Effectiveness of a Web-Based SUpport PRogram (SUPR) for Hearing Aid Users Aged 50+: Two-Arm, Cluster Randomized Controlled Trial

Abstract

Background Hearing aid (HA) use is known to improve health outcomes for people with hearing loss. Despite that, HA use is suboptimal, and communication issues and hearing-related activity limitations and participation restrictions often remain. Web-based self-management communication programs may support people with hearing loss to effectively self-manage the impact of hearing loss in their daily lives. Objective The goal of the research is to examine the short- and long-term effects of a web-based self-management SUpport PRogram (SUPR) on communication strategy use (primary outcome) and a range of secondary outcomes for HA users aged 50 years and older. Methods Clients of 36 HA dispensing practices were randomized to SUPR (SUPR recipients; n=180 HA users) and 34 to care as usual (controls; n=163 HA users). SUPR recipients received a practical support booklet and online materials delivered via email over the course of their 6-month HA rehabilitation trajectory. They were encouraged to appoint a communication partner and were offered optional email contact with the HA dispensing practice. The online materials included 3 instruction videos on HA handling, 5 videos on communication strategies, and 3 testimonial videos. Care as usual included a HA fitting rehabilitation trajectory only. Measurements were carried out at baseline, immediately postintervention, 6 months postintervention, and 12 months postintervention. The primary outcome measure was self-reported use of communication strategies (3 subscales of the Communication Profile for the Hearing Impaired [CPHI]). Secondary outcome measures included self-reported personal adjustment to hearing loss (CPHI); use, satisfaction and benefit of HAs and SUPR (use questionnaire; International Outcome Inventory for Hearing Aids [IOI-HA], Alternative Interventions [IOI-AI]); recommendation of HA dispensing services; self-efficacy for HA handling (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids [MARS-HA]); readiness to act on hearing loss (University of Rhode Island Change Assessment adapted for hearing loss [URICA-HL]); and hearing disability (Amsterdam Inventory for Auditory Disability and Handicap [AIADH]). Results Linear mixed model analyses (intention to treat) showed no significant differences between the SUPR and control group in the course of communication strategy use (CPHI). Immediately postintervention, SUPR recipients showed significantly higher self-efficacy for advanced HA handling than the controls, which was sustained at 12 months (MARS-HA; mean difference immediately postintervention: 5.3, 95% CI 0.3 to 10.4; P=.04). Also, SUPR recipients showed significantly greater HA satisfaction than controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.09 to 0.5; P=.006), which was sustained at 12 months, and significantly greater HA use than the controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.02 to 0.5; P=.03), which was not sustained at 12 months. Conclusions This study provides ground to recommend adding SUPR to standard HA dispensing care, as long-term, modest improvements in HA outcomes were observed. Further research is needed to evaluate what adjustments to SUPR are needed to establish long-term effectiveness on outcomes in the psychosocial domain. Trial Registration ISRCTN77340339; http://www.isrctn.com/ISRCTN77340339 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2016-015012

‘Dual Sensory Loss Protocol’ for Communication and Wellbeing of Older Adults With Vision and Hearing Impairment – A Randomized Controlled Trial

“…Also a program for partners of visually impaired older adults showed, with the exception of two items on awareness, no significant improvement in understanding of low vision, confidence to deal with low vision, self-efficacy or emotional well-being (Larizza et al, 2011). Finally, a recent modified web-based version of the home based communication program for people with hearing loss on which the DSL-protocol was based, called the SUpport PRogram (SUPR) for HA users aged 50+, also showed no effect on communication strategies, but only on short and long-term HA use and satisfaction (Meijerink et al, 2020).…”

Effectiveness of a web-based SUpport PRogramme (SUPR) for communication partners of persons with hearing loss: results of a two-arm, cluster randomised controlled trial and process evaluation

“…This was especially relevant for the PHLs' hearing loss and selfreported hearing disability (AIADH), as these could affect CPs' third-party disability. Note that the PHL groups in this study are smaller than in the effect analyses publication (Meijerink et al 2020), as 62% of the PHLs in the cRCT study did not have a CP.…”

“…We also aimed to explore whether the CPs' scores on the IOI-HA-SO items "use", "satisfaction", and "quality of life" differed significantly from that of their PHLs (IOI-HA) (see Statistical Analyses, dyad analysis). Therefore we also used the PHLs' data on these IOI-HA items (t1-t3) (Meijerink et al 2020).…”

“…HA-related intervention outcomes (proxy report and thirdparty disability: IOI-HA-so items "use", "satisfaction", and "quality of life") Our previous study among PHLs showed that SUPR caused slightly greater self-efficacy for HA handling and HA satisfaction (IOI-HA) (long-term effects), and a somewhat higher degree of HA use (IOI-HA) (short-term effect only) compared to controls (Meijerink et al 2020). This was in accordance with the PHLs' relatively good instruction video watching rates (up to 43%).…”

“…To evaluate SUPR's short-and long-term effects, a large-scale cluster RCT (cRCT) was performed among PHLs fitted with HAs (clients of the HAD chain) and their CPs. PHLs who received SUPR showed significantly greater self-efficacy for HA handling and HA satisfaction 12 months post-intervention, and more HA use immediately post-intervention, compared to PHLs in the control group (HA fitting only) (Meijerink et al 2020). We also conducted a Process Evaluation (PE) study among PHLs in the SUPR group and identified several factors that could explain the positive effects of SUPR on HA-related outcomes.…”