Gabrielle (Gaby) Saunders

Research Area Manager

Health Behaviour Change in Adults with Hearing Impairment

This project studied Health Behaviour Change in adults seeking hearing help for the first time. This project was carried out in collaboration with the National Center for Rehabilitative Auditory Research, Portland, OR, USA. 

From health psychology to audiology

Successful hearing aid rehabilitation depends to a large extent on people’s motivation, attitudes, and beliefs about hearing disability and hearing aids (Knudsen et al. 2010). This study applied models of health behaviour change commonly used in psychology to adults seeking hearing help for the first time. This study focused on the Health Belief Model (Rosenstock 1966) and the Transtheoretical Model (Prochaska & DiClemente 1983). These two models had already shown promise for explaining health behaviour change in adults with hearing impairment (Laplante-Lévesque et al. 2013; Saunders et al. 2013).

This project assessed the beliefs about hearing rehabilitation of adults seeking hearing help for the first time, and examined how these beliefs relate to whether people take up hearing aids and do well with them.

 Furthermore, this project developed and tested an intervention to change for the better the hearing attitudes and beliefs of people who had yet to seek help.

Assessment of hearing health beliefs

Participants (n=182) were adults with hearing impairment who are seen for the first time at an audiology clinic in Portland OR, US. The participants completed several questionnaires, including the Hearing Belief Questionnaire of Saunders et al. (2013) based on the Health Belief Model, and the University of Rhode Island Change Assessment of McConnaughy et al. (1983) based on the Transtheoretical Model. Responses on the two questionnaires above showed that the two models complement each other when describing motivation to take up hearing aids.

Six months later, most of the participants (n=160) reported whether they had acquired hearing aids and how they were doing with them. Participants who had exhibiting more positive beliefs and more motivation six months earlier were more likely to have taken up hearing aids. More specifically, people who took up hearing aids perceived their hearing problems as more severe, saw more benefits for hearing aids, had been prompted more to seek hearing help, and had more self-confidence in their abilities to become successful hearing aid users. An intervention was developed to promote those beliefs, and tested.

Development and test of a brief intervention to increase health behaviour change

An intervention that a health care provider without audiology expertise could quickly administered was developed. The intervention aimed to alter perceived benefit, severity, cues to actions, and self-efficacy. The intervention provided experiential/affective messages through photographs depicting consequences of hearing impairment and people were asked to consider whether they could identify to these photographs or not. The intervention also promoted intrinsic motivation by providing information about hearing help seeking.

The intervention was then tested in a randomised trial. People attending a primary care clinic appointment in Portland OR, US and who reported hearing difficulties but who had never sought hearing help were recruited (n=101). When attending, they received nine photographs to prompt reflections about whether their hearing difficulties impact them. They then had a short (less than 10 minutes) discussion with the healthcare provider where, if any negative impacts were identified, the healthcare provider gave information regarding help-seeking.


These are the 9 images used for the brief behavior change intervention.

Six months later, 12 of the 41 participants (29%) who received the intervention had sought help, compared to 7 of the 46 participants (15%) in the control group. Participants who received the intervention were 2.3 times more likely to have sought help.

Together, the project supports that motivation is central to effective help-seeking and hearing aid rehabilitation, and that a brief intervention can address this motivation

Further reading

Laplante-Lévesque, A., Hickson, L., Worrall, L. (2013). Stages of change in adults with acquired hearing impairment seeking help for the first time: Application of the transtheoretical model in audiologic rehabilitation. Ear Hear, 34(4):447-57.

Saunders, G.H., Frederick, M., Silverman, S., Papesh, M. (2013). Application of the Health Belief Model: Development of the Hearing Beliefs Questionnaire (HBQ) and its associations with hearing health behaviors. Int J Audiol, 52(8):558-67.

Saunders GH, Frederick MT, Silverman SPC, Nielsen C, Laplante-Lévesque A (2016). Description of adults seeking hearing help for the first time according to two health behavior change approaches: Transtheoretical Model (stages of change) and Health Belief Model. Ear and Hearing, 37(3), p. 324-333

Saunders GH, Frederick MT, Silverman SPC, Nielsen C, Laplante-Lévesque A (2016). Health behavior theories as predictors of hearing-aid uptake and outcomes. International Journal of Audiology, 55(3), pp. 559-568.

Saunders GH, Frederick MT, Silverman SPC, Nielsen C, Laplante-Lévesque A (In press). Development and pilot evaluation of a novel theory-based intervention to encourage help seeking for adult hearing loss. Journal of the American Academy of Audiology.

Learn more

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    A novel intervention to promote help seeking for hearing loss

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    Study Partners

    Gabrielle Saunders, Melissa Frederick and ShienPei Silverman, National Center for Rehabilitative Auditory Research (NCRAR), Portland OR, USA, were collaborating on this research project.