The aim of the study was to describe the current practice of audiologists counseling adult clients requiring amplification focusing on the nature and extent of services provided and perceptions of factors influencing practice within the South African context. All practitioners were registered with one of two professional audiology associations, the South African Association of Audiologists (SAAA) and the South African Speech and Language Hearing Association (SASLHA).
LIST OF TABLES
PAGE
LIST OF APPENDICES
CHAPTER ONE
INTRODUCTION AND RATIONALE
Introduction
Study background
The Health Professionals Counsel of South Africa (HPCSA, 2012) outlines in the scope of practice for audiologists that counseling is one of ten clinical services offered by the profession. Research shows that although hearing aid technology has advanced significantly over the past twenty years, there has been no increase in hearing aid use; only one in five adults has reportedly used hearing aids (Kochkin, 2007).
Definition of terms
Personal adjustment counseling: Audiologists focus on the duration of hearing loss and healthy incorporation of hearing loss into a client's self-image. Client/Patient: These terms are used interchangeably in this thesis to refer to the individual with hearing loss who is in need of Audiology services.
Abbreviations
This chapter also included the research question, rationale for the study, and definitions of the terminology used. This chapter highlights the methods adopted by the researcher to achieve the purpose and objectives of the study.
Summary
This chapter presents and discusses the study's findings based on results from a descriptive online survey. The interpretation of the results and the discussion of the results are presented simultaneously with the use of the available literature.
Introduction
The nature of acquired hearing loss in adults
- Barriers to acceptance of hearing loss
Group members recognize that it is not uncommon for individuals with hearing loss to feel ashamed, diminished, and denigrated. Unmet expectations and dissatisfaction with the sound of hearing aids are the main reasons why individuals with hearing loss end up shelving their hearing aids (Kochkin, 2007).
Counseling
- Types of Counseling
- Importance of counseling
- Pathway of counseling
Personal adjustment counseling helps the client and the family to deal with the emotional impact of the information (Margolis, 2004). When performing the hearing evaluation, the audiologist is primarily responsible for providing informational counseling to the client.
Counseling in the Audiology profession
Audiologists must attend to the client's needs to facilitate faster acceptance of hearing loss and become successful long-term users of amplification. Counseling should then be tailored to meet the client's needs by setting realistic expectations.
Training of audiologists
It means involving and encouraging the client to be active in the decision-making process of the rehabilitation plan (Hickson, 2012). Most audiologists are in the private sector providing services to a minority of the population who can afford these services.
Introduction
Aim and Objectives .1 Aim
- Objectives
Research design
The data were used to describe and explain the state of phenomena, views and reporting on current practices and for comparisons. A 58-question web-based questionnaire for registered audiologists in South Africa was used to explore, describe and compare differences in counseling offered to adult clients who required counseling rather than hearing amplification.
Study area and participants
- Inclusion and exclusion criteria
- Participants age and gender
- Description of participants’ educational background
A purposive sampling technique was used in this study, as it allows a specific population to be targeted (Maree & Pietersen, 2007), namely the audiologists who belonged to a professional association in South Africa, who are believed to be the most active members of the profession. The largest number of participants fell in the younger age category under the age of 35.
Age of Participants (n=150)
Participants Educational Background (n=150)
Sector of practice
The majority of participants, 60% (90) participants in this study reported working in the private sector, 20% (30) participants reported government hospital as their practice sector while only 9% (13), a minority of the participants were within government schools, hearing aid manufacturer and special needs school. None of the participants in this study reported working in a nursing home and in the category labeled "other" 17 of the participants (11%) indicated that their daily practice environment consisted of government clinics, private schools, consultants or tutors.
Years of clinical experience
The bar graph above shows the distribution of the time the participants spent in the profession. Seven (4.86%) participants reported having 0 years of clinical experience, meaning that this group of participants was in their first year of clinical work after graduation, ie.
Employed in client-contact environment
Percentage of work day spent on client-contact activities (n=144)
Development of questionnaire
The questionnaire was designed with a number of questions, most of which had to be selected from a list of five answers provided, to allow analysis of the closed questions. Multiple Choice Questions: A closed question method where participants can choose an answer from a range of options offered.
Percentage of case load who are adult clients (>18 years) (n=145)
Description of questionnaire
The research tool was drawn from a study conducted in the early 1980s entitled Audiologists and Counseling (Flahive & White, 1981), with 20 questions from the original questions modified and included in the questionnaire. Therefore, an assessment of current skills confidence and future training needs will highlight future curriculum needs in the South African context.
Wording of
Minor changes have been made to facilitate the flow of the questionnaire, with the order of the questions being slightly adjusted; General interest All participants agreed that the questions were appropriate, addressed the necessary points of interest and that the questionnaire was comprehensive.
Overall interest All participants shared that the questions were appropriate, addressed the necessary areas of concern, and that the questionnaire was comprehensive
- Data analysis
- Validity and reliability
- Ethical and legal considerations
- Summary
- Introduction
- Nature of counselling
- Counseling need versus counseling received by adult clients
- Average amount of time spent counseling
Voluntary participation involved respondents clicking on the link that directed them to the survey consent page (Appendix E). The consent form outlined the purpose, non-invasive and voluntary nature of the study.
Average amount of time spent counseling
When we look more closely at the estimated time spent per client per session on the various counseling activities with adult clients, participants indicate that the majority of their time is spent solely on counseling the adult client (see Figure 4.1). When asked about the average time spent counseling the adult and partner, results indicated that approximately half (49%) of participants spent 0-15 minutes with both parties, as shown in figure 4.1.
Average amount of time spent on the three types of counseling
Looking further at the time spent on the three types of counselling, Figure 4.2 shows that on average the majority of participants spent 0-15 minutes on counselling. The data in Figure 4.1 and Figure 4.2 indicate a similar trend: less time is spent on counseling as time increases.
When are the three types of counseling incorporated into practise?
Addressing the impact that hearing loss has on the client and family
The impact that hearing loss has on the client and their family is an important aspect of understanding the strain and emotional impact that both parties experience. The majority of participants (98%) were given information about the impact of hearing loss on the client based on information gathered.
How is the impact hearing loss has on client and family lives addressed?
Counseling skills .1 Rating of skills
Participants were asked to rate their skills in three areas of counselling, Figure 4.5 below shows their perceived skill.
Rating of counseling skills by Audiologists
Important attributes and skills that make a competent audiologist
Participants rated the attributes and skills that make a competent audiologist as shown in Figure 4.6.
Rating of attributes and skills that make a competent Audiologist
Strengths of Audiology participants
Active listening”, “good listener”, “good listening and communication skills”, “active listening”, “Ability to listen”, “the ability to listen”, “Really listening”. Experience in working with clients with hearing loss and hearing aids", "Good knowledge of technology",.
Current challenges faced by Audiologists in South Africa
- Types of counseling covered during professional training
- Perception of counseling skills
Participants indicated that during their professional training the following three types of counseling were covered; informational counselling, rational acceptance and adjustment counselling. Sixty-nine percent (69%) of the participants indicated that their professional training covered all three types of counseling.
Do you agree with the following statements?
Perceived need for training in counseling
When the audiologists' assessment of their skills was compared with their perceived need to improve their skills, it was interesting to note that informational counseling received the least need, while the need for further education in rational acceptance and adaptation counseling was greater (moderate and high need) on a five-point Likert scale seen in figure 4.8.
Perceived Need for Further Training in Counseling (n=149)
When the audiologists participating in the study were asked to indicate whether they would like to increase their counseling skills within Audiology in managing adult clients, an overwhelming majority of 82% of participants indicated yes, while only 8% said no and a minority of 8 .% were unsure. Audiologists were also asked for their suggestions for improving counseling of adult clients who need hearing aids; Table 4.6 below shows a summary of suggestions for the client and the audiologist.
Would you like to improve your skills of counseling within Audiology in managing adult
The suggestions mentioned below are very interesting as there are very practical examples that can be immediately applied in everyday practice.
Summary
The findings in this chapter support the literature and highlight areas of deficiency within the three types of counseling. Although audiologists rated their counseling skills highly, most participants indicated a need to improve their counseling skills regarding adult clients who need hearing aids.
Ways to increase knowledge of counseling within Audiology (n=126)
Introduction
To describe the nature of counseling offered by audiologists to adult clients who require hearing aids. To describe their views on the skills needed to counsel adult clients who need hearing aids and challenges.
Description of participants and context
When comparing this to the Flahive and White (1981) study, of the 266 participants who took part in the study, 50% of the participants reported six or more years of clinical experience and only 76% were employed full-time. The majority 90% of participants reported that they were employed in client contact settings and 55% of participants reported that >60% of their day was spent on client activities, which is 14% less than this research study.
Nature of counseling
- Counseling need versus counseling received
- Counseling incorporated into daily practice
- Addressing the impact that hearing loss has on the client and family
Evidence points in the direction of Audiological counseling using the client-centred approach (Cienkowski & Sanders, 2013). This may indicate a lack of time on the part of the audiologist or a lack of need on the part of the client.
Counseling .1 Rating of skills
- Important attributes and skills that make a competent audiologist
- Strengths as an Audiologist
This indicates that audiologists in South Africa are aware of the required qualities and skills that make a competent audiologist. This suggests that audiologists in South Africa are aware of the main characteristics that lead to competent audiologists recognizing their practice of these skills.
Current challenges faced by Audiologists in South Africa
In Figure 4.6 (Section 4.3.2), the results show the ratings of characteristics and skills that make a competent audiologist, sorted from very important to not at all important (five to one) on the Likert scale. Although most of the literature presented is of international standing, it is important to note that regardless of where in the world the client lives, the barriers to acceptance of their hearing loss manifest in the same way.
Training in counseling
- Types of Counseling covered during professional training
The themes that emerged in the study and related to clients are consistent with the literature presented earlier (Section 2.5) in relation to barriers to accepting hearing loss, namely; ownership, self-identity, stigma, self-efficacy, and unmet expectations. This disparity with the results shown in Figure 4.9 may suggest that participants may have reported their skills more favorably, which can be explained by the Hawthorne effect.
Summary
The strengths and limitations of the study are highlighted and suggestions for future research are made. The chapter will end with a summary of the entire study which provides a holistic view of this research finding.
Summary of the study
Strengths of the study
Limitations of the study
Participants appeared to be recent graduates, and the majority reported less than ten years of clinical experience. This study was based on audiologists self-reporting their skills, which may have led to the Hawthorne effect, than if their skills were observed.
Implications of the study
This is an indication that high-end technology may only be made available to the private healthcare system in South Africa.
Recommendations for future research
Most of the information collected from the client is obtained during the case history; an inquiry should be made as to what type of questions/areas need to be addressed in order to gather the right information about the client.
Summary
Factors influencing help-seeking, hearing aid acquisition, hearing aid use, and satisfaction with hearing aids: A review of the literature. Hearing healthcare professional influence on hearing aid user success - Correlations between delivery protocols and successful patient outcomes.
