Audiology and Speech Pathology - Theses
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ItemPsychologically Informed Practice in Hearing Healthcare: Perspectives and Needs of Clients and Audiologists( 2022)For many people, the sense of hearing provides a connection with others and the world around them. Losing one’s hearing can have a deleterious impact on many psychological and social aspects of life. Hearing loss can compromise psychological wellbeing, resulting in an increase in loneliness or reduced self-esteem, and it can also increase the odds of experiencing psychological symptoms, such as depression and anxiety. Given this association, audiologists are likely to encounter clients with psychological concerns on a regular basis. Understanding how these clients experience audiological rehabilitation may be an important way for audiologists to provide relevant and optimal services. Psychological factors, including mental health and illness, can also significantly influence the initiation, adherence, and success of audiological rehabilitation. Despite this, psychological factors are not adequately considered within hearing healthcare, so the recommended approach of person-centred care may need to be further extended to better address these factors. Psychologically informed practice (PIP) may provide a suitable framework that can be used to extend upon person-centred care, especially for clients with comorbid psychological symptoms. A PIP framework recognises the role of psychological factors in chronic health conditions and addresses these using psychological theories and frameworks. PIP has shown success in other rehabilitation settings and may therefore provide benefits within hearing healthcare. The aim of this thesis was therefore to explore the nature of mental illness, mental health, and psychological symptoms within audiological rehabilitation, from the perspective of clients and audiologists, and to provide a foundation of support for the implementation of PIP into hearing healthcare. Four studies were conducted to achieve the aims of this thesis. The first study included in-depth, semi-structured qualitative interviews to understand the experience of hearing loss and audiological rehabilitation for older adults with comorbid psychological symptoms. A novel theme found in this study was the bi-directional and cumulative relationship between hearing loss and psychological symptoms. Given the relationship between hearing loss and psychological symptoms, the second study included a systematic review and meta-analysis to determine the effect of interventions targeted at hearing loss on psychological symptom outcomes in adult clients. The meta-analysis showed that hearing aids, cochlear implants, and communication and education programs resulted in a small decrease in depression and anxiety symptoms. A mixed-method survey of audiologists working in adult audiological rehabilitation in Australia was then conducted to understand the nature of client-audiologist discussions about client mental health within audiological rehabilitation. This study found that audiologists occasionally discuss mental health, and clients are more likely than clinicians to initiate these conversations. The final study aimed to determine the barriers and facilitators to audiologists discussing and addressing client mental health, and to determine audiologists’ preparedness and willingness to implement aspects of PIP in audiological rehabilitation. Audiologists were generally motivated to incorporate PIP into audiological rehabilitation; however, a lack of knowledge about mental health and organisational barriers, such as time and resources, would need to be overcome. Overall, the studies in this thesis provide an understanding of how psychological symptoms are experienced, recognised, discussed, and addressed within audiological rehabilitation and suggested that the current way of delivering audiological rehabilitation is insufficient to achieve optimal outcomes for clients with psychological symptoms. These studies form an evidence-based foundation and rationale for the implementation of PIP within hearing healthcare.
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ItemPatient-practitioner interactions: older adults and their audiologists( 2014)Hearing impairment increases in prevalence with ageing. If left untreated, hearing impairment can be a barrier to successful ageing and can cause a variety of negative consequences. Recent investigations of factors associated with hearing aid uptake and use by older adults revealed a paucity of research examining the value and influence of patient-audiologist interactions. Within the health professions, there is a growing interest in patient-practitioner interactions and in particular the quality of professional exchanges termed “patient-centred”. Philosophical and clinical definitions of the term are reported throughout literature where decades of research illustrate relationships between patient-centred care and improved patient outcomes. Before such relationships can be examined in audiological rehabilitation for older adults, the term needed first be defined and the existence of patient-centred interactions explored. This research utilised a mixed-methods design to triangulate patient-centred care in audiological rehabilitation as defined by older adults with hearing impairment with observed patient/companion-audiologist communication in audiology consultations. A sequential exploratory design was used across two studies. Firstly, a qualitative descriptive study was conducted with a purposively sampled group of older adults who owned hearing aids. This study explored participants’ experiences with audiologists and their definition of patient-centred audiological rehabilitation. The findings of this study are represented visually in two models. The first model describes the people, behaviours and processes required to provide patient-centred audiological rehabilitation: a therapeutic relationship was seen as central to patient-centred audiology interactions; the audiologist and patient were seen as key players; and the way two processes occurred (information exchange and decision-making) was considered instrumental in whether audiological rehabilitation was patient-centred. The second model provided an operationalised description of how patient-centred care can be clinically implemented. In this model, there were four dimensions: 1) therapeutic relationship, 2) informed patients, 3) involved patients and 4) individualised care. Results from Study 1 provided a rationale and focus for the examination of patient-audiologist communication in initial consultations and thus informed the second study. In Study 2, 63 initial consultations between audiologists and older adults (and companions in 17 cases) were filmed and analysed using the Roter Interaction Analysis System (RIAS). This method was used to examine the presence and nature of patient-centred communication. Analyses were conducted in two phases: Study 2a focussed on the history-taking phase of initial consultations and Study 2b focussed on the counselling phase. Taken together, the results revealed a dearth of patient-centred communication in initial consultations. That is, little communication was invested in developing a therapeutic relationship; patients were primarily informed only about hearing aids and audiologists asked closed-ended, biomedical questions thus limiting information received about patients’ needs. Little patient and companion involvement was observed. Audiologists rarely sought input from those accompanying the client and, in the presence of a companion, asked fewer psychosocial and lifestyle questions and offered less psychosocial and lifestyle education than when a companion was not present. Limited individualisation of information and options was observed. At the conclusion of this thesis, the results of Study 2 were juxtaposed with the results of Study 1. The overall findings present an imperative to value and promote the quality of patient-audiologist interactions, beyond technical skills, in the provision of “patient-centred” audiological rehabilitation for older adults and in the education of students of audiology.