Annual progress reports

Annual progress reports of funded research

Hearing loss, the silent enemy of good health: Effectiveness, cost-effectiveness, and potential economic and social impact of interventions to promote treatment to facilitate improved hearing (2015556)

Associate Professor Julia Sarant (Chief Investigator A)
University of Melbourne
Budget: $541,448.90
Funding period: 2022 to 2025

Project Synopsis

Hearing loss impacts adults of all ages. Importantly, 7 in 10 adults aged over 70 years suffer from hearing loss. It is associated with significant psychological, physical, and cognitive health comorbidities (for example, cancer, stroke, higher death risk). Hearing loss is the third leading cause of years lived with disability (higher than diabetes and dementia), the leading cause of disability for people greater than or equal to 70 years, and the largest potentially modifiable risk factor for dementia. However, most Australians are unaware that hearing loss is associated with serious health comorbidities, waiting 10 years on average to seek help. Medical referral rates for hearing care and hearing aid uptake and use are grossly suboptimal. Three out of 1,000 general practice consultations involve hearing management, and 10 to 11% of adults worldwide who would benefit from hearing aids actually use them.

This project will address the issues of low referral and low uptake of hearing aids by identifying barriers to referral in medical practice and hearing aid uptake and use in consumers. Using this information, interventions will be designed to address barriers and their effectiveness and cost effectiveness evaluated. The economic implications of untreated hearing loss for the Australian population will also be evaluated.

New interventions to increase referrals and use of hearing aids and determination of the economic rate of return and cost-effectiveness of these will provide incentives for effective integration of this research evidence into health services and policy, leading to improved physical, cognitive and mental health outcomes for many Australians of all ages.

Progress report 30 April 2024

This grant comprises 3 projects:

Barriers & enablers to GP referrals to audiology: Systematic review, questionnaire design, questionnaire administration, and data analysis for step 1 (GP questionnaire) is complete. A systematic review article on GP referrals to audiology will be submitted for publication this week. A draft of the questionnaire results paper is 50% completed. Step 2 (Focus group) materials have been designed based on questionnaire data and multiple focus groups are currently being conducted.
Barriers & enablers to consumer take-up & use of hearing aids: Questionnaire design, questionnaire administration, and data analysis for step 1 (consumer questionnaire) is complete. A draft of the questionnaire results paper is 50% completed. Step 2 (Focus group) materials have been designed based on questionnaire data and focus groups are currently being conducted.
Health economics analysis: Work on a comprehensive analysis of the cost of untreated hearing loss is underway.

Improving access to the hearing services program for people from culturally and linguistically diverse backgrounds (2015700)

Professor Piers Dawes (Chief Investigator A)
The University of Queensland
Budget: $902,757.60
Funding period: 2022 to 2026

Project Synopsis

We want all people to have sufficient usable hearing to achieve their goals in life. Untreated hearing loss impacts communication, quality of life, educational and employment opportunities, social engagement, and physical and mental health. Unfortunately, people from culturally and linguistically diverse (CALD) backgrounds are more likely to experience hearing loss and less likely to access hearing services. Because Australia is a diverse country with 30% of people born overseas, hearing health inequality is a serious challenge.

Effective interventions for hearing loss are available via the Australian Government Hearing Services Programme (HSP). A review of the HSP recommended that the Government identify and analyse shortfalls in engagement with, and outcomes from, the HSP for CALD populations. The review recommended a co-design approach, working with CALD communities to address issues impacting on access to the HSP. To address these recommendations we will build on our expertise in hearing services, health inequalities, patient-centred care and co-design to:

Work with people from CALD communities to understand their engagement with, and outcomes from HSP services
Conduct interviews with HSP clinicians to understand barriers and facilitators for culturally responsive practice
Partner with people from CALD communities and HSP audiologists to co-design interventions for access to culturally safe HSP services
Trial and evaluate co-designed interventions in HSP clinics.

This project will inform development and delivery of accessible, equitable and culturally safe hearing services and provide an evidence base for strategies to encourage and promote behaviours that preserve and protect hearing health in vulnerable CALD populations across the life stages. The project will assure providers and consumers that the HSP is based on the best available evidence to adapt to client needs.

Progress report 30 April 2024

We have consulted with a diverse range of people and conducted the following research activities.

Barriers reported by service users from culturally and linguistically diverse people in accessing hearing services in Australia

Aims: To explore the barriers and facilitators that influence their access to, engagement with, and outcomes from, HSP services for children, adolescents, and adults from CALD communities we also explored the acceptability of the hearing care being offered to people from CALD backgrounds.
Findings: Despite the availability of free government-subsidised hearing services, diverse ethnic communities experience barriers to accessing and using these services. Given the adverse impacts of hearing loss (for example, on social, work, education, and family life), addressing these barriers are essential for all multicultural countries.

“You Are Just Making Him More Deaf”: Exploring Paediatric Hearing Services Engagements in Australia's Culturally Diverse Communities

Aims: to understand the factors influencing engagement with hearing services among children and teenagers in CALD communities in Australia
Findings: The active promotion of open dialogue, disclosure of hearing loss, and seeking assistance within the community and social circles by parents, coupled with empathy, cultural sensitivity, and effective communication by audiologists, play crucial roles in fostering acceptance and support for children from CALD communities using hearing services.

Factors influencing the accessibility and use of hearing services by diverse ethnic communities in Australia

Aims: To explore the factors influencing the accessibility and use of hearing services for people from diverse ethnic communities in Australia.
Findings: Five themes and several subthemes were identified among factors influencing the accessibility and use of hearing services reported by the participants. To remove barriers to access and use of hearing services, we must address the stigma of hearing loss and lack of trust in healthcare, increase knowledge about the impact and treatment of hearing loss among ethnic communities, and improve cultural responsiveness of hearing services.

Identifying Person-Centred Culturally Responsive Hearing Care Professional Behaviours: An International eDelphi Study

Aims: To identify the most important person-centred culturally responsive behaviours for hearing care professionals (HCPs) working with diverse ethnic communities.
Findings: The eDelphi study identified key behaviours for HCPs working with ethnic communities that improve access to and use of hearing services for people from diverse ethnic communities.

What does culturally responsive hearing care look like? An international Delphi study

Aims: To identify the most important culturally responsive behaviours by hearing care professionals form the perspectives of hearing professionals and research experts in culturally responsive healthcare.
Findings: The panel of the Delphi selected the top 10 most important behaviours for HCPs. Culturally responsive hearing care and clients’ satisfaction could be improved by facilitating these key behaviours.

Exploring barriers and facilitators for translators and interpreters in audiology clinics: A mixed-method investigation

Aims: To identify barriers and facilitators experienced by interpreters/translators from East Asian backgrounds engaging with hearing care professionals in audiology clinics
Findings: Barriers included a lack of educational resources for translation and interpretation in hearing clinics, interpreters needing to speak loudly to patients, client concerns about confidentiality and the absence of pre-appointment briefings for interpreters on patients’ health conditions. Key strategies that could facilitate translation and interpreting (T&I) services in hearing clinics include audiologists providing a briefing about patient hearing loss to interpreters, good quality informational resources about hearing for interpreters, privacy assurances for patients and setting up systems for regular feedback about T&I services.

These studies and student projects are currently ongoing:

HSP staff perspectives on culturally responsive hearing care
An international systematic literature review of barriers to hearing service access for people from ethnic minority backgrounds (PhD project output)
Accessibility of online information (PhD project output)
Levels of hearing loss among children from diverse ethnic communities in Australia (PhD project output)

Publications and other resources

Dawes, P., et al. (2024). Developing strategies to improve accessibility of hearing health services for people from diverse ethnic communities in Australia: Research Protocol. Figshare. https://doi.org/10.6084/m9.figshare.26499952.v1

Implementation and Evaluation of a Co-designed Program Targeting the Psychosocial and Emotional Impacts of Hearing Conditions in Adults (2015711)

Associate Professor Christina Bryant (Chief Investigator A)
University of Melbourne
Budget: $496,103.00
Funding period: 2023 to 2026

Project Synopsis

Despite the considerable psychosocial and emotional consequences of ear and hearing conditions, common clinical interventions, such as hearing aids, do not adequately address these difficulties. There is a paucity of evidence-based services that specifically target the emotional and psychosocial impacts of hearing conditions. The Hearing Wellbeing Program (HWP) was developed using a true co-design methodology informed by people with lived experience of ear and hearing conditions, audiologists, and psychologists. The aim of the HWP is to address the emotional and psychosocial impacts of ear and hearing conditions via an individually tailored program delivered by audiologists.

Given the recent COVID-19 pandemic, increase in digital literacy and number of regional / rural Australians, an online, self-paced version of this program would enable greater accessibility and long-term cost-effectiveness. This research project will therefore adapt the current HWP into an online version, which will be piloted in an initial feasibility study. Outcomes of this pilot will inform further optimisation of the online HWP and a subsequent randomised-controlled trial will assess the clinical effectiveness of the HWP to improve wellbeing for people with ear and hearing conditions.

The research project will be conducted in 3 phases:

Workplan 1: Development of an online version of the Hearing Wellbeing Program utilising co-design with audiologists, psychologists and people with lived experience of hearing conditions.
Workplan 2: Feasibility and pilot study of the online HWP to determine the barriers and facilitators to implementation and refining the study protocol for a randomised-controlled trial.
Workplan 3: A randomised-controlled trial of the effectiveness and implementation process of the online HWP for people with ear and hearing conditions.

Progress report 30 April 2024

Excellent progress has been made in the co-design phase of the project. The Hearing Wellbeing Program (HWP) is a suite of 10 paper-based modules that contain information and strategies related to the psychosocial impacts of hearing loss. The program was the output of a human-centred co-design project conducted by Australian charity, Soundfair in 2020, that sought to uncover a way to support the social and emotional needs of people living with hearing loss. The program uses evidence-based techniques from Cognitive Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT) and health behaviour change theory to educate and support people to self-manage the psychosocial impacts of hearing loss. Each module provides information about the topic, lived experience stories, and self-help strategies or activities aiming to strengthen that area of a person’s life. The co-design process aimed to convert these paper-based modules into an online format.

An interdisciplinary team of co-designers was recruited to ensure that expertise was represented in the key areas of lived experience, hearing health, psychology, and design. Adults with lived experience of hearing loss were recruited from the project’s Consumer and Community Advisory Committee (CCAC). The CCAC had already formed a collaborative relationship with the researchers and participants were recruited to represent a range of experiences. The intention in recruiting from the CACC was to reduce any potential power imbalances that may have arisen in a co-design situation. The CACC were compensated for their time via honorarium payment, consistent with similar lived-experience expertise roles within consumer organisations (for example, The Black Dog Institute). The research steering committee were consulted throughout the design process, providing further expertise in digital health intervention development, implementation science, education, and behaviour change. A health service designer with lived experience of hearing loss and a digital design agency specialising in the health and social sector were engaged to drive the HCD and digital development.

The digital version of the Hearing Well-being program is being trialled as an online product with 30 participants, 21 of whom have completed the 8-week trial and submitted all follow-up data. Qualitative interviews have been conducted with 7 participants, and the feedback obtained from them and the collected quantitative measures will inform the final version of the product to be tested in a RCT. Suggestions for improvement include using more visual material and reducing the length of the questionnaire battery.

Publications and other resources

Emma C Laird, Caitlin M Barr, Zoe Williams Christina A Bryant, Human centred design of a digital wellbeing program for adults with hearing loss, paper under review.

Building on newborn hearing screening success: towards national standards and data management (2015735)

Associate Professor Valerie Sung (Chief Investigator A)
Murdoch Children’s Research Institute
Budget: $1,436,994.31
Funding period: 2023 to 2026

Project Synopsis

Australian children born with hearing loss are some of the best supported in the world through government-funded universal newborn hearing screening (UNHS), diagnosis, device provision, early intervention and medical services.

However, there is no mechanism to measure progress, track outcomes, or document hearing health needs, especially for children who develop hearing loss later in life and Aboriginal and Torres Strait Islander children who experience hearing loss from chronic middle ear infections.

We will create a prototype Child Hearing health Outcomes Registry (CHOR) in two states, including all deaf or hard-of-hearing 0-18 year-olds, for later national extension. We aim to:

Map Australia’s fragmented hearing-specific services and datasets nationally and by state
Bring datasets into a single system in Victoria and Queensland, linked to universal administrative datasets
Develop a Core Outcome Set to measure what matters to children, families, services and funders
Evaluate the costs/benefits of developing/maintaining an Australian National CHOR (ANCHOR)
Provide proof-of-concept answers to urgent research questions, including:
1. Do children with UNHS-detected mild / unilateral hearing losses benefit from amplification or early intervention?
2. Should we re-screen hearing later in childhood?
3. Can we achieve outcomes equity for deaf or hard-of-hearing children?
4. Is a whole-population data system possible?

This grant unites researchers, families and stakeholders to facilitate systematic data capture to

ensure the government’s investments into UNHS and child hearing health interventions are improving outcomes
address inequity in service access, particularly Aboriginal and Torres Strait Islander and vulnerable children
track outcomes of ad-hoc post-UNHS screening
provide a national population-based child hearing research platform.

Progress report 30 April 2024

We have built a diverse national collaboration of hearing health stakeholders, meeting regularly to pursue project goals.

We have set up a Consumer Advisory Group, initially formed for project input, that will serve as an ongoing platform for knowledge exchange in child hearing research.

Aim 1 involves mapping Australia's hearing health services and databases. A Comprehensive survey, approved by HREC, will collect data during May and June, with reporting by August 2024.

Aim 2 aims to consolidate datasets into a Vic/QLD system linked to administrative data. Protocol development is underway, aiming for data linkage in late 2024.

Aim 3 focuses on developing a Core Outcomes Set. HREC approval was obtained in 2023 and focus groups and interviews to ascertain family and youth priorities are underway.

Project goals and methodology have been widely disseminated through community publications, conferences, and engagement events, with a methodology paper in progress.

We have achieved many goals in the last year and are confident we will continue to make progress towards completing many more goals in the next year. We have also achieved additional goals which were not originally planned but have been essential to achieve to ensure adequate stakeholder engagement. These include:

ensuring culturally sensitive and appropriate ways to approach the Deaf and Aboriginal and Torres Strait Islander communities
using robust methodological processes to set up the AusChildDeafness-CAG to ensure representativeness of families.

Publications, conference abstracts and other resources

Sung V, Smith L, Elliott K, & the ANCHOR Investigator Team. Australian National Child Hearing Health outcomes Registry (ANCHOR): Innovative solutions for meaningful data collection, storage, and linkage. Presented at the 75th Annual Scientific Meeting of the Australian Society of Otolaryngology Head and Neck Surgery. March 8, 2024. Perth, Australia.

Sung V, Smith L, Elliott K, & the ANCHOR Investigator Team. Australian National Child Hearing Health outcomes Registry (ANCHOR): Collaboration and connection across the nation. Poster to be presented at The 6th International Congress on Family Centred Early Intervention for Children Who Are Deaf or Hard of Hearing, May 15, 2024. Bad Ischl, Austria.

Shepard E, Porter A, Pang J, Feller H, Elliott K, Smith L, Sung V. Establishing a collaborative Australian Family Research Advisory Group to support children and young people who are deaf or hard of hearing: A Case Study. To be presented at The 6th International Congress on Family Centred Early Intervention for Children Who Are Deaf or Hard of Hearing, May 15, 2024. Bad Ischl, Austria.

Sung V, Elliott K, Smith L & the ANCHOR Investigator Team. Australian National Child Hearing Health outcomes Registry (ANCHOR): Collaboration and connection across the nation. To be presented at Hearing Across the Lifespan. June 7 2024, Cernobbio, Italy.

Sung V. Australian National Child Hearing Health Outcomes Registry (ANCHOR): An opportunity to measure educational outcomes that matter for deaf and hard of hearing children. To be presented at the Australian and New Zealand Conference for Educators of the Deaf. September 28, 2024. Sydney, Australia.

Empowering adults with hearing loss by increasing informed choice, accessibility, and uptake of hearing healthcare (2015748)

Associate Professor Melanie Ferguson (Chief Investigator A)
Curtin University
Budget: $683,027.43
Funding period: 2023 to 2026

Project Synopsis

The Problem

Hearing loss is highly prevalent and impacts many aspects of a person’s life including communication, social engagement, employment, general health, and wellbeing. Yet many people do not access hearing healthcare even though help exists and hearing aids, the most common intervention for hearing loss, are clinically effective. Barriers to hearing healthcare include poor understanding of hearing loss and its impact; poor knowledge of help-seeking for hearing healthcare options; no support to help decide which option is best; affordability of hearing healthcare and stigma related to hearing loss.

The Solution

Guided by theories of behaviour change and implementation science, this research will conduct a needs analysis, and then co-develop and evaluate a tailored decision support intervention (HearChoice) to help increase informed decisions, accessibility and uptake of hearing healthcare for adults with hearing loss. The aim is to empower adults with hearing loss by offering them choice and control over their own hearing healthcare, leading to improved individual, societal and economic outcomes.

The Proposed Research

There are 4 work packages (WP):

WP1: Identify and understand the needs, barriers and enablers to informed decision-making about hearing healthcare options for adults seeking help for their hearing loss.
WP2: Co-develop with consumers and key stakeholders, an online individualised decision support intervention (HearChoice) to facilitate informed decision-making about hearing healthcare. Options will include a comprehensive range of device-based and service-based interventions.
WP3: Evaluate the clinical-effectiveness, and perform an economic analysis, of HearChoice using a randomized controlled trial and process evaluation in adults with hearing loss.
WP4: Co-develop, with consumer and key stakeholders, an implementation plan to facilitate scaling up of HearChoice for the Hearing Services Program and ensure future sustainability of the intervention.

Progress report 30 April 2024

WP1: Stakeholder workshop

Target Statement has been co-developed.

WP1: Qualitative study

Adults with hearing loss. N=17. Semi-structured interviews completed.
Hearing care professionals. N=9. Focus groups completed.
Data analysed, 2 manuscripts in draft.

WP1: Online survey completed

Adults with hearing loss. N=300.
Hearing care professionals. N=50.

WP2: Development of HearChoice

HearChoice design specification co-developed, iteratively revised and refined.
HearChoice app under co-development.

We explored factors that help and hinder help-seeking and decision-making in hearing care via in-depth discussions with people with hearing loss and hearing care professionals. A large online survey of 300 adults with hearing loss supported these findings.

Currently, we are developing the HearChoice web-based app. Participants at all stages have shown strong support for HearChoice.

Publications and other resources

Ferguson M, Bothe E (2023). HearChoice: targeting online help-seeking and decision-making in hearing healthcare. Audiology Australia. Perth 12th October 2023, Sydney 26th October 2023, Brisbane 28th October 2023.

Ferguson M (2024). HearChoice: improving help-seeking, informed choice and decision-making in hearing healthcare. Australian College of AudiologyNational Congress. Cairns. 10th May 2024. Invited speaker.

Timmer B, Ferguson M et al (2024). HearChoice Online: improving help-seeking, informed choice and decision-making in hearing healthcare. Hearing Across the Lifespan. Cernobbio, Italy. 8th June 2024.

Ferguson M (2024). From nice-to-have to must-have: the essential role of co-design and participatory approaches in digital hearing healthcare. Computational Audiology VCCA 2024. Online 21st June 2024. Keynote speaker.

Prevalence of hearing loss in Aboriginal children caused by otitis media from birth to 5 years of age and evidence of the effectiveness of health promotion programs: evidence to inform national policy (2015750)

Associate Professor Christopher Brennan-Jones (Chief Investigator A)
Curtin University
Budget: $1,123,133.74
Funding period: 2023 to 2026

Project Synopsis

Aboriginal children are known to be at greater risk of otitis media (OM) and its associated hearing loss than the general population. Despite this, we still do not have reliable estimates of the prevalence of OM and hearing loss for Aboriginal children from birth to 5 years of age. Our team has piloted 2 prospective birth cohorts (one urban, one regional) which have given nation-first estimates of to the prevalence of OM and hearing loss at 2, 6 and 12 months of age. These findings have already had an impact and informed national policy and service delivery. These are the only cohorts in Australia examining the ear and hearing health of Aboriginal infants and children from birth.

This project will follow-up these children to 5 years of age. This will provide the first prevalence estimates for OM and hearing loss for a prospective cohort of children followed from birth to 5 years of age. It will answer key questions relating to the fluctuations of OM prevalence and hearing loss in early life, as well as identifying potential risk and protective factors associated with OM and hearing loss. This project will be crucial for informing service provision nationally. Follow-up of these cohorts will also demonstrate the feasibility and effectiveness of implementing an ear and hearing screening program for Aboriginal infants from 2 months of age, aligned with the national immunisation schedule and with integrated rapid access to specialist ear health care if OM or hearing loss is detected.

This project will also conduct a randomised-controlled trial of a simple, low-cost, family-led health promotion intervention that has been developed to improve resolution of OM and prevent hearing loss without the need for medical or surgical intervention. If effective, this intervention could be implemented in local and national ear and hearing health programs through our established collaboration with national service providers (Hearing Australia and National Acoustic Laboratories).

Progress report 30 April 2024

We are currently following-up participants to the two birth cohorts and recruiting participants for the clinical trial. Follow-up for the birth cohort studies is continuing as expected. Recruitment to the clinical trial component increased in 2023 with stabilised staffing levels, although was still slower than expected. We have gained approval to increase the number of sites in the trial (2 additional metro sites) and currently have some applications in progress that should further increase the number of sites (an additional regional site application in progress). Once implemented, this should help to further increase the recruitment rate to the trial. We are presenting the trial protocol at the 'Hearing Across the Lifespan' conference in Italy, June 2024.

Publications, conference abstracts and other resources

Rich J, Brennan-Jones CG. Healthy Ears: An adaptive clinical trial for otitis media with effusion. Recent Advances in Otitis Media. Milwaukee, WI, USA 19th June, 2023.

Pathways For Aboriginal and Torres Strait Islander Hearing Health: The PATHWAY Project (2015793)

Dr Jacqueline Stephens (Chief Investigator A)
Flinders University
Budget: $1,155,685.70
Funding period: 2023 to 2026

Project Synopsis

All children have the right to hear well. Hearing is crucial for language development, which for Aboriginal and Torres Strait Islander children is a central component of identity, passing on history and knowledge, and building relationships with family and country. However, Aboriginal and Torres Strait Islander children continue to have the highest rates of ear disease in the world despite huge efforts to address this. The hearing health patient pathway (from surveillance through to management) can be complex, current strategies are often implemented piecemeal and without integration, and children continue be lost from the patient pathway. The ongoing high rates of ear disease among Aboriginal and Torres Strait Islander children clearly demonstrate current approaches are ineffectual.

Hearing health solutions must be multifaceted strategies, co-designed with community, range of components of the patient pathway, and implemented in culturally appropriate ways to ensure efficacy, sustainability, and success. Our research occurs at the knowledge interface, combining Indigenous research methodologies with western methods, to co-design and implement a strategy which strengthens the evidence base for effective and robust ear health surveillance and management strategies. By utilising yarning methods, systematic literature review, and clinical data collected before, during and after a stepped wedge study, we will produce transformational evidence directly articulated with key Roadmap for Hearing Health actions, including providing evidence of a culturally appropriate approach to ensuring children are not ‘slipping through the cracks’ and missing out on ear health checks.

Our research team brings together early, mid and senior researchers and community members, who identify as both Aboriginal and non-Aboriginal people, and who have a wide range of expertise, skill, and lived experience to ensure our research is community-focused, flexible, and evidence-based.

Progress report 30 April 2024

The Pathways Project has been established over the past 12 months in close collaboration with our key partner organisation, Far West Community Partnerships. Progress includes the finalisation of the research protocol and standard operating procedure documents, receipt of ethical approvals, establishment of an Aboriginal Advisory Group, and commencement of a PhD candidate. Our study artwork was created by a local Aboriginal artist and we have continued to engage across the Far West of South Australia region with other key stakeholder organisations.

In coming months, the research team will commence capacity development and training of local staff employed by Far West Community Partnerships; these staff will be involved in research activities, including participant recruitment, data collection, analysis and reporting. Furthermore, widespread interest in the establishment of this project has lead to acceptance for presentation at several local and international conferences.

Publications and other resources

The study protocol was presented at the Public Health Association Preventative Health Conference in Darwin in May 2024 and will be presented at the OMOZ conference in Newcastle in August 2024.

A manuscript describing the establishment of the project is in preparation, as well as several systematic reviews which report findings informing the conduct of the project.

Hearables and behavioural activation for mental distress and social isolation in hearing impaired older adults (2015794)

Dr Andrew Ford (Chief Investigator A)
University of Western Australia
Budget: $571,966.00
Funding period: 2022 to 2025

Project Synopsis

Hearing loss (HL) is prevalent in later life and associated with increased risk of depression, social isolation, loneliness, mental illness and reduced quality of life. Additionally, the Covid-19 pandemic has brought about restrictions in social interaction and face to face contact, which has further impacted on the social isolation and mental health status of adults, particularly those with hearing loss.

Treatment of hearing loss can be relatively simple but traditional hearing aids are expensive and uptake is often sub-optimal. Personal sound amplification products (PSAPs - 'hearables') offer a simple, cost-effective alternative to conventional hearing aids, but no current evidence exists to determine if they improve the psychosocial consequences of age-related HL. Psychological therapies can be effective in treating mental distress in the elderly but factors such as availability of suitably trained therapists, cost and difficulties delivering the therapy in a socially isolated, hearing-impaired population pose challenges. Behavioural activation (BA) is a pragmatic and fairly simple psychological intervention aimed at improving mental health by increasing cognitive, physical and social activities.

BA has been shown to be effective in treating depression in the general population but no current evidence exists to determine if BA with or without hearing loss treatment is effective in ameliorating the psychosocial consequences of hearing loss.

The proposed project will aim to test if hearing amplification with PSAPs with or without a BA intervention program improves mood, relieves mental distress and social isolation, improves quality of life, and reduces health care costs in older adults with hearing loss. We will utilise a 2x2 factorial design to randomise 240 older adults aged 65 years and older with mild-moderate hearing loss to a 6-month clinical trial of hearing amplification and/or BA compared with an education intervention control group.

Progress report 30 April 2024

The project is currently in the recruitment phase of the trial. Consultation with a public relations firm has been undertaken to drive recruitment. Recruitment advertisements have been released in print and radio media, further advertisements on social media will be finalised soon and a newspaper editorial has been published.

Feedback from participants has largely been positive, especially with the Behavioural Activation intervention.

Publications and other resources

Harvey, B. (2024, August 17). Ben Harvey: Ear Science Institute Australia wants to test your ears for free Hearables. The West Australian; The West Australian. https://thewest.com.au/opinion/ben-harvey/ben-harvey-ear-science-institute-australia-wants-to-test-your-ears-for-free-hearables-c-15698216

Improving the psychosocial and emotional well-being of adults with hearing loss through co-designed evidence-based services: ACE2.0 (2015803)

Professor Nerina Scarinci (Chief Investigator A)
The University of Queensland
Budget: $527,012.40
Funding period: 2023 to 2026

Project Synopsis

Our team’s Active Communication Education (ACE) program, developed 2 decades ago, was a transformative interactive group education program that supported the everyday communication difficulties experienced by adults with hearing loss and their significant others. ACE has a strong evidence base with demonstrated efficacy (improved communication and psychosocial well-being). It has become apparent, however, given contemporary changes to the way we approach research through consumer co-design and contemporary barriers to the provision of hearing health care, there is a need to update ACE. To address this gap, our mixed-method, transdisciplinary study will co-design and implement the next generation of the program (ACE2.0: ACE Your Hearing). Our investigator team unites strong research and clinical expertise with lived experience of hearing loss and its psychosocial and emotional impacts on well-being.

This project will meet the TCR research objective to generate a greater understanding of the psychosocial and emotional impact of hearing loss on the individual and develop strategies to improve their well-being. Thus, the aim of this project is to develop ACE2.0 to address the psychosocial and emotional impacts of hearing loss using a co-design process with key stakeholders (consumers, advocacy groups and hearing service providers) that will enable program refinement and evaluation whilst addressing the challenges of implementation.

Our OBJECTIVES include:

extend the psychosocial and emotional support elements of the program to target the communication driven social challenges that people with hearing loss face; and
optimise the uptake of ACE2.0 by adults with hearing loss, their significant others, and the organisations delivering it, including through the publicly funded Hearing Services program.

Outcomes from our research will inform the nature and delivery of hearing health services, by establishing an evidence base for the development of future hearing policies, service delivery models and supports.

Progress report 30 April 2024

We have completed these activities:

Qualitative interview study to understand barriers to implementation of the Active Communication Education (ACE) program from the perspective of 17 hearing care professionals (HCPs) and four hearing service managers.
Qualitative interview study to understand the preferences and requirements of key stakeholders regarding the design and content of ACE2.0, including 21 older adults with hearing loss (HL), six significant others (SOs), and 17 HCPs.
An online survey of consumers (adults with HL and SOs, n=25) and HCPs (n = 15) on preferences in a new program and hearing business barriers to education.
Three co-design workshops were held, involving consumers (adults with HL and SOs, n=5), HCPs (n=4), AIs (n=3), and CIs (n=8) to discuss the results of studies 1-3. These workshops developed solutions to barriers to communication and psychosocial wellbeing and successfully generated key re-design features and preferences for ACE2.0.

We have ethics approval to commence the next two studies in 2024. These are:

Prototype testing of the newly developed ACE2.0 program
Pilot trial of the new program.

We have a number of hearing services partners who have agreed to participate in both of these studies (UQ Audiology clinic, Better Hearing Australia, Macquarie University clinic, Hearing Matters Australia and 2 independent businesses) and 3 additional sites that we are in negotiations with. Prototype testing commenced in July, and it is anticipated that the pilot-trial will be undertaken in September and October 2024.

Publications and other resources

Scarinci, N. (2024, May 9-10). Addressing the communication and psychosocial well-being of adults with hearing loss through evidence-based communication rehabilitation [Conference presentation]. Australian College of Audiology National Conference, Cairns, Queensland, Australia.

Scarinci, N. (2024, August 12-14).Co-Designing ACE2.0 to address the communication and psychosocial well-being of adults with hearing loss through evidence-based communication rehabilitation. New Zealand Audiological Society National Conference, Christchurch, New Zealand.