 Hello, everyone. It's a real pleasure to be giving another one of our connecting with Niles Sandbite webinars. And today I'm going to be talking about a study that looks at remote technologies that can be used for fine-tuning hearing aids. So effectively I'm looking at clinics from home. And the main focus of the webinar today is looking at a way to improve access to hearing health care. So this has been identified as one of the top priorities in our field. So we can see this in a number of influential documents that have been published. So in Australia, the Australian Department of Health published the roadmap for hearing health last year in 2019 and highlighted the fact that technological advances will improve hearing outcomes but made the point that it was essential that these technological advances were accessible and equitable for all. An older but still influential report is the Nassim Consensus Report on Hearing Health Care for Adults that was published in 2016 with a hold of the OTC DTC market on the horizon. And it was highlighted here that there needs to be some prioritisation in terms of research to provide an evidence base for innovative delivery models to treat hearing loss. And this was to include telehealth or connected health and mobile health. And the hearing aid manufacturers have been leveraging cloud-based technologies to address these over the last couple of years. So these are technologies such as apps to enable remote communication between patients and providers. So in terms of mobile tech for connected health and self-management, there are a number of different technologies. I've shown this slide before. And really it's giving a flavour of the technologies that we are looking at as part of NAL's Connected Health Research Program. All of these technologies will be covered in our webinar series. And today, as I said, I'm going to be talking about remote device remote hearing aid adjustment. So where does this fit along the patient pathway? Well the hearing aids are obviously given at the intervention part. So this is ensuring that the hearing aids are connected to smartphone applications using Bluetooth. But the real focus and the benefits of this is that remote assistant devices can provide ongoing support when the patient has left the clinic. So smartphone connectivity has really mushroomed and really exploded really over the last couple of years. And there are a number different types of applications that smartphones are being used for. So they can be used to self-fit hearing aids. And Brent Edwards is going to be talking about this in a webinar next week. Last week I spoke about some of the benefits of use being able to adjust the hearing aids and to adjust the sound quality using a smartphone app. And as I said today, I'm going to be talking about remote delivery and fine-tuning of hearing aids. And this is a study that was led by Liz Convery with her collaborators, Geeta Kides, Mark McClendon and Jennifer Grove. Liz is no longer at NAL, so that's the reason why I'm giving this presentation today. So there's been a study to show that unplanned fine-tuned appointments provide the or are the largest proportion of appointment types. So there is a real advantage to be able to minimise trips to the clinic and to be able to remotely fine-tune hearing aids. And this is what the resound smart app does. So just to explain it, we have the patient here who's been given their hearing aids. If they have a problem, for example background noise is too loud, they can make a note of this in their smart phone app where there is series of multiple choice questions that address a number of different listening situations that might cause difficulties. Having answered the multiple choice questions addressing what the particular problem is, the information then goes up through to the cloud and to the audiologist in the clinic. And the audiologist can adjust the program of the hearing aids accordingly depending on what the patient has said. And then they can, having programmed set up the program, they can send a package of information down through the cloud to the patient's smart phone app, which can then program the hearing aids. So you have this remote programming of hearing aids. So the study objective was to evaluate post-fitting use of the resound assist program with experienced hearing aid users. And as they were sort of going about their everyday lives, so looking at real world environments. And there were three different research questions. And the first one was how usable is resound assist. And the importance of looking at this was that usability needs to be assessed to ensure that induced can use whatever the application is. And at the time this study was carried out a couple of years ago, this was a relatively new technology not widely used. The second research question was how does patient provider communication virus resound assist compared to face-to-face consultation. And now this is become an essential question which is being asked clinically, as well as in research as we have moved into the new COVID era and the use of telehealth and connected health really has increased a lot over the last couple of months. And then the final research question was are hearing aid fitting outcomes influenced by the mode of client-clinician communication. So the study was a six-week trial. There were two groups, there was an intervention group and a control group. There were 15 participants in each and the control group was matched for age, gender and the four-frequency pure turn average. The intervention group had the resound assist but they didn't have the face-to-face follow-up week two which is typical and part of the standard Australian hearing health care program. The control group didn't have the resound assist app but did have the standard face-to-face follow-up for week two and of course both groups had the resound links 3D hearing aids. So looking at the results of the intervention group, 11 of the participants, 11 of the patients were successful in using the resound assist app so all of them used it at least once. There were three patients or participants who did not use the app and that was because they didn't feel they had a need to use it in that six-week period and one of the participants wasn't able to access the app at all so they were considered to be unsuccessful users. The usability was assessed using the telehealth usability questionnaire and there were a number of other different types of questionnaires out there which have typically used such as the UMARS which looks at mobile application scores. So in terms of the telehealth usability question, questionnaire high score is a poor usability and a low score is good usability and you can see that for most of the participants they rated the usability as really quite high, really very high and even the participant who rated usability less well still had a high usability score. At the end of the six-week study the hearing aid users were asked a number of different questions about their use of resound assist and the results are shown here. So on this slide here this is looking at ease of use of the assist feature and all of the 11 participants reported that they found the app easy or very easy to use. In terms of satisfaction with the range or type of questions there was a bit more variability here with some most people reporting that they were satisfied but there were a group of people who were only moderately satisfied with the range and type of questions and there were similar results for the range of the multiple choice answers that could be provided. In terms of satisfaction with the news settings that was set up using remote assist everybody except one participant reported that they were very or extremely satisfied. In terms of preferences whether they preferred having their settings adjusted using the app or face-to-face all of all 11 participants reported that they preferred the news settings to be programmed via the app rather than face-to-face. So I think what we're seeing here is very similar to what we've seen with some of the studies from now which shows that once clinicians have used telehealth or connected health systems they're much more likely to use it and that's their preference in future and we're seeing the same kind of results here with patients. But finally all of the participants reported that they would be extremely interested in having a similar feature in their hearing aids and going forward. So there were a series of open-ended questions and focus group and there was a focus group and that was conducted as part of the usability aspects and there were three key themes that emerged. The first was effectiveness so how accurately and completely could users accomplish their goals. The positive comments are here, the less positive comments on this side. So this patient here says I managed to install the news settings without difficulty and this participant says I had to choose other as my answer to many of the questions since my issue was not covered by the questions that were asked. In terms of efficiency so what is the resource burden on users relative to effectiveness, this participant here said it was quick to learn how to use it even for me who is not bad into technology and again time and time again in these kind of studies we see older adults reporting that they're not that efficient at technology but actually once they give me opportunity quite often they can go ahead and use it really quite well and really quite effectively and efficiently. Whereas this participant said I felt I had to spend time typing details of my problem into the text box as well as answering all the questions. So both of these points here were really reflecting some of the questions and that we saw on the previous slide around some a little bit of dissatisfaction in terms of the questions were asked and finally in terms of satisfaction how pleasant and acceptable is the technology to users. So this person says I like the look of the app, it didn't look like a game so it wouldn't be overly enticing for others to look at same meetings so basically other people wouldn't be distracted by it and also we've seen it before you know it then if it doesn't look like a game it makes it more socially acceptable to be able to make adjustments to hearing aids on the go without looking as though people are just simply playing or fiddling with their hearing and fiddling with their smartphones. Whereas this patient here said red on black can be difficult to read so that was really sort of a really putting into the whole usability issue. In terms of the patient provider communication there were a whole bunch of problems that arose because this is what we've seen in typical everyday life in hearing aid clinics and there's a whole different range of issues that were raised and what can be seen is that the range of types of problems are similar regardless of the communication mode whether it was app based or face to face. We saw that some of the participants reported for example that they had difficulties or the game was too soft or loud there was feedback or too much background noise and all of these could be adjusted using the remote assist app but about half the problems that people complained about couldn't directly be addressed or solved by fine tuning using the app. So for example here we've got people reporting that they had itchy ear canals or the hearing aids kept slipping out of their ears and these are the kind of problems that really need to be addressed in clinic with an audiology so requiring face-to-face care whereas here there were some problems around maintaining Bluetooth connection or couldn't stream and I think it's important to bear in mind that there are other alternate means of problems solving using online multimedia methods for example the C2HR online program. So moving to the hearing aid fitting outcomes so there were four key outcome measures that were obtained between the for the intervention and the control groups and there was no significant between these two groups in terms of hearing aid fitting and that was measured sorry hearing aid benefits and that was measured using the AAFAB questionnaire hearing aid satisfaction using the saddle there was no difference in speech discrimination in noise thresholds or hours of daily hearing aid usage using data logging so no significant difference across either the groups although it should be noted that the participant sample is quite small and so it is much more difficult to go and show any significant effects. So in conclusion I'm looking at the three research questions the app and feature was seen to be usable and the participants found the app was highly usable in terms of its effectiveness efficiency and satisfaction and the kind of experiences and feedback that were gained and could then be used to build upon and refine further technology. In terms of the patient provided communication the study showed that there were similar problems regardless of the communication mode used whether it was face-to-face or with the app and it's important to say that not all the problems can be solved at a distance and some require face-to-face care or some other kind of online support to enhance any of the or to address any of the problems that arise. And then finally in terms of hearing aid outcomes there was shown to be no difference between the face-to-face and the remote technology model with no detrimental effect on hearing aid outcomes so an app-based communication method is a viable way to improve hearing healthcare accessibility. So what about COVID-19? So everybody's a bit sick of it now but we are seeing that the pandemic has actually caused disruption to hearing healthcare and shown in this cartoon here that I came across about six weeks ago which is actually really quite true so there's some work that we're doing and another project now that David Allen has spoken about in a previous webinar which looked at the difference that the pandemic has made in terms of one of our studies. So we were looking to increase the use of the telecare app so this is the Signia Telecare app which works very very similar to the journey sound app that I've been talking about today and the red line here is the number of COVID infections in Australia. So we were looking to try and increase the use of telecare app and we had done some work and identified some interventions to do this which we implemented just towards the end of January beginning of February and we started to see see here this is like increasing and taking care and increase of COVID infections and we can see that when we introduced the interventions to improve take it to telecare we actually did see this and it was all looking pretty good until the pandemic hit and we can see that from the beginning of March in Australia there was as we see in other countries a large rapid exponential growth in the number of COVID infections and what was really fascinating was when we were continuing to monitor the use of the telecare app our intervention clearly sort of gone out the window and we saw that the uptake of the telecare app pretty much mirrored that of the COVID infections. So this was a really interesting finding what we're seeing is that social distancing has required as required fewer face-to-face clinic appointments and we see this in the results here. So good quality remote services and I needed more than ever we're actively looking at this at now working with I'm here in Australia so watch this space we've got some really interesting results that we can present over the next over the rest of the year. So finally I'd like to thank the people who conducted the study Elizabeth Convry, Gita Kaisa, Margaret McClellan and Jennifer Growth which was funded by January Sound and just to highlight there's a whole series of sound bites webinars on Connected Health some of them have already taken place so David and David and Jeremy this week have given their webinars taken in Paola and doing it some their webinars in a couple of weeks time and I've got a couple more lined up.