NIHR Nottingham Hearing Biomedical Research Unit
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Transcript of NIHR Nottingham Hearing Biomedical Research Unit
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BSHAA Conference 17.5.13
“If it wasn’t for the DVD I’d have stopped wearing my hearing aids” Interactive videos for hearing aid users
NIHR Nottingham Hearing Biomedical Research Unit
Mel Ferguson
Note: unpublished data have been removed to prevent future publishing conflicts
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2 million
The unmet need in the UK
Davis 1995; ONS 2010; Davis et al. 2007
10 million
74
10+
Estimate of nos benefitting from a hearing aid= 4 million
Access to hearing services is not optimal
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Non-use of hearing aids
• 2010/11: NHS England n= first time users
• Non-use of hearing aids =
– Costs of non-hearing aid use• To NHS: Annual =• To person with hearing loss = communication difficulties
• HA use and benefit for many is not optimal • HA fitting occurs too late or not at all
Hearing aids alone are not the only option
350,000
~20%
~£25-30m
reduced social interaction
reduced quality of life
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Non-use of hearing aids
• 2010/11: NHS England n= first time users
• Non-use of hearing aids =
– Costs of non-hearing aid use• To NHS: Annual =• To person with hearing loss = communication difficulties
• HA use and benefit for many is not optimal • HA fitting occurs too late or not at all
Hearing aids alone are not the only option
350,000
~20%
~£25-30m
reduced social interaction
reduced quality of life
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Habilitation for Hearing Loss
Evaluate interventionsbased on scientific principles of:
- brain plasticity
- learning theory
- patient centred care
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Brain plasticity
Auditory and cognitive training
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Brain plasticity
Does auditory training work?See systematic review in people with hearing loss
Henshaw and Ferguson, PLoS One, 2013
•Improvements shown for the trained task
•Some evidence of generalisation to measures of speech intelligibility, cognition & communication
Auditory training on phonemes (mild HL) results in
- significant training on the task
- significant improvement in challenging listening situations
- improvements in complex, but not simple cognition
- no improvement in speech in noise (Ferguson et al, in review)
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Brain plasticity
So what about training cognition directly?
Study of 54 hearing aid users
See Poster “Holding back the ears – auditory and working memory training in people with hearing loss” Henshaw & Ferguson
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Patient centred care
Motivational engagement
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Motivational engagement
30 minute ethnographic video (clinician training)Available online:
http://hearing.nihr.ac.uk
See poster“Feasibility of using motivational tools in an audiology clinic”
Offers useful tips and advice to aid clinical practice
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Learning theory
Interactive patient education
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Delivery and retention of information
Some questions for you:
How many see clients on a regular basis?
How many give (i) verbal info (ii) written info (iii) some other media
How many are fully satisfied that the client gets all the info they need?
How much information is remembered 6 weeks after the final appt with you?
Lots of information
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Delivery and retention of information
“You get a lot of information …by the time you get home, you’ve forgotten most of it.” 51% found difficulties using aid at first (RNID Hear Me Out, 2011)
Retention of information in first-time HA users after 6 weeksOverall = 49.6%Practical = 62.9% Psychosocial = 34.3% (El-Molla, Smith, Henshaw, Ferguson)
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• Information booklets, as standard
• Internet
• Constructivist learning theory• the learners construct an internal representation by taking an active role
• higher interactivity with learning materials promotes learning
(Zhang et al, 2006)
• Re-usable Learning Objects (RLOs)
Supplementary delivery of information
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Re-usable learning objects (RLOs)(or interactive video tutorials to you and me)
Highly visual illustration of concepts support
learning goal
Activity and engagement with the content
Self-assessment – a test of mastery of content
Interactive multimedia clips
• Commonly used in elearning environments• Participatory approach - high quality materials aligned to the user’s needs• Improve motivation and compliance with health treatments
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1. To develop a series of reusable learning objects (RLOs)
- range of auditory rehabilitation subjects
- accessible to hearing aid users and their families
2. To evaluate the benefits and cost-effectiveness of the RLOs
Randomised controlled trial (CTU)
RLO+ or RLO+
HEAR IT study
Q: Do video tutorials supplement advice and information provided by audiologists and result in enhanced benefit and use for hearing aid users?
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StoryboardWorkshopsHA users
Spec
Review
Develo
p
Review
Use &evaluation
RLO development – participatory design
StoryboardWorkshopsHA users
StoryboardWorkshops
NAS audiologists
Pilot
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Delivery of RLOs
50-54 yo 70-74 yo
PC use = 85% = 36%Internet use = 66% = 17% Henshaw, Clark, Kang, Ferguson, J Int Med Res 2012
HA ControlsEarmould insertion
Expectations
AdaptationPhones and
ALDsTrouble-shooting
Communicn tactics
Introduction
1hour duration
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Each reusable learning object (RLO) has:
• Learning outcomes
• Subtitles
• Reinforcement and consequences
• Variety of images - Photos, animations, videos (including testimonials)
• Interactive quiz
• Problems? Go back to Audiology
Based on educational principles
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Troubleshooting“the earmould may not be inserted correctly””
Video clips are not available through this ppt but sample clips can be seen on the NHBRU website
http://www.hearing.nihr.ac.uk/public/interactive-video-tutorials-for-hearing-aid-users-hear-it
So please do take a look.
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Each reusable learning object (RLO) has:
• Learning outcomes
• Subtitles
• Reinforcement and consequences
• Variety of images - Photos, animations, videos (including testimonials)
• Interactive quiz
• Problems? Go back to Audiology
Based on educational principles
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Acclimatisation“gradually our brain adapts”
Video clips are not available through this ppt but sample clips can be seen on the NHBRU website
http://www.hearing.nihr.ac.uk/public/interactive-video-tutorials-for-hearing-aid-users-hear-it
So please do take a look.
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Communication partners“hearing loss is not visible”
Video clips are not available through this ppt but sample clips can be seen on the NHBRU website
http://www.hearing.nihr.ac.uk/public/interactive-video-tutorials-for-hearing-aid-users-hear-it
So please do take a look.
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Each reusable learning object (RLO) has:
• Learning outcomes
• Subtitles
• Reinforcement and consequences
• Variety of images - Photos, animations, videos (including testimonials)
• Interactive quiz
• Problems? Go back to Audiology
Based on educational principles
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Interactive Quiz
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Interactive Quiz
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Each reusable learning object (RLO) has:
• Learning outcomes
• Subtitles
• Reinforcement and consequences
• Variety of images - Photos, animations, video (including testimonials)
• Interactive quiz
• Problems? Go back to Audiology
Based on educational principles
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To date, recruited n=203evaluated n=152
planned total n=170
Today: results from n=100
Interim results
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RLO access and compliance
RLO uptake and compliance
Expressed interest in RLOs and participating in study = 78%
Compliance was high• 92% watched all the RLOs more than once • 8% watched at least half
There is high interest and compliance with the RLO concept.
Barriers to RLO access
n=675 (49.5% fit criteria)
**No access to DVD, PC or internet = 32%Poor understanding of English = 9%Inability to use RLOs due to cognitive decline = 15%
These barriers have implications for implementation into clinical practice.
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RLO re-use suggestsself-management
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Internet use was higher than initially expected
Age: mean 67.7y (range 42-94y)(age not interested = 74.8y, 50-92y)
Delivery method %
Internet access 30
Interactive DVD for TV 50
Interactive DVD for PC 15
Passive DVD 5
37% opted for internet; 63% opted for DVD
Henshaw et al (2012) 70-74y=17%65-69y=36%
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Highly significant effect of video group - total (p<.001)- practical (p<.001) - psychosocial (p<.001)
Error bars = mean +/- 95% CI
V+ group: better knowledgeof HAs and communication
20 item questionnaire; free recall 6 weeks post-fitting
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Highly significant difference evident for both practical and psychosocial scores (p<.001)
V+ group: better knowledgeof HAs and communication
Error bars = mean +/- 95% CI
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V+ group: better practicalHA maintenance skills
Highly significant effect of video group (p<. 001)
- but only for HA/EM clean and phone use (p<.001)
Error bars = mean +/- 95% CI
Practical Hearing Aid Skill Tasks; 18 items
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HA outcome measures:limited benefits of V+
No significant difference between groups
HA non-useV+ n= 0V- n= 5 (10%)
Error bars = mean +/- 95% CI
Glasgow Hearing Aid Benefit Profile Satisfaction with amplification in daily life
Significant effect of group overall p=.50
V+ more satisfied re negative effects (b/g noise, feedback, phone), p<.01
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RLOs were rated as highly useful
• Quantitative and qualitative methods
On a scale form 0-10, where was highly useful
Range 8.6-9.3, average 9.0
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Positive feedback on RLOs
• 5 point scale (strongly agree to strongly disagree)
• Gave me confidence to use HAs and communicate
• Gave me additional advice to the audiologist
• If I had a problem I would refer back to RLOs
• Quiz was valuable to show me what I’d learned
• Prefer RLOs to written information
• More likely to contact audiology
agree disagree
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The users voice: seemed to like them
For more sample clips go tohttp://hearing.nihr.ac.uk/
Insertion
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Users voice: post-evaluation focus groups
• 3 groups, mix of V+ and V-, n=7-10
• Main themes– RLOs aligned to people’s experience– Content supported by the majority
– Repeated watching• … I found that I had missed something. So I went back and looked at
it again
– Sharing of videos with others (family, friends, neighbours)• I have passed my DVD on to on old couple who both have hearing
aids …" I kept telling her. "Play that DVD and you will know why," because you have got to get used to it, haven't you?”
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Post-evaluation focus groups
– Provided reassurance, helped remember things• Improved awareness and confidence• it explained how we have to learn to rehear things. That is not an
aspect that I [was aware of], to re-educate the brain to interpret what you hear.
– Communication partners were involved• “Well, I went through them, right the way through. I begged my wife
to watch them as well which I thought was important”
• “I sat my husband down. I said, "I would like you to watch this." Well, "What do I need to watch this for? I am not deaf," but I said, “It will help you to understand me.” So he did…. But yes, I did find it very, very useful for that”
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• Series of 7 RLOs or interactive video tutorials developed• Using tried and tested educational principles• Views and perspectives embedded from over 35 HA users
• RLOs• uptake and compliance is high • patients are referring back to them• There are barriers due to accessibility and English not main language
• Outcomes for video tutorial users • Better knowledge of HAs and psychosocial related issues• Better practical skills (e.g. maintenance and phone)• No difference in reported use, but more satisfied on ‘negative aspects’• RLOs rated as highly useful• Positive feedback e.g. confidence, helping to remind, reassurance, CPs
Summary
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Delivery across NHS
•If beneficial•Vision – part of standard patient management for PHL to supplement information
•Implementation within Audiology- concept is simple- benefits are readily recognised- demands on Audiologist’s time will be low- intervention accessible to many- cost of intervention is low
Slide from 2010
When will they become
available?
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Would you be interested in these RLOs for your clinical practice?
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How much would you pay per DVD/internet access?
Million dollar question
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Delivery across NHS
•If beneficial•Vision – part of standard patient management for PHL to supplement information
•Implementation within Audiology- concept is simple- benefits are readily recognised- demands on Audiologist’s time will be low- intervention accessible to many- cost of intervention is low
Slide from 2010
When will they become
available?
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• Develop an RLO specifically for CPs
• Hi-tech, hi-interactivity RLOs for internet use
• Low-tech option i.e. interactive booklet
• Address expectations prior to HA fitting
• Training• Basic hearing aid use, communication tactics
• Nursing homes – training for care assistants• Hospitals – training for nurses• GPs
Further research
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Thanks to....
NHBRU team
Marian BrandrethHolly Thomas
Helen HenshawAshana Tittle
Nottingham AudiologyService
Will BrassingtonKaren Goodrum-Clarke
Julie BradyLeena KapillaAlissa BaguleyJoanne RoweAnnie Jones
Helen Bastow
Patient panelAnne DarbyTina Wales
Rachel RavenlockPatricia Barnes
Video stars (Pat, Chris, David, Tina, Caroline and Clive)
University of Nottm
Heather Wharrad UoN HELMPaul Leighton EM RDS
James Henderson UoN HELM Mike Taylor UoN HELM
BAA Team of the year
Research funded by
NIHR RfPB grant
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• Series of 7 RLOs or interactive video tutorials developed• Using tried and tested educational principles• Views and perspectives embedded from over 35 HA users
• RLOs• uptake and compliance is high • patients are referring back to them• There are barriers due to accessibility and English not main language
• Outcomes for video tutorial users • Better knowledge of HAs and psychosocial related issues• Better practical skills (e.g. maintenance and phone)• No difference in reported use, but more satisfied on ‘negative aspects’• RLOs rated as highly useful• Positive feedback e.g. confidence, helping to remind, reassurance, CPs
Summary
?