katie ekberg univeristy of queensland and caitlin barr university of melbourne

New research on using Ida Motivation Tools to determine client stages of change

By Amanda Farah Cox

New research published in the International Journal of Audiology uses Ida Motivation Tools to assess what stage of change people with hearing loss are on. “Identifying clients’ readiness for hearing rehabilitation within initial audiology appointments: a pilot study” by Katie Ekberg of the University of Queensland, and Caitlin Barr of the University of Melbourne, is the outcome a project funded by the Ida Research Grant.

The pilot study used the Line and Circle to determine if Ida Motivation tools could be easily integrated into a first appointment and if the tools were helpful for determining a clients’ readiness to adopt hearing technologies. It found that the tools are an effective conversation starter about clients’ ambivalence toward using hearing technology and that they could be easily included into the appointment.

“The results of the study suggested that the follow-up questions were a particularly useful part of the Line tool,” says Katie Ekberg. “The results would encourage clinicians to practice asking the follow-up questions every time they use the Line tool.” In one such example, using the tools helped the audiologist to draw out that the client was concerned about the cost of hearing aids, and about her ability to use them.

Aiding understanding

Previous research has shown that people with hearing loss who attend appointments with hearing care professionals are not necessarily ready to accept help. It is not uncommon for someone seeking more information about hearing loss to make an appointment and get a hearing test even though they are not yet ready to use hearing technology.

Because people with hearing loss who actively choose to use hearing technology have significantly better outcomes than those who passively accept it as a recommendation from their hearing care professional, it is important for hearing care professionals to assess how motivated their clients are to actually adopt and use technology. Understanding how motivated an individual is and the cause of their concerns is therefore important in order to provide care suitable for that person.

To aid this understanding, five audiologists were trained by the researchers in how to use the Motivation Tools. The training explained the transtheoretical model, included a step-by-step guide in how to use the Circle and the Line, and addressed how to use follow-up questions to get more information from clients. The workshop also briefly looked at how to use the tools to individualize care.

The study highlighted how using the tools brought out more detailed responses from clients and called on them to reflect on their feelings about hearing rehabilitation and articulate their ambivalence. 

“Clients sometimes started their responses by marking the question as ‘difficult’ or ‘hard’ to answer, which highlighted that their feelings about hearing rehabilitation and hearing aids were not simple or straightforward,” says Ekberg. “Clients did, however, always go on to provide expanded responses to the follow-up questions even though they marked the question as ‘hard.’”

Part of a well-rounded practice

The pilot study found that including the motivation tools made no significant difference to the average length of appointments and that the tools could be implemented “without any sign of awkwardness or disruption.”

“Clinicians in the study were positive about using the tools in the future,” says Ekberg. “Clinicians at one of the clinics have incorporated the Motivation tools into a PowerPoint they use with clients within the management phase of the appointment, prior to presenting clients with the different rehabilitation options available to them.”

The study also showed how the Motivation Tools are part of a well-rounded person-centered practice: Some clients said that they placed a high level of importance on improving their hearing when completing the tools, but also displayed signs of ambivalence or concern. This shows the need for active listening on the part of the hearing care professional when completing the tools together as part of a person-centered intervention.

The authors concluded that further research could include the Box to help clients with decisional balance and resolving ambivalence. Read the full article in the International Journal of Audiology.