This research was a cross-sectional survey design and due to the online distribution of the survey, the calculation of the exact response rate is not possible. A causal relationship could not be established between the perceived importance of the concepts in client- clinician interaction and hearing aid adoption. However, the findings have implications for clinicians in how to interact with their clients who are first time hearing aid
candidates.
Effective counseling can modify clients’ perceptions and attitudes toward hearing aids (Beck, Harvey, & Schum, 2007; Brooks, 1989). Adequate information informs clients of what hearing aids can and cannot do and facilitates an informed decision with a realistic view of the benefits and barriers to hearing aid adoption. For instance “relating hearing aid technology to client’s lifestyle and listening needs”(item 47) helps a client to
understand how hearing aids may help the individual to return to activities that s/he used to participate in before restricted by the hearing impairment. In order to relate the
technology to a person’s lifestyle and communication needs, clinicians need to listen to the client’s personal experience about living with the hearing impairment. The
importance of the client’s story in shared decision making in rehabilitative audiology is reported by Laplante-Lévesque, Hickson, and Worrall(2010). Adults with hearing impairment who had no experience with rehabilitative audiology participated in a shared decision making trial to make decisions regarding rehabilitative intervention options. Participants expressed that their experiences must be at the centre of the shared decision making (Laplante-Lévesque et al., 2010).
Barriers to adhering to healthy behaviours also can be discussed during the client- clinician interaction. For example by explaining to client that “background noise might be a problem” (item 35) a client would be informed about hearing aid limitations, or letting the client know that “the decision is not final” (item 99) or they have the “opportunity to try a different hearing aid” (item 24) could help the client to perceive fewer barriers in making the decision to adopt hearing aids. Providing extra time for clients to make decisions and allowing them to change their decisions are reported as steps in shared decision making in rehabilitative audiology (Laplante-Lévesque et al., 2010).
Participants in this study were adults who had a recent hearing aid recommendation; therefore they may represent more motivated individuals in the population of persons with hearing loss. It is also possible that people, who were seeking hearing health care due to the pressure from their significant other, may have not volunteered to participate in this study. As such, generalizations of the results should be made with caution. The findings of the current study are opposite to the beliefs’ of hearing health care
professionals about the importance of client’s readiness and attitude toward hearing loss and hearing aids in the client’s decision to uptake hearing aids. Clients who present to a hearing clinic for consultation may be more open to what clinicians have to say than clinicians belief and as suggested by Beck et al. (2007) are in the verge of change. The results of this study have several implications for clinical educators and researchers. Hearing health care educators can incorporate training in client-centered communication into their education program for hearing health care professionals. Researchers and clinical educators can design and evaluate the efficacy of programs aimed at improving clinicians’ communication skills.
Given the importance of information exchange in hearing aid purchase decisions for the clients as identified in this study and the significance of the provision of information in shared decision making, development and use of tools that can facilitate information exchange is of great value. Self-assessment scales can help clinicians to gather information from clients and elicit client’s story. Decision aids help clinicians to
communicate information in a standard way to clients (Laplante-Lévesque et al., 2010). Decision aids can facilitate and improve clients’ participation in decision making by increasing client’s knowledge of possible options and providing an accurate perception of advantages and disadvantages of the options (O’connor et al., 2009).
Currently, there are no psychometrically validated instruments available to measure the quality of the interaction in the audiological interactions. Results of this study inform the development of an instrument to measure clients’ perception of the quality and client- centeredness of the interaction. Such an instrument could have valuable clinical
application in providing clinicians with feedback on their communication skills and help them modify the interaction to be client-centered form the clients’ point of view. The instrument can also be used in training of the client-centered communication with students. Such an instrument can provide feedback on client-student interactions in clinical placements.
4.7
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Chapter 5
5
Discussion
The purpose of this dissertation was to gain a better understanding of the impact of the client-clinician interaction in the hearing aid adoption process. The specific goals of this dissertation were: 1) to identify factors in the initial client-clinician interactions that were perceived by clients and clinicians to influence hearing aid adoption in first time hearing aid candidates, 2) to investigate the importance of the identified factors from clients and clinicians perspectives, and 3) to compare client and clinician views of the importance of the identified factors for discrepancies.
In this chapter, a brief summary of the key findings of the three articles included in the dissertation and their overall contribution to the current knowledge on client-clinician interaction will be presented. The findings of the study in Chapter 4 regarding the
differences in the rank order of the importance ratings of the concepts between client and clinician groups is discussed by grounding client-centeredness as a moral concept. Lastly practice and research implications are presented.