Factors in the Client-Clinician Interaction That Are Perceived to Influence Hearing Aid Adoption in

166 Pages·2017·2.14 MB·English

WWeesstteerrnn UUnniivveerrssiittyy
SScchhoollaarrsshhiipp@@WWeesstteerrnn
Electronic Thesis and Dissertation Repository
6-15-2012 12:00 AM
FFaaccttoorrss iinn tthhee CClliieenntt--CClliinniicciiaann IInntteerraaccttiioonn TThhaatt AArree PPeerrcceeiivveedd ttoo
IInnflfluueennccee HHeeaarriinngg AAiidd AAddooppttiioonn iinn FFiirrsstt TTiimmee HHeeaarriinngg AAiidd
CCaannddiiddaatteess aanndd TThheeiirr RRaatteedd IImmppoorrttaannccee bbyy CClliieennttss aanndd CClliinniicciiaannss
Laya Poost-Foroosh, The University of Western Ontario
Supervisor: Mary Beth Jennings, The University of Western Ontario
Joint Supervisor: Margaret F. Cheesman, The University of Western Ontario
A thesis submitted in partial fulfillment of the requirements for the Doctor of Philosophy degree
in Health and Rehabilitation Sciences
© Laya Poost-Foroosh 2012
Follow this and additional works at: https://ir.lib.uwo.ca/etd
Part of the Speech and Hearing Science Commons
RReeccoommmmeennddeedd CCiittaattiioonn
Poost-Foroosh, Laya, "Factors in the Client-Clinician Interaction That Are Perceived to Influence Hearing
Aid Adoption in First Time Hearing Aid Candidates and Their Rated Importance by Clients and Clinicians"
(2012). Electronic Thesis and Dissertation Repository. 603.
https://ir.lib.uwo.ca/etd/603
This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted
for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of
Scholarship@Western. For more information, please contact [email protected].
FACTORS IN THE CLIENT-CLINICIAN INTERACTION THAT ARE PERCEIVED TO
INFLUENCE HEARING AID ADOPTION IN FIRST TIME HEARING AID
CANDIDATES AND THEIR RATED IMPORTANCE BY CLIENTS AND CLINICIANS

(Spine title: Client-Clinician Interaction Influences In Hearing Aid Adoption)

(Thesis format: Integrated Article)

by

Laya Poost-Foroosh Bataghva

Graduate Program in Health and Rehabilitation Sciences

A thesis submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy

The School of Graduate and Postdoctoral Studies
The University of Western Ontario
London, Ontario, Canada

© Laya Poost-Foroosh Bataghva, 2012
THE UNIVERSITY OF WESTERN ONTARIO
School of Graduate and Postdoctoral Studies

CERTIFICATE OF EXAMINATION

Co-Supervisors Examiners

______________________________ ______________________________
Dr. Mary-Beth Jennings Dr. Lynn Shaw

______________________________ ______________________________
Dr. Margaret F. Cheesman Dr. Sophia E. Kramer

Supervisory Committee
______________________________
Mary Beth Bezzina
______________________________
Dr. Lynn Shaw
______________________________
Dr. Nicholas A. Kuiper

The thesis by

Laya Poost-Foroosh Bataghva

entitled:

Factors in the client-clinician interaction that are perceived to influence
hearing aid adoption in first time hearing aid candidates and their rated
importance by clients and clinicians

is accepted in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy

______________________ _______________________________
Date Chair of the Thesis Examination Board

ii
Abstract
The purpose of this dissertation was to gain a better understanding of the impact of the client-
clinician interaction in the hearing aid adoption process. The specific goals of this
dissertation were: 1) to identify factors in client-clinician interactions that were perceived by
clients and clinicians to influence hearing aid adoption in first time adult hearing aid
candidates, 2) to investigate the importance of the identified factors from clients and
clinicians perspectives, and 3) to compare the importance of the identified factors between
clients and clinicians. These goals were achieved using a mixed-methods approach.
Three studies were undertaken. In the first study a concept mapping approach was used to
explore the collective views of clients and clinicians in identifying factors in client-clinician
interaction that influence hearing aid adoption. Ten audiologists and 13 clients generated 122
statements that formed eight conceptually homogenous clusters of factors. The concepts
were: 1) ensuring client comfort, 2) understanding and meeting client needs, 3) client-
centered traits and actions, 4) acknowledging client as an individual, 5) imposing undue
pressure and discomfort, 6) conveying device information by clinician, 7) supporting choices
and shared decision making, and 8) factors in client readiness. In the second study, nine
audiologists and 11 clients who participated in the first study rated the importance of the 122
statements. Clients rated the concept conveying device information by clinician more
important than audiologists. In the third study, a broad and geographically diverse sample of
clients and clinicians including audiologists and hearing instrument practitioners rated the
importance of the 122 items identified in the first study. The comparison of the client and
clinician groups’ ratings revealed discrepancies between the groups’ ratings. The largest
discrepancy was between the importance each participant group assigned to the concepts
conveying device information by clinician, which was rated much higher by clients and
factors in client readiness, which was rated much higher by clinicians.
This work contributes to the literature on client-clinician interaction in the audiological
interactions. Results have implications for training of students and clinicians in facilitating
the integration of shared decision making and client-centered care in hearing aid adoption

process.
iii
Keywords
hearing loss, hearing aids, hearing aid adoption, hearing aid uptake, client-clinician
interaction, client-centered care, concept mapping, mixed methods

iv
Co-Authorship Statement
Chapter 2 of this dissertation is published and was co-authored by Drs. Jennings, Cheesman,
and Shaw and Christine Meston. Drs. Jennings and Cheesman supervised the research,
provided methodological guidance, and reviewed and revised draft of the manuscript. Dr.
Shaw contributed to the design and data analysis. Christine Meston contributed to the data
collection and data analysis.
I intend to submit chapter 4 for peer review and publication. Drs. Mary Beth Jennings and
Margaret Cheesman will be co-authors for this forthcoming publication. They have
significantly contributed to the design and peer review process to ensure proper interpretation
of the findings.

v
Acknowledgments
This thesis would not have been possible without the constant support of many people. It is a
pleasure to thank the following individuals for their support, patience, and guidance during
my doctoral studies:
First and foremost, my utmost gratitude to my supervisors Mary Beth Jennings and Meg
Cheesman who were abundantly helpful and offered invaluable support and guidance
through the past few years. Thank you both for reading many drafts of many versions of all
my chapters with care and patience.
My gratitude is also due to Lynn Shaw for being on my supervisory and examination
committees and providing insightful feedback on my research.
I would like to thank members of my examination committee, Sophia Kramer, Mary Beth
Bezzina, and Nicholas Kuiper for generously committing their time and expertise in the
review of my thesis document.
I am grateful for the help and support from faculty, staff, and friends in the Health and
Rehabilitation Sciences program, especially those at the National Centre for Audiology. A
special thanks to Andrew Johnson for his support and feedback on my statistical analysis. My
sincere thanks go to Steve Beaulac for his IT support, assistance and efficiency. Lucy
Kieffer, Nancy Inchley, Cathy Collins, thank you for the constant support in administrative
issues and occasional chats. My gratitude to my fellow students, Nazanin Pourmand,
Christine Meston, Sheila Moodie, Marlene Bagatto, Stella Ng, Jeff Crukley, Danielle Glista,
Iman Elsabah Ibrahim and others without whom my years as a PhD student would have been
far less fun, far less enriching.
I am very appreciative to J.B. Orange for being a great mentor in teaching and working with
graduate students.
I would like to thank Rhysa Leyshon for her assistance in learning the concept mapping
method and Michael Huffman for his instant and helpful replies to my questions about CS
software.
vi
I am thankful to Alison Clark for proof reading my thesis document.
I am very grateful to my participants without whom this research would not have been
possible. Many thanks go to Canadian Academy of Audiology and Canadian Hearing
Instrument Practitioners Society for distributing surveys to their members.
Last but not least, I would like to thank my husband, Sasan Borhani and my daughters, Parya
and Nousha. Sasan, I am truly indebted to you as a pillar of love and support. Thank you for
believing in me and being here with me as I complete this milestone. Parya and Nousha, I
love you and thank you for being so mature through the duration of my doctoral studies and
providing space that I needed to complete this thesis.
Funding Acknowledgment
I would like to thank Unitron, Canada Foundation for Innovation, Ontario Research Fund,
Ontario Neurotrauma Foundation, and Ontario Graduate Scholarship in Science and
Technology for providing financial support.

vii
Table of Contents
CERTIFICATE OF EXAMINATION ........................................................................... ii
Abstract .............................................................................................................................. iii
Keywords ........................................................................................................................... iv
Co-Authorship Statement.................................................................................................... v
Acknowledgments.............................................................................................................. vi
Table of Contents ............................................................................................................. viii
List of Tables .................................................................................................................... xii
List of Figures .................................................................................................................. xiii
List of Appendices ........................................................................................................... xiv
Chapter 1 ............................................................................................................................. 1
1 Introduction .................................................................................................................... 1
1.1 Hearing impairment in the aging population .......................................................... 3
1.1.1 Hearing loss prevalence .............................................................................. 3
1.1.2 Age-related hearing loss ............................................................................. 4
1.1.3 Psychosocial consequences of untreated hearing loss ................................ 4
1.2 Hearing aids: advancements and use ...................................................................... 5
1.3 Hearing aid adoption ............................................................................................... 6
1.3.1 Personal factors influencing hearing aid adoption ...................................... 7
1.3.2 Social factors influencing hearing aid adoption.......................................... 8
1.3.3 Hearing health care professional factors ..................................................... 8
1.4 Client-provider interaction .................................................................................... 12
1.5 Dissertation purpose.............................................................................................. 14
1.5.1 Worldview................................................................................................. 15
1.6 Overview of concept mapping .............................................................................. 17
viii
1.6.1 Suitability and advantage of concept mapping ......................................... 18
1.6.2 Concept mapping steps ............................................................................. 18
1.7 Organization of the dissertation ............................................................................ 22
1.8 References ............................................................................................................. 23
Chapter 2 ........................................................................................................................... 36
2 Factors in Client-Clinician Interaction That Influence Hearing Aid Adoption ........... 36
2.1 Method .................................................................................................................. 38
2.1.1 Participants ................................................................................................ 38
2.1.2 Procedures ................................................................................................. 40
2.1.3 Brainstorming ........................................................................................... 40
2.1.4 Sorting and rating of the statements.......................................................... 41
2.1.5 Multidimensional Scaling (MDS) and Hierarchical Cluster Analysis ...... 41
2.1.6 Interpretation ............................................................................................. 42
2.2 Results ................................................................................................................... 43
2.3 Discussion ............................................................................................................. 46
2.3.1 Client-centered interaction ........................................................................ 49
2.3.2 Client empowerment ................................................................................. 51
2.3.3 Implementing the themes into practice ..................................................... 52
2.4 References ............................................................................................................. 56
Chapter 3 ........................................................................................................................... 62
3 Client-Clinician Perspectives of the Importance of the Factors in the Client-Clinician
Interaction .................................................................................................................... 62
3.1 Introduction ........................................................................................................... 62
3.2 Factors Influencing Hearing Aid Adoption .......................................................... 63
3.3 Purpose of the study .............................................................................................. 66
3.4 Method .................................................................................................................. 66
ix