Using Motivational Interviewing in Sri Lanka
Buddhinie Nonis is a clinical audiologist at Vision Care Optical Services in Colombo, Sri Lanka. Last year, she was introduced to the Motivation Tools at a summer camp for young audiologists from around the world hosted by Eriksholm Research Center. Buddhinie took the Ida tools back home and began implementing them in her clinical research. She is now in the process of writing a report on her results and has shared a few insights with us.
“I started using Ida tools for my research in September 2017,” Buddhinie says. “The goal was to understand the ambivalence in using amplification devices in patients from two main districts of Sri Lanka.”
“In a Sri Lankan context, there’s a considerable gap between when patients first get a recommendation for amplification devices and when they finally obtain them,” she continues. “People take a long time to accept the hearing loss as well as the hearing aids. So making them aware of, and able to understand, their own need to use hearing aids was the key challenge that Ida tools help to address.”
Buddhinie used the Line and the Circle with patients who were making their first visit to a hearing care professional and had no middle ear pathology. She used two tests, Pure-Tone Audiometry and Tympanometry, to identify suitable candidates for her research and then used the Motivation Tools with them.
“First they had to rate the two questions in the Line tool. Then I interviewed the patients to learn their specific communication and emotional needs. Eventually I was able to determine where in the process of behavior change the patient stood.”
Many of the challenges that Buddhinie faces with motivation and acceptance of hearing technology will be familiar to hearing care professionals around the world. She cites financial issues, lack of acceptance and perceived importance of hearing in improving quality of life, and cosmetic issues as key factors. But she also sees progress as well.
“The extent to which obtaining hearing aids is affected by stigma and lack of awareness has reduced a great deal over the last few years. People are becoming more and more aware of hearing health care, but it does not outweigh the need for a continuous effort to publicize it.”
In details she has shared on the Learning Hall, Buddhinie found a significant relationship was established between the perceived importance of improving hearing and the decision to use amplification devices on the first visit itself. Family influence was another major factor, with 66% of those who came to the appointment having been encouraged to do so by family members.
“The tools are a method for the patients to reflect on their own attitudes and reluctance to change longstanding behaviors,” she says. “It really helps the clinician to understand how ambivalent the patient is on their first visit. There were patients who were not willing to accept that their communication difficulty could be assisted with hearing aids. Most were able to obtain more insight of their difficulties through the tools.”