We know that family-centered care (FCC) can lead to better outcomes for clients. However, we also know that FCC is not always applied in adult audiology services. Clinicians often report that while they support the idea of FCC, they do not always know how to put it into practice.
The Behavior Change Wheel (BCW):
Applying FCC in the clinic often requires behavior change from clinic staff. The Behavior Change Wheel (BCW) is a model from health psychology that can help identify behaviors that need to be changed and design an intervention for how to change them.
The BCW involves following eight steps across three stages:
- understanding the behavior
- identifying intervention options, and
- identifying content and implementation options.
A recent study at The University of Queensland, in collaboration with Sonova, used the BCW to identify key steps to improve FCC in adult audiology clinics. This included improving: (1) the attendance of family members to audiology appointments; and (2) the involvement of family members within the appointment.
A whole-of-clinic approach:
To improve both family member attendance and involvement, the changes in behavior require a whole-of-clinic approach. All staff in the clinic, including front-of-house staff, clinicians, and managers, need to be involved in applying FCC practices. This is something that is not often considered when talking about an FCC approach – often it is expected that clinicians will make changes to their practice, but other staff members are not considered.
However, our research identified that front-of-house staff have a key role in improving family member attendance at appointments as they are most often the ones who arrange appointments with clients.
Three steps to improving FCC in your clinic:
Following the eight steps of the BCW, the research team identified three key steps to improve FCC in adult audiology clinics. These include:
1. Inviting a family member to all appointments:
When booking an appointment, always inviting a family member to attend with the client and explaining the reasons why it is important for them to attend.
For example, during a booking phone call, a front-of-house staff member might say: “Hearing difficulties can affect you as well as the people close to you. We need to understand both perspectives for us to be able to help with your hearing and communication. Who is someone close to you who could attend the appointment with you?”
2. Clinic room set-up:
Setting up the physical environment so that family members are included in the appointment. For example, setting up a chair for the family member next to the client’s chair in the appointment room so that both client and family member are equal distance from the clinician (see diagram below for an example).
3. Setting an agenda:
Starting an appointment by letting the client and family member know that input from both of them will be sought during the appointment.
For example, a clinician might say: “Today I’m going to ask you both some questions about how things are going. First, I’m going to ask you (the client) some questions, and then I will ask some questions to you (the family member). Does that sound ok?”
They may later follow up by asking the family member a similar open history-taking question that they have asked the client: “And how do you find (client’s name)’s hearing?”.
Following these three steps are likely to improve FCC in your clinic. Recent research in social psychology has suggested that this type of family involvement and support in healthcare is a strong predictor of well-being for adult clients and their families.
More information about this study can be found in the following paper:
Ekberg, K., Timmer, B., Schuetz, S., & Hickson, L. (2020). Use of the Behaviour Change Wheel to design an intervention to improve the implementation of family-centred care in adult audiology services. International Journal of Audiology, 1-10, DOI: https://doi.org/10.1080/14992027.2020.1844321.
You can also find this and other articles dedicated to well-being topics in the IJA special supplement.