Purpose: There is a well-established relationship between hearing loss and psychological symptoms. To ensure audiological rehabilitation is provided appropriately for older adults with comorbid psychological symptoms, a greater understanding of their preferences and experiences is needed. This study sought to understand experiences of hearing loss and audiological rehabilitation from the perspective of older adults with comorbid psychological symptoms (e.g., depression, anxiety, psychosis). Design: A qualitative study using in-depth semistructured interviews was conducted with older adults who had attended audiological rehabilitation within the last year and scored above established cutoffs on measures of depression, anxiety, and psychosis. A thematic analysis generated themes that related to participants' experiences of hearing loss and audiological rehabilitation. Results: Participants included 14 older adults (eight men and six women) with an average age of 70.5 years ( SD = 4.45, range: 64–80) who received hearing aids or a cochlear implant. Three major themes emerged from the analysis of participant interviews. “ The cumulative impact of hearing loss and psychological symptoms” theme describes the two-way, additive relationship between hearing ability and psychological symptoms. “The experience of loss throughout hearing loss and audiological rehabilitation” captures subjective losses, the impact they have, and how participants cope with them. In contrast, “The experience of gain throughout hearing loss and audiological rehabilitation” describes the participants' reported gains, their related impacts, and coping strategies. Conclusions: The experiences of participants revealed that the presence of comorbid psychological symptoms can influence the experience of hearing loss and audiological rehabilitation. These findings have implications for how audiological rehabilitation is provided to ensure optimal outcomes for adults with hearing loss and comorbid psychological symptoms. Supplemental Material: https://doi.org/10.23641/asha.12985955

Objectives: Psychological factors, such as mental illness, mental health, attitudes, emotions, and coping styles, are known to impact the success of audiological rehabilitation. However, evidence suggests that audiologists are not sufficiently addressing client psychological factors. Psychologically informed practice, implemented in other healthcare professions, is a framework that guides clinicians in addressing both the physical and psychological factors of a condition throughout rehabilitation. Psychologically informed practice may also be an appropriate framework to improve client outcomes in audiology. The objectives of this study were (1) to determine the barriers and facilitators to audiologists addressing client mental health, psychological symptoms, emotions, and feelings, and (2) to determine audiologists’ preparedness and willingness to implement aspects of psychologically informed practice in audiological rehabilitation. Design: A cross-sectional survey was conducted with a convenience sample of 118 Australian clinical audiologists (83.1%, n = 98 female) working in adult audiological rehabilitation. Results: Most participants (91.5%) reported at least one barrier to discussing mental health with clients, with the most common being insufficient knowledge and skills in mental health (39.8%). Applying the COM-B model of behavior change, audiologists reported that factors related to motivation were primarily facilitators, and factors related to opportunity (e.g., lack of time) and capabilities (e.g., insufficient knowledge) were barriers to discussing client mental health. Many participants (83.1%) reported willingness to incorporate a clear protocol, including when and how to refer to psychological services, within audiological rehabilitation. Conclusions: Audiologists were generally motivated to incorporate psychologically informed practice into audiological rehabilitation; however, lack of knowledge and organizational barriers would need to be overcome. The insights gained in this study provide a foundation for developing a viable approach to psychologically informed practice, which may ultimately encourage audiologists to engage in person-centered care more actively.

To understand the nature of mental health discussions in audiological rehabilitation, specifically, the types of conversations, when and how they are initiated, and the participant factors associat...

Background/Objectives: Uptake of remote cochlear implant (CI) services is feasible in clinical studies, but implementation into regular clinical practice is limited. Effective implementation requires demonstration of at least equivalent outcomes to in-person care. Use of outcome measures (e.g., specific tools such as speech tests or surveys) that are relevant and sensitive to both modes of service facilitates evidence-based provision of CI services. Following our previous study, which developed a core outcome domain set (CODS) (i.e., a set of CI outcome areas important to measure), this study aimed to (1) review current awareness and use of outcome measures implemented clinically, in-person, or remotely; and (2) provide recommendations for a pragmatic core outcome set (COS) to assess remote technologies for CI users. Methods: Expert Australian/New Zealand clinical CI professionals (n = 20) completed an online survey regarding use of, and familiarity with, pre-identified outcome measures mapping to the previously identified CODS. Respondents rated the outcomes’ usefulness, ease of use, trustworthiness, and recommendation for future use. Stakeholder workshops (clinician, n = 3, CI users n = 4) finalised recommendations. Results: Four of the six most regularly used and familiar measures were speech perception tests: BKB-A sentences, CNC words, CUNY sentences, and AB words. The long- and short-form Speech, Spatial, and Qualities of Hearing Scales (SSQ/SSQ-12) were the top-ranked patient-reported outcome measures (PROMs). These outcome measures were also perceived as the most trustworthy, easy to use, and likely to be used if recommended. Conclusions: A pragmatic COS, relevant to both remote and in-person delivery of CI services, including recommendations for measurement of service, clinician-measured and patient-reported outcomes, and how these might be developed in future, is recommended.

To develop items and evaluate content validity of a new patient-reported outcome measure, Living with Cochlear Implants (LivCI), designed to assess personal and psychosocial factors relevant to adult cochlear implant (CI) users and candidates. The LivCI was developed following COSMIN best practice guidelines and involved extensive stakeholder engagement. Items (n = 87) were initially generated within five key themes: convenience and management, function and participation, stigma and identity, visibility and aesthetics, and psychosocial wellbeing. Content validity was assessed via cognitive interviews with CI users (n = 7) and candidates (n = 7), and an online survey of CI professionals (n = 15) that evaluated item relevance, clarity and theme fit. Lived experience participants found most items relevant and clear, with some revised or removed based on ambiguity or redundancy. Experts rated items highly (mean 3.6-3.9 out of 4), following removal of seven items and reclassification of several others. Readability scores met recommended standards for public-facing health measures. Further psychometric testing has reduced items and validated the LivCI. Content validity with stakeholders was a key stage in the development of the LivCI. The LivCI was shown to assess personal and psychosocial factors relevant to adult CI users and candidates.

To propose the application of Keyes's Model of Social Wellbeing to guide hearing care professionals (HCPs) in providing social coaching to address the impact of hearing loss on social wellbeing in older adults. A discussion paper introducing Keyes's Model of Social Wellbeing and its application in enhancing the social wellbeing of older adults with hearing loss. Qualitative insights and evidence from various studies are provided to support the application of the proposed model. Examples of how HCPs can use social coaching to help address the effects of hearing loss on social coherence, integration, acceptance, contribution, and actualisation are provided. N/A. Hearing loss significantly impacts all five constructs of Keyes's Model of Social Wellbeing, leading to challenges in social coherence, integration, acceptance, contribution, and actualisation. Effective social coaching by HCPs can mitigate these impacts by providing tailored support, enhancing communication skills, and fostering a sense of belonging and purpose. Integrating social coaching into audiology practice and policy, guided by Keyes's Model, can improve social wellbeing for older adults with hearing loss. This person-centred approach requires HCPs to understand the social implications of hearing loss and deliver targeted interventions to support their clients' social and emotional needs.