 Hello everybody, it's a real pleasure to be giving the second webinar in our Connecting with NAL Soundbytes webinar series. Today I'm going to be talking about the Adult Hearing Loss Research Programme and I want to give you an overview of some of the work that we're doing, give you a bit of a taste of it and talk about what's really important for us in terms of the research. Some of you will know that I moved from the UK to Australia to work for NAL just over a year ago and today I'm going to be talking about the research that's been carried out over the last year. So you can see here the Department of Geological Science that I lead and these are all the research audiologists and the names that you see here are the research audiologists who have contributed to the research that I'm talking about today. One of the really great things about working at NAL is the multidisciplinary approach that we take and so we work very closely with the engineering department which is headed by Jorge Mejia and also the behavioral science department which is headed by Liz Beach. So this is a schematic of the Adult Hearing Loss Programme. Our aim is to drive outstanding people-focused research and to promote excellent evidence-based outcomes to improve quality of life for adults with hearing difficulties. So this is our main, our aim here at the Centre, Healthy Hearing, Healthy Aging. And there are three research themes which are part of the programme showing the red triangles. First is Connected Health, then Outcome Measures and Special Populations. And then depending these research themes are some of the NAL competencies that contribute to the research and have been developed over the last couple of years. So we have a number of competencies that feed into the research we do but the projects we're talking about today, these are primarily behavioral insights, human technology interaction and big data and machine learning. So the goal of the work that we do now is to create impact. So create impact in terms of improving the lives of people who have hearing loss. And we can do this in a number of different ways. We can create tools and questionnaires that can be used by audiologists and patients to measure their outcomes and look at the effects of different interventions. And we can also influence clinical practice guidelines to help provide an evidence-based for clinical practice. There are a number of guiding principles that guide the research that we do in the adult hearing loss research programme. First off is applying theory to the work that we do. So what you can see here is the ICF framework, which many of you will be familiar with. And the research that we do tends to sort of sit more in the participation part of the framework, although we do more work recently looking at the personal factors part of the framework. In terms of theory and health behaviour change, we know that's really important in a lot of the work that we do. So again, we're increasingly using a health behaviour change theory to help guide some of the work we do, and in particular the ConV model, which is shown here. In terms of research priorities, it's really important that the research that we do is the most important research because there's so much that we can do. Now has done some work over the last couple of years using design thinking principles to identify what the research priorities should be, and some of that has fed into the work I'm talking about today. And this complements really nicely some research priorities that are identified by other methods, for example, the research recommendations from the NICE guidance on hearing loss in the UK. Using involving public and patient-centered research is really important because we know that if we involve end users in the research, we get outputs which are much more related and aligned to the end users needs, and that's really, really important. And then finally, it kind of goes without saying the research that we're doing has a very patient-centered approach. So I'm going to talk about one of the first, one of the research themes, one of three. The first one is connected health, and we've got a number of different projects in this area which are led by David Allen, Jeremy Pan, and Taegun Yang. And they'll all be presenting more on the detail of the research I'm going to talk about over the next couple of months. So what we have here is the varying different types of mobile tech that can be used in connected hearing health and can be used to self-manage hearing loss and hearing aids. So we're using all these different tools in the research that we'll be working on at the moment now. What we want to do is to design tools and methods that can be used all the way along the patient pathway. So most of you will be very familiar with this where people become aware they have hearing difficulties, they take action, get the hearing assessed, have some kind of intervention, often hearing aids, and then there's ongoing support. So we're looking at having an end-to-end digital pathway. Now, one of the things we know that although there's been research on connected health for at least a decade, there's actually been fairly slow uptake of connected health practices in clinical practice. And so I'm trying to increase the uptake of connected health is one of the games of one of our projects. So I've referred to a PPI patient and public involvement earlier. In Australia, this is called a community and consumer involvement. And this is where we bring patients and audiologists and we involve them really right from the very outset of the research to help guide the research questions that we're asking. So the important thing is that the patient, the public and the healthcare professions are working with the researchers, not for us. So you may have heard the expression not about us without us. So that's very much the approach that we're taking. And the reason for embedding PPI at the heart of the research is that it can help address some of the mismatch that we often see in research where the needs of the users are not met by the research agendas. So by involving patients in helping us set the research agendas, we're hoping to be aiming to overcome that. And we also know that PPI ensures that the research that is done is aligned to the patients and the end users needs. So what is it that patients and audiologists want want and what works? So we've currently got four connected health projects currently being carried out. I'll talk you through them very, very briefly, but as you can see we're covering across the whole of the patient journey. So the first one is looking at barriers and facilitators to connected health. And the idea of this project was to increase uptake of connected health within clinic. As a project looking at pre-assessment, so before people even come into the clinic, and the aim of this is to better prepare patients and audiologists for the hearing assessment deployment for for the assessment and the intervention parts of the journey. We're carrying out a project looking at in-person versus remote services. So what we found with COVID is because there's been a real need because of such distancing to minimize face to face contact, there've been many more remote services developed. It's a great opportunity to be able to look to see whether the outcomes delivered by remote services are the same or different to those that delivered in the conventional in-person services. And our fourth project is looking at post-fitting and we're looking to improve support and increase motivation and make sure that people know what it is that they need to do once they've had their hearing aids or their intervention. So I've mentioned this idea of increasing uptake of connected health. And I came across this schematic a couple of weeks ago. And I kind of think it sort of says it all really. The COVID pandemic has really transformed the way that we run remote services. And we can see this really, really nicely in this figure here. So this is from one of our projects and what you can see has got months along here. The red line is the number of people who had COVID-19 in Australia. And you can see there was a really sharp increase throughout March and then it leveled off. But what's really, really fascinating is on the project that we're doing at looking at the trying to improve or increase the uptake of telecare sort of a smart smartphone connected to hearing aid and app. What we can see is that round about January beginning of February, we started to implement some interventions to try and improve uptake. And there was some improvements shown. But as soon as the pandemic started to take hold, we saw that the uptake of services, uptake of the telecare app, pretty much mirrored that of the COVID infections. So as I said before, social distancing requires us to have fewer face-to-face clinic appointments. And what's really important is that good quality remote services needed now more than ever. And the research that we're doing is going to be contributing to that. So I'm going to leave Connected Health now move on to the second research theme that I mentioned, which is African Maceous. And this is a talk about a project that's led by David Allen. So within the Australian Hearing Health Care, there are no national guidelines on what outcomes should be used, why, how, and when. And really this is no different to many, many other countries. This is a project that's being funded by the Department of Health and specifically to look at outcomes that are measured within the Hearing Services Program. So this is a program where hearing health care is provided free to many of those people who are eligible. And so it's probably the closest you get to the UK National Health Service. So we're looking at trying to improve outcomes in the Hearing Services Program. This really came about from a roadmap, the roadmap of hearing health that was produced by the Department of Health in 2019. And one of the aims of that was to try and standardize national reporting appearing loss and to establish a national database. So the overall aim of this project is to develop and deliver recommendations on evidence-based, patient-focused outcomes to measure the success of the Hearing Services Program. So this is really a schematic of how we've gone about it. So we started off by carrying out some scoping workshops to find out what professionals in the public thought was important in terms of measuring outcomes for hearing rehabilitation. There is no consensus on what outcomes should be used. So we've run two Delphi reviews, which are consensus activities. And we did start it off with a Delphi review of professional stakeholders. But what's really, I think what's really exciting about this project is that we're also doing a Delphi review of clients and publics. So we're making sure that clients, public, patients are at the heart of this particular project. And then shortly we're going to be carrying out a national survey on what people are currently doing in terms of outcomes. All of this work will be together into some consensus workshops that we'll be running in a couple of months' time with both professionals in the public, with the aim being, as I said, to provide recommendations to the Department of Health. Now I'm not able to give you any results at the moment, but I do want to share a couple of snippets because this is really fascinating. So we've had at least one round of each of the two Delphi reviews. And what the results are showing is that there are many domains that are being suggested by professionals that they think are important and are not currently captured by existing standard outcome measures. So for example, measures or domains such as well-being, social isolation and loneliness. And for the when we look at the Delphi review of the patients, although we see some similarities in the domains between the professionals and patients, what's really interesting is that there is some marked differences of what they think is important. So for example, that hearing loss impacts less on the family is one domain and that they can have more control over their hearing. So as I said, this research is continuing for another three months and we'll be talking about the results as they become available. The third and final research theme I'm going to talk about today is on special populations and we've got two different populations in this group. One is unilateral hearing loss. And this is research that's being led by a power of charity. And both power and ingrid have just started working on doing some work in aged care. But of course, the pandemics really got in the way of that. We were going to if I were just starting to do some work from a quarry university to start looking at doing some surveys in care homes. So I'm going to just say a bit about the unilateral hearing loss work that we've done with a study that was done last year. And what's really interesting about this project is that and it's been able to, we've been able to use some of the new methods and technologies and techniques that NAL has developed over the last few years. One of those is looking at the NAL DCT, the Dynamic Conversation Test, which really gives a measure of what it's like to have realistic conversation. So the materials were recorded in real world environments and we can play them in the 41 speaker and the son of chamber. So this is a larger picture of it. It's a huge Anacoke chamber with 41 speakers to really give an idea of real world sound all around you. So one of the other tests we did was looking at collecting outcomes using ecological momentary assessment. So we're looking at real world, real time measures of what people think the impact of unilateral hearing loss is. And then finally, we've been looking at cognition, so looking at working memory. And we found for all these three tests that the people of unilateral hearing loss have performed more poorly than those who had normal hearing. And then the final method that we use was looking at head tracking. So just how much people of unilateral hearing loss had to move their heads in terms of being able to pick up what was being said. So there were two speakers, one at 25 degrees and one at 40 degrees from the midline. And we can see that our normal hearing population here was able to pretty much target fairly closely where the sound was coming from. And this was done by having a head tracking camera on the top of the head for the unilateral hearing loss group. And this has been normalised for the side of the poor ear. You can see that they've had to move they have to move their heads a lot more to be able to tune in to find out where the sound was coming from. And again, not surprisingly, we see a really significant difference. So it's really giving us some understanding of some of the unique issues that are relevant to unilateral hearing loss. And we have another project that we're currently developing a proposal that we'll be looking to start in a couple of months time. In terms of our other population, which was aged care, so this is looking at hearing related communication in care homes. As I said, this research has been put on hold because of the pandemic. But we're going to be using some of the research priorities that were identified and some of the work that I did when I was in Nottingham. We know that hearing loss is complex, dementia is complex, care homes are complex. So the work that we did used a real synthesis approach, which aims to look at very complex situations. This involves looking at the literature and involving people who are really key to the situation. In this case, we involved audiologists, care home managers, people who work in care homes, family of people who are in care homes. And we ended up with five different research priorities that will start to pick up and investigate when the pandemic dies down. So that's really a whistle stop tour of the adult hearing loss program. And what's really exciting is that we have a whole bunch of other projects that we're currently developing. So I just really sort of scratched the surface on some of the work we've been doing over the last year. We've probably got about four or five really, really exciting projects that we just went to get signed off or we're just finishing the proposals for that. We maybe I'll even be able to give a webinar on those and towards the end of the series. So look out for some really great, exciting, relevant research for both people with hearing loss and hearing health care professionals. And finally, I just want to go and say that as you will have probably gathered, it's really important for us that we work with people with hearing loss and also hearing health care professionals. We've recently just started hearing health care professional database where people are interested in helping us with our research we can sort of have all together in a database and we can call upon when we've got different projects. And this means mainly being focused on Australian audiologists, but we're really, really happy to have people internationally and take part in our research. And you can see some of our research, particularly the Connected Health, we can take much wider than just Australia. Paola is Paolin Chetis and leading on this, so either drop Paola an email if you're interested or you can use a QR code here to get directly into the database and into your details. So what's coming up next in terms of the adult hearing loss we search? So we've got a number of different webinars by the project leads here. So David's going to be talking about the outcome measure studies, some of the connected health studies and talk about future trends. Jeremy is going to talk about the pre-assessment project, so looking at preparing people appropriately taken is going to be talking about our post-fitting project, which is looking at motivation and providing the best information for people following an intervention. Paola will be talking about the unilateral hearing loss research we're doing and talk about some connected health guidelines that we've developed. And finally, I'm going to be talking about some work that I've done over the last couple of years and which is very relevant to the work that we're doing here, looking at smartphone connected hearing aids and remote technologies. So finally, I'd like to thank again the Department of Geological Science, absolutely great bunch of people to work with. Thank the Department of Health who fund NALS research. And also to thank Hearing Australia, who we partner very closely with and we're working with on a number of projects and who help fund some of our research.