 Hello everyone, thank you for joining me today. It's my absolute pleasure to talk to you about empowerment and why it's important. And I'm also going to share with you some of the research findings about empowerment and in particular the first formal exploration of empowerment in the hearing health journey. And finally I'm going to share some examples of tools and tips that we can all use to help empower our clients and ourselves perhaps along the hearing health journey to improve outcomes. Now empowerment really is a highly topical area at the moment. The World Health Organization actually recognised empowerment as critical to the delivery of optimal health care. So what is empowerment? So for me as a researcher and clinician I found this word really quite intriguing and wanted to understand it more. And today I actually am also very interested and intrigued to understand what you the audience of clinicians, practitioners and clients out there feel about empowerment. So if you could be so kind bear with me and please pop in the chat a word, a meaning, a feeling, something that resonates with you when you think of empowerment in the hearing health journey. So please if you wouldn't mind I'm going to give you a moment to enter it into the chat. You can be anonymous for this and you can be quite honest. So if it's I don't understand that's why I'm here today that is great. Pop that in. So please we really would love your input and what we're going to do is compile your responses, present them to you towards the end and you can see how you've developed in your journey of empowerment and understanding. So while you're popping your answers in I'm just going to tell you a little bit about empowerment in general. So in general empowerment takes many different forms in different contexts in different times across different organizations and communities and people. But on an individual level really empowerment is referring to the process whereby people gain greater control over decisions and actions affecting their lives. And it's most sort of common feature is that it enables an individual to gain mastery over an issue of concern to them. So how do we gain mastery over an issue of concern to us? Luckily in 1995 a researcher named Zimmerman proposed a framework of psychological empowerment and in it he suggested there were really three critical ingredients or components for if one is to become empowered. And the first being that an individual must perceive they can influence a given situation or setting and that's called an intrapersonal component. Secondly Zimmerman proposed that this individual must possess knowledge and skills to understand that given environment. So that's the interactional component. And then finally an individual must perform empowered behaviors that influence specific results. So following on from that initial work around psychological empowerment proposed by Zimmerman there was really a boom in research and the research literature focusing on empowerment in chronic health care conditions. So empowerment has been linked to positive health outcomes in many chronic health care conditions in particular with there's a lot of literature around diabetes and cancer but also chronic pain insomnia endometriosis and tinnitus. And really it for example empowerment can really increase your patient's feelings of autonomy, their feelings of their ability to self manage and also increase their coping abilities. So there's this correlation between people with chronic health conditions that rate themselves as feeling empowered with positive health outcomes in their condition. What about what the hearing research tells us about empowerment in hearing rehabilitation? Well some aspects of empowerment have certainly emerged in the research literature and in particular one in the area of mHealth is it's been seen to be a benefit. So mHealth is really the use of mobile phones or wireless technology to help us with medical care. And there was a study by Maidment and his colleagues in 2019 where participants were given access to a smartphone app to control their listening devices. And what participants reported was that they really felt a greater sense of control, less frustration, greater participation and they saw optimal device use in their hearing aids. So it's strong evidence around mHealth and there's also a body of literature that sort of also talks about empowerment and certainly aspects of empowerment that clinicians can really foster in their clinician-client relationship and that can certainly influence the adoption of hearing aids. So for example they can be supporting the development of knowledge, supporting the development of skills and strategies and also active participation in shared sort of decision making. So up until now really there was no systematic investigation of empowerment in the hearing health journey and so this was a real unmet need until really this study understanding patient empowerment along the hearing health journey in 2022 which was a research collaboration between NAL and WS audiology and this was the really formal exploration of patient empowerment in the hearing health journey that I had a privilege to be a part of and a big shout out to all my colleagues who had joined me in this work. So what did we do? Well we aimed to actually explore how empowerment manifests itself on individuals in the journey from really first awareness of their hearing loss through to hearing aid fitting and becoming an active hearing aid user and we also wanted to conceptualise empowerment along the hearing health journey. So how did we do this? We used a qualitative methodology. Now the qualitative methodologies have a lot to offer because it allows us to gather unique insights from people with lived experience and this is very powerful and I guess as my favourite quote from Researchers Green and Thorogood stated this is a process that allows us to understand the phenomenon as opposed to measuring it. So we conducted face-to-face interviews with 18 adults who'd recently experienced their first hearing rehabilitation so they'd been fit with hearing aids from six to 36 months that was their first hearing aid fitting. Eight were interviewed in Stockholm and ten in Sydney and our interview guides the questions we used were really covering components of that existing Zimmerman theory and those components identified in literature and we asked really that we would focus on three periods when the participant first noticed the hearing aid and hearing the hearing challenges excuse me when they first got their hearing aid and today. So those three phases and analysis really involved us really becoming familiar with those interviews, identifying, analysing and really reporting patterns within that data and then we summarise all that important sort of things from those interviews and try and sort of arrange them in a meaningful way. So what we found five themes emerged from our interviews and a lot of them aligned and also expanded on Zimmerman's sort of dimensions in relation to hearing healthcare which sort of highlights the real importance of investigating empowerment within the context you're interested in. So these themes were knowledge, skills and strategies, participation, self-efficacy and control and each of these themes we gave them a formal definition in the context of the hearing health journey and you can read that formal definition in our open access paper about this study. So firstly one of the first themes that came out strongly was knowledge and participants certainly identified a lot about knowledge about themselves and it being a central part of their journey. So knowing about themselves, knowing about the situations that they find challenging to hear in, knowing about the type of person they are and what works for them. There were also sort of themes around acquiring information mainly many from their audiologist but also knowing about where to turn, where to turn for information for example and many reported turning to the internet library or literature and also knowing where to turn for help and this is where many said they turned to their audiologist in their hearing care centre. So also many spoke in depth about hearing just in general hearing aids, hearing aid apps, programs, ALDs and I guess once they had acquired information, assimilated that information they really were really quite happy to share with their you know communication community what they knew. So for example one person said today I wouldn't go read up on it I would go and ask my hearing clinician instead and another said I know this one friend who said oh they're too expensive and I said no they're not and I said go you know you can do it. So that was someone sharing their knowledge and encouraging and another example it was so good to be able to hear. Of course apologies we've gone back it was so good it's easiest to say to be able to. We have something going on I actually wish I'd learned it already so a lot of people had wished that they had learned some of what they knew after the hearing aid field they wished they'd known hearing aids had been so good. So sometimes lacking knowledge around perhaps hearing hearing aids it wasn't always such a negative thing sometimes it was around wishing they'd known better. Okay let's move on. The next actual theme was skills and strategies. Now in Zimmerman's framework it was skills but a theme of strategies also came up strongly in the empowerment journey in hearing health and there was participants spoke of developing strategies. Interestingly in the pre-fitting stage participants spoke in depth of strategies they required themselves to manage hearing challenges and that kind of suggests that they don't always rely on clinicians and practitioners particularly in the beginning of their journey to understand how they might manage and strategies they might use and some use them subconsciously or consciously. So for example I always look carefully at the one who's talking I learned that by myself maybe it was subconscious I don't know but I've learned that. Now post-fitting they also talked about also developing strategies from that they gained and using them from audiologists. Now certainly they also had developed strategies were both adaptive and maladaptive so some of the adaptive strategies they spoke of was sitting closer to the person to hear better some maladaptive strategies they used were things like potentially withdrawing into their world and not going to things and things that certainly led to isolation and miscommunication. So for example well it was precisely when we were in a group of people that I often sank into my own world because I couldn't hear everything. Okay and finally they also mentioned using skills using a range of skills hearing aid management handling problem solving or skills for daily use of hearing aids. The next thing was participation and originally in our work we had defined this as participation in one's hearing care and with their client-clinician relationship. However what came up really spontaneously was a lot of patients spoke about participation in life, participation really beyond hearing care and so again the importance of investigating these themes within the context of interest. Interestingly most of the active participation sort of references were clustered at the fitting of the hearing aid and post-fitting phases and lack of participation were often clustered in the pre-fitting phase. So also they mentioned lacking involvement sometimes in their life and also within that appointment and clinical setting but this was not viewed as a bad thing necessarily. Lacking involvement when the audiologist was setting up their hearing aid was considered quite reasonable to them because you know they realised the clinician had expertise and knowledge and so they were happy to let that participant be less active in that participation. Self-efficacy came up as a theme where participants really sort of spoke of gaining confidence in communicating after being fit with hearing aids or when they were beginning to use hearing aids. Some participants also reported a sense of confidence that really didn't change before or after their hearing journey. So there was a mix of differences around confidence and also there was certainly a lack of confidence reported by some participants particularly in situations that they really were lacking confidence in were around communication settings and also around managing their hearing aids and acclimatising. I feel confident when I sit and talk and I hear what people say most of them when they've had been fit with their hearing aid is an example and also that's sort of like when I was with my group of friends I mean they're really close but I wasn't confident to tell them that I actually hear anything they're saying. So this lack of confidence in communication and finally control. Now this theme is central to most of our empowerment literature and yet within the hearing context it's quite varied. So some participants report using hearing aids and relating this to a sense of control a little like the Maidment Research but others sort of answered that their sense of control was not affected at all by their hearing challenges or their use of hearing aids they were always confident. So for example I got my hearing aids in and I am in control and also another person I still think that I've got control in my everyday what I wanted to do and what I can do and it's rare that I don't feel that I have a sense of control. So that was an example of someone who just felt control was always there for them and certainly when we have situations where people can't potentially remove themselves from difficult scenarios or can't hear for example a siren so issues around safety there can be issues of lacking control. So I got caught in a situation like this where you can't politely escape for a while. So again oh no I have to do a lot of nodding and smiling so I'm not in control in these situations and this is why I avoid them. So we were finally able to conceptualise or put words to this journey of empowerment in the hearing health journey and it was a process through which individuals with hearing related challenges acquire and use knowledge skills strategies and increase self-efficacy participation and control of their hearing health care hearing solutions and everyday life. So that operation of empowerment you might really be wondering so what as a clinician I do a lot of these things it's quite clear to me and it's quite obvious and I guess the importance of putting words to this process is that it really sets the stage for the development of tools and the validation of tools for clinicians to use in clinical settings for them to monitor and measure empowerment and progress with empowerment. So that's probably the exciting part about doing something around conceptualisation for us. So what implications do we have for clinicians and clients? Well this work aligned with previous work as you saw with clinicians being able to empower foster empowerment through giving knowledge sharing skills and strategies and fostering decision shared decision making but it also extended on the prior work that was done by suggesting aspects of self-efficacy and control are a part of that journey and really that clients need more than just device centred care. And as I said by putting words to something that is a bit abstract to us as clinicians then it actually is and these things that are already part of our clinical practice it helps us really because we can now put words to them we can tick and check that our clients are feeling empowered and then we can fine tune and target our rehabilitation to their needs. So some tools that I'd like to share with you finally that can help you during that first appointment that hearing aid appointment and post that are out there now. So one from the IDA Institute is called my hearing explain tool and this is a great conversational tool to allow you to explain the audiogram and their hearing in a very client human centric way in a simple way it also helps clients to explain their hearing loss to others and so you can concentrate on looking at their needs rather than spending time just providing all this information in technical ways. So this is a great tool look out for it and also there is a great audiology online presentation by one of now's behavioural scientists that discovers really a lot of strategies and explains tips around understanding our clients some giving us some behavioural insights into and understanding the decisions they make during the clinical setting. So really recommend that short podcast. What about at the fitting stage? There's a lot of information that also is given at the fitting stage and forgotten at the fitting stage. So there is a great short interactional multimedia program called C2 here and another called M2 here which really helps provides a lot of information and interactive little videos that can really help hearing aid use to a fit for the first time and they found that these actual videos rather than just information really helped better inform their participants and gave them confidence and skills and they enjoyed them much more than just reading information. So that's a great tool just around acquiring information and finally a way of checking some of the knowledge that your clients have obtained is through the Haski self survey which is this great sort of inventory checking how people are doing with their hearing aids and their skills they've acquired and finally for those psychosocial needs there's a great great article by Beckett and colleagues who help and provide suggestions around that. So we'll give you some links to all of those papers and podcasts and tools we spoke of and again thanks to all my colleagues and I really look forward to exploring empowerment now and into the future and really exploring those outcomes that come with it and meeting the needs of clients around us. So thank you very much.