Ideas for the Pre-Contemplator

“I’m not ready to use hearing aids!”

Stage 1: Precontemplation

“Who, me? I don’t have a problem. People mumble!”

Stage 1: Pre-Contemplation

• During the pre-contemplation stage, the patient has no intention of changing within the foreseeable future (6 months)

• They may not be aware that they have a problem or they may be unwilling to make a change

• Individuals in this stage are often labeled as “in denial”, “resistant” or defensive about their current status

• The cons of changing outweigh the pros of changing

Processes of Change for Precontemplators

• Goal is for precontemplators to acknowledge and/or increase their awareness of the negative aspects of their problem

• To move out of this stage, information and feedback are needed

Pre-contemplation

• Review “Beyond Hearing Loss” video, which gives an overview of hearing loss issues

• Give statistical information comparing hearing aid users to non-users

• Provide reading materials• Audiologic Assessment• HHIE screening

“Beyond Hearing Loss”

• 12 minute video

• Available from Johns Hopkins Center for Hearing and Balance

• 410-955-6680

The Impact of Hearing Aid Usage

• Findings of National Council on Aging www.ncoa.org (1999)

• Reports results of 2,069 hearing impaired respondents

• Significantly higher incidences of anxiety, frustration, and depression, and social withdrawal, even in folks with mild losses

Pre-Contemplation

• Use drawings of cartoon-like characters to start discussions about various communication issues

• Use Erber (1988) “Eight Conversational Occurrences” to initiate discussion about communication problems and hearing loss

I Feel Like I Work So Hard

I am exhausted from working to hear

everyone

Pre-Contemplation

The boss said he wanted the

money, not that it was

sunny.

Conversational Occurrences

1. Perceived message correctly• Received meaningful message that was expected and appropriate• (“Where’s the main post office?” – “Two blocks down and turn right.”)

2. Perceived incorrect meaningful message• Received message that fit the conversation, but was incorrect• (Bad apples: “They’re not good for anything but chucking!” – actually, “chutney”)

3. Perceived meaningless message confidently• Perceived message clearly, but did not make sense and did not fit the

conversation• (“Didn’t she understand?” – “No. I explained it in my typical Garibaldi faction.”

Actually, “…typically garbled fashion.”)

Conversational Occurrences Continued…

4. Perceived nonsense• Received syllables and word-like patterns, but could not understand them• (“Did you get all your work finished?” – “Mau fitr pekd laimmi aruipeng!”)

5. Perceived fragments• Received only part of the message• (“Why didn’t you buy the tape recorder?” – “Because we saw…………in the shop

window”)

6. Perceived (distorted) acoustic cues only• The speaker’s mouth was not visible• (as over the telephone; or his/her mouth was obscured by hair, a hand, or an

object)

Conversational Occurrences Continued…

7. Perceived (incomplete) visible cues only• The speaker was too far away; the speaker’s voice level was too low; the hearing

aids and/or batteries were malfunctioning

8. Perceived nothing• The receiver was distracted or was not paying attention, so the speaker’s

utterance was neither heard nor seen

(Erber, 1988)

Signs and Symptoms• Frequently asking people to repeat• Inappropriate response to what is said• Difficulty understanding in groups• Puzzled expression when listening• Intently watching the speaker’s mouth• Strained expression around eyes

» Trychin, 2003

Signs and Symptoms• Turning the head to one side to hear better• Avoid social situations-withdraws• Talk too loudly or very softly• Turn up TV or radio much too loud• Blame people for not speaking clearly• Defensive about communication problems

» Trychin, 2003

Problem Situations Reported by HOH

• Hearing alarm signals• Voice from another room• Can’t see speaker’s face• Poor illumination• People whispering• Voices on TV or radio

» Trychin, 2003

Problem Situations Reported by HOH

• Conversations in a moving car• Family dinners at holidays• Understanding conversations on the phone• Several people talking• Medical situations• Outdoors-wind, traffic, etc.

Trychin, 2003

Problem Situations Reported by HOH

• Person whose speech is not clear• Misinterpretation of mistakes• Unaware person is talking to me• Movies, plays, lectures, classes• Stopped for traffic violations• Dancing and talking

» Trychin, 2003

Problem Situations: Family Members

• Difficulty remembering what to do• Not knowing whether she/he understands• The variability in his/her ability to

understand• Hard to get her/him to understand me• TV or radio is much too loud

– Trychin & Albright, 1993

Problem Situations: Family Members

• Having to repeat often• Having to interpret too frequently• When we become frustrated or irritated• When she/he doesn’t pay attention

– Trychin & Albright, 1993

Problem Situations: Family Members

• Not talking as much as before• When he/she is not understanding

someone else• Being asked to repeat embarrassing

jokes or remarks

» Trychin & Albright, 1993

Problem Situations: Family Members

• Becoming too dependent on me• Being isolated from friends and family• Not doing things we enjoyed previously• Having to repeat in pressure situations• Not traveling or going new places

» Trychin & Albright, 1993

Reactions

• Physical

• Emotional

• Behavioral

– Cognitive

• Trychin, 2001

Physical Reactions to Communication Problems

• Muscle tension-shoulders, neck, back• Stomach problems• Fatigue• Head aches• Increased blood pressure• Appetite changes-eat more, eat less

» Trychin, 1991

Behavioral Reactions to Communication Problems

• Bluffing• Withdrawing• Blaming• Demanding• Dominating conversations• Guilt tripping

» Trychin, 1991

Emotional Reactions to Communication Problems

• Anger• Anxiety• Depression• Embarrassment• Frustration• Guilt

» Trychin, 1991

Cognitive Reactions to Communication Problems

• Can’t think straight-confused• Hard to focus attention• Distracting thoughts• Distrustful of others• Decreased self esteem• Difficult to remember what you did not hear

clearly in the first place

» Trychin, 1991

Mental Health Risks of Hearing Loss

• Becoming chronically nervous; Anxious• Becoming chronically sad; Depressed• Feeling anger much of the time• Loss of group identity• Feeling marginal in own family• Loneliness

» Trychin, 1991

Mental Health Risks of Hearing Loss

• Becoming distrustful of people• Withdrawing from social contact• Developing poor self-image• Feeling incompetent• Feeling unacceptable to others• Feeling marginal socially• Feeling loss of influence or control

» Trychin, 1991