ACHIEVE in practice: A patient-centered approach to auditory rehabilitation (AR)

In many clinics, the pace of daily care can mean device management becomes the primary focus. Yet, the success of the ACHIEVE Hearing Intervention extended beyond best-practices hearing aid fittings to an emphasis on patient-centered education and auditory rehabilitation (AR).

ACHIEVE audiologists followed a structured, evidence-based program supported by a standardized Toolkit for Self-Management and study adapted videos^1,2, helping ensure every participant received the same core education, regardless of provider.³

In this article, I share what that approach looked like in practice, and the specific elements hearing care providers can apply immediately, even in busy clinics.

ACHIEVE’s AR approach at a glance: the four core components

In ACHIEVE, patient-centered auditory rehabilitation (AR) was delivered through four practical elements that can be integrated into routine fittings and follow-ups, even in busy clinics.

Component 1: Goal Setting

Individualized, patient-centered listening goals are foundational to understanding what matters most to each patient. In ACHIEVE, goal setting was central to technology selection, counseling priorities, and AR planning. Additionally, the process served as a form of validation of patients’ lived communication experiences.

The Client-Oriented Scale of Improvement (COSI)⁴ was used to structure goal setting. A key take-away was how goals were defined. Goals are most useful when they are specific and contextualized:

• What is the difficult listening task?
• How often does this situation occur?
• Who is difficult to hear?
• Where does it happen?
• When does it happen?

This process allows patients to better quantify success and barriers over time.

>> Implement Monday morning: During hearing aid selection, set 2-3 specific listening goals with every patient, identifying the who, what, where, how often, and when of each situation. 

Component 2: Initial Education

It is common for new hearing aid users to feel apprehensive during fittings. Questions like “Can I manage this on my own?” and “Will I remember all of this?” are rarely voiced, but often present.  A strength of the ACHIEVE AR program was a combination of ample appointment time and take-home educational materials to refer to when questions came up.

At the fitting, education focused on the first few weeks of hearing aid use supported by:

• Adapted C2Hear™ videos ^2,3 addressing hearing aid expectations and acclimatization.
• Companion handouts on expectations and acclimatization

How it was delivered:

• In the first wave of ACHIEVE, these videos were viewed and discussed in-clinic.
• In the second wave, participants were encouraged to view them independently before or shortly after the fitting. This reduced in-clinic time while delivering the same support, normalizing early hearing aid experiences and reducing use-related anxiety.

When patients experience concerns in early hearing aid use (e.g., “Why does my voice sound so strange?”, “Will I ever stop noticing the refrigerator?”), having materials to revisit can be grounding. Preparing participants in advance appeared to reduce urgent, reassurance-driven follow-ups and increase overall satisfaction.

>> Implement Monday morning: During fittings, briefly discuss what is normal with first-time hearing aid use and provide links to the C2Hear™ videos and a take-home handout to reference later.

Component 3: Listening Strategies

As hearing care providers, we know that amplification alone does not resolve communication difficulties. Still, in busy clinics, device management can unintentionally overtake patient-centered counseling.

Based on common complaints of older-adult hearing aid users, ACHIEVE delivered two topics to every participant: communication strategies and listening in noise. 

How it was delivered:

• Video
• Handouts 
• Reviewed in-clinic or remotely across two follow-up appointments.

How participants applied it between visits:

• Using principles from the Progressive Tinnitus Management model⁵, participants actively selected strategies they wished to try between visits.
• Strategies were documented by the participants using a goal strategy worksheet
• Outcomes were reviewed at future appointments.

This approach emphasized shared decision making, self-efficacy, and reflection- key components of patient-centered AR.

>> Implement Monday morning: Review listening strategies with every patient and provide a handout for reference at home.

>> Implement Monday morning: Ask patients to select specific strategies aligned with their listening goals and intentionally follow-up on their effectiveness.

Component 4: Supplemental Materials

Patients feel seen when clinicians remember and revisit what matters to them. While many older adults prioritize face-to-face conversations and listening in noise, many also have goals related to other topics, such as TV listening, religious services, meetings, and telephone use.

After covering core AR topics, ACHIEVE participants were offered supplemental, goal-driven materials tailored to their individual concerns. Patients again selected strategies they wished to try, reinforcing proactive engagement and autonomy in their care.

>> Implement Monday morning: Don’t overlook less common goals. Keep resources available for a range of listening situations, even if they fall outside of typical clinical patterns. This is what patient-centered care is all about – personalization!

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Summary: What this changes for patients, and your clinic

Using ACHIEVE AR tools can validate patient experiences, revisit challenges over time, and support patients in developing self-management skills. This approach helps patients see hearing care as more than a device alone. It highlights practical factors they can influence in their listening environments. Well prepared, educated patients often report higher satisfaction and require fewer reassurance-based visits, freeing clinical time while strengthening therapeutic relationships.

5 tips to implement Monday morning:

1. During hearing aid selection, set 2-3 specific listening goals with every patient, identifying who, what, where, how often, and when of each situation. 
2. During fittings, briefly discuss what is normal with first-time hearing aid use and provide links to the C2Hear™ videos and a take-home handout to reference later.
3. Review listening strategies with every patient and provide a handout for reference at home.
4. Ask patients to select specific strategies aligned with their listening goals and intentionally follow up on their effectiveness.
5. Don’t overlook less common goals. Keep resources available for a range of listening situations, even if they fall outside of typical clinical patterns.

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This article is part of our ACHIEVE Learnings series, designed to translate evidence into practical, clinic-ready steps. Watch for the next post, where we’ll continue to explore how best practices from the ACHIEVE study can support patient outcomes across domains of well-being.

Good news! All videos and handout resources discussed in this article are available to you for free! Videos; Handouts (Toolkit)

ACHIEVE study context
The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was a large randomized controlled trial evaluating a best-practices hearing intervention versus a health education control and its relationship to cognitive outcomes over three years in older adults with untreated hearing loss. Learn more about the study design and participant characteristics here.

Source of Funding:

The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study is supported by the National Institute on Aging (NIA) grant R01AG055426, with magnetic brain resonance examination funded by NIA R01AG060502 and with previous pilot study support NIAR34AG046548 and the Eleanor Schwartz Charitable Foundation, in collaboration with the Atherosclerosis Risk in Communities (ARIC) Study, supported by National Heart, Lung and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C,HHSN268201100008C, HHSN268201100009C, HHSN268201100010C,HHSN268201100011C, and HHSN268201100012C). Neurocognitive data in ARIC is collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD), and with previous brain MRI examinations funded by R01HL70825 from the NHLBI. Hearing aids, hearing assistive technologies, and related materials used in the ACHIEVE Study were provided at no cost to the researchers or the participants from Sonova/Phonak LLC. Neither the funders of the study, nor the sponsoring manufacturer, had no role in study design, data collection, data analysis, data interpretation, or writing of the report. 

Acknowledgments: Members of the ACHIEVE Collaborative Research Group are listed at achievestudy.org. The authors thank the staff and participants of the ACHIEVE and ARIC studies for their important contributions.

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Authors:

Sarah Faucette, AuD, PhD, Associate Professor

Dr. Faucette is an Associate Professor at the University of Mississippi Medical Center. She serves at ACHIEVE’s Jackson site as the lead research audiologist. Faucette also teaches Audiological Management in the UMMC AuD program and works clinically in adult diagnostics and treatment.

Haley Calloway, AuD, Assistant Professor

Dr. Calloway is an Assistant Professor in the Department of Otolaryngology at the University of South Florida. She is a clinical audiologist and specializes in diagnosing and treating hearing disorders for adult and pediatric populations. She is also a Research Audiologist in the Auditory Rehabilitation & Clinical Trials Laboratory.

Theresa Chisolm, PhD, Professor

Dr. Theresa (Terry) Chisolm is a Professor of Audiology in the Department of Communication Sciences and Disorders at the University of South Florida (USF). Dr. Chisolm specializes in rehabilitative audiology and is a licensed and certified audiologist, with over 40 years of clinical and research experience. Previous research examined the efficacy of a computer-based auditory training program for use post-hearing aid fitting, the benefits of group aural rehabilitation, approaches to auditory rehabilitation for veterans with mild traumatic brain injury, and systematic reviews of hearing-related quality of life outcomes from hearing aid use. Her current role as a co-investigator on the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Randomized Study has spanned from initial conceptualization to development of the manualized best-practices hearing intervention to implementation and fidelity monitoring with her co-PI colleagues at USF’s Audiology Rehabilitation Clinical Trial’s laboratory (ARCT), Drs. Victoria Sanchez and Michelle Arnold.

LinkedIn: https://www.linkedin.com/in/theresa-chisolm-4234366b/

Victoria Sanchez, AuD, PhD, Associate Professor

Dr. Sanchez is a clinician scientist at the University of South Florida where she provides patient care, teaches and mentors trainees, and conducts research in the Auditory Rehabilitation & Clinical Trials Laboratory. 

LinkedIn:  www.linkedin.com/in/victoria-sanchez-aud-phd-60009119a

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References:

1. Ferguson, M., Brandreth, M., Brassington, W., Leighton, P. & Wharrad, H. (2016). A randomized controlled trial to evaluate the benefits of a multimedia educational program for first-time hearing aid users. Ear & Hearing, 37(2): 123-136.

2. Ferguson, M. A., Brandreth, M., Brassington, W. & Wharrad, H. (2015). Information retention and overload in first-time hearing aid users: An interactive multimedia educational solution. American Journal of Audiology 24: 329-332.

3. Arnold, M. L., P. Oree, K. Hyer, V. Sanchez & N. S. Reed. 2019. Development and formative assessment of the Hearing Loss Toolkit for Self-Management. Seminars in Hearing 40: 049–067.  

4. Dillon, H., A. James & Ginis, J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. J Am Acad Audiol, 8(1): 27-43.

5.  Henry, J.A., Zaugg, T.L., Myers, P.J., Kendall, C.J. & Turbin, M.B. (2009). Principles and application of educational counseling used in progressive audiologic tinnitus management. Noise Health, 11(42):33-48. doi: 10.4103/1463-1741.45311. PMID: 19265252.