 My name is Tegan and I'm a research audiologist here at NAL. Today I would like to share with you some of the work we've been doing in the post-fitting space. Before I start, as is the custom in Australia, I would like to acknowledge the traditional custodians of the land of which we stand and pay my respects to elders past, present and emerging. If you have already attended some of our other soundbites talks, you may have already seen this diagram. It reflects the different areas we are interested in as part of NAL's multidisciplinary connected health research program. Connected health or telehealth focuses on using additional technology to provide healthcare to people who can't or prefer not to access services in the traditional face-to-face model. This can be due to distance, time or disability, but also opens up many more options to our clients so that they can have more choice about how and when they receive care. This is particularly relevant with the recent increase in access to connected health services due to the COVID-19 epidemic. My colleagues and I are currently focusing on the area of ongoing support and how the use of a new technology could help bridge the gap between client and clinician in the post-fitting period. For this project, we use the design thinking approach. This differs from traditional research methods as the researchers don't start by developing a research question or completing a literature review. In design thinking, you identify the stakeholders first. In this case, our stakeholders are people who wear hearing aids and they're audiologists. You empathize with them, you talk to them, ask them questions and find out what they think are the most important issues. You then form your research question around what the stakeholders have actually said that they want. We wanted to know what they thought the barriers and facilitators were for success with hearing aids and how they would feel about using technology to mitigate some of these challenges. To further enhance this client-centered focus, we also formed a patient and public advisory group. The concept of PPI is becoming more common in research and can take on many different forms. Our PPI panel is an elected group of people who have lived experience of hearing loss and hearing loss advocacy. Their involvement includes attending team meetings, advising on protocols and proofreading all participant-facing documents. Every few months, we get together as a group to discuss our progress and share ideas. In Australia, this is the usual clinical pathway, at least for clients accessing the Government Hearing Services program. You would come in for a hearing assessment and then decide to either go on to a fitting or not. At the fitting, the clinician would set up the hearing aids for you and talk you through the management of them. Then around two weeks later, you would come back for a follow-up appointment, where you could make adjustments and review your cosy goals. If the client is happy with the hearing aids, they are then signed off and are not usually recalled for 12 months. As I mentioned before, we were interested in the post-fitting period of the hearing rehab journey. In particular, we are focusing on the initial period between the fitting and follow-up appointments, which is usually around two weeks. In late 2019, we talked to a number of stakeholders in either one-on-one interviews or small focus groups. We interviewed six audiologists, five were female and one was male. All were aged between 31 and 42 years old and had between seven and 12 years experience in audiology. We also interviewed 10 people who were hearing aids. Two came to one-on-one interviews and the rest came to one of two focus groups. We had four women and six men, ranging in age from 43 to 84 years. There was quite a range of hearing loss and hearing aid experience. Through a semi-structured interview format, we asked our participants what they thought was most challenging about the post fitting period, what they thought made it easier, and how they felt about additional technology could benefit people getting used to hearing aids for the first time. Today, I would like to share with you some of the main themes to come out of the interviews and focus groups. The three main themes were motivation, information and preparation, and time pressure. Motivation was a major theme to come out of our data. For the clinicians, motivation was the key to whether someone could persevere with their hearing aids or whether they got fitted with them at all. To quote one of the clinicians, it depends on whether they are really actually ready for a hearing aid and whether they're going to persevere through the uncomfortable bits. The client group also mentioned the need to be self-motivated and discussed some of the characteristics that made up a motivated person. For example, I'm a very resourceful person. If I need to know something, I will figure it out, or I've got support. They agreed that someone who is motivated knows what they want and where to get information, or has people around them who can help. Both groups talked about how motivation might be high at the fitting appointment, but left to fend on their own, new hearing aid users often struggled. The client group talked about being unsure of what to ask or how to get more help, like this example. I just got my second lot of hearing aids, and she didn't really explain enough, and I'm having a little bit of trouble. I don't know. Maybe I should have asked her further. It was a little bit casual. They also felt that especially for older adults, there should be more support in the first few weeks post-fitting. I wish older people who were wearing hearing aids for the first time got a little more support with their transition period. You probably need to do a bit more hand-holding. Clinicians echoed this and talked about how disappointed they were when clients returned for their follow-up appointments, having been unable to persevere with wearing their hearing aids. There are a lot of people who give up, and you see them at follow-up appointments. It's so frustrating, but also sad for them. You want them to do well and get benefit. For the clinicians, hearing aids success was also linked to giving their clients the right information. Not too much or too little, in simple language, easy to read, personalized for the client, not too many handouts, verbal and written, and using visual elements. They wanted to prepare their client for what they perceived to be a challenging road ahead without overwhelming them with too much information. I do like to keep it mostly verbal because I don't want to bombard them with printouts. The clients, on the other hand, talked about feeling under-prepared and not getting adequate information. I didn't get very good instruction, and I think I need to adjust them. In our effort to avoid overwhelming our clients, are we then not providing enough information? Or is it the pressure to give all of the information during an already packed appointment? And thinking about the fitting appointment itself, both groups talked about the amount of information to get through in a short amount of time. To quote one of our clinicians, just trying to fit it all in, there's so much to get to. Sometimes it's such a rush to explain everything and set it all up. But that rushed feeling can impact our clients. I come away feeling that I'm being shoveled out the door and I don't know what questions to ask because I don't know what's wrong. Getting hearing aids can be an overwhelming experience, especially for the first time. Are we focusing more on the client's concerns or on the list of tasks that we need to get through in the hour? Are there any other options out there to help ease this time pressure? As I mentioned earlier, we also asked our participants about their feelings on technology. There is a widespread assumption that technology is not for the older generations, but this is an increasingly outdated notion. According to a US study, in the year 2000, only 14% of adults 65 and over used the internet. In 2019 it was 77%. Older adults are likely to use more than one smart device every day and are spending half of their leisure time on screens. Beyond smartphones and tablets, there are a number of other devices such as smartwatches, fitness trackers, and smart security systems that are being marketed towards older adults more and more. These devices are being used for more than just entertainment and social media. For example, smart voice assistants like Google Home or Amazon Alexa are being used in the healthcare field for the management of chronic conditions such as diabetes and asthma. Overall uptake for these voice-activated devices is increasing with the fastest rate of adoption being in the over 55 age group. The clinicians that we interviewed talked about how heavily they rely on technology at work, how if something isn't working they may have to cancel their appointments to fix the problem. For example, technology is a big part of my role. If it doesn't work, I can't work. They are used to combining many different types of software and hardware and troubleshooting any issues as they come up. Because of this, audiologists are comfortable with technology and often early adopters. They are used to trialling new technology at work which gives them confidence when they approach new technology. Some of the hearing aid users that we spoke to felt that they were too old to learn new things and felt that they lacked confidence with technology. I think we are too old to live in a world with machines telling us what to do. They also talked about a lack of awareness of technology, that they didn't know where to find information about new devices and that they didn't speak the language of technology. I think that sounded really great to me. Why hadn't I heard of it? Others acknowledged that older adults are a growing market for technology, saying, a lot of people in our age group are very techno savvy. They all regularly use the internet and smartphones and talked about the idea of keeping up with their grandkids. Bringing together these two very different views on technology is this quote from one of the clients. Even though I have a complete and total aversion to having to speak to a lump of metal or plastic, if it's recommended by the clinician, I would do it. Audiologists play a major role in introducing our older clients to technology, whether it's new devices, remote controls or smartphone apps. They trust our recommendations and rely on us for support. Inspired by that wonderful vote of confidence in our profession, my team and I have been investigating different technology options to improve a new client's experience of getting hearing aids and a clinician's experience of fitting them. We project that increasing motivation and support for both groups will lead to better outcomes overall. Thanks so much for listening to my presentation, and I would also like to say thanks to my colleagues, Humphrey, Ingrid, Kyle, Ronnie, Mel and Jorge for their excellent work on this project and ongoing.