Psychologically Informed Practice in Audiological Rehabilitation: Audiologist Perceived Barriers, Facilitators, and Preparedness

Abstract

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.

Audiologists’ attitudes and practice toward referring for psychosocial intervention with cochlear implant patients

“…All participants indicated that they believed at least some patients would benefit from referral to a professional specializing in psychosocial care and that intervention would be beneficial. This aligns with prior evidence suggesting audiologists have positive attitudes toward psychosocial intervention in pediatric ( 23 ) and adult ( 39 , 44 , 47 , 48 ) audiological care. Audiologists recognize their role in psychosocial care ( 23 , 43 ), and express interest developing knowledge and skills required to appropriately address mental health needs among their patients ( 44 , 48 ).…”

“…Specific feedback indicated that the respondents were comfortable with the screeners, and they appreciated the audiologists inquiring about their mental health. Findings from this study are comparable to those of other studies in which audiologists reported not to regularly use mental health screeners or other structured questionnaires as a part of clinical practice ( 39 , 48 ). The use of mental health screeners would take the burden of initiating concerns related to psychosocial health of the patient and allow audiologists to guide counseling in a way that these concerns are addressed.…”

“…Each of these team members are qualified to provide emotional counseling and make referrals for psychosocial care, and the involvement of other professionals should not prevent audiologists from also playing a role in the psychosocial management of patients. A small percentage of audiologists have the persistent belief that counseling is outside the audiologists’ scope of practice ( 39 , 48 ), although nearly all audiologists in our study reported at least a willingness to refer for psychosocial services.…”

“…The relationship between confidence and preparedness in psychosocial counseling is reported in literature for both pediatric ( 23 , 63 ) and adult audiological care ( 25 , 39 , 48 , 59 ). Inadequate preparation for psychosocial care can result in audiologists feeling uncertain or uncomfortable in making recommendations regarding psychosocial health ( 43 , 49 ).…”

“…In our study, most participants reported little impact of knowing when and where to refer. Audiologists should have the knowledge and skills to recognize the need for psychosocial referral when patient needs expand beyond the audiologists’ scope of practice ( 25 , 48 ). Previous research indicates that knowing when and how to refer can be a barrier to refer for psychosocial care ( 39 ) In addition to a more systematic approach to graduate-level training in counseling skills to clinician education, clarification of the audiologist scope of practice could be valuable in improving patient-centered care among individuals with hearing loss.…”