 Welcome to today's webinar everyone. My name is Jeremy and I'm a research audiologist from the audiological science department here at now. It is my pleasure to be giving this presentation on behalf of my project team. In Australia we like to start off our speeches with an acknowledgement of the country. So before I dive into this presentation I wish to acknowledge the traditional custodians of the Eora Nation, the land and water on which we meet and I pay my respect to Elders past, present and emerging. And with that I would now like to start the presentation. By the end of this webinar we hope you will gain an increase in knowledge of our approach to this research project as well as an increase in understanding of the unmet needs of clients and audiologists that might be addressed through Connected Hearing Health. Throughout this presentation I will be using the terms tele-audiology and connected hearing health interchangeably to mean the use of technology to bring new ways of delivering hearing health care services and improving communication between clients and their audiologists. In 2019 a team of now researchers from the departments of digital signal processing, communication sciences and audiological science set out to investigate if there were any unmet needs of clients and audiologists in the tele-audiology landscape. The team engaged in a design thinking sprint which is an intensive group learning exercise that span approximately six weeks. During this time they left behind their own assumptions and biases in order to empathize with this population and gathered information about barriers and facilitators to tele-audiology services using surveys and interviews with stakeholders to define the problem. These stakeholders include individuals with lived experience of hearing loss, audiologists, staff members who facilitate tele-audiology sessions and hearing device manufacturers. The sprint team uncovered a number of findings some of which were unmet needs however in the interest of time and relevance to the pre-assessment project I will only present two of these and they are the effect of tele-audiology on the client-audiologist relationship and efficiency. By that I mean savings in time, travel and number of face-to-face appointments required. If you're interested in more details about this sprint I encourage you to tune in to next week's soundbar webinar which will be presented by my colleague and the tele-audiology sprint leader Nikki Chong-White. So the outcome of this sprint resulted in some very ecologically valid data and it also resulted in defining and prioritizing a set of unmet needs that now could translate into research actions to address them and one of these research actions resulted in our pre-assessment tele-audiology project. The pre- assessment tele-audiology project was built upon the foundations of this client and audiologist wish list. What became clear through our literature review and the sprint data is that a lot of tele-audiology services are being delivered for the latter part of the patient pathway but there is a gap, an opportunity where connected hearing health services hasn't received much attention. But what should we be doing in this pre-appointment or pre assessment space? With more questions come more discovery to be done. So the overall aim of this project was to find out what clients and audiologists currently do, want and or need between the time a client takes action like booking in an appointment and arriving at the clinic. The next question we asked is what role does connected hearing health play in all of this? So this time a different research team set out to do some more discovering but with a slightly different focus because we were now looking at a very specific timeframe within a patient's hearing journey. This involved a two stage investigative approach. Firstly the team conducted 15 ethnographic observations of initial hearing appointments across seven different clinics in rural and regional settings. It was a fly on the wall experience and this was important because while any clinical audiologist could describe to you what happened in initial appointments it is very different from experiencing it and capturing the nuances of the interactions and all that happens in the room. It's the idea of stepping into the shoes of the client and the audiologist that required a very different mindset. In fact I'd say that it was a blank mindset. We were a multi-disciplinary team of engineers, a speech pathologist, a behavioral scientist and research audiologists. So not everyone knew what initial appointments were like. We left behind our assumptions and biases at the door and just observed what happened in these appointments. And these observations led our team to appreciate that first appointments are very, very busy. This case history taking, otoscopy, hearing assessments, discussion of results and sometimes a bit of counselling was involved and in some cases a hearing atrial as well. Also a lot of rapid rapport building took place, decisions to be made, some clients had questions for audiologists and others didn't and some people obviously have done some Dr. Googling before they got there. Now what if we can allocate some of these components to free up some time in that initial appointment? What will clients choose to do after they take action and book in the appointment? And what would audiologists do with that extra time if they had it? More importantly my research team asked what role would connected hearing health serve in all of this? And with that we moved on to stage two of our investigations. The second approach we took to further our understanding of this pre appointment space involved conducting in depth interviews with audiologists and clients who had less than two years of experience with hearing aid use. We designed this interview guide in consultation with our public and patient involvement panel to ensure that our research remains relevant and has the potential of translating into clinical practice to create impact. The interview guide was developed with the combi model of behavior change and it consisted of open questions that encouraged our participants to recount their experiences and to explore with motivation and opportunities to manage behavior change might occur. For example, a question we asked our audiologist participant was what would you like to do or talk about with your new adult clients in that initial assessment appointment that you don't already do? And why? The answers will then enable us to see where connected hearing health solutions might fit in and potentially what those solutions look like. For those of you who are not familiar with the concept of a PPI panel, it is a consultative panel made up of stakeholders who has direct experience with issues we're trying to solve. For our PPI project, our PPI panel is made up of individuals with lived experience of hearing loss. They are not research participants, but they're part of the research team and their role was integral to co-designing of our research questions and methods. These interviews were then transcribed and our team conducted thematic analysis of the transcripts to extract common themes. And here's what our people had to say. For the client interviews, we found three recurrent themes emerged. And these relate to preparedness, expectations and trust. I'll now share some of these interview segments with you to illustrate the point. On preparedness, client one reflected on and compared his or her previous health care experience with their hearing appointment experience and said, Yes, information would have been brilliant. Really important. I know when I had an operation in 06, I was given a lot of information to make choices. So I felt that prepared me a little and I think now I go into every situation with that expectation. I'd like to have time and I'd like to have a buffer to take it all in and think it through. So clearly client one was anchoring his or her expectations that they would have some information about what to expect in their first appointment and would appreciate having the time to digest new information. On expectation, client number four said, I had no idea it would be so hard. I thought it would be like putting on glasses and walking away. To us, this demonstrated that the clients like our participants have encountered a mismatch between his or her expectations and experience with the hearing journey. So perhaps this is something that could be addressed before the client arrived at the clinic. On trust, again, this quote came from client number four, who was answering an interview question about whether he or she felt comfortable discussing the hearing issues with their audiologist at the first appointment. And client four replied, I do think it's important. It's a bit like a doctor. You have to have someone you feel you can trust. And we know that there's a lot of literature out there indicating that successful hearing outcomes for adult clients are associated with the strength of this client clinician bond. So it seems to us that there is an opportunity to address preparedness, expectations and established trust. If we consider capitalizing on that time when clients are doing nothing but waiting for the day of the appointment to arrive, which sometimes could be a day or two or even two weeks in some cases. What if we can address these while they're waiting to see you? And how might that happen? So I hope you remember what those three client interview themes were because we're about to experience a deja vu moment. This slide presents the three key themes from the audiologist's interviews, which are preparedness, motivation and rapport. On preparation, audiologist number one said, I will then ask whether they have had a hearing test? What do they think of hearing aids? Have they done any research on hearing aids? Do they know anything about the cost of hearing aids? And are they prepared to consider a hearing aid? The quote continues for a little longer with the audiologist asking a hypothetical client some more questions and then it ends with some assessing their motivation. What's interesting here is that the audiologist equates the term preparation with client motivation. Whereas when clients mentioned preparation, it was usually in relation to wanting more information to help them make more informed choices or wanting some more details about what to expect in that first appointment. So this highlights the need for some clarity around what both parties mean by the word preparation. On motivation, audiologist who said, one of the things I think was interesting for me, it is important to try and work out early what is a client's or what is a person's reason or motivation to come? Are they a reluctant dragged along participant? Or are they yep, I'm really motivated and keen to improve my hearing help. If you have that information fairly clearly, it does tend to frame that discussion. So what we're hearing here is that audiologists prefer to gauge a client's motivation and reason for attending an appointment very early on so they can plan ahead for those discussions in that first appointment. Lastly on rapport, whoops, rapport. Okay, again, we have audiologists too who said I'd like to explore that bit a bit more and not feel rushed and cursory. That's potentially valuable. It's almost like a mini counseling sometimes and you can't do that in a hurry. If you really need to get to the nitty gritty and help tailor things a bit more for the client, then sometimes a bit more time would be good and not feel that you're having to rush. And there's that next person waiting out there. So we've captured that answer from audiologists too when we asked them if you could change something about the way your first appointment to currently structured. What would that be? So it seems we're staff clinicians want to spend more time building up that rapport and trust with their clients, but they don't currently have that extra time to do this. Again, what can we do in this pre-assessment space and how? So to sum up the bigger picture, the findings from these interviews revealed a converging needs and wants of clients and audiologists to be better prepared by the time they arrive at this initial appointment and build that trust and rapport very early on. And what we're seeing is an opportunity for audiologists to reconsider the clinical pathway. So while clients embark on their patient journey much earlier from the moment they're aware of their hearing issues and making that appointment to see an audiologist, what can audiologists do to match the start of this journey? What can they offer to their clients before meeting them for the first time? Or what do they currently do to facilitate client preparedness? And how do you establish this trust and rapport even before the client attends their first appointment? And how can you enhance this via connected hearing health means? Lastly, this type of research would not be possible without our research participants. These are individuals with lived experience of hearing loss, their communication partners, their families and audiologists, all of whom generously gave us their time and trust to champion the cause to help improve hearing health and wellbeing for many people with hearing difficulties. So if you wish to take part in shaping our research, here is our QR code to sign up to our Hearing Health Professionals data piece. And it's a very quick five minute process. I'd also like to shine the spotlight on some upcoming soundbites webinars on connected hearing health. And these will be brought to you by these friendly faces here, my colleagues Mel, David, Tagan and Paula. So please keep your eyes and ears out for the soundbite schedule for these talks and many more. Last but not least, some acknowledgments that do. I'd like to say a big thank you to our research participants, our PPI panel members. You are what drives our people centered research because it won't be about you without you. Thank you also to the tele-audiology sprint team that generated the research project that we're currently doing as it was based on the perceived needs of these clients and audiologists. And thank you also to my wonderful, wonderful project team, Mel, Niki, Margot, James, Jess and Liz. And all of this will not be possible without the wonderful now soundbites production team, Scott Brewer, Jess Cooper and our lovely Xiao Ying. You're doing a fantastic job.