No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
An Evaluation of Motivational Interviewing for Increasing Hearing Aid Use: A Pilot Study
Abstract
Background:
Motivational interviewing (MI) has been used in consultation settings to motivate hearing aid users to increase hearing aid usage. However, the effect of MI on those who use their hearing aids only rarely or not at all has not been explored.
Purpose:
The aims of this pilot study were to evaluate the effect of MI counseling with elderly hearing aid recipients found to have low hearing aid use at a six-month follow-up appointment and to describe clients' subjective assessments of their perceived need for hearing aids three months after MI counseling.
Research design:
The study had a within-subjects pretest-posttest design.
Study sample:
Forty seven hearing aid recipients who had used their new hearing aids, an average of <90 min/day, were recruited at a follow-up appointment six months after hearing aid fitting.
Intervention:
Thirty minutes of MI counseling was provided at the six-month follow-up appointment. If needed, hearing aid adjustments and technical support were also provided.
Data collection and analysis:
The effect of MI counseling in combination with adjustments and technical support was assessed in relation to datalogged hearing aid use, which was assessed immediately before (at the six-month follow-up) and three months after (at the nine-month follow-up) the intervention. Hearing aid experiences were also assessed three months after MI.
Results:
Thirty seven participants (79%) returned for the nine-month follow-up visit and had modest but significant increases in datalogged hearing aid use in the three months following MI counseling. Of the 37 participants who returned, 51% had increased their hearing aid use to at least 2 h/day after the MI counseling. Most of the 37 participants who attended the nine-month follow-up reported increased need for (59%) or increased benefit and contentment with (57%) their hearing aid three months after MI; these participants also had significantly higher datalogged hearing aid use following MI.
Conclusions:
These findings suggest that follow-up appointments using MI counseling in conjunction with technical support may be useful for increasing hearing aid usage among low-users, and a randomized controlled trial is warranted.
... The September 2018 Journal of the American Academy of Audiology article, ''An Evaluation of Motivational Interviewing for Increasing Hearing Aid Use: A Pilot Study'' (Solheim et al, 2018) presents an effort to explore how motivational interviewing (MI) can be used in audiologic practice to increase hearing aid wear time for patients. In this study, participants (N 5 47) demonstrating an average hearing aid wear time of ,90 minutes per day at six months postfitting were provided with one 30minute session of MI. ...
... MI is an empirically supported psychotherapy, and other areas of healthcare have successfully used MI to support desired behavior change to increase treatment adherence (Rubak et al, 2005). Solheim et al (2018) is one of the first studies to investigate MI in audiology, an important and needed area of research that has the potential to advance hearing healthcare and improve patient outcomes. ...
... Through purposeful MI, providers guide-rather than direct-patients through problemsolving and effective behavior change at the latter's pace. Solheim et al (2018) procedures for MI delivery may provide clinical audiologists with the impression that MI can be used as a secondary one-time intervention appended to the technical aspects of an audiologic appointment, as demonstrated by the study's use of a technical audiologist to handle programming changes and an educational audiologist to counsel through MI separately. Given that an MI approach is more similar to a marathon than a sprint, it is imperative that studies testing such interventions account for the time it requires for behavioral change to occur-especially when patients are in the precontemplative or contemplative stage of change. ...
... Three of the five intervention studies examined interventions delivered by audiologists targeted at current hearing aid users who under-used and/or reported little benefit from the hearing aid (Aazh 2016a;Saunders and Forsline 2012;Solheim et al. 2018). In the fourth study, new hearing aid users were the population of interest (Ferguson et al. 2016). ...
... Five studies were identified that included interventions employing: motivational engagement (Ferguson et al. 2016), motivational interviewing (Aazh 2016a;Solheim et al. 2018), diagnostic and interactive narratives (Naylor et al. 2015) and performance perceptual counselling (Saunders and Forsline 2012) in relation to hearing aid use and benefit outcomes. ...
... The present review identified five intervention studies that investigated the effects of interventions provided during audiologist-patient interactions on patient hearing aid outcomes. These interventions included performance perceptual counselling (Saunders and Forsline 2012), diagnostic and interactive narratives (Naylor et al. 2015), motivational tools (Ferguson et al. 2016) and motivational interviewing (Aazh 2016a;Solheim et al. 2018). Three of the five intervention studies reported a significant effect of the intervention on hearing aid use and benefit. ...
Objective: To conduct a systematic review of the evidence in relation to what hearing healthcare professionals do during hearing aid consultations and identifying which behaviours promote hearing aid use and benefit among adult patients.
Design: Searches were performed in electronic databases MEDLINE, EMBASE, CINAHL, PsycInfo, Web of Science, PubMed and Google Scholar. The Crowe Critical Appraisal Tool and Melnyk Levels of Evidence were used to assess quality and level of evidence of eligible studies. Behaviours of hearing healthcare professionals were summarised descriptively.
Study Sample: 17 studies met the inclusion criteria.
Results: Twelve studies described behaviours of audiologists and five studies were intervention studies. Audiologists were typically task- or technically-oriented and/or dominated the interaction during hearing aid consultations. Two intervention studies suggested that use of motivational interviewing techniques by audiologists may increase hearing aid use in patients.
Conclusions: Most studies of clinicians' behaviours were descriptive, with very little research linking clinician behaviour to patient outcomes. The present review sets the research agenda for better-controlled intervention studies to identify which clinician behaviours better promote patient hearing aid outcomes and develop an evidence base for best clinical practice.
... Several studies have investigated the impact of MI on HA use [6,18,19]. However, these studies have had significant limitations. ...
... However, these studies have had significant limitations. Aazh et al. [6] and Ferguson et al. [19] studies were only pilot studies and had limited power, while Solheim et al. [18] did not use a control group. Furthermore, none of the above studies considered the long-term outcomes of MI and whether these positive results would persist. ...
Background
Hearing loss is the third leading global cause of disability and is associated with poorer quality of life. Hearing aids are often recommended for hearing loss; however, hearing aid uptake and use rates are perpetually low. Motivational interviewing (MI) is a patient-centered counseling aimed at addressing the desire in the patient to change their behavior. The aim of this study is to investigate the impact of one-on-one MI sessions on hearing aid use among new adult users.
Methods
A multi-center, prospective, randomized patient-blind controlled trial with a pre- and post-tests design. New hearing aid users ≥ 18 years of age will be recruited from Vancouver, Canada. They will be randomly assigned to a treatment or control group. The treatment group will attend a one-on-one MI session hosted by a practicing MI therapist in addition to standard in-person audiological care. The control group will receive standard in-person audiological care. Data is collected at baseline and at 1, 3, 6, and 12 months’ follow-ups. The primary outcomes are data-logged hearing aid use hours and patient-reported outcomes as measured by the International Outcome Inventory for Hearing Aids questionnaire. Associations between intervention and hearing aid use hours and self-reported outcome measures will be assessed.
Discussion
This trial is designed to evaluate the efficacy of one-on-one MI in improving hearing aid use in new adult users in the short and long terms. Results will contribute to the evidence on whether MI counseling has an effect on hearing aid use and may guide future clinical practices.
Trial registration
ClinicalTrials.gov NCT04673565. Registered on 17 December 2020.
... Specific counseling approaches that have been examined are motivational interviewing, solution-focused therapy, cognitive behavioral therapy, acceptance and commitment therapy, wellness, and positive psychology. A handful of studies examine motivational interviewing, including applications to voice therapy (Behrman, 2006;Van Leer et al., 2008), hearing aid use (Solheim et al., 2017), and cognitive rehabilitation (Hoepner et al., 2019;Hoepner & Olson, 2018;Hsieh et al., 2012;Medley & Powell, 2010) and broadly in speech-language pathology/audiology (Mcfarlane, 2012). Lewis (2000, 2003) examined solution-focused therapy in aphasia couples' interventions. ...
... While reviewing each of those techniques is not the purpose of this article, a summary of empirical contributions within the CSD discipline follows. Motivational interviewing has been examined in voice therapy (Behrman, 2006), hearing aid use (Solheim et al., 2017), cognitive rehabilitation (Hoepner et al., 2019;Hoepner & Olson, 2018;Hsieh et al., 2012;Medley & Powell, 2010), and, broadly, speech-language pathology/audiology (Mcfarlane, 2012). Solution-focused therapy has been examined in aphasia couples' interventions (Boles & Lewis, 2000. ...
Purpose
The purpose of this article is to examine the current state of counseling curriculum within the discipline. The last systematic survey of counseling curriculum within the disciplines of communication sciences and disorders was completed with data from 1983 (McCarthy et al., 1986). The Council on Academic Accreditation in Audiology and Speech-Language Pathology (2017) states that counseling should be included in accredited programs but does not specify to what extent. Currently, there are no standards to specify number of credits, need for a stand-alone course, or guidance regarding content delivered.
Method
The present investigation collected data on the status of counseling curricula in accredited communication sciences and disorders graduate programs. A Qualtrics survey was distributed to identify counseling curriculum practices across accredited programs. Quantitative data such as percentages and frequency counts were compiled to summarize program offerings. Qualitative analyses were used to characterize written responses. Survey responses were also cross-validated with a review of offerings listed on program websites.
Results
Of programs currently accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, 42.4% responded to the current survey. Fifty-nine percent of programs offer a stand-alone course. Review of curricula from program websites indicated that only 40% of accredited programs offer a stand-alone counseling course. Quantitative details about requirements, number of credits, and embedding counseling within other courses were compared to data from the 1983 survey. Qualitative analyses identified common learner outcomes and the nature of course or curricular content.
Conclusions
Investigators found a lack of consistency in incorporating counseling across programs and discussed implications of this in speech-language pathology practice. A decrease in the number of programs that offer a stand-alone counseling course was identified as compared to offerings in 1983, as well as a disparity regarding how programs provide training in counseling. Furthermore, survey responses differed from curriculum listings on program websites. Information derived from this study may serve as a starting point for the development of flexible standards that provide direction for achieving consistent preparation of counseling skills.
Supplemental Material
https://doi.org/10.23641/asha.12149703
... Specific counseling approaches that have been examined are motivational interviewing, solution-focused therapy, cognitive behavioral therapy, acceptance and commitment therapy, wellness, and positive psychology. A handful of studies examine motivational interviewing, including applications to voice therapy (Behrman, 2006;Van Leer et al., 2008), hearing aid use (Solheim et al., 2017), and cognitive rehabilitation (Hoepner et al., 2019;Hoepner & Olson, 2018;Hsieh et al., 2012;Medley & Powell, 2010) and broadly in speech-language pathology/audiology (Mcfarlane, 2012). Lewis (2000, 2003) examined solution-focused therapy in aphasia couples' interventions. ...
... While reviewing each of those techniques is not the purpose of this article, a summary of empirical contributions within the CSD discipline follows. Motivational interviewing has been examined in voice therapy (Behrman, 2006), hearing aid use (Solheim et al., 2017), cognitive rehabilitation (Hoepner et al., 2019;Hoepner & Olson, 2018;Hsieh et al., 2012;Medley & Powell, 2010), and, broadly, speech-language pathology/audiology (Mcfarlane, 2012). Solution-focused therapy has been examined in aphasia couples' interventions (Boles & Lewis, 2000. ...
Purpose: The purpose of this article is to examine the current state of counseling curriculum within the discipline. The last systematic survey of counseling curriculum within the disciplines of Communication Sciences and Disorders was completed with data from 1983 (McCarthy, Culpepper, & Lucks, 1986). The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA, 2017) states counseling should be included in accredited programs, but does not specify to what extent. Currently, there are no standards to specify number of credits, need for a standalone course, or guidance regarding content delivered.
Method: The present investigation collected data on the status of counseling curricula in accredited Communication Sciences and Disorders graduate programs. A Qualtrics survey was distributed to identify counseling curriculum practices across accredited programs. Quantitative data such as percentages and frequency counts were compiled to summarize program offerings. Qualitative analyses were used to characterize written responses.
Results: Of programs currently accredited by the CAA, 42.4% responded to the current survey. 59% of programs offer a stand-alone course, while 41% do not. Quantitative details about requirements, number of credits, and embedding counseling within other courses were compared to data from the 1983 survey. Qualitative analyses identified common learner outcomes and the nature of course or curricular content.
Conclusions: Investigators found a lack of consistency in incorporating counseling across programs, and discussed implications of this in speech-language pathology practice. While more programs include training in counseling practices than in 1983, there is disparity regarding how programs provide training in counseling. Information derived from this study may serve as a starting point for the development of flexible standards that provide direction for achieving consistent preparation of counseling skills.
Keywords: Counseling, Scholarship of Teaching and Learning, Cultural and Linguistic Diversity
... Many tools and recommendations for clinical practice have been developed in to improve and monitor the audiological assessment and rehabilitation process, patient motivation and readiness, hearing aid use and hearing aid satisfaction. These include use of outcome measure questionnaires (Gatehouse, 1999), speech recognition testing (Turton et al., 2020), motivational interviewing and engagement (Aazh, 2016;Ferguson et al., 2016;Solheim et al., 2018), group rehabilitation (Collins et al., 2009), computer based auditory training (Henshaw & Ferguson, 2013), mobile health educational interventions (Maidment et al., 2020), counselling (Johnson et al., 2018a), involving communication partners (Meijerink et al., 2020) and using patient-centred care (Barker et al., 2016;Grenness et al., 2014b). ...
This thesis aims to advance the understanding of how speech testing is, and can be, used for hearing device users within the audiological test battery. To address this, I engaged with clinicians and patients to understand the current role that speech testing plays in audiological testing in the UK, and developed a new listening test, which combined speech testing with localisation judgments in a dual task design. Normal hearing listeners and hearing aid users were tested, and a series of technical measurements were made to understand how advanced hearing aid settings might determine task performance. A questionnaire was completed by public and private sector hearing healthcare professionals in the UK to explore the use of speech testing. Overall, results revealed this assessment tool was underutilised by UK clinicians, but there was a significantly greater use in the private sector. Through a focus group and semi structured interviews with hearing aid users I identified a mismatch between their common listening difficulties and the assessment tools used in audiology and highlighted a lack of deaf awareness in UK adult audiology. The Spatial Speech in Noise Test (SSiN) is a dual task paradigm to simultaneously assess relative localisation and word identification performance. Testing on normal hearing listeners to investigate the impact of the dual task design found the SSiN to increase cognitive load and therefore better reflect challenging listening situations. A comparison of relative localisation and word identification performance showed that hearing aid users benefitted less from spatially separating speech and noise in the SSiN than normal hearing listeners. To investigate how the SSiN could be used to assess advanced hearing aid features, a subset of hearing aid users were fitted with the same hearing aid type and completed the SSiN once with adaptive directionality and once with omnidirectionality. The SSiN results differed between conditions but a larger sample size is needed to confirm these effects. Hearing aid technical measurements were used to quantify how hearing aid output changed in response to the SSiN paradigm.
... The number of studies excluded for each reason for exclusion is shown in Figure 1. For example, 18 studies appeared to meet the inclusion criteria, but after full-text reviewing, they were excluded as they were not truly qualitative or did not contain qualitative data (e.g., Leek et al., 2008;Lund et al., 2020;Solheim et al., 2018b). Table 3 summarizes the key characteristics (study sample, data collection, data analysis) and classification of the studies in the review. ...
There has been an increasing number of qualitative studies exploring the experiences and perceptions of adult hearing aid owners throughout their hearing aid journey. As these studies and reported experiences vary greatly, a systematic review was conducted to identify and synthesize the key concepts in adult hearing aid owners' experiences during and after fitting. A systematic search of three electronic databases was conducted, yielding 443 results. Articles were evaluated for inclusion based on pre-determined eligibility criteria, including conventional, smartphone-connected, and direct-to-consumer hearing devices. Twenty-five studies met the inclusion criteria. The quality of the included articles was evaluated using the Rating of Qualitative Research scale. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Synthesis Without Meta-Analysis (SWiM) were followed. A narrative synthesis was conducted, and studies were grouped into three main domains, namely experiences of owners related to a) hearing aid adoption and fitting (n = 3), b) hearing aid use (n = 20), and c) hearing aid sub-optimal use (n = 25). Hearing aid owners mainly reported on how their attitude towards hearing aids affected experiences during the fitting stage. Improved psychosocial functioning was the most prevalent perceived benefit of hearing aid use. Owners described sub-optimal use in terms of hearing device-related and non-device-related concepts. The COM-B (capability, opportunity, motivation-behavior) model is used to discuss specific service-delivery, hearing-device, and hearing-aid-owner related concepts and clinical implications, including behavior change techniques to enhance understanding of the concepts that hearing aid owners perceive as essential to improve hearing aid experiences.
... Meta-analytic reviews have documented that motivational interviewing outperforms traditional advice giving across treatment studies of adults [20][21][22] and adolescents. [23][24][25] In the field of speechlanguage pathology, motivational interviewing has been applied to voice therapy, 26,27 hearing aid use, 28 and cognitive rehabilitation. [29][30][31][32] The spirit of motivational interviewing is threefold. ...
Adolescents who stutter often pose a unique clinical challenge for clinicians. They are a population simultaneously striving for independence from adults and social connection with their peers at a time when social fears surge and lifelong habits take root. It is a time when they may seem “unmotivated” to learn and utilize new communication or coping skills related to stuttering. How can clinicians maximize adolescents' engagement in stuttering therapy to improve meaningful outcomes? The purpose of this article is to describe a transtheoretical approach to assessing adolescents' readiness to make positive changes to living with stuttering, and to provide motivational interviewing strategies that clinicians can employ to help propel adolescents toward personally significant change. These principles will be applied to the case study of a 14-year-old who stutters to demonstrate how clinicians can put this approach to work as they meet their adolescent clients “where they're at.”
... Importantly, motivational interviewing moves away from a practitionercentred (or "paternalistic") mode of care, facilitating collaboration between the healthcare provider and patient in treatment and management decisions. In the context of audiology, motivational interviewing has been successfully applied in adults living with hearing loss to facilitate patient-centred counselling and rehabilitation (Beck and Harvey 2009;Aazh 2015;Solheim et al. 2018). Furthermore, motivational interviewing is recognised by professional bodies as key to the provision of patient-centred care in the adult aural rehabilitation process (British Society of Audiology 2016; National Institute for Health and Care Excellence 2018). ...
Objective:
To assess the benefits of the Ida Institute's Why improve my hearing? Telecare Tool used before the initial hearing assessment appointment.
Design:
A prospective, single-blind randomised clinical trial with two arms: (i) Why improve my hearing? Telecare Tool intervention, and (ii) standard care control.
Study sample:
Adults with hearing loss were recruited from two Audiology Services within the United Kingdom's publicly-funded National Health Service. Of 461 individuals assessed for eligibility, 57 were eligible to participate.
Results:
Measure of Audiologic Rehabilitation Self-efficacy for Hearing Aids (primary outcome) scores did not differ between groups from baseline to post-assessment (Mean change [Δ]= -2.28; 95% confidence interval [CI]= -6.70, 2.15, p= .307) and 10-weeks follow-up (Mean Δ= -2.69; 95% CI= -9.52, 4.15, p = .434). However, Short Form Patient Activation Measure scores significantly improved in the intervention group compared to the control group from baseline to post-assessment (Mean Δ= -6.06, 95% CI= -11.31, -0.82, p = .024, ES= .61) and 10-weeks follow-up (Mean Δ= -9.87, 95% CI= -15.34, -4.40, p = .001, ES= -.97).
Conclusions:
This study demonstrates that while a patient-centred telecare intervention completed before management decisions may not improve an individual's self-efficacy to manage their hearing loss, it can lead to improvements in readiness.
... In other contexts, research exploring effective management of chronic pain has found acceptance-and mindfulness-based interventions can mitigate the effects of pain on quality of life and improve symptoms of depression and anxiety (Veehof et al. 2016). In audiology, studies have explored the effects of motivational interviewing on hearing aid use, highlighting the potential benefit of therapeutic interactions with respect to helping individuals understand and effectively manage hearing care (Aazh 2016;Solheim et al. 2018). In addition, prior research indicates audiologists prefer therapeutic practice patterns that foster person-and family-centered care (Laplante-L evesque, Hickson, and Grenness 2014) and that audiologists desire more education and training to effectively implement such care (Meibos et al. 2017). ...
Objective: Hearing loss is a chronic condition that impacts functioning among individuals with hearing loss and caregivers of children with hearing loss. Even though treatments for hearing loss can alleviate functional impairment, psychological factors like psychological inflexibility may interfere with treatment engagement and adherence, undermining the benefits of treatment. Measuring psychological inflexibility may inform care providers’ case conceptualisation, improving the quality and precision of audiological interventions. Thus, this study aimed to develop and validate measures of psychological inflexibility in hearing loss for adults and caregivers of children with hearing loss.
Design: Participants were invited to complete an online survey.
Study samples: Our sample comprised adults with hearing loss (N = 264) and primary caregivers of children with hearing loss (N = 275).
Results: The final versions of Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) and Acceptance and Action Questionnaire-Management of Child Hearing Loss (AAQ-MCHL) showed good to excellent internal reliability and concurrent and discriminant validity.
Conclusion: Although the AAQ-AHL and AAQ-MCHL showed acceptable psychometric properties, more tests are needed to further validate these measures and verify their utility in research and clinical settings.
• Background: : Hearing loss is the third leading global cause of disability and is associated with poorer quality of life. Hearing aids are often recommended for hearing loss; however, hearing aid uptake and use rates are perpetually low. Motivational interviewing (MI) is a patient-centered counselling aimed at addressing desire in the patient to change their behaviour. The aim of this study is to investigate the impact of one-on-one MI sessions on hearing aid use among new adult users
• Methods: A multi-center, prospective, randomized patient-blind controlled trial with a pre- and post- tests design. New hearing aid users ≥ 18 years of age will be recruited from Vancouver, Canada. They will be randomly assigned to a treatment or control group. The treatment group will attend a one-on-one MI session hosted by a practicing MI therapist in addition to standard in-person audiological care. The control group will receive standard in-person audiological care. Data is collected at baseline and at 1, 3, 6, and 12 months follow-ups. The primary outcomes are data-logged hearing aid use hours and patient reported outcomes as measured by the International Outcome Inventory for Hearing Aids questionnaire. Associations between intervention and hearing aid use hours, and self-reported outcome measures will be assessed.
• Discussion: This trial is designed to evaluate the efficacy of one-on-one MI in improving hearing aid use in new adult users in the short- and long- terms. Results will contribute to the evidence on whether MI counselling has an effect on hearing aid use and may guide future clinical practices..
• Trial registration: ClinicalTrials.gov. Review Board NCT04673565. Approved: December 17, 2020. https://clinicaltrials.gov/ct2/show/NCT04673565?cond=motivational+interviewing&cntry=CA&draw=2&rank=8
Background
Workers in production agriculture are frequently exposed to high noise levels and face unique barriers to implementing hearing protection, leading to occupational hearing loss. Motivational interviewing is a promising approach to assist workers in preserving their hearing.
Methods
This pilot study used a mixed-method approach to evaluate the feasibility of an innovative motivational interviewing intervention for agricultural producers from February to May 2021. Qualitative data included coaches’ and participants’ comments and were coded using a structural coding approach. Quantitative data included Likert-type-style responses given by participants in a post-intervention survey. Data types were then integrated.
Results
Sixteen participants were recruited during the 4-month pilot. Participants’ satisfaction scores averaged above six on a 7-point scale for all satisfaction questions. Implementation factors included the intervention’s flexibility, services provided by the coaches beyond motivational interviewing, and difficulties with recruitment.
Conclusions/Applications to Practice
This motivational interviewing intervention was highly acceptable to participants, but factors affecting implementation may challenge scalability.
Purpose The aim of the study is to conduct a meta-analysis examining the impact of motivational interviewing (MI) on hearing aid (HA) use compared with standard care.
Research Design The research design is a systematic review and meta-analysis. Cochrane ENT, Central, Medline, Web of Science, ICTRP, and ClinicalTrials.gov electronic databases were searched. Inclusion criteria consisted of randomized controlled trials (RCTs) published between 1988 and 2018 that compared MI to standard care.
Study Sample The study sample consists of four RCTs, investigating a total of 176 patients.
Data Collection and Analysis RevMan 5.3 and a random effect model were used for analysis.
Results The standardized mean difference in data-logged hours of HA use was not statistically significant (0.34 [95% confidence interval or CI: −0.10, 0.78; p = 0.13]). The mean difference for user-reported outcomes on the International Outcome Inventory—Hearing Aids of 0.41 [CI: −1.00, 1.82; p = 0.57] was also not significant.
Conclusion There is no current evidence that MI significantly improves HA use or user-reported outcomes. However, there were limited studies included in this review and further research is indicated.
Objective:
To examine the impact of self-efficacy and expectations for hearing aids, and readiness to improve hearing, on hearing aid outcome measures in first-time adult hearing aid users Design: A prospective, single centre design. Predictor variables measured at the hearing assessment included measures of self-efficacy, expectations and readiness to improve hearing. Outcome measures obtained at six-week follow-up were the Glasgow Hearing Aid Benefit Profile and Satisfaction with Amplification in Daily Life.
Study sample:
A sample of 30 first-time adult hearing aid users were recruited through a public-sector funded audiology clinic.
Results:
When measured prior to hearing aid fitting, self-efficacy for hearing aids predicted satisfaction with hearing aids but was not related to other hearing aid outcomes. Expectations of hearing aids, in particular positive expectations, and readiness to improve hearing predicted outcomes for hearing aid satisfaction and benefit, although not hearing aid use. Hearing sensitivity was not correlated with hearing aid outcomes.
Conclusions:
These results suggest that assessment of expectations of hearing aids, and readiness to improve hearing, may be useful to help identify individuals attending audiology clinics who would most likely benefit from hearing aid provision.
Motivational interviewing (MI) for the treatment of alcohol and drug problems is typically conducted over 1 to 3 sessions. This paper reports on an evaluation of an intensive 9-session version of MI (IMI) compared to a standard single MI session (SMI). Although no differences between IMI and SMI were found for methamphetamine use, there was an unexpected finding that women but not men with co-occurring alcohol problems in the IMI condition reduced the severity of their alcohol problems significantly more than those in the SMI condition at 4- and 6-month follow-up. Stronger perceived alliance with the therapist was associated with better outcome. Findings indicate that alcohol outcomes for women might be improved with the addition of more MI sessions. A current study is assessing the impact of IMI for women with more serious alcohol problems. Qualitative interviews are being conducted with women to better understand how IMI is helpful and why it appears to add benefit for women but not men.
Objective:
Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other drug use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes.
Method:
We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed with the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use; motivation to change; and positive expectancies.
Results:
Sequential analysis indicated that facilitator open-ended questions and reflections of change talk increased group change talk. Group change talk was then followed by more change talk. Multilevel models accounting for rolling group enrollment revealed group change talk was associated with decreased alcohol intentions, alcohol use, and heavy drinking 3 months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies.
Conclusions:
Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which were then associated with individual changes. Selective reflection of change talk in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change.
Background
Engaging patients with an eating disorder in change is difficult and intensive treatment programs have high drop-out rates. The purpose of the study was to determine whether Motivational Interviewing (MI) in the form of a brief, pre-treatment intervention would be associated with higher completion rates in subsequent intensive treatment for an eating disorder.
Thirty-two participants diagnosed with an eating disorder participated in the study. All participants were on the waitlist for admission to an intensive, hospital-based treatment program. Sixteen participants were randomly assigned to four individual sessions of MI that began prior to entrance into the treatment program (MI condition) and 16 participants were assigned to treatment as usual (control condition). The main outcome was completion of the intensive treatment program. Participants also completed self-report measures of motivation to change.
Results
Participants in the MI condition were significantly more likely to complete intensive treatment (69% completion rate) than were those in the control condition (31%).
Conclusions
MI can be a useful intervention to engage individuals with severe eating disorders prior to participation in intensive treatment. MI as a brief prelude to hospital-based treatment for an eating disorder may help to improve completion rates in such programs. Further research is required to determine the precise therapeutic mechanisms of change in MI.
Abstract
Hearing impairment is one of the most common disabilities among Western populations and represents a considerable communication disorder. Increasing human longevity is expected to raise the number of elderly suffering from hearing loss. A major challenge of audiological rehabilitation has been to encourage those who have fitted hearing aids to use them. The aim of this study was to describe hearing aid use among older adults and to identify motivational factors associated with hearing aid use. A 17-item questionnaire was developed. Ninety participants (≥65 years of age) were recruited from a waiting list for hearing aid refitting. Twenty-two per cent had used their previously fitted hearing aids less than one hour per day. A factor analysis revealed four factors related to hearing aid use (Cronbach’s alpha): accepted need; defined as the acknowledgement of a need for hearing aids (0.869), follow-up support; defined as organised check-ups and accessibility to professionals (0.900), social assessment (0.552) and consciousness (0.505). The first two factors explained 25% and 24% of the variance, respectively. Logistic regression revealed that the use of hearing aids was significantly associated with accepted need and follow-up support, suggesting that these factors are important and should be emphasised in rehabilitation programmes.
Aims:
We investigate the effect of motivational interviewing (MI), delivered in a brief intervention during an emergency care contact, on the alcohol consumption of young people who screen positively for present or previous risky alcohol consumption.
Methods:
MEDLINE, CINAHL, EMBASE, PsycARTICLES, PsycINFO, PSYNDEX and Scopus were searched for randomized controlled trials with adolescents or young adults that compared MI in an emergency care setting to control conditions and measured drinking outcomes.
Results:
Six trials with 1433 participants, aged 13-25 years, were included in the systematic review and meta-analysis. MI was never less efficacious than a control intervention. Two trials found significantly more reduction in one or more measures of alcohol consumption in the MI intervention group. One trial indicated that MI may be used most effectively in young people with high-volume alcohol consumption. Separate random effects meta-analyses were performed based on the highest impact that MI added on reducing the drinking frequency and the drinking quantity at any point in time during the different study periods. Their results were expressed as standardized mean differences (SMDs). The frequency of drinking alcohol decreased significantly more after MI than after control interventions (SMD ≤ -0.17, P ≤ 0.03). In addition, MI reduced the drinking quantity further than control interventions in a meta-analysis of the subset of trials that were implemented in the USA (SMD = -0.12, P = 0.04). Meta-analyses of the smallest mean differences between MI and control groups detected no differences in alcohol use (SMD ≤ 0.02, P ≥ 0.38).
Conclusion:
MI appears at least as effective and may possibly be more effective than other brief interventions in emergency care to reduce alcohol consumption in young people.
To evaluate satisfaction ratings and use patterns of advanced digital hearing aids (HAs) in a group of hearing-impaired adults by means of self-report questionnaires.
A self report questionnaire study.
One hundred seventy-seven hearing-impaired adults who were fitted with advanced digital HAs at the Speech and Hearing Center at Sheba Medical Center were asked to participate in a structured telephone interview regarding HA satisfaction and use by means of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Patients who were not using their HAs completed a nonuse questionnaire.
One hundred thirty-one patients participated in the survey, yielding a response rate of 74%. Eighty-three percent used their HAs regularly, whereas 17% were nonusers. Of the users, 92% were satisfied to some degree with their HAs. The global SADL score was 5.12 on a scale of 1 to 7. Background variables that were significantly associated with satisfaction ratings were hours of HA use per day, fitting mode (binaural vs. monaural), age, and degree of hearing loss. Although nonuse was not significantly associated with background variables, the main reasons for nonuse were excessive amplification in background noise and minimal functional benefit.
High satisfaction and use rates were characteristic of adults fitted with advanced digital HAs. Patients should be advised that longer use of HAs per day may lead to higher satisfaction and that binaural amplification is advantageous, especially while communicating in noise. Finally, expectation from HA functionality in challenging listening situations should be realistic, as additional research and technology development is still needed.
Little research exists on the impact of behavior change interventions in disadvantaged communities. We conducted a prospective study to explore the effectiveness of motivational interviewing on physical activity change within a deprived community and the social- psychological and motivational predictors of change in physical activity including stage of change, self-efficacy, social support, and variables from self-determination theory and the theory of planned behavior. Five motivational interviewing counsellors recruited 207 patients and offered motivational interviewing sessions to support physical activity behavior change. At 6-months there were significant improvements in physical activity, stage of change, and social support. A dose-response relationship was evident; those who attended 2 or more consultations increased their total physical activity, stage of change and family social support more than those who attended just one. Hierarchical regression analyses indicated that number of sessions and change in stage of change predicted 28.4% of the variance in change in total physical activity and, with social support from friends, 21.0% of the variance in change walking time. Change in perceived behavioral control and attitudes, friend social support, and number of sessions predicted 16.8% of the variance in change in vigorous physical activity. Motivational interviewing is an effective approach for promoting physical activity amongst lower socio-economic status groups in the short term. The study demonstrates good translational efficacy, and contributes to a limited number of physical activity interventions targeting low income groups in the UK.
This study examined the effectiveness of an Adolescent Motivational Interviewing Cessation program on smoking cessation change. The study was done with a nonequivalent control group pretest-posttest design.
The participants were 39 high school students from G city, who were in school from September 1 to October 30, 2009. The students were assigned to the experimental group (20) and participated in the motivational interviewing cessation program or to the control group (19) who did not participate. Data analyses involved χ²-test, independent t-test, Repeated Measures ANOVA, and utilized the SPSS program.
The experimental group had significantly less daily smoking, nicotine dependence and smoking temptation in comparison to the control group. The experimental group had significantly higher stage of change in comparison to the control group.
The results of the study indicate that a motivational interviewing cessation program delivered to adolescents who smoke is an effective method of encouraging cessation, and can be utilized as an effective nursing intervention for adolescents who smoke.
Objective:
The aim of this study was to investigate self-reported hearing difficulties, uptake, and hearing-aid outcomes and their relationships to demographic, cognitive, psychosocial, and health variables in 85 year olds.
Design and study sample:
Three hundred and forty-six elderly adults participated in a survey that included questionnaires and home visits. Fifty-five percent of participants admitted to having hearing difficulties, and 59% of these owned hearing aids. The participants' most frequently cited reason for not acquiring hearing aids was that they did not think their hearing problem was perceived as severe enough. Participants with hearing difficulties who did not own hearing aids showed worse general and mental health. Many of the elderly participants were successful in their rehabilitation, and their hearing-aid outcomes were similar to those of a younger group, with the exception of a greater proportion of non-users among the elderly.
Conclusion:
Many older people with self-reported hearing difficulties do not acquire hearing aids, despite this study's findings that older people are likely to have success with hearing rehabilitation. It is important to make greater efforts to try to increase elderly adults' awareness of hearing loss and the benefits of hearing rehabilitation.
To assess the daily life consequences of hearing loss in older adults and to explore the influences of hearing loss, subjective assessment of health and general life satisfaction, gender, age and marital status.
Eighty-four participants, each older than 65 years, were consecutively recruited from a hospital waiting list for outpatient hearing aid fitting. All participants were assessed by pure-tone audiometry. Daily life consequences of hearing loss were measured using the Hearing Disability and Handicap Scale, which assesses perceived activity limitation and participation restriction. Another questionnaire was used to measure self-assessed health and life satisfaction.
Adjusted linear regression analysis showed that activity limitation was significantly associated with increased hearing loss (p = 0.028) and decreased health (p = 0.009), and participation restriction with lower estimated life satisfaction (p ≤ 0.001). Gender, age and marital status were not determinant factors for perceived activity limitation or participation restriction.
Daily life consequences of hearing loss, health conditions and general life satisfaction are closely related. These findings indicate that health factors and psychosocial aspects should be emphasised as a natural part of audiological rehabilitation.
The objectives of this study were to describe preconceptions and expectations of older adults about getting hearing aids and to explore the influence of hearing loss (HL), hearing aid experience, gender, age, and marital status on these preconceptions and expectations.
A total of 174 participants aged above 65 years were randomly selected from a waiting list for hearing aid fitting. Hearing threshold was tested using pure tone audiometry. A self-report questionnaire with a specific focus on preconceptions and expectations about getting hearing aids, external influences, and the psychosocial problems associated with HL and the use of a hearing aid was administered.
A FACTOR ANALYSIS REVEALED THREE FACTORS: positive expectations, barriers, and social pressure. Cronbach's α was 0.847 for positive expectations and 0.591 for barriers. Cronbach's α was not statistically applicable to the social pressure factor, as it consisted of only one item. Adjusted linear regression analysis revealed that participants with moderate to severe HL and hearing aid experience had a significant increase in positive expectations. Male gender was associated with fewer barriers to hearing aids. Age and marital status had no influence on the three factors.
Less positive expectations and more problem-oriented preconceptions among subjects with mild HL may explain why hearing aids are scarcely used. Additionally, lower estimated need and modest plans for regular use among this group could mean hearing aids are not used. Rehabilitation should focus on investment of time, continuity of use, realistic expectations, and follow-up support.
Data suggest that having high expectations about hearing aids results in better overall outcome. However, some have postulated that excessively high expectations will result in disappointment and thus poor outcome. It has been suggested that counseling patients with unrealistic expectations about hearing aids prior to fitting may be beneficial. Data, however, are mixed as to the effectiveness of such counseling, in terms of both changes in expectations and final outcome.
The primary purpose of this study was to determine whether supplementing prefitting counseling with demonstration of real-world listening can (1) alter expectations of new hearing aid users and (2) increase satisfaction over verbal-only counseling. Secondary goals of the study were to examine (1) the relationship between prefitting expectations and postfitting outcome, and (2) the effect of hearing aid fine-tuning on hearing aid outcome.
Sixty new hearing aid users were fitted binaurally with Beltone Oria behind-the-ear digital hearing aids. Forty participants received prefitting counseling and demonstration of listening situations with the Beltone AVE (Audio Verification Environment) system; 20 received prefitting counseling without a demonstration of listening situations. Hearing aid expectations were measured at initial contact and following prefitting counseling. Reported hearing aid outcome was measured after eight to ten weeks of hearing aid use.
Sixty new hearing aid users aged between 55 and 81 years with symmetrical sensorineural hearing loss.
Participants were randomly assigned to one of three experimental groups, between which the prefitting counseling and follow-up differed: Group 1 received prefitting counseling in combination with demonstration of listening situations. Additionally, if the participant had complaints about sound quality at the follow-up visit, the hearing aids were fine-tuned using the Beltone AVE system. Group 2 received prefitting counseling in combination with demonstration of listening situations with the Beltone AVE system, but no fine-tuning was provided at follow-up. Group 3 received prefitting hearing aid counseling that did not include demonstration of listening, and the hearing aids were not fine-tuned at the follow-up appointment.
The results showed that prefitting hearing aid counseling had small but significant effects on expectations. The two forms of counseling did not differ in their effectiveness at changing expectations; however, anecdotally, we learned from many participants that that they enjoyed listening to the auditory demonstrations and that they found them to be an interesting listening exercise. The data also show that positive expectations result in more positive outcome and that hearing aid fine-tuning is beneficial to the user.
We conclude that prefitting counseling can be advantageous to hearing aid outcome and recommend the addition of prefitting counseling to address expectations associated with quality of life and self-image. The data emphasize the need to address unrealistic expectations prior to fitting hearing aids cautiously, so as not to decrease expectations to the extent of discouraging and demotivating the patient. Data also show that positive expectations regarding the impact hearing aids will have on psychosocial well-being are important for successful hearing aid outcome.
In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms.
In the British population only 20-25% of people who report hearing difficulties possess a hearing aid.1 – 2 We have proposed that adult hearing screening would increase the use of hearing aids.1 – 3 In three studies conducted in Wales between 1982 and 1992 all people aged 50-65 in four general practices were sent a screening questionnaire on hearing difficulties. Those who reported hearing problems were tested audiometrically and were offered a hearing aid if the average hearing level in their worse ear was worse than 30 dB. Two of these studies showed that this intervention increased by threefold the possession of hearing aids in the target populations.2 – 3 Screening was thus effective in the short term; in this …
Very few older people with severe hearing loss use hearing aids to reduce the negative consequences of reduced hearing in daily functioning.
Assessment of a screening test and a standardised auditory rehabilitation programme for older people from the general population with untreated severe hearing loss.
Intervention study and qualitative exploration.
Leiden 85-Plus Study, a prospective population-based study of 85-year-old inhabitants of Leiden, the Netherlands.
Hearing loss was measured by pure-tone audiometry in 454 subjects aged 85 years. Subjects with hearing loss above 35 dB at 1, 2, and 4 kHz who did not use hearing aids were invited to participate in a standardised programme for auditory rehabilitation. In-depth interviews were held with participants to explore arguments for participating in this programme.
Of the 367 participants with severe hearing loss (prevalence = 81%), 66% (241/367) did not use a hearing aid. Three out of four of these participants (n = 185) declined participation in the auditory rehabilitation programme. The most common reason given for not participating was the subjects' feeling that their current hearing loss did not warrant the use of a hearing aid. Subjects who participated in the programme were found to suffer from more severe hearing loss and experienced more hearing disability. Those who did not participate in the programme felt they could cope with their disabilities and considered a hearing aid unnecessary.
Untreated hearing loss is prevalent among older people from the general population. The majority of older people decline auditory rehabilitation. For these people the use of a hearing aid is not perceived as necessary in order to function on a daily basis. Older people who have expected benefits from a hearing aid have already obtained them, marginalising the benefits of a rehabilitation (and screening) programme.
Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease.
To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes.
A systematic review and meta-analysis of randomised controlled trials using motivational interviewing as the intervention.
After selection criteria a systematic literature search in 16 databases produced 72 randomised controlled trials the first of which was published in 1991. A quality assessment was made with a validated scale. A meta-analysis was performed as a generic inverse variance meta-analysis.
Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content, while combined effect estimates for cigarettes per day and for HbA(1c) were not significant. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect. More than one encounter with the patient ensures the effectiveness of motivational interviewing.
Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.
Objective: The aim was to explore patients’ accounts with regard to their experience of taking part in a pilot study evaluating the feasibility of conducting a randomised controlled trial (RCT) on the effect of motivational interviewing (MI) on hearing-aid use. Design: This was a qualitative sub-study embedded in a pilot RCT in NHS in which participants who reported using their hearing aid(s) less than four hours per day were randomised to MI combined with audiology standard care (MISC) (n=20), and standard care alone (SC) (n=17). A constructivist approach informed by grounded theory was used. 34/37 patients who took part in the pilot RCT underwent in-depth interviews one-month after the interventions. All interviews were audio-recorded, transcribed and analysed thematically. Results: Five themes emerged in relation to the participants’ perspectives about the key components of the research programme which influenced their hearing aid use. The themes comprise: (1) additional support, (2) clinician effect, (3) commitment to research, (4) research process, and (5) feeling better about self. Most people highlighted a combination of the themes related to the target interventions provided as well as the themes related to the research participation effect in general. Conclusion: The provision of hearing aids in the NHS may benefit from adopting a more compassionate patientclinician relationship, additional patient education, and post-hearing-aid-fitting support. These were among the main themes which seemed to have helped people to improve their hearing-aid use. Finally, this study suggests that the general research participation effect seems to have influenced the levels of hearing-aid use in both groups. Strategies to minimize the research participation effect need to be considered in the design of the future full-scale trials.
Conclusion:
Audiological parameters alone do not determine the choice to use hearing aids (HA). Subjective hearing-related QoL is a major factor that determines whether or not an older person will continue to wear HA.
Objective:
This study aimed to identify which audiological parameters and quality-of-life (QoL) measures determine whether or not older persons will continue wearing HA.
Methods:
Charts of 157 patients aged ≥65 years who attended the HA service unit at the Otolaryngology Department were retrospectively reviewed. After HA fitting and a trial, the patients were divided into groups, depending upon whether or not they wanted to continue wearing the HA (users, 58.2%; non-users, 41.8%) and then audiological parameters were compared between them. At least 4 months after the HA fitting, the self-reported QoL questionnaire, Hearing Handicap Inventory for the Elderly (HHIE), was mailed to all 157 patients and HHIE scores were compared between HA users and non-users.
Result:
Speech discrimination score and dynamic range did not significantly differ between HA users and non-users. A difference in the average hearing threshold was marginally significant. The response rate to the HHIE was 65.2%. Total HHIE and emotional scores were higher (more impaired) among HA users than non-users.
Objective:
This investigation evaluated the associated factors with self-reported outcome in hearing aid users by adopting the Korean version of International Outcome Inventory for Hearing Aids (IOI-HA) and Hearing Handicap Inventory for the Elderly (HHIE).
Methods:
Two hundred and eight participants were enrolled in this study. Participants completed the HHIE at pre-fitting, HHIE and the IOI-HA at 1 and 3 months after fitting. The outcomes of both questionnaires were analyzed with regard to the variable factors reported or expected to be associated with the outcome of hearing aid use.
Results:
The hearing-related handicap evaluated by HHIE score at pre-fitting had significant associations with age and the severity of hearing impairment. The IOI-HA score with hearing aid use was significantly correlated with WRS and the severity of hearing impairment. The improvement of HHIE score showed a significant correlation with WRS.
Conclusion:
Word recognition score (WRS) is the most significantly associated factor for outcome of hearing aid use. In addition, audiometric configuration, previous experience of hearing aid use, and initial hearing handicap should be considered as associated factors with hearing aid outcome.
Objective:
This study examined the efficacy of Motivational Interviewing (MI) to reduce hazardous drinking and drug use among adults in treatment for depression.
Method:
Randomized controlled trial based in a large outpatient psychiatry program in an integrated health care system in Northern California. The sample consisted of 307 participants ages 18 and over who reported hazardous drinking, drug use (primarily cannabis) or misuse of prescription drugs in the prior 30 days, and who scored ≥5 on the Patient Health Questionnaire (PHQ-9). Participants were randomized to receive either 3 sessions of MI (1 in person and 2 by phone) or printed literature about alcohol and drug use risks (control), as an adjunct to usual outpatient depression care. Measures included alcohol and drug use in the prior 30 days and PHQ-9 depression symptoms. Participants completed baseline in-person interviews and telephone follow-up interviews at 3 and 6 months (96 and 98% of the baseline sample, respectively). Electronic health records were used to measure usual care.
Results:
At 6 months, MI was more effective than control in reducing rate of cannabis use (p = .037); and hazardous drinking (≥4 drinks in a day for women, ≥5 drinks in a day for men; p = .060). In logistic regression, assignment to MI predicted lower cannabis use at 6 months (p = .016) after controlling for covariates. Depression improved in both conditions.
Conclusions:
MI can be an effective intervention for cannabis use and hazardous drinking among patients with depression. (PsycINFO Database Record
Age-related hearing loss is a common disorder with important consequences for quality of life. We performed a systematic review of the evidence investigating the effect of age-related hearing loss on cognition and quality of life in the elderly, and evaluated the effect of interventions for hearing loss. There is a large body of evidence associating hearing loss with detriment to physical and mental health, cognition, independence, social interaction and quality of life in the elderly. Hearing rehabilitation programmes, hearing AIDS and cochlear implants show beneficial effects in restoring communicative ability in this group and subsequently improve quality of life. Furthermore, much of the benefit seen is comparable to that in younger adults. However, both identifying those at need of such interventions and implementing them effectively are sub-optimal. Treatment approaches that better address the difficulties within this group need to be developed and the role significant others have to play in hearing rehabilitation should be explored.
The aim of this study was to evaluate the feasibility of conducting a randomized controlled trial (RCT) on the effect of motivational interviewing (MI) on hearing-aid use.
This was a pilot single-blind, randomized parallel-group study conducted in the UK.
Thirty-seven adult patients who reported using their hearing aid(s) less than four hours per day were randomized to MI combined with Standard Care (MISC) (n = 20), and Standard Care only (SC) (n = 17).
Of 220 patients invited, 37 were enrolled giving the recruitment rate of 17%. One participant withdrew giving the retention rate of 97%. It was feasible to combine MI with SC for facilitating hearing-aid use and deliver the intervention with high fidelity in an audiology setting. The measure on hearing-aid use (data logging) one month after interventions favoured the MISC group.
This pilot study suggests that conducting an RCT on using MI for facilitating hearing-aid use in people who do not use their hearing aids is feasible, and that MI combined with SC may have more positive effects on hearing-aid use compared to SC only.
To use the self-determination theory of motivation to investigate whether different forms of motivation were associated with adults' decisions whether or not to adopt hearing aids.
A quantitative approach was used in this cohort study. Participants completed the treatment self-regulation questionnaire (TSRQ), which measured autonomous and controlled motivation for hearing aid adoption. Sociodemographic data and audiometric information were also obtained.
Participants were 253 adults who had sought information about their hearing but had not consulted with a hearing professional. Participants were categorized as hearing aid adopters if they had been fitted with hearing aids 4-6 months after completing the TSRQ, and as non-adopters if they had not.
Multivariate logistic regression was used to examine associations between autonomous and controlled motivation, sociodemographic and audiometric variables, and hearing aid adoption (n = 160). Three factors were significantly associated with increased hearing aid adoption when the influence of other variables was accounted for: autonomous motivation, perceived hearing difficulty, and poorer hearing. Controlled motivation was not found to influence hearing aid adoption.
These empirical findings that link autonomous motivation to decisions of hearing help-seekers have implications for the ways practitioners may evaluate motivation and could inform discussions with clients about hearing aid adoption.
Background:
Between 68.1-89.5% of clients report that they are satisfied with their hearing aids. Two variables that are thought to contribute to dissatisfaction with hearing aids are product performance, and a mismatch between performance and client prefitting expectations about hearing-aid performance (i.e., disconfirmation). A focus on variables related to satisfaction is relevant to improving hearing rehabilitation services.
Purpose:
The aim of this study was to determine if measures of hearing-aid performance and disconfirmation, specifically related to hearing ability and hearing-aid problems, were associated with overall hearing-aid satisfaction among a sample of hearing-aid users.
Research design:
A retrospective research design was employed.
Study sample:
A total of 123 individuals participated in the study (57% male; mean age: 72 yr). All participants owned hearing aids.
Data collection and analysis:
A personal details questionnaire and the Profile of Hearing Aid Consumer Satisfaction questionnaire (Wong et al, 2009) were completed by participants, 3-12 mo after they obtained hearing aids. Overall hearing-aid satisfaction was a dichotomized variable (satisfaction vs. dissatisfaction); therefore, logistic regression modeling was applied to the data to determine which variables were associated with overall hearing-aid satisfaction.
Results:
Sixty-one percent of the sample reported that they were satisfied with their hearing aids. Hearing-aid satisfaction was associated with the ability to hear with hearing aids and better-than-expected performance in this same area; fewer hearing-aid problems; and fewer problems with hearing-aid manipulation, hearing-aid appearance, and wearer discomfort than were anticipated before hearing-aid fitting.
Conclusions:
It is recommended that to improve hearing-aid satisfaction, clinicians should ensure optimal hearing-aid benefit in the listening situations that the person with hearing impairment most wants to hear better; reduce the likelihood of hearing-aid problems occurring; and promote positive disconfirmation (performance exceeds expectations) with respect to both hearing ability and hearing-aid performance through the education of clients about the likely benefits of hearing aids in a variety of listening environments, and the potential problems they could face with hearing-aid manipulation and wearer discomfort.
Objective
Motivating people with chronic pain to engage in therapy can be difficult, especially when individuals have not experienced adequate pain management. Therefore, it may be useful for clinicians to use a motivational assessment as a part of treatment to help patients achieve immediate benefits. Additionally, because the social context impacts chronic illness, the significant other should be included in the assessment. This article describes a motivational assessment that was developed for people with chronic pain and their partners.InterventionThe motivational assessment begins with gathering information from questionnaires that each partner completes, conducting a semi-structured interview about the couples' relationship and pain history, and observing the couples converse about pain coping. Next, tailored feedback is provided to each couple regarding their strengths and weaknesses with suggestions for how to improve their relationship and pain coping skills. This tailored feedback engages the couple in this conversation by adhering to the principles of motivational interviewing.Case ExampleA case example of a couple who completed this motivational assessment is described. This assessment resulted in immediate improvements in marital satisfaction, pain severity, and mood for the couple.Conclusions
This article provides a guide to clinicians for using a motivational assessment to help patients with a chronic illness achieve immediate benefits.
Objectives
To determine whether hearing impairment, highly prevalent in older adults, is associated with activity levels.DesignCross-sectional.SettingNational Health and Nutritional Examination Survey (2005–06).ParticipantsIndividuals aged 70 and older who completed audiometric testing and whose physical activity was assessed subjectively using questionnaires and objectively using body-worn accelerometers (N = 706).MeasurementsHearing impairment was defined according to the speech-frequency (0.5–4 kHz) pure-tone average in the better-hearing ear (normal <25.0 dB, mild 25.0–39.9 dB, moderate or greater ≥40 dB). Main outcome measures were self-reported leisure time physical activity and accelerometer-measured physical activity. Both were quantified using minutes of moderate-intensity physical activity and categorized as inactive, insufficiently active, or sufficiently active. Ordinal logistic regression analyses were conducted and adjusted for demographic and cardiovascular risk factors.ResultsIndividuals with moderate or greater hearing impairment had greater odds than those with normal hearing of being in a lower category of physical activity as measured according to self-report (OR = 1.59, 95% CI = 1.11–2.28) and accelerometry (OR = 1.70, 95% CI = 0.99–2.91). Mild hearing impairment was not associated with level of physical activity.Conclusion
Moderate or greater hearing impairment in older adults is associated with lower levels of physical activity independent of demographic and cardiovascular risk factors. Future research is needed to investigate the basis of this association and whether hearing rehabilitative interventions could affect physical activity in older adults.
Accessible summary
Brief manualized training over a 4‐week period in motivational interviewing (MI) in conjunction with patient worksheets, session audio recordings and independent ratings of adherence and competence resulted in mental health nurses (MHNs) on an inpatient eating disorder ward significantly improving their MI adherence and competence.
Despite the brevity of the training, MHNs' satisfaction with the training was high.
When compared with a similar time period on the ward before MI training, premature discharge rates were significantly lower after MI was utilized by the nurses.
Abstract
This study examined whether: (1) brief training in motivational interviewing ( MI ) can prepare mental health nurses ( MHNs ) to provide MI to patients; and (2) this MI impacts on patients with respect to premature discharge. Six MHNs on an inpatient eating disorder unit were trained in MI , and their treatment adherence and competence were evaluated at post‐training and 2‐month follow‐up. Premature discharge was examined by comparing a 3‐month period in 2009 before MI administration with 2010 when MI was being administered. MHNs significantly improved their MI adherence and competence. Satisfaction with the training was high as was patient satisfaction with MI . Premature discharge rates significantly decreased. Brief training in MI is sufficient to significantly increase competency and adherence in the practice of MI by MHNs , which may in turn be effective in improving patients' treatment adherence by reducing premature discharge rates. Future research will need to utilize a randomized controlled design in order to further investigate these findings.
Objectives
To determine whether hearing impairment, defined by using objective audiometry, is associated with multiple categories of self-reported physical functioning in a cross-sectional, nationally representative sample of older adults.DesignMultivariate secondary analysis of cross-sectional data.SettingThe 2005–06 and 2009–10 cycles of the National Health and Nutrition Examination Survey.ParticipantsAdults aged 70 and older who completed audiometric testing (N = 1,669).MeasurementsHearing was measured using pure-tone audiometry. Physical functioning was assessed using a structured interview.ResultsIn a model adjusted for age and demographic and cardiovascular risk factors, greater hearing impairment (per 25 dB hearing level (HL)) was associated with greater odds of physical disability in activities of daily living (odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.1–1.9), instrumental activities of daily living (OR = 1.6, 95% CI = 1.2–2.2), leisure and social activities (OR = 1.5, 95% CI = 1.1–2.0), lower extremity mobility (OR = 1.4, 95% CI = 1.1–1.7), general physical activities (OR = 1.3, 95% CI = 1.1–1.6), work limitation (OR = 1.4, 95% CI = 1.0–1.9), walking limitation (OR = 1.6, 95% CI = 1.3–2.0), and limitation due to memory or confusion (OR = 1.4, 95% CI = 1.1–1.8). Hearing impairment was not associated with limitations in amount or type of work done (OR = 1.2, 95% CI = 1.0–1.6).Conclusion
Hearing impairment in older adults is independently associated with greater disability and limitations in multiple self-reported categories of physical functioning.
Objective:
To examine associations between audiological and non-audiological factors and successful hearing aid use in older adults.
Design:
In a retrospective study, audiological factors, attitudinal beliefs (as derived from the health belief model), client demographics, psychological factors, and age-related factors were evaluated.
Study sample:
Participants included 160 individuals, 60 years or older, with unilateral or bilateral hearing impairment (HI), fitted with hearing aids for the first time in the previous two years. Participants were assigned to either an unsuccessful hearing aid owner group (n=75) or a successful hearing aid owner group (n=85) based on their self-reported hearing aid use and benefit.
Results:
A multivariate, binomial logistic regression model indicated five factors associated with group membership: participants who had greater support from significant others; more difficulties with hearing and communication in everyday life before getting hearing aids; more positive attitudes to hearing aids; coupled with greater perceived self-efficacy for advanced handling of hearing aids; or who were receiving more gain from their devices; were more likely to be successful hearing aid owners.
Conclusions:
These findings highlight the importance of addressing non-audiological factors in order to assist older adults achieve success with hearing aids.
Objective:
To examine the influence of audiological and non-audiological factors on help-seeking for hearing impairment (HI) in older adults.
Design:
A retrospective research design was employed. Participants completed 14 measures, after which two multivariate, multinomial logistic regression models were fitted to the data to determine which factors were associated with consultation for HI and hearing aid uptake.
Study sample:
Three-hundred-and-seven individuals who were 60 years or older and who presented with a unilateral or bilateral HI participated in the study. Non-hearing aid owners were assigned to a non-consulter group (n=55) or a consulter group (n=92); hearing aid owners were assigned to an unsuccessful hearing aid owner group (n=75) or a successful hearing aid owner group (n=85).
Results:
A similar combination of factors was associated with the decisions to consult a health professional about HI and/or to adopt hearing aids. The most important factors related to attitudinal beliefs (e.g. perceived benefits of hearing aids) and external cues to action (e.g. support from significant others). Greater HI also influenced consultation and adoption of hearing aids.
Conclusions:
Findings highlight the importance of non-audiological factors in hearing rehabilitation to improve consultation for HI and hearing aid adoption.
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s.
In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors.
Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change.
Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence.
All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Motivational interview techniques combined with an evidence-based guideline provide valuable tools for the treatment of childhood obesity. The National Association of Pediatric Nurse Practitioners' Healthy Eating and Activity Together guidelines were adopted in a rural pediatric office. After a 6-month pilot, effectiveness of treatment was evaluated with a retrospective chart review. The results suggest that children were motivated for healthy lifestyle changes but had difficulty maintaining motivation and compliance with healthy change choices after 1-2 months; however, with consistent use of motivational interviewing techniques combined with diet and exercise counseling, there was a trend toward lowered body mass index and waist measurements.
The reasons are not clear as to why people who need hearing aids and possess them do not use them. We aimed to describe the incidence and predictors of hearing aid ownership and use among older adults.
We included 2,015 Blue Mountains Hearing Study participants aged ≥55 years who were examined between 1997 and 1999 and 2002 and 2004. Hearing levels were measured with pure-tone audiometry.
The 5-year incidence of hearing aid use and ownership was 8.1% and 8.5%, respectively. Age was associated with incident hearing aid ownership and use, multivariable-adjusted odds ratio (OR) per decade increase in age of 1.79 (95% confidence interval [CI], 1.21-2.64) and of 1.66 (95% CI, 1.15-2.40), respectively. Any level of hearing loss (HL) at baseline predicted a 2.8-fold increased likelihood of using a hearing aid at follow-up. Hearing handicap was associated with 7% increased likelihood of incident aid use. Key reasons provided for not obtaining/using a hearing aid were: not recommended one (8.0%), its high cost (1.7%), and believing that they did not need one (9.0%).
Incident hearing aid ownership and usage was relatively low among hearing impaired adults. Age, question-defined hearing handicap, and measured HL were significant predictors of incident hearing aid use/ownership.
Hearing loss is a common sensory impairment experienced by older persons. Evidence shows that the use of hearing aids and/or assistive listening devices (ALDs) can benefit those with a hearing loss but that historically the uptake and use of these technologies has remained relatively low compared with the number of people who report a hearing loss.
The aim of this study was to determine the prevalence, usage, and factors associated with the use of hearing aids and ALDs in an older representative Australian population.
A population-based survey.
A total of 2956 persons out of 3914 eligible people between the ages of 49 and 99 yr (mean age 67.4 yr), living in the Blue Mountains, west of Sydney, completed a hearing study conducted from 1997 to 2003.
Hearing levels were assessed using pure tone audiometry, and subjects were administered a comprehensive hearing survey by audiologists, which included questions about hearing aid and ALD usage. Logistic regression analysis was used to identify factors associated with hearing aid and ALD usage.
Of the surveyed population, 33% had a hearing loss as measured in the better ear. 4.4% had used an ALD in the past 12 mo, and 11% owned a hearing aid. Of current hearing aid owners, 24% never used their aids. ALD and hearing aid usage were found to be associated with increasing age, hearing loss, and self-perceived hearing disability.
These results indicate that hearing aid ownership and ALD usage remains low in the older population. Given the significant proportion of older people who self-report and have a measured hearing loss, it is possible that more could be helped through the increased use of hearing aid and/or ALD technology. Greater efforts are needed to promote the benefits of these technologies and to support their use among older people with hearing loss.
With an annual issue of 100,000 hearing aids in Denmark it is of interest to quantify their use and non-use.
Adult reapplicants (n = 1003) with five-year-old hearing aids (median) were interviewed about their hearing aid use, and those possessing unused aids (n = 182) were contacted a year later with a postal questionnaire. The data were compared with 683 returned International Outcome Inventory - Hearing Aid (IOI-HA) questionnaires from a national quality control project conducted in the same period which had been mailed to 1125 of our patients from a central site.
Of the 1003 hearing-aid users, 83% wore an aid for at least 3-4 hours daily while 13% never wore any. In the IOI-HA-survey, non-use was reported by only 2%. Among the 182 who were contacted a year later, the proportion of users tripled to 67%. Non-use was predominantly (70%) due to unpleasant sound quality, lack of benefit, or a poorly fitting ear mould/shell. Hearing aid usage increased with increasing hearing loss and with the patients' level of experience. Conversely, non-use seemed to increase with the length of the observation period.
Although only 13% had stopped using their aids after five years, this represents a considerable loss which can be reduced through active follow up. The reported that the 2% non-use rate in the IOI-HA-clientele can be ascribed to the fact that the survey took place only 2-3 months post issue, but it may also reflect a non-response bias.
During the last 30 years several hearing disability and handicap questionnaires have been designed and used for clinical purposes. The present study includes a review of the most frequently used scales. The aim of the present study was to evaluate the reliability and validity of the Hearing Disability and Handicap Scale (HDHS), which is a shortened and modified version of the Hearing Measurement Scale. Correlations between the Hearing Handicap and Support Scale, the Communication Strategy Scale from the Communication Profile of the Hearing Impaired, pure tone audiometry and speech recognition scores in noise were analysed. Data from 168 men with noise induced hearing loss of different degrees was obtained. Also a test-retest was conducted. The disability section of the HDHS seemed accurate but offered no improvement of prediction compared to previous scales. Even though the reliability of the handicap section was sufficient, its validity and clinical use is discussed and suggestions about improvements given. Since standardised scales are necessary if results are to be compared worldwide, guidelines regarding the clinical use and benefit of hearing disability and handicap scales are required.
Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids, and many do not choose to wear hearing aids. Two group communication education programs aimed at such older people are described. The 'Keep on Talking' program has a health promotion focus, and is aimed at maintaining communication for older adults living in the community. An experimental group (n = 120) attended the program, and a control group (n = 130) received a communication assessment but no intervention. Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills. At the follow-up evaluation at 1 year, 45% of the experimental group, compared to 10% of the control group, had acted to improve their communication skills. The 'Active Communication Education' program focuses on the development of problem-solving strategies to improve communication in everyday life situations. Preliminary outcomes have been assessed on a small scale (n = 14) to date. It is concluded that communication programs represent an important adjunct to, or supplement for, the traditional approach that focuses on hearing aid fitting.
Hearing loss is one of the most prevalent chronic conditions affecting the health of the aged. It is typically medically non-treatable, and hearing aid (HA) use remains the treatment of choice. However, only 15-30% of older adults with hearing impairment possess an HA. Many of them never use it. The purpose of our study was to investigate the use of provided HAs and reasons for the non-use of HAs. This population-based survey was set in the city of Kuopio in eastern Finland. A total of 601 people aged 75 years or older participated in this study. A geriatrician and a trained nurse examined the subjects. Their functional and cognitive capacity was evaluated. A questionnaire about participants' socioeconomic characteristics and the use of HAs were included in the study protocol. The subjects who had an HA were assigned to three groups on the basis of HA use: full-time users, part-time users and non-users. Inquiries were made about the subjective reasons for the non-use of HAs. An HA had been prescribed earlier to 16.6% of the study group. Fourteen percent of the females and 23% of the males had been provided with an HA. The HA owners were older than persons who had not been provided with an HA. Twenty-five percent of the HA owners were non-users, and 55% were full-time users. A decline in cognitive or functional capacity and low income explained the non-use of HAs. The most common subjective reasons for the non-use of HAs were that the use did not help at all (10/24), the HA was broken (4/24) or it was too complicated to use (5/24). The non-use of HAs is still common among the aged. Elderly people who have been provided with an HA and who have a cognitive or functional decline are at risk to be a non-user of an HA. Therefore, they need special attention in counseling.
As hearing impairment affects communication, it seems intuitive that both the person with hearing impairment and the significant other (SO) will experience effects as a result of the impairment and subsequent rehabilitation. The present study examined the effect that hearing impairment and aural rehabilitation has on the person with hearing impairment and the SO's quality of life (QOL). Ninety-three people with hearing impairment completed a measure of hearing-specific QOL (Hearing Handicap Inventory for the Elderly) and health-related QOL (Short Form-36), while 78 SOs completed a modified version of the Quantified Denver Scale and the Short Form-36, prior to and 3 months following hearing aid fitting. The results emphasize the significant impact of hearing impairment on both the person with hearing impairment and the SO. The results also demonstrate the effective role that hearing aids play in reducing such negative effects for both parties.
The aim of this study was to find out how the use of hearing aids has been affected by the changes in hearing rehabilitation, hearing aids and society over the past 20 years. Seventy-six first-time hearing aid users were interviewed at their homes, and the results were compared with those of an earlier study made with the same method in 1983 in Finland involving both new and experienced hearing aid users. Hearing aid use and handling skills as well as satisfaction with the hearing aid were explored with interviews using the same questions in both studies. The number of first-time hearing aid users who did not use their hearing aids had decreased from 33.3% in 1983 to 5.3% at the present. Conversely, the number of regular users rose from 40.9 to 56.6%. The use of hearing aids was increased. The users were better able use their hearing aids and were more satisfied with them and the number of those who considered the counseling provided sufficient had also increased.
Can motivational interviewing in emergency care reduce alcohol consumption in young people? A systematic review and meta-analysis
- S Kohier
- A Hofmann
Kohier S, Hofmann A. (2015) Can motivational interviewing in
emergency care reduce alcohol consumption in young people? A
systematic review and meta-analysis. AlcoholAlcohol 50(2):107-117.
Stages of change in adults with acquired hearing impairment seeking help for the first time: application of the transtheoretical model in audiologic rehabilitation
- A Laplante-Lévesque
- L Hickson
- L Worrall
Laplante-Ldvesque A, Hickson L, Worrall L. (2013) Stages cd
change in adulta with acquired hearing impairment seeking heip
for the first time: application of the transtheoretical rnodel in au
diologic rehabilitation. Ear Hear 34(4):447-457.
Motivational Interuiewing: Helping People Change
- W R Miler
- S Rollnick
Miler WR, Rollnick S. (2012) Motivational Interuiewing: Helping
People Change. United Kingdom: Gullford Press.
Motiuatieraal lnterviewing: Helping People Chcznge
- W R Miller
- S Rollnick
Miller WR, Rollnick S. (2013) Motiuatieraal lnterviewing: Helping
People Chcznge. 3rd ed. New York, NY: Guilford Press.
Outeomes of hearing aid fitting for older ing aid use over the past 20 years. Rur Arch Otorhinolaryngol people with hearing impairrnent and their significant others
- J Solheim
- K J Kvaerner
- L Sandvik
- E S Falkenberg
- A Vuorialbo
- M Sorri
- I Nuojua
- A Muhli
Solheim J, Kvaerner KJ, Sandvik L, Falkenberg ES. (2012) Facview to treat obesity in the pediatric office. J Pediatr Nurs
tors affecting older adults' hearing-aid use. Scand J Disabil Res
26(5):474-479.
14:300-312.
Vuorialbo A, Sorri M, Nuojua I, Muhli A. (2006) Changes in hear
Stark P, Hickson L. (2004) Outeomes of hearing aid fitting for older
ing aid use over the past 20 years. Rur Arch Otorhinolaryngol
people with hearing impairrnent and their significant others. Int J
263(4):355-360.
Providers study ofmotivational interviewing as a prelude to intensive treat as weight coaches: using practice gujcles and motivational interment for an eating disorder
- C V Weiss
- J S Milis
- H A Westra
- J C Carter
- S B Tripp
- J T Perry
- S Romney
- J Blood-Siegfried
Weiss CV, Milis JS, Westra HA, Carter JC. (2013) A preliminary
Tripp SB, Perry JT, Romney S, Blood-Siegfried J. (2011) Providers
study ofmotivational interviewing as a prelude to intensive treat
as weight coaches: using practice gujcles and motivational interment for an eating disorder. J Eat Disord 1:34.
Patients' experience ofmotivational interviewing
- H Aazh
Aazh H. (2016a) Patients' experience ofmotivational interviewing