Being patient-centered means encouraging patients to be active participants in their health care and recognizing that the patient is the expert of how their hearing loss is experienced. Patient-centered care also builds on shared responsibility in goal-setting and decision-making and requires a therapeutic alliance between patient and professional.
Patient-centered care takes into account the whole person, beyond the physical symptoms of a disorder, and includes the psychological, social, and environmental factors as well. So, how do we, as clinicians, find out about these external factors? How do you explore the psychological, social and environmental factors that play a role in your patient’s life, and impact the outcome of rehabilitation?
The use of self-report questionnaires allow clinicians an insight into the impact of hearing loss on an individual. However, while validated questionnaires such as the Hearing Handicap Inventory for the Elderly (HHIE) or Speech, Spatial and Qualities of Hearing Scale (SSQ) have their merits, they may also ask about situations that have little value or relevance to the individual. Other self-report measures such as the Satisfaction with Amplification in Daily Life (SADL), Abbreviated Profile of Hearing Aid Benefit (APHAB) or International Outcome Inventory – Hearing Aid (IOI-HA) can be used to measure hearing aid outcomes. However, these scales typically ask patients to give a generalized, non-specific rating of satisfaction or benefit, using their recollections of their hearing ability in particular situations. Open-ended questionnaires which can be individualized, such as the Client Oriented Scale of Improvement (COSI), have a tendency to focus on improved hearing ability or speech understanding to be the only goals of hearing aids provision, when other factors, such as reduced listening effort, are also worthy hearing aid outcome goals.
In other words, while the use of questionnaires such as those cited and the many others available in audiology are valuable in obtaining a global measure of outcomes in clinical practice, they lack individualized real-world applicability or ecological validity.
Ecological momentary assessment
In recognizing the drawbacks of self-report measures, a small number of audiology studies have been using Ecological Momentary Assessment (EMA) as an approach to obtain accounts of experiences from individuals in their everyday situations. EMA, or experiential sampling, involves asking individuals to answer survey questions in real time to capture information about their real-world experiences as they are experienced. While EMA involved the use of paper surveys or diaries in the past, the increasing uptake of, and individual’s familiarity with, smartphones has meant the approach has seen an increase in reliability. There are now a myriad of mobile health (mHealth) apps available which can be programmed to alert individuals to answer surveys by means of time- or event-based triggers. The larger touchscreens available on modern smartphones means surveys can be answered quickly without creating excessive burden on the individual.
EMA in audiology research
EMA has been utilised in hearing research to investigate experiences of tinnitus, hearing difficulty and hearing aid use. EMA has been demonstrated to be a robust research tool, and valid for use with adults with hearing loss. One of the advantages of using EMA is that individuals describe their listening intention and environment in-situ as well as self-report their performance on hearing dimensions beyond speech understanding, as well as psychological factors such as affect. For example, one recent pilot study using EMA revealed that older adults with mild hearing loss perceive benefit from a short trial with hearing aids in terms of speech understanding and reduced listening effort but also in feeling less hampered by their hearing difficulty and getting more listening enjoyment when wearing hearing aids. The study also revealed interesting individual results, such as one participant who reported some benefit in speech understanding but a significant change in feeling less negatively affected by their hearing loss when wearing hearing aids. This significant benefit may not have been revealed using traditional means of self-report or goal-setting.
The future of EMA
While its value as a research tool is clear, EMA can evolve to be a powerful eAudiology tool as well. Future EMA tools could allow professionals to view their patients’ survey questions remotely, allowing insight into their hearing performance in real-world situations. It will empower patients to be an active participant in their hearing care journey while providing professionals further insights into hearing aid candidacy and outcomes. Furthermore, such eAudiology EMA tools will allow professionals to remain connected to their patients between appointments and give patients further support to self-manage their hearing care.
Dr. Timmer’s recorded webinar on this same topic will be available on Phonak Learning (accessible in participating countries). For more information, please visit https://learning.phonakpro.com.