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Note: unpublished data have been removed to prevent future publishing conflicts

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

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

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

Habilitation for Hearing Loss

Evaluate interventionsbased on scientific principles of:

- brain plasticity

- learning theory

- patient centred care

Brain plasticity

Auditory and cognitive training

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)

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

Patient centred care

Motivational engagement

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

Learning theory

Interactive patient education

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

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)

• 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

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

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?

StoryboardWorkshopsHA users

Spec

Review

Develo

p

Review

Use &evaluation

RLO development – participatory design

StoryboardWorkshopsHA users

StoryboardWorkshops

NAS audiologists

Pilot

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

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

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.

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

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.

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.

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

Interactive Quiz

Interactive Quiz

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

To date, recruited n=203evaluated n=152

planned total n=170

Today: results from n=100

Interim results

How do we measure success?

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.

RLO re-use suggestsself-management

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%

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

Highly significant difference evident for both practical and psychosocial scores (p<.001)

V+ group: better knowledgeof HAs and communication

Error bars = mean +/- 95% CI

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

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

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

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

The users voice: seemed to like them

For more sample clips go tohttp://hearing.nihr.ac.uk/

Insertion

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?”

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”

• 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

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?

Would you be interested in these RLOs for your clinical practice?

How much would you pay per DVD/internet access?

Million dollar question

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?

• 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

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

• 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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