Improving uptake and outcomes of hearing aid fitting for older adults: What are the barriers and facilitators?

of age-related hearing impairment increases, there is an imperative to better address the hearing health care needs of older adults. Advances in hearing aid technology have led to more satisfi ed hearing aid users; however, there remains a large proportion of older adults with hearing impairment who are reluctant to trial hearing aids, and a proportion who report poor outcomes with hearing aids. This special issue presents a series of papers that investigate the issues surrounding hearing aid uptake and outcomes. As per standard procedures for the International Journal of Audiology, all submissions were peer reviewed by external reviewers prior to being accepted for publication. The opening two papers of the special issue (Meyer, Hickson, Lovelock, Lampert & Khan; Hickson, Meyer, Lovelock, Lampert & Khan) discuss the results of a large retrospective study that identifi ed the combination of factors (audiological and non-audiological) important for help-seeking for hearing impairment and success with hearing aids. Many studies in the past have identifi ed key factors (e.g. attitude towards hearing aids, degree of hearing loss, self-perceived hearing diffi culties); however, the studies presented in this issue are unique in that they looked at the impact of more than 40 factors on help-seeking for hearing impairment and hearing aid success, and used multivariate modelling to elucidate which of these were most important. The most important facilitators of help-seeking and successful hearing aid use were positive attitudinal beliefs about hearing aids, the support of signifi cant others, and self-effi cacy for hearing aids. Self-effi cacy refers to the level of confi dence an individual has in his or her ability to manage and adapt to using hearing aids. The fi nding that hearing aid self-effi cacy was important for uptake and success with hearing aids led to the development of three smaller studies which feature next in this special issue. The fi rst of these papers (Meyer, Hickson & Fletcher) looked in depth at hearing aid self-effi cacy and the factors associated with selfeffi cacy. It became clear that non-hearing aid owners differed from hearing aid owners; however, one factor that was associated with adequate hearing aid self-effi cacy within both cohorts was good selfreported vision. Given that hearing aids are small, advanced forms of technology, it also seemed feasible that the low levels of hearing aid self-effi cacy reported by non-hearing aid owners and unsuccessful hearing aid owners could in fact be attributed to a more general fear of technology. Accordingly, the next paper (Ham, Bunn, Meyer, Khan & Hickson) examined if hearing aid uptake and success with hearing aids was also associated with the use of general, everyday and advanced technologies (e.g. mobile phones and navigation systems, respectively). It was hypothesised that non-hearing aid owners and unsuccessful hearing aid owners would use fewer advanced technologies, relative to successful hearing aid users; however the analysis did not support that hypothesis. In the third paper of the series (Caposecco, Hickson & Meyer), we considered the potential importance of written hearing aid user guides for improving self-effi cacy. If designed appropriately for older adults, user guides could be a valuable resource to address the barrier of low self-effi cacy for hearing aids evident in some older adults. It was evident from this research that hearing aid user guides are poorly designed for the target population of older adults and are therefore unlikely to promote self-effi cacy. There were numerous problems with the user guides, in particular in terms of their scope, layout, and typography, vocabulary, and reading level. We hope this research will inform the development of improved user guides for hearing aids in the future. Another factor that is often claimed to infl uence successful hearing aid use is a client ’ s tolerance for listening in the presence of background noise. With this in mind, a study was conducted to explore the potential clinical utility of an Australian version of the acceptable noise level test (Walravens, Keidser, Hartley & Hickson). Unfortunately the research indicated that the test had low test-retest reliability and there was no evidence that it was of value as a predictor of long-term hearing aid use. To this point in the special issue, the focus of the research is on clientrelated factors that are important for hearing aid uptake and success with hearing aids. In the remaining three papers the focus is shifted to the critical role of the audiologist in hearing rehabilitation. As an introduction to this next section, a review is presented of current literature on patient-centred care and what this means for audiology (Grenness, Hickson, Laplante-L é vesque & Davidson). Patient-centred care Foreword