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Changing Language in Audiology

Jane Shorrock

Mrs

Barnet
5 posts

#3843

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I attended a BSHAA conference recently and heard a very interesting lecture by Curtis Alcock, who spoke about the stigma atached to hearing aids.  The focus of the talk was how the language used by audiologists is very negative eg hearing LOSS, ear MOULDs, hearing AIDs etc, which serve to reinforce the view of a hearing test, hearing aids etc being associated with getting old, which nobody wants to be associated with.    People therefore reject or avoid having a hearing test.  Curtis suggested some very simple phrases that we could change, in order that people may want to approach, rather than avoid a hearing test.  eg "are you aware you have a hearing loss?", could be replaced with "Have you noticed any changes in your hearing?.."   Instead of the accusatory " You can't hear these sounds" (people feel accused and defensive) try saying "your hearing doesn't allow you to hear these sounds" etc  He has some great discussion articles on www.audirathinktank.com   

I am preparing to undertake a university study on how we can change atitudes towards hearing loss, but there are very few peer reviewed articles on this.  Could anybody help or point me in the right direction, as I must find 3 peer reviewed articles to critique.  Any advice would be greatly appreciated

 

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Stella Ng

Director of Research

5 posts

#5901

Replied on:

Great points, Kris. Certainly asking patients would be a good starting point.

 

Taking a bit of a different angle (my apologies if a bit off topic..it's just where my brain goes these days), I think a critical social sciences perspective is helpful here. Through such a perspective, the question isn't one of cause and effect in terms of particular language /wording resulting in different choices by patients.

 

Rather a critical discourse analyst, drawing on the theories of Michel Foucault, for instance, would examine the ways in which our overarching social Discourses have shaped our fundamental approaches to hearing rehabilitation as a whole, positioning us to see people and possibilities in a particular way...e.g. People with hearing loss as having a need we can fulfill, and technology and rehab as being the ways to fix their problems (or however we word it). Critical social scientists would argue it's important to understand why certain norms (e.g. audiology practice) came to be normal, and who they serve to empower and disempower. How are we, as audiologists/hearing health professionals, shaped to see things in a particular way?

 

Discourses, in this use, shape how we see the world and make possible and impossible certain ways of thinking and behaving. E.g. while we may agree with these discourses, the discourse of evidence based practice, or the discourse of compliance, or the discourse of rehabilitation... are all socially constructed. They're not natural phenomena found in the natural world, but rather ways we have come to understand and function in the natural world in response to natural phenomena.

 

It's, I'd argue, our moral imperative as a helping profession to continually challenge these and all assumptions underlying our practices and paradigms of practice. My mentor, Lorelei Lingard, always said "language IS social action." While we don't draw a lot (although your work often does :-) from the humanities and social sciences, I think these other fields of study have a lot to offer in terms of theoretically robust opportinities to understand how we practice and how we could practice more ethically and with compassion.

 

So this is kind of a high-level, philosophical, not super practical post, but hopefully thought provoking...

 

:)

 

 

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Curtis Alcock

Owner

Exeter
71 posts

#5691

Replied on:

I have now started a discussion question on the topic of "normal" if anyone's interested in exploring it further:

 

idainstitute.com/forum/Discussion/show/the-concept-of-normal-and-its-impact-of-self-identity-and-social-identity-in-hearing-healthcare/

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Stella Ng

Director of Research

5 posts

#5683

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I think another important nuance to keep in mind is a lot of what I was saying and what Phelan says in the paper I attached is coming from a pediatric/child & family perspective. That adds an additional layer to consider re: identity and normality.

 

Great discussion!!

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Curtis Alcock

Owner

Exeter
71 posts

#5682

Replied on:

Oh, and I forgot to add that I used the term "corrective" also in reference to the paper that Stella uploaded for us. See, for example, the quote:

"However, a more nuanced examination has revealed how the rhetoric

surrounding these technologies focuses on normalization, i.e. on

CORRECTING or fixing what is perceived as ‘‘deviant’’ or abnormal

bodies and behaviours." (emphasis added)

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Curtis Alcock

Owner

Exeter
71 posts

#5681

Replied on:

Oops, missed the link: see en.wikipedia.org/wiki/Glasses

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Curtis Alcock

Owner

Exeter
71 posts

#5680

Replied on:

I was using the term in reference to spectacles/contact lenses which are frequently referred to as "corrective lenses". (see:

I don't think we can ever apply the term "corrective" to hearing technology. With "corrective lenses" it is correcting where the light falls (functional again), not the person. It's a very important distinction, and one I have been trying to highlight all along. Hope this clears the misunderstanding.

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Fiona Barker

Clinical scientist

Sunningdale
41 posts

#5679

Replied on:

The issue of 'being normal' came up in a Delphi review that I conducted (and hope to publish the results of soon!) last summer. The panel were split between those who felt that living well with a hearing loss would, for some people, mean returning to their perception of 'normal' (be that a cognitive, emotional or behavioural definition) and those panel members who felt that living well would mean recognising that limitations/restrictions/adaptions might be necessary but coping with them well. The panel were composed of a varied mix of people with hearing loss and professionals working with them. I think this highlights, as Stella said, that this will be a personal judgement and we need to be sensitive to that and adapt ourselves and our professional interventions to work with that. Some people will yearn for/expect a return to normal, others will expect to adapt to changing circumstances.

Curtis, you use the term 'corrective' technology which, in linguistic terms implies that something needs to be corrected although I accept that, for you, you see it as enabling rather than correcting anything. Some people I know would view the use of the term 'corrective technology' as deeply offensive. This shows how language in and of itself is not the central issue but rather how we can learn to be better listeners (both to what people say to us and to what we say to other people) and hope to try and be open to the viewpoints of anyone we come into contact with. Sometimes a very difficult task.

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Curtis Alcock

Owner

Exeter
71 posts

#5678

Replied on:

Some really important insights in this paper. Thank you for sharing it, Stella. And I agree entirely with your conclusion about "no singular best way" and our need to be "constantly thoughtful and questioning".

The paper also raises so many other valuable starting points that it may even be worth starting a new discussion thread on this paper, if anyone's interested in joining me?

For example, take the whole issue of "normalcy". The very fact that even the WHO classes people as having "normal" hearing or not…

I've often wondered whether we shouldn't consider a model similar to optics, where rather than saying "normal vision" they say "20:20 vision": it's what a person's vision can functionally do.

As someone who has been short-sighted with an astigamtism since my early teens I don't consider myself "deviant", although I certainly felt embarrassed the first time I took out my glasses to wear in class. Fortunately my classmates boosted my confidence in wearing them by saying how they "suited me". But for the rest of the time I've seen using corrective technology as enabling me to do things I couldn't otherwise do (such as drive a car, enjoy the cinema, clay pigeon shoot if I wanted to).

In this sense, the technology is a "fix", but I don't see it as fixing ME to make me a "normal" person – I never have done. I see it as something that ENABLES me to have the choice to do things I couldn't otherwise do. Perhaps if this corrective technology didn't exist for me (such as would have been the case many years in the past) I would see things differently (no pun intended): I wouldn't be able to live the same life as the majority. I wouldn't be able to join in. But at the same time, if nobody drove, or went to the cinema or did clay pigeon shooting then my reduced visual acuity would never come into play. So it's the combination of the societal context with my (in)ability that causes the problem. In the same way that if everyone was fluent in a universal sign language, background noise would no longer a problem for anyone.

But of course the MAJORITY use an aural/oral language – and majorities create norms. Not necessarily a problem if that "norm" is to use a cell phone, for example. But if society is built on the assumption that people will hear first time, accurately, that's different. You can either connect, or you can't. If you can't, there needs to be another way to connect otherwise you get excluded from what the majority can do.

It's an interesting topic I'd like to explore with other here, if anyone's interested. Because it does have huge implications not only for language, but our messages (including marketing). Let me know if you're interested and we can start a new discussion.

 

But briefly coming back to "normal hearing", and "hearing test" and the idea of "pass/fail", probably not the best starting point in view of the present discussion. So what might our equivalent of "20:20 vision" be? Would it (theoretically) have a better effect? How could we test it?

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Stella Ng

Director of Research

5 posts

#5677

Replied on:

Many excellent comments in this thread. I do think we need to be careful that we don't slide from stigmatic language toward another negative - a focus on "promises" and "normality" that may at times be unrealistic, subtly prejudiced toward a universal normative ideal, which can unintentionally depict technology as a "fix" that makes people "more normal". (As this implies that they're not normal until they get this fix).

 

A LOT of excellent and relevant work around discourses of disability has been done in the critical social sciences and disability studies, and in occupational science/therapy. Using hearing aids, attending aural rehab, etc. should not be promoted with an undertone of striving to be "better" or "more normal." This type of language of the promise and potential of normality can seem at first like a good thing, but can have unintended negative consequences on people's identities. It also places all the onus on individuals with hearing loss to conform and do the work, instead of on changing societal attitudes to be more accepting, supportive, etc. For families of children with hearing loss, the messages of achievement and normality used to promote technology and rehabilitation can make parents feel immense pressure and guilt if we're not very careful in our language use. For teens, language of "achievement" based on a normative ideal can result in unspoken tension as they are striving to work through their identity and autonomy.

 

There's probably no singular best way to talk about any of this, but rather a need to accept many different ways to talk about hearing and hearing loss, depending on the client, the context, etc. and just being constantly thoughtful and questioning about what our language is really saying and representing, just like everyone in this thread is doing.

 

I've attached an article that speaks to this.

Phelan, Wright, Gibson 2014.pdf

PDF - 204 KB - Oct 17, 14

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Ryan Carpenter

Senior Clinical Marketing Manager

Sydney
6 posts

#5672

Replied on:

The term 'Personal Communication Assistant' might seem a little silly now, but it probably made sense at the time for Phonak to give it a try. As you suggested, this terminology was relevant back when 'Personal Digital Assistants' were seen as desirable by a demographic group younger than the average hearing aid wearer.

Of course, PDAs gave way to smartphones and then mobile devices, and now we are moving on to simply 'wearables', which would aptly describe hearing aids. If the term PCA had a chance, I think it's window of opportunity has passed!

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Curtis Alcock

Owner

Exeter
71 posts

#5650

Replied on:

The simplest evidence would be a lower average first-time user age and a higher proportion of first time users with milder reductions in hearing. And yes, this is what hearing care professionals are reporting who have been experimenting with their language.

 

But of course language is just one contributing factor in this (it's also a lot to do with avoidance of stereotyping and a message about routine hearing checks throughout life). The influence of language will be different for different people depending on their life experience and memories.

 

Language only has its power because of the thoughts and feelings we are triggering (mainly) through a) Schema Activation and b) Negative valence. For example, if years ago my aunty had a hearing aid "because she was deaf" and her house always smelt fusty, this will trigger a different set of thoughts and feeling for me than if the only time I'd ever come across the term hearing aid was when you told me about it. Then the only problem with the word would be in the plural (A.I.D.S.) or if I didn't see myself as needing "aid", but rather wanted a tool to solve an external problem (e.g. background noise).

 

So in the above example, one use of the term "hearing aid" may reduce my likelihood of taking action and one probably not. So delaying a person's behaviour is unlikely to be universal, but will be a factor that we have some control over.

 

So yes it would certainly be useful to carry out research and I have recently approached a university with this intention. But I'm not sure it's something that a model such as the behavioural change wheel or COM-B model would pick it up because to do so people would have to be aware of how their attitudes are being formed and be able to accurately quantify and report that process themselves.

 

Much of the literature on attitudes reveal that our conscious mind tends to invent stories to explain our reactions to things, and these stories may or may not be true. Someone may mean, "I'm not ready for hearing aids" but this might be expressed in phrases such as "I hear everything I want to hear." Their rationalising tells them it's because they don't have a problem, even though their family and friends may think otherwise! What a person can't necessarily explain is why they've come to the conclusion they hear enough.

 

There are several reasons for this, which I won't go into here as they've been covered elsewhere (e.g. Actor-Observer Effect, Availability Heuristic, Loss Aversion and Status Quo Bias, Cognitive Dissonance…).

 

So how might we test any effect of our language delaying action?

 

Firstly, we have to begin with the premise that often the people who are "delaying" (in our terminology) at one stage earlier (e.g. previous months/years) previously had no need to take action. They see themselves as the same "hearing" person they always were, so often externalise the problem (it's the background noise, they're mumbling). After all, these are the same difficulties a person with clinically normal hearing will experience from time to time – background noise CAN be too loud, people DO sometimes mumble – so how is the delaying person to know that these same experiences now mean something internal? That the problem is with them?

 

As a result of this, if we carry out the research only AFTER someone has contacted us and begin going through the circle, that's going to be too late. We'll have missed the point BEFORE the delay. Instead we need to see how the general public reacts to specific language without them realising what we're looking for. Because once we explain our goal, we influence the results!

 

So the reason for assessing the general public is because it is the general public that one day, theoretically, becomes the same person who approaches hearing care. For the most part they are "ordinary people" rather than a specific, special population. They are you and me, with all our historical perspectives.

 

So there are several ways we might test it. First we would need to have a measurable action (e.g. a response to a request for information or a reaction time test). Then we would prime/expose them with/to certain words and see whether the requests increased or decreased, or if their reaction time sped up or slowed time. For example, do they choose a picture of an old person or young person more quickly after exposure to the word hearing aids?

 

The second way might be with free association. You would get someone to list the first words that spring to mind when exposed to certain stimuli (words and pictures).

 

I could go into more detail but that should provide a general starting point for getting at the underlying disposition towards the word.

 

Now the second stage of research would be this: if people are associating the term hearing aids with a specific stereotype ("older than me, deafer than me") through schema activation based on previous memories and exposure to stimuli over the years from our profession/industry, do they perceive themselves as fitting into that category? If they don't, they are less likely to take action. They will wait till they consider themselves to have reached that stage, when they see themselves as a potential user. (My suspicion is they have altered their perception of hearing aids from one of "value-expressive" to "utilitarian" – I would like to research this too.)

 

We know this "am I the sort of person" is a factor because there is a huge wealth of research that already shows that people choose products that are consistent with their self- and social-identity and use products or products to extend, express or create that identity.

 

So if we don't activate an unhelpful schema by using a less familiar term, or one that we can begin associating with positive ideas in keeping with people's self-identity (see, for example, Jennifer Aaker's work on Brand Personalities), it becomes less likely they will be deterred because of a conflict in social or self-identity, leading to cognitive dissonance which we ALSO know can delay action.

 

Which is an important point to remember: that there's already a huge wealth of literature and research that already explains how people react and behave in response to language, and I mean a huge wealth. Whilst it would be a valuable exercise to do all our own research specific to hearing care, we can also learn from those many researchers who have clearly established the principles of how language shapes perceptions, attitudes and behaviour and then apply them to what we ourselves do. We don't necessarily need to reinvent the wheel.

 

Because realistically, we may be waiting forever for someone to decide to spend money on a research project on this particular topic.

 

Meanwhile what's to stop us doing some very simple things that would not cost us anything and would cause no harm? All we need to do is that every time we're about to say "hearing aids" or write it in a letter, try saying "hearing technology" or something of your own invention that doesn't have the negative valence or associations attached to it that hearing aid has. That way we're at least giving people the chance to process our information without us unintentionally clouding it with unhelpful priming. In other words, why do we need to put up potential barriers when we don't need to?

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Fiona Barker

Clinical scientist

Sunningdale
41 posts

#5649

Replied on:

Do we know that our use of language is affecting people's behaviour ie delaying their decision to take action? Although one can make a reasoned case that it might I'm not sure we know that this is what is going on.

What might be helpful is to do some research strongly based within a comprehensive theoretical model of human behaviour. Using something like the behaviour change wheel and the COM-B model of behaviour (michie 2014)it should be possible to carry out a thorough examination of the factors affecting capability, opportunity and motivation that influence behaviour in this context. The language we use might be one of them but wIthout such a sound theoretically based behavioural definition and analysis of the problem we might be putting all our research and intervention eggs in the wrong basket because we have assumed something that is not in fact at the root of the problem. Even the good reviews that have been done on this subject (see for example McCormack 2013) have missed the opportunity to couch their findings within a theoretical framework or model such as this. That can then form a theoretically based platform for sensible intervention development. The great advantage of the behaviour change wheel is it then links the behavioural analysis with a systematic evidence based way to develop interventions.

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Curtis Alcock

Owner

Exeter
71 posts

#5648

Replied on:

Personally I think Personal Communication Assistant is a dreadful term! Far too long-winded.

 

The point is simply this: "Words trigger thought, beware what is caught". (technical term = schema activation if anyone's interested)

 

So are we triggering thoughts that are helpful to our objective, or unhelpful. That's all.

 

The term hearing aid is not a "sacred cow". Somebody invented it! They used to call them deaf aids!

 

But the term has an effect on perceptions. These perceptions are harming people (increasing delay in intervention, increasing shrinkage of lifestyle – and potentially areas of their brain, that's psychosocial harm, possibly even physical even we talk about brain shrinkage).

 

We must therefore be prepared to experiment and explore different terms to use. Most consumers won't think it's BS – they'll take their lead from us with enough repetition. But it has to be memorable (Personal Communication Assistant is not!) and not have any negative connotations. Ideally it should be short enough for twitter!!!

 

And if we can't think of anything now, we can use "hearing technology" as a generic term which can then include hearing aids, PCAs, PSAPs, ALDs and whatever terms we eventually find works.

 

BTW, the lady I mentioned has agreed to be videoed.

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Christine Eubanks

Director of Audiology

Richmond
8 posts

#5647

Replied on:

I think a fair amount of marketing would have to be done, to establish that "Personal Communication Assistant" = PCA. In the same way that "Automatic Teller Machine" = ATM, etc. Because "Personal Communication Assistant" just sounds like so much BS. It's not the way people naturally talk, so you sound like you are spouting marketing hype. But a "PCA" could eventually be a thing. I used to carry a PDA to keep my calendar and contacts, before I got a "smart phone"....

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Curtis Alcock

Owner

Exeter
71 posts

#5643

Replied on:

This morning I had the most amazing conversation with a woman who explained to me her own triggers for using hearing technology around 7-8 years ago.

She explained how at the time she was a successful businesswoman who had begun experiencing difficulties catching things in important meetings. But the sole reason she began using hearing technology, she explained, was because of the marketing of the original Audeo from Phonak.

Do you remember the one? It showed a boxer with a black eye, a beekeeper and a punk rocker. It made absolutely no mention of hearing aids. Instead it described the technology as a "Personal Communication Assistant". (I've attached an image as a reminder.)

Can you remember the reaction of the profession when Phonak brought out this marketing?

The majority of us rejected it, didn't we? We said "our target audience wouldn't relate to it". Even today I hear hearing care professionals look back on that campaign with a "What ever were they thinking? They haven't got a clue when it comes to marketing, have they?"

From what I recall, Phonak ended up withdrawing the campaign – mainly, I believe (I am going to confirm this) as a result of the feedback from "the market" (i.e. us professionals, their customers). Since then, they have taken a more traditional approach. Their newest versions are referred to as "receiver in the canal HEARING AIDS."

But here is the gist of what this lady, who is herself a baby boomer and remember was working when this happened, said:

"Here was something that made me think that anyone – ordinary people –could be using this technology, just like they were using headphones, so here was something I could wear too. This company who made it were calling it a personal communication assistant. It was a bit of a mouthful, especially whenever I tried to describe it to friends and family, but it meant that for me it wasn't a "hearing aid", because as soon as I hear that word I immediately associate it with old people, I didn't see myself as old. I feel really strongly about this: If they had called it a hearing aid I wouldn't have done something about my hearing."

 

Yes, it's one person's experience. But she said all of this unprompted. She said it whilst I was concentrating on connecting up her new hearing system. (She had lived elsewhere when she first began using hearing technology, so I can't take any of the credit for the original fitting or perceptions. She firmly credits Phonak's marketing of the time with that.)

But the question is: how many more people, un-retired, in "mission-critical" listening environments today, are we deterring because we assume they have to fit in with our status quo and stereotypes – through our language and our imagery?

And what has happened to all that innovation in the messages we began to see in the mid 2000s? When I ask manufacturers about this they explain that we, the Profession, didn't like it and asked for a more traditional approach because we told them "that's what the market wants".

Doesn't it make us wonder whether we might not be our own worst enemies? Not to mention the doors we are closing to people who trust us to empower them.

What would it take to experiment with our language a little? There's no need to change everything wholesale. We just need to provide some alternatives for people. Something different to the traditional assumptions of who our audience is.

img_gallery_01_big.jpg

- 58 KB - Oct 09, 14

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Curtis Alcock

Owner

Exeter
71 posts

#5629

Replied on:

[continued from post above]

 

That leads us to an interesting question: does it even matter whether we use the term "hearing aid" or an alternative term for potential new users?

 

Here we have to understand how language works. This is, of course, harder for us within hearing healthcare because most of us don't really cover this in our training or continuing professional development. For that we must turn to the fields of cognitive psychology, psycholinguistics, social cognition and sociology.

 

We could summarise how language works in 4 categories: Perceptions, Associations, Relationships and Knowledge (which spells out the handy acronym PARK).

 

1) PERCEPTION: language shapes the way we see the world. That's why using different wording can alter someone's perception and change their behaviour, which is why Framing is so powerful (see: en.wikipedia.org/wiki/Framing_(social_sciences)

 

Some words are intrinsically positive (e.g. pleasure), whilst others are intrinsically negative (e.g. depression), and some are neutral (polygon) or ambiguous. These words, whether we hear them or read them will actually affect our behaviour. Negative words will make it easier for us to carry out AVOID-based behaviour (e.g. pushing a lever away) and positive words will make it easier for us to carry out APPROACH-based behaviour (e.g. pulling a lever towards us). The positivity/negativity comes about as a result of their...

 

2) ASSOCIATIONS: the words we use bring up thoughts and feelings of other things. For example, the word "bank" will bring up thoughts of perhaps money or rivers or both. Each of these associations will be linked to our experiences and memories, and other ideas. Some words have strong associations for us that won't be so for other people (e.g. parents). Other words have strong cultural/common associations: for example, Table and Chair, Black and White.

 

3) RELATIONSHIPS: words separate things into groups, and as humans we tend to categorise our own relationship to these groups. I've noticed, for example, that even on the IDA forums, where we all share the same goals, people tend to separate themselves into groups (e.g. audiologist vs hearing therapist; private for publicly-funded) and we have a bias towards our own groups. But if we were all to attend a conference of other types of professions, we may group ourselves as hearing care professionals vs the NON-hearing care professionals, particularly if we were competing for resources! The groups we belong to can change based on the context, and language plays a role in this. The language we use can therefore determine whether or not someone will see themselves in one group or another, which is why Labelling is so powerful: en.wikipedia.org/wiki/Labeling_theory

 

4) KNOWLEDGE: words and language enable us to access previously stored knowledge. This will then affect how we perceive, process and react to subsequent incoming information. As an example, if we say "You have AGE related hearing loss" then say "You need to wear hearing aids", we are telling them that wearing hearing aids is a SIGN of growing old. We can therefore make it easier or harder for someone to receive our message based on what you precede it with, something called "Priming" (see: en.wikipedia.org/wiki/Priming_(psychology) ).

 

With this in mind, how might a potential (new) "hearing aid" user process that term? Positively? Negatively? Neutrally?

 

What PERCEPTIONS are we creating for them when we say they need "aid"? Does that empower them or weaken them? If we say that we have some "technology", does that empower or weaken them? Think how those two words are used in other, more common contexts.

 

What ASSOCIATIONS and KNOWLEDGE will spring to mind if we say "hearing aids"? What memories will they have? Will they be positive or negative? Think how the words are used in contexts they will be more familiar with. For example, if you enter the term "aids" into a database of what words are most likely to spring to most people's minds, you'll get the words "disease", "death", "help" and "HIV". Are these associations we want with what we do?

 

What RELATIONSHIPS do we impose on someone because of the historical usage of this term? Are they now one of the "deaf" or one of the "hearing"? Which way would they WANT to see themselves? The Collins Dictionary, for example, describes a hearing aid: 1. a device for assisting the hearing of partially deaf people… worn by a deaf person. Would you want to wear that if you had just been diagnosed with a mild hearing loss?

 

So here we are:

a) First, we've reminded our potential new user of all the less effective hearing aids of the past, including the ugly one their mother would never wear, and the one their grandfather wore that was always squealing, and he couldn't hear with it anyway. So are these new ones are just a "sexier" version of those?

b) Secondly, we've activated thoughts of disease and death, which dredge up negative feelings, resulting in avoidance-based behaviour (as a quick guide to activation of thoughts, see: www.wisegeek.com/what-is-spreading-activation.htm)

c) Thirdly, we are saying they are in need of help, which damages their self-concept (see Stigma: Notes on the Management of a Damaged Self-Identity by Goffman).

 

So on balance, do we think we are making it easier or harder for someone to process a subsequent piece of advice from us by continuing to use the term "hearing aid" or "hearing aids"?

And the ultimate question: is it in our clients/patients BEST INTERESTS to continue to use such a term when we could so easily explore alternatives that don't have the historical/cultural baggage the present term has?

 

We don't have to be victims of yesterday's status quo; we can be the inventors of tomorrow's.

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Curtis Alcock

Owner

Exeter
71 posts

#5628

Replied on:

It's an interesting one about the term "hearing aid".

 

There are several things to bear in mind here.

 

LONGER TERM USERS

=====================

 

Long time users of "hearing aids" have often learnt to be comfortable with using this term themselves ("There's nothing to be ashamed of wearing hearing aids. If only others would realise the benefits of them like I have."), and as part of the original psychological process of accepting the "benefit versus cost" of transitioning from non-user to user they can become attached to the term.

 

For those who are interested in the psychological, it is a result of cognitive dissonance: see this very interesting paper and then apply it to the process of becoming a "hearing aid user".

 

Aronson, Elliott; Mills, Judson (1959). "The effect of severity of initiation on liking for a group". Journal of Abnormal and Social Psychology 59 (2): 177–181. doi:10.1037/h0047195.

Link: faculty.uncfsu.edu/tvancantfort/Syllabi/Gresearch/Readings/A_Aronson.pdf

 

So with long term users, it is probably sensible to use the term "hearing aid" because it requires no additional "cognitive processing" and it will generally have good associations for them through their acceptance and beneficial use of it.

 

 

POTENTIAL USERS & THE GENERAL PUBLIC

==========================================

 

Most of us on this forum, as long time advocates of "hearing aids", have become familiar with the term through constant usage. Familiarity leads to liking (through The Mere Exposure Effect, see: en.wikipedia.org/wiki/Mere-exposure_effect). Anything new sounds wrong to us. It's a cognitive bias.

 

Also we, as professionals/experts, suffer from another cognitive bias called the "The Curse of Knowledge", where it becomes "extremely difficult to think about problems from the perspective of lesser-informed parties". ( See: en.wikipedia.org/wiki/Curse_of_knowledge)

 

"Less-informed parties" here would include the general public, and of course within the general public is the potential (new) user of "hearing aids".

 

This has two important implications:

 

1) We, as the experts, tend to assume the general public is as familiar and as comfortable with the term "hearing aid" and its usage/correctness as we are.

2) We will naturally assume the potential (new) hearing aid user would be as protective of the terminology as we are, so we assume they would question our use of any alternative terminology, should we choose to use it.

 

It turns out, however, this is not the case, for several reasons:

 

a) The majority of people in society don't really think about "hearing aids" because it's not normally relevant or important to them (around 97% of society have little or nothing to do with hearing aids). So why would they care what terminology we might use? The only time they are going to *maybe* care is when the idea of "hearing aids" becomes relevant to them...

 

b) As something begins to become relevant, they must build up their internal library of information about it in order to take action.

 

But because all this is new to them, they must dependent more on other sources of expertise. One of these sources of information (though not the only one) is the hearing care professional. Just as when you or I go to a dentist, optician or even financial advisor, we EXPECT (hope?) them to know stuff we don't, so too do the people who come to us (see Cialdini's principle of Authority: https://sites.google.com/site/724ecialdiniwiki/chapter-6-authority---directed-deference)

 

Now, if a professional in another fields uses a term we are unfamiliar with, what do we think? Do we think, "They're trying to pull the wool over my eyes?" or do we think "I need to update my out-of-date knowledge? Things may have moved on."

 

Of course how they react depends on the perception we convey to them: do we present ourselves as "specialised experts" or "looking to sell them something"? It makes a difference. If we have established trust, they will trust what we say. If we haven't, they won't. But whether or not we use one term or another is not going to make or break trust. It's far more complex than that.

 

[To be continued in post below]

 

 

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Profile picture - John Waters

John Waters

2 posts

#5627

Replied on:

Great discussion guys, thanks. I don't have much to add but would certainly echo Fiona's comment above - using the patient's language as a starting point can be quite powerful, if the patient will admit to some difficulties (be it their own acknowledged ones or externally placed ones) if you refer back to those and say why the hearing device will help them tackle it, seems to work well for a lot of people.

 

I like the use of earpiece instead of earmould, I think I'll switch to that!

 

Hearing aid though I think is less avoidable - I think patients tend to have a good 'BS Meter' and my gut feeling is that if I used 'hearing device' - the patient might think -- 'hold on, why is this chap not calling a spade a spade here? I'm not sure I entirely trust this, its like someone is trying to pull the wool over my eyes'. Then as we all know once that trust is gone you can whistle goodbye to having much positive effect.

 

That's why I like earpiece, beacuse 'ear mould' isn't a name that's readily available to people so you can call it what you will on first arrival.

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Curtis Alcock

Owner

Exeter
71 posts

#5625

Replied on:

You make a very important point, Christine. Ultimately, it's not so much the words we use, but the THOUGHTS and FEELINGS we trigger in our audience as a result of those words.

 

Sometimes people think it's all about using positive language. It's not. It's about PURPOSEFUL language... About being aware of why we're using the words and making sure these match our objective ("Choose your frame to match your aim.")

 

Yours is a great example of this: the negative language created a dissonance that the parents could only alleviate by taking appropriate action, i.e. the intended purpose. Interestingly the same word "fail" is not as effective for children or adults having a hearing assessment because they cannot do anything to alleviate the dissonance: we would be leaving them with a damaged self-image. (Unless the same assessment is used to demonstrate/measure benefit as a result of intervention, e.g. a functional free field listening test).

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Christine Eubanks

Director of Audiology

Richmond
8 posts

#5624

Replied on:

We learned this lesson the hard way in talking about the results of newborn hearing screenings. Well-meaning professionals thought that the word "fail" was too scary, so it was decided that babies either passed their screening, or "referred" -- meaning that they would be referred on for another screening. Of course parents had no idea what to make of a "refer" on a test, and in the haze of new parenting they often just put it out of their minds. After a while, when it was clear that parents did not know how to follow up on recommendations, we went back to the word "fail". It's a fine line between scaring parents and imparting an appropriate level of concern. SO sometimes it's not the words but how you use them!

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Rikke Nalepa Olesen

København K
1 post

#5623

Replied on:

Test

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Ryan Carpenter

Senior Clinical Marketing Manager

Sydney
6 posts

#5155

Replied on:

Maybe we should take some cues from the fashionistas and tech conoscenti. We can call hearing aids "bespoke augmented reality earware"!

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I hired a Coach to observe my A.R. Class and to mentor my new Au.D.s. She had some wonderful comments to make but the one that was the most disconcerting to me was that, as a consumer, when I spoke to her about Aural Rehabilitation, she heard "oral" rehabilitation. That propelled her to the common consumer fear/misconception of "deaf and dumb" i.e. "can't hear well, speak well/think well." I was appalled but I do think her take as an educated person who lacked hearing impairment knowledge that we need to change our language. The new title of my classes is "Beyond Hearing Aids, Sound Advice." and I am in the process of having the descriptor of my classes changed on the outside advertising on my building.

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Deborah Moncrieff

Assistant Professor

Pittsburgh
14 posts

#4381

Replied on:

I am teacing a course in Management of Adult Hearing Loss and one of the students asked me if audiologic rehabilitation is reimbursed in countries outside of the US. If you see this message and can share with me some information about how AR is reimbursed in your country, I thank you in advance for helping me clarify this quesiton for my student~

 

 


Curtis Alcock

Owner

Exeter
71 posts

#4373

Replied on:

"maybe the best one can do is attempt to pick up on cues from the patient and listen as actively as possible."

 

I think we can be more confident than this by simply asking ourselves the following questions:

 

1. Does the language I am using reflect how this person sees themselves?

-------------------------------------------------------------------------------

If not, then either they will simply reject what we say or we will cause "cognitive dissonance" to occur. So the language we use will be different depending on whom we are speaking with. If they consider themselves "deaf" or "hard of hearing" then yes they see this as a part of them (i.e. an attribute). So we should be confident to reflect this in our language (unless it is resulting in a "thinking trap" for them).

 

But our error often comes in trying to convince people who do NOT see themselves this way that they are either "deaf" or "hard of hearing" when actually they see the problem as being external to them: it's the background noise, it's people not speaking clearly etc.

 

Our job may not actually be to try and convince such individuals that they're wrong (which would lead to cognitive dissonance) but to provide them with the tools they need to solve those "external" problems (hearing technology, listening skills, etc). In other words we need to be giving them something to APPROACH (solving the problem) rather than AVOID (having a condition).

 

2. Does the terminology I use focus on a CONDITION or HEARING?

-------------------------------------------------------------------------------

As practitioners often tend to see things in terms of conditions that need to be treated. Many people don't like to have conditions: it makes them 'different' and vulnerable. I wear contact lenses: they enable me to see more clearly. But I do not consider myself to be visually impaired or blind or even have a sight loss! Yes, I am short-sighted - but this tells me I am sighted... I just need some parts of my sight sharpening up FOR SPECIFIC THINGS, like driving.

 

But our normal terminology expects people to consider themselves to be hearing impaired, deaf or having a hearing loss, rather than needing parts of their hearing sharpening up for SPECIFIC THINGS.

 

Yet many of the times we use the phrase "hearing loss/impairment" we can just as easily rephrase it to refer to someone's hearing ability. For example, "you have a high frequency hearing loss" (condition) can be reframed as "your hearing is currently missing some of the higher pitched sounds such as the [s] and [t]". This changes the THOUGHT PROCESS we trigger from "I have a condition" (AVOID) to "how can I get those sounds back within my range" (APPROACH).

 

Changing our language is as much about changing our own mindset too. Have you noticed how much of our terminology uses "hearing" as a mere adjective to describe a condition? It shows where our focus is - on the condition. But if we want to reach the millions of people who we are currently failing to reach, it needs to be on the hearing, which is far more attractive than imposing a condition on people! So are there ways we can make hearing the main noun?

 

3. Does the language I am using label someone or activate a stereotype?

-----------------------------------------------------------------------------

Labelling and stereotypes are a way of separating one thing from another. People are very particular about the social groups they belong to. To say someone is "hard of hearing" may be a description, but it's also used as a label for a group of people. In the mind of our audience, do they consider themselves part of that group? If not, are we suggesting they become part of that group? Does accepting the need for a hearing aid act like a membership card for that group? If they become part of this other group, does that mean their relationship with their lifelong group will change ?

 

The implication with our language is that there are two groups: Normal hearing versus deaf or hard of hearing. Many people who currently avoid hearing care feel they belong MORE to "normal hearing" than "hard of hearing". Whilst we all know there are shades and degrees of reductions in hearing range, our language says otherwise - so sends a different message to the public.

 

So how we "divide" things with our language is really, really important. It has consequences for perceptions.

 

4. Does the language I use have other easily-recalled meanings that clash with the thought processes I am trying to trigger in this person?

-----------------------------------------------------------------------------

For example, deaf is often used to mean anything other than 'normal' hearing. But it is also used aurally to mean the Deaf Community, who use sign language as their main language. It can also mean someone who has NO hearing. This is one of the reasons for such friction between two partners: "You're deaf!" (i.e. you said pardon because you didn't hear me) versus "I'm not deaf!" (i.e. I can hear). They're using the same word to mean different things.

 

Another example, aids (shorthand for hearing aids) is also the same as AIDS the disease.

 

A THOUGHT EXERCICE

---------------------------------------

Often when we've been involved in a profession for some time we forget how to think as someone outside the profession. So it's not always easy for us to understand the impact our words have. We can't see the wood for the trees, as they say.

 

So I often find it helpful to imagine another profession, such as, say, a brain specialist, and try to imagine how I would find it if they used equivalent language.

 

So ask yourself how you would feel, and what thoughts would run through your mind, if you were told by a specialist that:

 

"You have a brain loss."

"You have a brain impairment."

"You are hard of thinking."

"You are retarded." -- in this context meaning your brain is not working as well as a 'normal' brain.

 

Try to really imagine being told each one. Put yourself in the room with the consultant. Imagine that your partner had been telling you for some time how you were going retarded. But you knew you weren't - though you know you sometimes came across some situations where it was harder for you to think clearly. But did that mean you were retarded? Imagine being told that you now need a brain aid, whilst recalling that the only people who spring to mind who used brain aids were retarded people. Imagine that you have to make the decision to accept a brain aid. What runs through your mind?

 

Now: What would you like to be told instead?

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Timothy Cooke

Ida Institute
96 posts

#4372

Replied on:

I see your point Fiona. There is probably no one set of terms or positive words that will increase patient satisfaction and lead to more positive outcomes. Each person is different. Each person may describe their hearing loss in different terms, and may react differently to the use of different terms by their hearing care professional.

 

I suppose what a clinician can do, as you state very clearly, is to employ patient-centered care principles and listen closely to how the patient describes their hearing loss and their life. By looking out for particular cues or reactions from the patient, maybe the clinician can get a better sense for how one should speak to this particular patient.

 

It really gets back to the complexity of the clinical encounter where the patient and the clinician both bring their own perspectives into the room, and must find a way to communicate with each other in a common language that both understands and can relate to. I suppose one can also add that the common language should also attempt to at least "do no harm" and not create negative thoughts or reinforce social stigmas with the patient. This is a very difficult task, for as you say, clinicians may have very different preconceptions about how a word may be received by a listener. Again, maybe the best one can do is attempt to pick up on cues from the patient and listen as actively as possible.

 

Framing the Clinical Encounter - goo.gl/vyICP - Tine Tjørnhøj-Thomsen

 

Also finding this thread very interesting. =)

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Fiona Barker

Clinical scientist

Sunningdale
41 posts

#4368

Replied on:

I think there is a lot to be said for introspection and listening to how clients describe their own hearing/environment/difficulties and echoing back thier language. Introspection is important as it can our own perceptions of word use that we sometimes transfer onto people we work with. I once worked with someone who did not like to use the word Deaf with parents of newly diagnosed children. This was as much to do with the clinicians own perceptions of the negative connotations of that word than the worry about how it might be perceived by the listener. It extended to delaying the introduction of the family to the local deaf children's society as it was felt mentioning the word deaf might be too painful for them. Other clinicians might have very different even very positive feelings about the word deaf if for example they have deaf parents or know other positive deaf role models. Those clinicians might have very different preconceptions about how this word might be recieved by a listener. Choice of language is not only coloured by how we feel the listener might perceive the message but on how the speaker feels about the language. Both interact in a complex way.

It does us no harm as clinicians to examine our own perceptions of 'positive' and 'negative' langauge use before we start asking clients/listeners how they feel. It may not be the word itself that is positive or negative but the way/context in which it is used that is positive or negative. This can be very influenced by the clinicians own feelings. By avoiding the use of particular words that we feel might cause offence we might actually be reinforcing the stigma associated with them.

Finding this thread very interesting!

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Curtis Alcock

Owner

Exeter
71 posts

#4367

Replied on:

There is a lot of published literature on the way that the language used affects the audience, and whilst this is not specific to hearing care per se, it does provide us with established and transferrable principles which have been shown to have predictable (though sometimes counterintuitive) outcomes.

 

Some of these principles have also been specifically tested within other healthcare fields (such as dentistry and breast screening), particularly framing.

 

Examples of research that help to guide include:

 

1. Schema activation

2. Semantic priming

3. The mere exposure effect

4. The availability heuristic

5. Framing

6. Psycholinguistics, particularly Lexical Access

7. Prospect Theory

8. Cognitive Response Model

9. The Primacy Effect

10. Self-fulfilling prophecies

11. Cognitive Dissonance

12. Actor-Observer Effect

13. Self-Categorization

14. Social Identity

15. Classic conditioning

16. Persuasion & Influence

 

All of these areas of research do much to inform how we use our language. It is then a matter of applying those principles to the words that we use and the messages we present.

 

Interestingly some of the charities in the United Kingdom have carried out some focus groups on terminology (see for example: www.hearinglink.org/page.aspx ) and what's very interesting is that some participants like the language that's used; others object to it (but remember that they're also members of the charity, not new to hearing care). Action on Hearing Loss also carried out focus groups before changing their name, but even they ran into objections from people. So asking people what they think is not necessarily constructive.

 

Also we have to remember that people will "make do" with the language that's available to them and will not necessarily know any different.

 

So if we want to gather data the first step has to be what we are doing now anyway: we first need some "introspection" by applying the principles established in the literature regarding language and attitude change to establish our "testable theory".

 

The danger with waiting for data (Who's going to carry out that research? Who's going to fund it?) is that we never move forward until it's been carried out – and even then, the results may be ambiguous.

 

Meanwhile, what's to stop each of us testing responses for ourselves whilst we're waiting for that data to be gathered by the hypothetical researchers? Doing so doesn't avoid the real matter at hand (which you allude to but I don't think you actually specify). I would have thought we can do both in parallel.

 

Ultimately, choosing the right language is not actually about avoiding objectionable language or finding words that people resonate with; it's about triggering the thought processes you intended to trigger in your audience, rather than ones that accidentally produce the opposite response.

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Kris English

Professor/Audiologist

Akron
29 posts

#4366

Replied on:

The thing is ... as much as I love to discuss language, we have no data informing us that the language mentioned above is actually off-putting from the patient's perspective. We can assume and speculate, but what do we really know? Anecdotally, a few patients have cringed when discussing amplification and being tested, but maybe the complaint about choice of words is an avoidance mechanism to avoid the real matter at hand. We don't actually know if our typical language is objectionable, and more importantly, we don't know if, should we use alternative language, it would help patients consider change. If new words and different phrasing make no difference, then we'd be focusing on the wrong thing.

 

It's been shown time and again that carefully chosen words can change opinions, attitudes, decisions -- but we aren't there yet. We don't know what patients will resonate to, care about, warm up to. We need to know what patients say about this topic. There may be internal marketing research from focus groups, and if there is, I sure wish it would be published for the rest of us.

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Timothy Cooke

Ida Institute
96 posts

#4365

Replied on:

I have enjoyed reading this ongoing discussion about the power of words and naming conventions to engender positive attitudes among patients.

 

I remember reading this article a while ago on the BBC website about the "Healing Power of Positive Language." news.bbc.co.uk/2/hi/health/8326171.stm

 

The article describes how a cancer patient in the UK realized that a lot of the terms used by her nurses and doctors negatively affected her mood. On top of all that, dealing with cancer treatment is a very difficult ordeal. 

 

It would be excellent if there existed a "Positive Word Book for Audiology" that contained alternative terms and phrases to ensure a more positive patient experience and engender a more positive attitude surrounding hearing health and hearing loss.

 

Does someone know if such a collection already exists? Or, does something like this for the health care community in general?

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Curtis Alcock

Owner

Exeter
71 posts

#4364

Replied on:

I tend to use:

 

"Hearing checks" - if I'm referring to ROUTINE hearing checks throughout life. It implies that you're simply making sure everything is as it should be. People by nature are "loss averse", so they want to avoid preventable problems.

 

"Hearing assessments" - if I am referring to it more formally... such as one of the services we provide.

 

"Baseline your hearing" - If I'm referring to getting it checked for the first time. This provides another reason for having your hearing assessed other than "to see if you need hearing aids" or because there's something wrong with their hearing (as detected by others, usually!). I've found that people are very open to the idea of having a baseline for their hearing, so that they are prepared to detect future changes.

 

"Profile your hearing" - if I'm carrying out a hearing assessment, as in "So we're now going to profile your hearing. We want to know what sounds are within your hearing range, and if there are any sounds that currently fall outside of it." So we're not here trying to "detect hearing loss" (the traditional approach) - we are simply seeing what their hearing RANGE is capable of. Also note the use of the word "currently", so we are priming people to know that should anything be outside their range, it's a temporary state that we may be able to overcome. "Assess" implies that it may or may not be good (value). Profile implies you're simply trying to know what their hearing can and cannot do (functional).

 

The rule I try to follow is to keep my language "functional" (can do/can't do) rather than colouring their perceptions with unhelpful values "Ooooh! Your hearing is pretty bad!" Hope this make sense.

 

Also, I try to keep "hearing" separate from "understanding", because "understanding" involves more than just detection of the sound. In other words, I may be able to get them to detect a sound with a hearing aid. I may even get them to hear an [s] sound that they couldn't before. But I can't necessarily improve their brain's ability to put it all back together into meaningful words and sentences. Yes, I may be able to improve this with auditory training, but it's important to keep a person's motivation focused on these things separately, otherwise they will be disappointed in your ability as an auditician if you cannot make them understand with hearing aids.

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Curtis Alcock

Owner

Exeter
71 posts

#4363

Replied on:

Instead of using the word 'earmould' (which sounds like a fungus found in the ear), I am using the word "earpiece".

 

It's the same word often used by the police/security with their Walkie Talkies and custom earphones for iPhones.

 

There may be better suggestions out there. For example, earpiece could sound like a piece of the ear... unlikely, as pieces of the ear don't often fall off, but possible.

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Paul Peryman

audiologist

Christchurch
60 posts

#4362

Replied on:

Hello Jane and others,

When people go to see someone about their hearing, perhaps they have already attributed their difficulty in understanding spoken messages, for example, to not being able to hear well enough. The person is going to have a hearing test to find out if measurements confirm this. They might also have thought about the possibility of needing to wear hearing aids and have formed an opinion about this.

 

One way to convey hearing test results to patients/clients is to introduce the notion that the person can still hear (relating this to their everyday experiences), but that hearing different sounds, particularly speech, is dependent on certain conditions being met. This immediately makes the discussion of results positive from the point of view that the patient/client begins to learn about hearing, and what they and others need to do to restore ability to hear more and to restore conversational fluency.

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Mary Ellen Curran

Clinical Audiologist

Providence
18 posts

#4361

Replied on:

This thread is fascinating. Motivational Interviewing and Pain Management may hold insights. Insurance companies want patients to fill out a really depressing pain scale before every pain treatment. It focuses on the negative and forces patients to complain to get treatment. This model seems to exacerbate pain and makes people have to think of the down moments, rather than empowering them with positive moments. "So what were you able to do this week?...I hiked with my family...fantastic...." Celebrate that improvement. We can get the same information out of patients, but rather than framing it negatively, we could frame questions more positively "what are you able to do with them that you could not do without? If you could change something about them, what would it be?" We can get the same information out of them but with more empowering language. I don't remember who gave me this question, but it works really well: "If it weren't for your hearing difficulties, what would you like to do?" Does anyone have any other good questions?

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Profile picture -

posts

#4357

Replied on:

I also teach Audiologic Rehabilitation Classes and feel the terminology is negative. We recently renamed the series of three classes as : Beyond Hearing Aids, Strategies for Successful Communication. It is still not good enough and advice is welcome. L

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Jennifer Thwaites

Audiologist

Sleaford
11 posts

#4356

Replied on:

I see where you are coming from, but I feel that you commnent "We are going to evaluate your ability to understand" could be a little patronising, particularly to new patients who are starting thier journey with us. Surely PTA is an assessment of detection ability rather than discrimination or understanding? Speech testing would be needed to assess this discrimination further, and I for one do not have the time allowed during my initial assessments for this.

 

I prefer to describe the appiontment as a "hearing assessment" and then discuss the issues with understanding and discrimination later on in the appointment.

 

I do like the way you use "hearing instrument" rather than hearing aid - much more positive!

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Kurt Trede

National Account Manager / Trainer

Somerset
1 post

#4355

Replied on:

Patients state "I can hear but cannot understand" never "I can understand but not hear" so why say hearing test - "We are going to evaluate your ability to understand" seems more appropriate and less taxing.

In addition to that I counsel that words such as hearing aid versus hearing instrument are much more de-motivating; using the word "hear" instead of "understand" which is what is meant (Can you hear me now or Can you understand me now?). You hear leave rustling and understand speech.

Any way to avoid having the patient think negative thoughts that will have a negative impact on their motivation to try amplification is a positive.

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Jennifer Thwaites

Audiologist

Sleaford
11 posts

#4352

Replied on:

Hi there

 

First of all - Wow! What an interesting discussion thread! It has certainly made me think about the language that I use with my patients. I have recently attended a Counselling Skills for Audiologist course at the Ear Foundation in Nottingham, and reading this thread has refreshed and re-enthused me to keep trying hard to think about how I convey information to my patients.

 

I have a few questions for you all though...how would you suggest that you make ear moulds sound more positive? Surely they are what they are - not pretty things!

 

I feel that the constraints of the NHS provisions for hearing aids also work against us. We do not have the range of instruments that our dispensing colleagues have, which in itself breed stigma and negative attitude. How would others tackle this?

 

I look forward to hearing your opinions

 

Thanks

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Matthew Kaplan

Student

Land O Lakes
3 posts

#4347

Replied on:

Glad to see someone getting to the heart of the problem! With all of the great technological advancements occurring with hearing aids, until we get past the negative association, it is really in vain. No matter how great hearing aids become, the negative association will keep a certain population of people from obtaining them. Audiology is still a relatively young field and the faster we can get rid of the negativity associated with hearing loss and hearing aids the better.

I was sad to see you had to change your topic due to lack of literature, but isn’t that just the problem? I think bringing the topic to this website was a great start. I am eager to read your article and congratulations on finishing it!

 

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Jane Shorrock

Mrs

Barnet
5 posts

#4345

Replied on:

Hi,

Thanks to all of you for your very welcome and interesting suggestions. My study is now complete (I got 70%!), although I did have to change my topic slightly, as there was very little material I could access on changing the language used, to the effectiveness of group adult audiological rehabilitation. Thank you, Margaret for kindly sending me your article on Stigma and hearing aids, which I read with interest and it make excellent background reading material. Fiona, the Ida institute material on motivational interviewing is fascinating and I am trying to incorporate that into my consultations. It's well worth a look. Thanks also for the suggestions from Luke and Linda. It's an area that really does interest me. My tutor, Maryanne Tate Maltby's help and advice on academic writing was invaluable, as I had very little experience in this area, and this is a whole new language in itself!!

I am going to make a conscious effort to keep looking at Curtis Alcock's website. I think he is a bit of a star! Thanks again

 

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Brendan McAteer

Student

Tampa
3 posts

#4344

Replied on:

Thanks for the post, Jane. I think this is an excellent point! I would have loved to attend that lecture. We recently had a representative from Starkey give a lecture at our school and he discussed the need to change the language associated with aural rehabilitation, as well. When explaining the definition of “aural rehabilitation” he mentioned that it might be more beneficial to just say something simple like “physical therapy for the ears” instead of going on and explaining it in terms that the patient won’t comprehend. If the patient can associate aural rehabilitation with something successful that has generally good outcomes, they might be more inclined to take it seriously. I believe changing the language used by audiologists will do wonders for our field. I never really thought about how negative hearing loss, ear moulds, and hearing aids sounded before…but it’s true! I’m certainly going to be a lot more self-conscious now about how phrase things with patients. I’m also going to look up those discussion articles on the website you listed above. Thanks again.

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Sara Gerstle

Student

Tampa
3 posts

#4343

Replied on:

You have made some interesting and valid observations in your discussion post. I agree with your viewpoint that there still is a negative stigma associated with hearing loss. The way in which an audiologist states certain phrases will have a direct affect on their patients. It may hinder the patient’s journey. Furthermore, the patient may not want to test his/her hearing or pursue any means of amplification. Negative language about hearing loss can delay the patient’s process from taking action in order to improving their hearing abilities.

 

In my Adult Aural Rehabilitation course, we have discussed how audiologists reinforce the stigma of hearing loss. For example, the audiologist may try to “hide” the hearing aid with neutral colors and smaller devices. We should embrace the hearing loss instead of concealing it. Also, I attended a lecture by Dr. Abrams who spoke about the future of Rehabilitative Audiology. Dr. Abrams proposed that we change some of the audiologic terms in order to relate to our patients. One suggestion dealt with making Aural Rehabilitation “cool” by naming it “Exercises for the Brain” to retrain our ears. I believe that patients may be more responsive to this type of terminology instead of scientific terms.

 

It is important for audiologists to use appropriate language with patients to encourage the most effective care and treatment. Hopefully in the near future, audiologists can change society’s negative attitude toward hearing loss.

 

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Luke Tia

Student

Gainesville
4 posts

#4335

Replied on:

Hi Jane,

 

Perhaps you already have the artices you need, but you may still find "The Sitgma of Hearing Loss" by Margaret I. Wallhagen from Vol. 50 of The Gerontologist to be helpful.

 

The article mentions the role of hearing aid advertisements in reinforcing the idea that the use of hearing aids and hearing loss are stigmatizing. This occurs through advertising lines such as "when you wear it you'll soon experience that to others it's simply invisible" (p. 72). The article also suggests creating "more positive cultural norms and stereotypes of older adults" and "supporting a positive image of hearing aid use and the importance of maintaining communication and connection to others" (p. 74). A simply change suggested would be for primary health care providers to routinely assess hearing loss, something which few do as of now (p. 74).

 

Another article you may find helpful is "Hearing Loss- and Hearing Aid-Related Sitgma: Perceptions of Women with Age-Normal Hearing" by Susan F. Erler and Dean C. Garstecki and published in Vol. 11 of the American Journal of Audiology in December of 2002. This article offers a slightly different approach to dealing with "old-fashion" views about hearing aids. Instead of directly challenging such beliefs, the authors suggest emphasizing how hearing aid use can improve quality of life with older female clients and to emphasize control, competence, and confidence in middle-aged female clients (p. 91).

 

Best wishes for your study!

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#4334

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Richard Einhorn, the world class composer who was interviewed about the value of hearing loops when he listened to his composition at the Kennedy Center, likes to say that "Trying to hide a hearing loss is so 19th century." You may wish to read his perceptions and all the information about Apps and how he used Apps that are widely available to remediate his hearing loss in the HLAA Journal. I sat with him in a restaurant and he was able to converse by using high quality insert earphones and his Apps as Assistive Listening Devices

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Fiona Barker

Clinical scientist

Sunningdale
41 posts

#3890

Replied on:

Jane if you are looking for papers then the literature on motivational interviewing would be a good place to start. There's a ton of stuff on that which would be relevant to what you are doing.

My interest in language use is with vestib patients and reducing anxiety. Has a big impact there too - just changing one or two words or phrasing things differently can help reduce anxiety.

Hope that helps.

Fiona

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Helen Michaud

Speech-Language Pathologist

Quebec
3 posts

#3888

Replied on:

Hi Jane,

I think the baby boomer generation will be particularly sensitive to wording and to the way services are presented. I try to present and adapt my services in a way which reflects how they perceive themselves or how they wish to be perceived: active, dynamic and modern.

Helen

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Jane Shorrock

Mrs

Barnet
5 posts

#3887

Replied on:

Helen, that is exactly the kind of thing I mean!  It sounds so much better, doesn't it?  Definately gets a more positive response, from the client

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Helen Michaud

Speech-Language Pathologist

Quebec
3 posts

#3886

Replied on:

There is a typo in my previous message. Cafsetting should read as Cafe-setting!

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Helen Michaud

Speech-Language Pathologist

Quebec
3 posts

#3885

Replied on:

I agree, wording is definitely important!  In fact, since I've been paying more attention to this aspect I've noticed that it makes a difference when I recrute people for my various aural rehabilitation groups. People respond more postively when groups don't sound 'handicapped' or too 'rehab'. So, instead of calling a group 'Conversation therapy in noisy environments' I use names such as 'Tertulia' (a Spanish word which means lively discussion and debate in a café-setting). For another group  I had several older gentlemen who shared an interest for all things  outdoors so I called their conversation therapy group 'Hunting and Fishing'. Another group I facilitate for older women who are widowed or divorced and feeling isolated as a result of their hearing impairment focuses on  communication strategies and social participation. I baptized that group 'Women in action'.  I facilitate groups in French, so the names I use don't sound as corny in French as they may sound in English!

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Profile picture - Ellen Dreyer

Ellen Dreyer

2 posts

#3863

Replied on:

How about  saying " we need to measure your hearing ( or hearing levels)"  instead of "giving/taking a hearing test?"  A test that  no matter how hard they try they will never "pass".

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Margaret Wallhagen

Professor, Nursing, GNP

San Francisco
9 posts

#3859

Replied on:

Hi Jane,  It is great to hear that you are focusing on this issue and I'd love to hear more about your plans and what you find. I did a paper on stigma as a result of my studies that's published in The Gerontologist (if it would be helpful for you to have it and you can't find it, please let me know and I can email it to you).  What struck me was not just how individuals talked about hearing loss and hearing aids but how it also seems that the profession contributes to this by advertising aids as "nearly invisible", reinforcing the idea that they should not be seen or it's shameful to wear rather than suggesting that hearing aids indicate that one is interested in staying engaged and hearing what others have to say. We need to reframe. And primary care practitioners need to do more screeing and referring to value hearing as a health issue - making it more associated with common health promoting issues. Good luck with your work. Keep me posted. Meg

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Jane Shorrock

Mrs

Barnet
5 posts

#3856

Replied on:

Thanks for the comments, guys.  It's encouraging.  Let's start by getting rid of "stigma"  I read this article by Curtis Alcock, who suggested this:

"For example, we should never use the label STIGMA. Instead

we should label it “old-fashioned attitudes”.

You see the problem with the label stigma is that if we encounter someone who knows nothing about hearing aids or hearing care and we use the word stigma, our audience begins thinking, “Why would there be a stigma anyway?” and so they start to answer that question themselves by creating their own reasonsfor there being a stigma, and so we end up inadvertently perpetuating the stigma.

But if we say “old fashioned attitudes”, then people think to themselves, “Well I don't want to be seen as behind the times” so they're more inclined to listen to new messages about hearing care."  

Very simple, but effective.  These small changes in the way we frame our message to our clients make a noticeable difference.  It seems to make them less hostile and more accepting.  In my view, for what it's worth, any change like this is a positive change, and I would love to find out more.  I just need some academic papers to review!


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G.Suresh Naidu

Audiologist,speech&language therapist

secunderabad,Andhra Pradesh ,India
7 posts

#3854

Replied on:

Hi Jane , it  is going to be Good Study and by the way many of us use these terminology while explaing  to the patients.many times i also used  " you can't here these sounds with them.i also want change my  way of  counselling .

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Janet Trychin

Audiologist

Erie, PA
13 posts

#3853

Replied on:

Yes, yes...go for it Jane.  I have had many clients complain that they hate having to 'take a test' that they are unable to do well at!  I love the idea of rewording the foundations of how we say what we say (!!??) in the test booth.  And, by the way, while you are changing things...would you mind reworking our hearing categories...as a 'mild hearing loss' is far from mild, especially for the young child.  Yay...you definitely have my support...how can I get the message across without turning the client off or frightening the client to death!?

Be glad to help...

Janet

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Jane Shorrock

Mrs

Barnet
5 posts

#3844

Replied on:

Sorry, the link is www.audira.org.uk

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