The Circle

Every person and every hearing loss story is unique, but there are 
common patterns that people follow on their journey towards better hearing. The Circle depicts the phases a person with hearing loss typically goes through: Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse, and Permanent Exit. 

By understanding where your client is on their journey, you can provide them with the most relevant information and support at the most appropriate time. 

Assess which one of the stages below best describes your client’s feelings about getting hearing devices and read the suggestions on how to best support them.

Pre-contemplation: “I don’t have a problem”

In this stage, the client doesn’t realize they have a hearing loss or doesn’t think it’s serious enough to seek help. They are surprised when it is brought up by those around them. They don’t recognize any of the symptoms you describe.

How to assist your client at this stage 

  • Give the client information to review at home and suggest they book a new appointment when ready

Contemplation: “I don’t think I have a hearing loss”

The client is ambivalent about making a change. They feel comfortable with their present situation, but also fear the consequences of not acting on their hearing loss. 

How to assist your client at this stage

  • Use the Line to explore your client’s experiences with hearing and communication. Listen to the client  
  • Give brief advice regarding possible options for improving their hearing and communication
  • Acknowledge and support their growing awareness of the situation 

Preparation: “I think I need help with my hearing”

The client continues to express ambivalence or has reached a tipping point where they are ready to act on their hearing loss but isn’t sure how to proceed. They seek information to support their decision from a hearing care professional and others, but also consider dealing with it alone. 

How to assist your client at this stage

  • Provide advice on how to improve communication with others
  • Listen and answer client questions
  • Focus on the benefits of better hearing. Don’t suggest that there is only one correct way forward
  • Use the Box if the client continues to express ambivalence 

Action: “I am going to do something about my hearing loss”

The client has decided to act on their hearing loss. They may want to talk about their hearing difficulties with other people and seek acknowledgement and appreciation. They may worry about not being able to follow through.

How to assist your client at this stage

  • Create a joint strategy for moving forward in line with the client’s needs
  • Encourage and support the client by focusing on the personal benefits of improved hearing and communication

Maintenance: “I am using my hearing devices”

The client has begun using hearing devices and/or effective communication strategies. At this stage, they may still feel ambivalent. Some are pleased to be using hearing devices but find it hard to accept the implications of hearing loss. Others see hearing devices as a necessary evil. Some feel sad and forget the reasons for acting on their hearing loss. Those that feel successful will advance to Permanent Exit. Others will struggle and fall back to Relapse.

How to assist your client at this stage

  • Provide support and suggest communication strategies
  • If the patient is ambivalent, use the Box to explore their situation

Relapse: “I don’t like using my hearing devices”

The client struggles to wear the hearing devices consistently or gives up all together. They may feel like a failure for not being able to persevere and may be more irritable than usual. Some clients may enjoy the freedom of not having to concern themselves with hearing devices. Some will be motivated to try again.

How to assist your client at this stage

  • Focus on the advantages of better hearing and communication. You can use the Line or the Box to review their reasons for taking action. 
  • Emphasize the manageable steps that previously enabled your client to implement new strategies
  • Stress past, positive experiences, even if they were short lived
  • Try to agree with your client on a new plan

Permanent Exit: “My hearing devices are here to stay”

Your client feels comfortable using hearing devices and communication strategies and can manage their hearing loss. 

How to assist your client at this stage

  • Provide the option of returning for support

It is very important to remember that people with hearing loss frequently move back and forth in the Circle more than once before new behavior is well established. 

The Circle draws upon the Patient Journey and the Stages of Change model.

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The Circle clinic handout

The Circle clinician helper sheet