 Hello to everybody and welcome to our soundbites webinar and I want to say it's a real pleasure to be sharing the first of our season two soundbites connecting with now webinars with Sherri Lee Rutherford and the Ida Institute. Sherri Lee and I have known each other for about five or six years when we worked together on a number of different things in the UK both professionally in terms of different activities but also on patient-centred research. And so now Sherri is in South Africa and I'm in Australia. It seems particularly special for us to be hosting this first collaborative international soundbite webinar from the same same hemisphere but opposite sides of the world. So today's session is focusing on research that I and colleagues have and are doing in collaboration with the Ida Institute and where we have in the past received Ida Institute research grants and we've just recently got one from the from the institute and I'm going to be talking about this in the context of the connected hearing health research in now. So first on is a project that was led by one of my colleagues David Dr. Maidman who's at Lefford University in the UK now which used the Ida Institute's why improve my hearing telecare tool and this is a tool that's delivered prior to the hearing assessment appointment so I'll be giving the results of that study and secondly my colleagues at now taken yarn this speech of myself recently received an Ida Institute research grant to use in my hearing explained tool and I'll be talking about our plans for that research. So this is a new set of webinars so what's new so other than the collaborative nature of working with leaders in the hearing health care field that the event is live and we want it to be much more interactive so there's going to be a couple of polls and a Q&A in the middle of the presentation and also at the end so we would really really love to hear from you you can give questions as you go along and don't be shy please please join in we really want to share this event with you so we're really excited to be kicking this off and I'll now hand over to Cher who'll give a brief overview of the Ida Institute so over to you Cher. Thank you so much to Mel and everyone at now and the soundbites team for inviting us and for inviting Ida to join you on this webinar and we're just thrilled to join you and we're excited about the friendship that we have with now and of course we're very excited about the work that we are all doing together so I will say just a few words about introducing the Ida Institute for anybody who may not yet be aware Ida is a non-profit organisation that was established back in 2007 and our mission is to build a community that embraces person-centered care and empowers people to get the hearing care that they need and at Ida we thrive on collaboration and co-creation is at the heart of everything that we do and so we enjoy and we prefer to work with people professionals, academics and persons with hearing loss to co-create innovative solutions, tools and resources in hearing and in communication that helps us to make the care that we deliver more human-centered and so the resources for person-centered care involve clinical tools, telehealth tools for clients and patients, professional development tools and of course ethnographic videos and so if you're not yet familiar with the tool section on our website you can visit IdaInstitute.com and you can feel free to get lost in the myriad of tools and resources that are available. The Ida Learning Hall is also something worthwhile visiting it is our free e-learning platform where we've co-designed training courses and educational materials with collaborators from all around the world to help you on your journey to become a more person-centered clinician and these courses are accredited by the leading accrediting audiology accrediting bodies around the world so that could be worth your while exploring as well and then finally another thing that we do to support the development of person-centered care further is our research grants so Ida provides three small research grants to recipients every year and we do that excuse me to further support the development and the evidence specifically in audiology and hearing care and so of course that's also going to be the topic of our discussion today where we're going to be talking a little bit more about the tool and the research that now is going to do to help us develop that evidence further so with that thank you so much Mel again for for the very kind invitation and I'll hand over back to you. Okay so I'm going to move on to the first presentation and given that the one of the studies is about tele-care and we've seen a huge increase in the in the use of tele- audiology over the last seven to eight months as a result of the COVID pandemic I just wanted to give you a flavour of the kind of technology that we're looking at at Niles Connected Hearing Health Research Programme so we're looking at a whole range of different types of tech but today we're going to particularly be focusing on pre-assessment and pre-fitting preparation but when we're thinking about delivering health care it's not just about the tech we need to think about how this fits into the patient pathway so this is so this slide here gives an overview of the research that we're doing it now and what we really want to be to do is to maximise the impact of the research that we're doing for patients and audiology so we want to find out what it is that they want and we want to find out what works so we've got a couple of projects sitting in the health service research area so one is looking at barriers and facilitators to connected hearing health with the aim to the aim was when we did it to try and increase uptake but of course it's in a huge uptake over the last few months. We did another study also on the back of COVID looking at outcomes clinical outcomes for in-person versus remote services and with the name being to minimise face-to-face clinic appointments and down the bottom we've got two of our sort of technical innovation developments which have a very mature patient focused feel about them so one is looking at a pre-assessment where we're looking at preparing patients and audiologists before the hearing assessment appointment and then study looking at post fitting to improve support and to increase motivation. So when we are thinking about person-centered care this is how often how I think about it so we have the audiologist and the patient in the clinic and both of them when they are at the assessment or fitting appointment have got different thoughts in the head so with the audiologist it might be they're thinking about getting the hearing aid fitted in the short time that they have for the patient it might be around wanting to tell their story and so when we think about person-centered care we're thinking about a shared understanding of needs, desires and interests and we're looking for a collaboration between the audiologist and the patient and that really is the sort of where we're getting to with patient-centered care. So with the first study that I'm going to talk about this is a study like I said which we carried out in the UK and we were looking at assessing the why improve my hearing telecare tool and the idea was that we wanted to encourage patients to reflect on their own individual needs and abilities but before they came in into the clinic to make them better prepared to work more jointly more closely with audiologists and making sure that things that are important and relevant to them are addressed. So the study that we carried out was a mixed method study so the first part was a randomized control trial where people were randomized either into the why improve my hearing tool along with standard care or they're in the control group with standard care only and it was quite a large study of 57 adults with hearing loss. At the end of the study we showed that there was no significant in the outcomes at 10 weeks we had a whole bunch of outcome measures but we did see that see a significant increase in patient readiness so they're readiness to do something about their health and we saw 10% increase in the why improve my hearing group compared to the control group but probably what was more interesting from this study was that we also did some qualitative semi-structured interviews so we did this with 10 adults with hearing loss and five audiologists and the idea was to explore the views of both patients and audiologists towards the tool when in the audiology. So this is where that was done by David Maidman and Edna Hepham and myself. So from the qualitative research there were three overarching themes one was that the tool helped patients to prepare for the clinic appointment in advance and it helped enhance discussion between the patient and the audiologist and we also had some signs this had the potential to influence outcomes after the appointment. So looking at the first theme being better prepared so people reported that they'd be that the tool helped them to become more aware of the difficulties they were having and sort of gave them a bit more of an idea of what they wanted out of any rehabilitation and it also helped patients who were unaware or in denial of their hearing loss. So one of the quotes was you almost have to be confronted by the problem to take it forward. We also showed that the tool helped enhance patients readiness and motivation to engage with adult rehabilitation and encourage people to think about specific difficulties. So this audiology said the motivation from the tool is that it encouraged patients to take control of their own hearing health and not just be passive. So moving on to the second theme which was that the tool enhanced discussion between the patient and the audiologist. So there were reports that the tool helped improve the flow and the efficiency of the appointment and also helped to give an idea about what to expect in the appointment. So this patient said it gives you the agenda. I knew what the discussion was going to be about knowing it made me relax more. And as I mentioned patient-centred care earlier it made the appointment more patient-centred for both the patient and the audiologist. So we want this and it helps support the audiologist and understanding the needs of the patient. So I got a lot out of the patient and it was more personalised for her so really tapping into that person-centred approach. Finally in terms of outcomes there was a suggestion that this may have the potential to influence uptake of hearing aids but also to improve outcomes after the appointment. So this audiologist said I'm not sure she would have been so enthusiastic about trying hearing aid if we had not used this tool. It helped her to come to that decision herself and talk herself around to the idea that hearing aids would be beneficial for her. So it really helps patients sort of get more control over their hearing health care. Okay so what are we doing it now? So in terms of what patients and audiologists want this is reflected in now's approach to innovation and tech development. So I'm going to just move on to some work we're doing on some pre-assessment work. So we're using this sort of model work which involves design thinking and lean startup and agile methodology. So in the beginning with design thinking we're thinking about what is the problem to the patient. So what are the issues? What is it that people want? So that's the empathised part of it. In terms of defining what the issues are what they might look like what the focus might be that's the next stage in the process and then the next stage is to start ideating to think about what kind of solutions or features might address the particular problem. And once the design thinking phase is over it's time to move on to the startup phase and we use this sort of build measure learn approach this lean startup approach which uses MVP. So some of you may have heard of minimal viable products which is basically these sort of bare bones of a means to be able to identify what kind of features people want and having done one MVP and learning what it wants it's a iterative process which can go through a number of times and the study that I'm just going to talk about in a second is on his fifth and final MVP. So we're really getting a good idea of what it is that patients and audiologists want and then the final stage is the development of whatever the tool is going to be. So maybe the development of an app who may be the developer of an online tool and this sort of agile sprint process is the process that we're following in now. So what do clients and audiologists want? So this is a study that's being led by Jeremy Pang in the bottom right of the slide and what we've seen in the discovery phase is that clients say that they want to be better prepared and to be able to have more of an expectation of what they want from the hearing journey. So this is very, very similar to the study I was talking about a minute ago. But what also has come out of this study is this theme of trust, this idea around personalised and self-paced patient education to really sort of try and facilitate acceptance. In terms of what audiologists want again they want to be better prepared so it's obviously a really key theme here and try and understand the client's motivation. So again we saw this in the UK study but what also came out in this study was this idea about developing and building rapport. So clients don't always know what they want to ask and having some sort of information beforehand can really help build rapport. And where we're at with this study is that both clients and audiologists want to be better prepared and then to a productive relationship built on trust and rapport early on in the hearing journey. So going back to where we are at the moment we've done the discovery phase when the final stages of this iteration lean startup process and then depending on where that goes we're going to move on to the development of our tool and I can talk a bit more about that later. So there's lots going on watch this space. It's probably time now to move on to the sort of second part of our session today where we're going to be talking about the My Hearing Explained and Cher is going to give a bit of an overview of that so over to you Cher. Thanks Mel and just while that presentation is coming up that's wonderful so the tool that we want to share a bit about today is called My Hearing Explained and I'm just going to do sort of a brief overview of what the tool is and what it's intended to do and then Mel I will hand back over to you and you can tell us about just the really exciting research that you guys are going to do at now and using the IDA grant to do exactly that. So the My Hearing Explained tool if we go to the next slide it is a tool that is designed to transform the complex information from a hearing test into language that is easy to understand. It's designed to help people understand the hearing loss and then also to enable them to explain it to the people that are important to them in their life. It's very much designed as a conversation tool and it is something that can be used as both a self-report tool and a tool to explain results. So if we go to the next slide. So what it is it's a personalised infographic and it's centered around an illustrated head and it's surrounded by icons for loudness, clarity and brain energy and so what you have underneath is a box that you can fill out with the patient where you're going to fill out what they struggle with and also what they can hear and this here is interesting because we are trying to also maintain a strength-based perspective which is very much in line with the principles of good information sharing and then there's also spaced document the patient's most important communication situations and then on the left hand side of the panel as you're looking at it the patient now has an opportunity to indicate on the scale what their ability to hear sound is and what their ability to understand speech is and also how they rate their energy for listening. So this is the self-report part of it so the patient can rate that and later on when you as the clinician are doing the audiological testing and the speech testing you can also put your markings on there and then there can be a discussion about how these might agree or maybe there's some interesting discrepancies and you can explore with them further why that might be and then there's also a space to document and things that you've discussed all your different recommendations and the treatment options so that perhaps you've recommended some technology assistive devices different strategies referrals and so on and so this is very much helping the clinician to facilitate shared decision making which is one of the cornerstones of person-centered care and yeah so if we go to the slide how it works pretty easy you can download it again freely from the IDA website you can print it there's also an editable pdf if you are working remotely so you can do it via screen share and then you simply use the tool to guide your conversation in the appointment and importantly the tool has been designed first and foremost for the patient or the client so the idea is that they take it home as a as a document and as a summary of the things that you have discussed and the tool is intended for sharing so we should encourage our clients to take it home share it with their loved ones and have that conversation about hearing loss and how it impacts their life and also what they plan to do about it further and so on the next slide our final slide here is just to say that I think or I hope it's clear that you can use this tool throughout the appointment so you can use it during the case history phase and you can use it during the explanation phase and also the management phase of the appointment and the real purpose of the tool is to facilitate a conversation and help people make sense of their hearing and then also enable them to share it with their families and I think an important characteristic of this tool is that it demonstrates in a very physical way that you as a clinician have been actively listening and yeah so I'm going to hand over back to you now because Mal because you are going to do some amazing research on this tool and and help to provide further evidence to support the use of this tool so back to you. Okay thanks Cher so yes so we with a couple of now researchers taken young who's a researcher audiologist and Liz Beach who's head of behavioral sciences and we earlier this year we were lucky to get an I do institute research grant and the study that we're going to do is to assess the use of the my hearing explained tool with a focus being on to align communication strategies between adults with hearing loss and their communication partners and the person who's leading this research is to own up in the top right hand corner of the slide there. Okay so we've got a slightly shorter planning to communicate this is the short title of this study and as many of you listening today will know that hearing loss affects many areas of people's lives it's not just about the hearing loss it affects their communication it affects their cognition both of which are addressed in the my hearing explained tool and it affects other things such as things like mental health and we know that communication partners are also impacted by hearing loss so there's been quite a bit of research talking about third person disability so a communication partners also can experience some of the psychosocial and other issues around hearing loss such as stigma. Communication partners we know can play an enormous role in the success of hearing rehabilitation and we know and it's been shown on a number of studies in systematic reviews that by aligning strategies of the adult with hearing loss and the communication partners by joint working leads to better outcomes in the end and people there's been some research done in other areas outside of audiology so in the field of behavioural insights and that research shows that people who share their intentions are more likely to make the change and more likely to stick to them so this is something called pre-commitment so this is where it's really great working it now where we can bring together audiology behavioural sciences and put them together and create really novel research so what we mean by pre-commitment I'll give you an example so this would be for example if somebody was cooking dinner so the communication partners cooking dinner and the adult with hearing hearing loss was eating their dinner that when they were pairing it they were very mindful that they faced each other when they were having a conversation or if they went into the fridge and to get something out they would stop talking whilst they were facing away from their partner whilst in the fridge and when they turned back around again they could continue with the conversation so it's those kind of communication strategies we're looking at and what's really interesting I'm going to try this out quite recently is that there can be sort of these sort of it can can have these things around bets so you know to go and see whether people actually do what they say they're going to do and so you can have a bet which is like you know if you do that you know I'll cook you dinner for the rest of the week or what's been shown is that if you take something away from somebody that's more likely to be motivating than if you give somebody something so maybe for example taking away somebody's early evening gin and tonic if they don't do what they had agreed to do so these are the kind of things that we're going to be looking at around the pre commitment so the actual study itself the research question is does the tool facilitate understanding of hearing loss and lead to a line communication strategy so the keyword here is aligned so we wanted to go and assess whether tool improves the understanding of the communication improves the communication partner's understanding and in terms of their impact of the hearing loss for the person who has it and see whether there's going to be an improved understanding compared to the standard audiogram we also want to go and have a look at the perceptions of hearing loss from both the from both parties point of view from the person with hearing loss and the communication partner and see how they intend to align their communication strategies depending on the discussions that they've been having and then finally to assess the value of the pre commitment commitment and urging the setting of and subsequent achievement of the communication goals so it's all around looking at goals is looking around the needs of both the both parties who will be taking part in the research so we're looking to recruit sorry it's a bit slow we're looking to recruit 16 dyad so dyad is a couple and we're going to randomise them into two groups one group will get the standard audiogram the other group will have the hearing tested using the my hearing explained tool the results will be explained to the adult with hearing loss and then there's going to be a discussion between the two of them in terms of the results of the hearing loss as to whether they got the pta or the my hearing explained tool and together we're going to look to develop communication strategy so there's going to be some discussion around that with the looking at developing a pre commitment nudge and then post discussion there's going to be some questionnaires and joined semi structured interview four weeks later and then finally we're going to have a follow-up interview to assess how well each of them or the couple are aligned in terms of their communication strategy and was the pre commitment pre commitment nudge successful so it's got some sort of novel angles to it in terms of the behavioural insights and I think it's really important to see whether we can try and get um um align strategies and outcomes better um align between the two so I'd like to ask you um how you developed the tool because I think you had a really sort of participatory approach to that yeah yeah thank you for that question Mel I think um you know we we anecdotally have known for a long time and um you know many clinicians I think will agree that we've always realised that the the audiogram is um is limited in many ways but when we look at the audiogram as a counselling tool specifically and um as a tool to um help people understand their results we we had to do um a little bit of field research and so we've done quite a bit of surveys and interviews and focus groups in the run up to the development of the tool and I think what was super interesting we uncovered so many interesting things and that will be a talk in itself but um I think one of the most interesting things that we found is when we asked um clinicians um are you interested in um having a new tool or a resource available to help you explain the hearing test results 99% um of the respondents actually indicated yes and so for us that was a very strong motivator um and and a confirmation that we were on the right path with trying to innovate and find a new solution um for talking about hearing test results and I think the field research also the interviews and the focus groups from uh from different consumer groups um that we ran they all confirmed each other and there were wonderful comments from um from consumers and clients who were kind of highlighting the limitations of the audiogram in terms of really understanding you know what can I hear um and what is the functional impact of a hearing loss on my life so so we kind of had that confirmation from both clients and professionals that there's a gap and so it's always nice when you're trying to design a new tool that there's agreement from both parties on that so a very strong yes um that helped us to to move forward with that project and thank you everybody for some of the comments that are coming in now we just want to go and say um a final thank you to chef for joining us today it's been a real pleasure as always to share the screen with you share and thanks to the soundbites team and thanks everybody for for tuning in