Ecological momentary assessment and its potential as a future clinical tool

In this interview, Dr. Barbra Timmer shares how ecological momentary assessment (EMA) differs from traditional self-report measures, what the latest research has shown, and how you can use this tool in daily practice to support the entire patient journey.

Barbra Timmer, PhD, MBA, MAudA (CCP)

Adjunct senior research fellow at the University of Queensland, Brisbane, Australia, senior scientist at Sonova AG and President of Audiology Australia

Barbra’s research interests include improving outcomes for adults with hearing loss, the use of family-centered care in clinical practice, interventions for hearing and balance issues and the use of smartphones and teleaudiology to support an eAudiology approach in audiology.

Contact the Interviewee

Dr. Barbra Timmer recently presented at the ‘Hearing well and being well – a strong scientific connection’ conference in Frankfurt and her presentation titled, ‘Ecological momentary assessment and its potential as a future clinical tool’ was filled with eye-opening evidence on the importance of using real-world information to highlight individualized hearing aid benefit beyond speech understanding and can affect communication and well-being. Some of the key highlights are included in this interview. Happy reading!

Here is our interview…

Hello Barbra, thank you for joining us. You’ve been doing some fantastic work at the University of Queensland looking at new approaches in eAudiology, specifically Ecological Momentary Assessment (EMA). Can you tell us what EMA is?

Hello Jacqueline. It is a pleasure to be here. EMA captures data about experiences in real time, in participants’ natural environments. EMA can be conducted on smartphones, making it more reliable to survey experiences in real time and multiple times per day. EMA is used across many health disciplines to investigate chronic conditions, such as pain, substance addiction, eating disorders, and mental health disability. EMA is also valid and relevant for audiology research.

How can EMA be used in audiology research?

EMA differs from the traditional self-report measures used today in clinics. In general, self-report gives good insight into the activity limitations and restrictions the client experiences with hearing loss. However, the traditional self-report measures require input from the client based on his/her memory and experience of select listening situations. These are then often generalized across listening situations. EMA surveys the participant’s experience in real-time, in their natural environment, in listening situations relevant to them, and at multiple times per day, allowing for a more reliable self-report.

Your team recently conducted a study on mild hearing loss and EMA. What were you looking to investigate with this study?

For adults with mild hearing impairment, the most common intervention would be hearing aids. However, some audiologists adopt a ‘wait and retest’ approach rather than recommend and fit hearing aids. We were looking to investigate and determine, using EMA, if hearing aids provide benefit for adults with a mild hearing impairment.

Why might audiologists adopt a ‘wait and retest’ approach before recommending hearing aids?

I think there are various reasons for this but looking at the MarkeTrak series of consumer surveys, we can see that a significant number of individuals with self-reported hearing loss, who don’t own hearing aids, state that their audiologists indicated their hearing loss was not bad enough or that hearing aids would not help.

This second study showed that hearing aids can improve not only reported speech understanding, but also aspects such as listening effort and enjoyment in real-world listening situations.”

What were your key conclusions from the study?

We had seen from an earlier EMA study that mild hearing impairment may have some bearing on speech understanding in common, non-complex real-world listening events, but greater impact on other aspects that affect daily communication.

This second study showed that hearing aids can improve not only reported speech understanding, but also aspects such as listening effort and enjoyment in real-world listening situations. As a result, hearing aid outcome goals for adults should include more aspects than only improved speech understanding. The real-world data can be used to highlight individualized hearing aid benefit, as well as a need for further counselling, or hearing aid modifications.

Do you think EMA can support patients in their hearing journey for better outcomes?

Absolutely. EMA can support the entire patient journey. At the hearing assessment appointment, EMA can give insight into candidacy and specific hearing difficulties. During the hearing aid trial period, individualized goals can be set using EMA to enhance hearing aid experience. Furthermore, EMA can inform audiologists which adjustments are needed for fine-tuning the hearing aids to clients’ needs. If difficulties arise, EMA can be used to alert audiologists to provide assistance. Lastly, EMA can be a part of continuous care, especially as clients’ listening goals and outcomes may change overtime.

Would you say Phonak Hearing Diary is similar to an EMA tool?

The Phonak Hearing Diary is a simplified EMA tool. In research we have the luxury of using longer surveys and more complicated data analysis as part of the methodology. The Hearing Diary is a user-friendly quick in-situ survey which patients can fill in to show their level of satisfaction with hearing aids in specific situations.

How does Phonak Hearing Diary fit into the clinical pathway?

I believe it can really complement the hearing aid fitting and acclimatization process. It gives clinicians a tool to see where the patient was satisfied with their hearing aids, or not, and includes the issue and listening situations. This provides them with insight into specific fine-tuning or counselling needs. Plus, the clinician can access this information at any time and can see the need for a follow-up appointment with that patient. It’s a great addition to individualized, person-centered care.

Can you give us 3 takeaways from this research that clinicians can start using in their daily practice?

Here are my takeaways:

  1. Do not use pure-tone thresholds as a predictor for hearing aid benefit. If your patient complains about hearing difficulties, address these, even if their audiogram suggests a slight or mild hearing loss.
  2. Set rehabilitation goals that go beyond improved speech understanding and incorporate other goals that could impact communication and general well-being.
  3. Look at using the many new eAudiology tools available today to gain greater insight into your patient’s hearing needs and difficulties, and outcomes. 

Wow, these are great findings and would certainly change the conversation surrounding individualized hearing care, especially for those with mild hearing loss. Thank you for your time and we will definitely stay tuned!

For more information about EMA and its potential as a future clinical tool you can read a peer-reviewed article in Hearing Research that summarizes EMA and a previous blog article by Dr. Timmer on this same topic.

You can learn more about Phonak Hearing Diary at