting, creating a feeling of shame which may result in a worsened **physical health**, a reduced **quality of life** and maybe a **higher mortality**. To treat this hearing impairment and rehabilitate patients, a hearing aid (or cochlear implant), additional hearing solutions, communications strategies, vocational rehabilitation, speech reading, sign language and speech-to-text apps can all help. An example of a communication strategy can be coping with hearing loss by Mayo Clinic. **Design of an intervention: Implementation of an intake tool** Within the ENT clinic there is an ICF-based *e*-intake tool. This consist of an 62-item questionnaire, where afterwards a Patient ICF profile will be constructed. Within this profile, 5 different factors are categorized as no problem (green), a possible problem (orange) or a problem (red). After the construction of this profile, an intake visit is done to talk about the profile. This tool is based on the Bio-psycho-social Model of Function, Disability and Health -- it tries to specify the problems people encounter in daily life -, and thereby provide better options to help your patients. This profile is used to facilitate **shared decision making**. The **Behavior Change Wheel** is used to design an intervention using sources of behavior (green; stage 1), intervention functions (red; stage 2) and policy categories (grey; stage 3).  *Stage 1 Understand the behavior* **Step 1-3:** these steps are done by the clinician, and reviews the results from the intake form before the visit and discusses the problems raised in the form during the visit. **Step 4:** What needs to change (COM-B model)? Capability and opportunity influence motivation, and all influence behavior. *Capability:* - Psychosocial: knowledge, psychosocial skills, strength/stamina in mental processes - Physical: physical strength, skill or stamina *Motivation:* - Reflective: plans (self-conscious intentions) and evaluations (beliefs about what is good or bad - Automatic: emotional reactions, desires, impulses, reflex responses etc. *Opportunity:* - Social: social cues and cultural norms - Physical: time, resources, location, environmental cues *Stage 2: Identify intervention options* **Step 5:** Identification of relevant intervention functions to achieve target behaviors using APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects, and Equity). **Step 6:** Identification of relevant policy categories to support the intervention using APEASE criteria. *Stage 3: Identify content and implementation options* **Step 7:** Identification of BCTs (behavior change techniques) to specify the content of implementation strategies (consensus meeting) **Step 8:** identification of modes of delivery to deliver each of the chosen BCTs This results in the translation of BCTs to an intervention content.