A Self-Affirmation Intervention to Promote Hearing Aid Use

September 14, 2020 updated by: Kerry Ware, University of Manchester

Randomised Controlled Trial of a Self-Affirmation Theory-Based Intervention to Promote Hearing Aid Use

Hearing aids are the number one treatment for hearing loss and it is estimated that out of the 2 million of UK individuals who are supplied with hearing aids 1.4 million will use their hearing aids to varying degrees and the other 0.6 million will stop using their hearing aids altogether.

The proposed research is looking to improve hearing aid usage by using a self-affirmation intervention which lowers the threat of participants' ageing anxiety. The target of lowering participants' ageing anxiety to improve hearing aid use is because there is a stigma of hearing aids making people seem old and this stigma can make individuals resistant to wearing their hearing aids as they do not want to be seen in this light.

The current proposed research is an extension of a pilot study that was conducted in 2016 which found that a self-affirmation intervention may be useful in improving individuals' hearing aid usage. They randomly allocated 50 first-time hearing aid users either to a group that undertook a self-affirming exercise (e.g., "If I feel threatened or anxious, then I will think about the things I value about myself") or to a no-intervention control group. Consistent with the idea that self-affirmation helps people deal with threat, first-time hearing aid users reported significantly lower anxieties about ageing after self-affirming. Moreover, according to the data usage downloaded from their hearing aids (data-logging), the self-affirming group were found to have worn their hearing aids an average of two hours per day longer than the control group. Due to the limited number of participants, the effects of the intervention were not statistically significant. Nevertheless, the low cost and high potential public health "reach" alongside the effect size of d = 0.43 indicates that the intervention shows promise.

The main aim of this research is to re-test the self-affirmation intervention from the previous pilot study with a sufficiently large enough sample to answer the following "Does a self-affirmation intervention improve participant's hearing aid usage when compared to participants in the control group?

Study Overview

Detailed Description

Participants will be recruited through two NHS audiology clinics where they will be invited to participant in this study via an invitation letter either enclosed within their appointment letter or given to them at their audiology appointment. The information used to identify potential participants is that of their diagnoses (must be using or being supplied with hearing aids) . The audiology clinic staff will be identifying potential clients therefore it is believed that there is unlikely to be a breach of confidentiality. All participants will be sent a £10 shop-for-all voucher for participating in the second stage of the study (10-week post appointment) this will be sent to participants home after 6 months and this will include an invitation to a follow up questionnaire.

All prospective participants will be required to give written consent before being assigned to the study and those unable to do this will not be included. After consent is given participants will be allocated to either the intervention group or the control group. Procedure of the proposed study is as follows:

  1. Each participant will be randomly assigned to either the control group or the intervention group. Blinding of both the participant and the researcher with regards to which group the participant has been assigned to will be achieved by all questionnaires being placed in opaque envelopes which will have a number printed on the front of the envelope. The numbers from the envelope will be placed in a computerised list generator and an order list of how they are to be administered will be produced. Alternatively participants can go online and the platform will randomly assign them to either the intervention or the control questionnaire.
  2. Participants in both groups fill in a questionnaire which contain the following Scales: The Anxiety toward Ageing Scale (AAS), The Attitudes Toward Loss of Hearing Questionnaire (ATLH) and The Glasgow Benefit Hearing Aid Scale (GBHA) as well as a self-report question on their daily hearing aid use. The intervention group also undertake a self-affirmation exercise which is placed at the end of the questionnaire. This is expected to take 20-30 minutes.
  3. Participants return 10 weeks later (post) and have their hearing aid usage downloaded (hours per day the aids were worn) from their hearing aids by an audiologist before subsequently filling in another questionnaire which again contains the AAS, ATLH, GBHA and a self- report question on their daily hearing aid use. This is expected to take 30-40 minutes.

3A: If it is not possible for the participant to come back for a follow up appointment the second questionnaire will be sent out postal to the participants address or an email with a hyperlink to the follow up questionnaire online will be sent to participants who previously completed the first questionnaire online.

4: Six months later participants are contacted via email ( hyperlink) or post to fill in an optional questionnaire containing the AAS, ATLH, GBHA and a self-report question on their daily hearing aid use which they send back to the researcher. This should take 20-30 minutes. If participants receive the follow up questionnaire through the post the shopping voucher will also be enclosed. Online participants will also receive their shopping voucher through the post.

5: A debrief form will be sent out via e-mail or post by the principal researcher 3 weeks after the follow up questionnaire was returned or alternatively if they decide to not to complete the follow up questionnaire the debrief will be sent 4 weeks after the initial questionnaire request was sent.

A G-power analysis was conducted to detect a small-moderate effect size (Cohen's D of 0.35) with 80% power at the 5% significance level which indicated that a sample of 260 participants (130 per group) would be required. This study will attempt to recruit 400 based on a similar pilot study having a 34% attrition rate. The data collection phase will continue until 260 participants have completed the 10 week follow up.

The study design is a mixed Design: Between-participants factor is condition (control vs intervention). Within-participants factor is time (pre-intervention vs post intervention (10-week) vs exit (6 month after post ). We will use a series of 2 (Intervention, control) x 3 ( pre-intervention, post intervention and exit) repeated ANOVA to assess to assess the outcome measures. If a small-moderate effect size (Cohen's d = 0.35) is found on any of the principle and secondary measures, then the Hayes PROCESS macro will be used to examine the possible mediating effects of the intervention on participants' hearing aid usage. If data is missing at the 10-week follow up the participant concerned will be excluded from the analysis at this point. The present study also has a longitudinal element and attrition at 6 months is expected. Any missing data will be addressed by using the "last observation carried forward technique".

All data such as contact details and ethnicity will be pseudonymised and kept in a separate, password protected file, in a restricted access folder on a secure University server. All paper copies of contact details and questionnaire data will be secured in Manchester University in a locked filing cabinet. Only the study team and regulatory monitoring and auditing authorities from the University of Manchester will have access to this data.

All the questionnaire data will be anonymised and kept in a separate, password protected file, in a restricted access folder on a secure University server. Only the study team and regulatory monitoring and auditing authorities from the University of Manchester will have access to this data.

The physical personal data copies will be kept until completion of the study then will be destroyed in accordance with University of Manchester regulations. All consent forms and questionnaire data are deemed as essential and this will be kept for 5 years to comply with University of Manchester regulations.

The current study will go through ethics approval with the National Health Service, Health Research Authority in the UK before it will be allowed to proceed. The study has already been through a preliminary ethics review at the University of Manchester.

Study Type

Interventional

Enrollment (Anticipated)

400

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adults 18+ receiving hearing aids for the 1st time already have hearing aids fitted able to provide written consent and can complete the simple questionnaire

Exclusion Criteria:

  • Anyone younger than 18 anyone who does not wear a hearing aid anyone lacking in capacity to provide informed written consent.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention
Given the associated questionnaire which has the embedded self-affirmation exercise.

The self affirming exercise is as follow:

The beginning to a sentence appears below. Below it are 4 different ways of completing the sentence. On the lines provided, please write out the beginning of the sentence and then complete it with 1 of the 4 options we have given you.

If I feel threatened or anxious, then I will …………………………………..

Options are as follows:

think about the things I value about myself, remember things that I have succeeded in, think about what I stand for or think about things that are important to me

Active Comparator: Control
Given the associated questionnaire without the embedded self-affirmation exercise.
Given a questionnaire minus the self affirming exercise

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Hearing aid usage data from participants hearing aids
Time Frame: At the 10 weeks after baseline is taken
The daily use of participants hearing aid use is pulled from their hearing aids data logging
At the 10 weeks after baseline is taken

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Participants self-reported measure of hearing aid use.
Time Frame: Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Measured by asking participants "Thinking about how much you used your present hearing aid(s) over the past two weeks. On an average day, how many hours did you think you used the hearing aid(s)?"
Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Participants Anxiety toward Aging
Time Frame: Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Will be measured by using The Anxiety Towards Ageing Scale (AAS; Lasher & faulkender,1993) this is a 20-question questionnaire. An example of the questions included is: "I expect to feel good about life when I am old" it is measured on a 7-point Likert scale 1= strongly disagree to 7= strongly agree.
Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Participants hearing loss/aid stigma.
Time Frame: Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Will be measure using the subscale of "negative associations" from The Attitudes towards Loss of Hearing Questionnaire (Saunders & Cienkowski, 1996) there are 4 questions within this subscale an example is: "The thought of wearing a hearing aid makes me feel older." It is measured on a 7-point Likert scale 1= strongly disagree to 7= strongly agree.
Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Participants perceived benefit / satisfaction participants have for their hearing aids
Time Frame: Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.
Will be measured by using the 4 standard questions presented on The Glasgow Benefit Hearing Aid scale (Gatehouse & Browning,1996). An example of these questions is "Please think about listening to the television with other family members or friends when the volume is adjusted to suit other people. Over the past two weeks, how much difficulty do you have in this situation?" It is answered on a 6-Likert scale 1= not applicable 2= Not at all and 6= Very much indeed.
Baseline pre-intervention: 10 weeks after baseline: 34 weeks after baseline.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Kerry Ware, The University of Manchester

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Anticipated)

October 5, 2020

Primary Completion (Anticipated)

December 20, 2021

Study Completion (Anticipated)

September 26, 2022

Study Registration Dates

First Submitted

May 4, 2020

First Submitted That Met QC Criteria

May 8, 2020

First Posted (Actual)

May 11, 2020

Study Record Updates

Last Update Posted (Actual)

September 16, 2020

Last Update Submitted That Met QC Criteria

September 14, 2020

Last Verified

May 1, 2020

More Information

Terms related to this study

Other Study ID Numbers

  • 274086
  • IS-BRC-1215-20007 (Other Grant/Funding Number: NIHR Manchester Biomedical Research Centre)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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