Factors affecting help-seeking behavior for hearing rehabilitation in Singapore. by Professor William Martin, Ph.D. & Low Liwen Isabel
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1 Factors affecting help-seeking behavior for hearing rehabilitation in Singapore by Professor William Martin, Ph.D. & Low Liwen Isabel
2 Hearing loss in Singapore Prevalence of hearing loss in the World in 2010: 5.3% => 360 MILLION PEOPLE (by WHO) Prevalence of hearing loss in Singapore in 2010: 2.9% (according to National Health Survey)
3 Hearing loss in Singapore Country Year published Age (years) Singapore (Lim & Yap, 2000) Singapore (Wu et al., 2004) Hearing loss prevalence using 4FAHL (%) Mild HL At least moderate HL Total HL ELDERLY POPULATION (screening at 40 db BEHL) (screening at 50 db HL) - 83 (screening at 30dB HL) Previous studies on prevalence of hearing loss in Singapore do not follow the WHO definitions of hearing loss.
4 WHO definitions of hearing loss Mild hearing loss: db HL in the better ear Disabling hearing loss (or at least moderate hearing loss): >40 db HL in the better ear
5 Country Year published Age Hearing loss prevalence using 4FAHL (%) (years) Mild HL At least moderate HL Total HL ELDERLY POPULATION WHO estimates U.S. [NHANES] (>25 db BEHL) UK [National Study of Hearing] Sweden (Johansson & Arlinger, 2003) Australia (Hickson et al., 1999) Australia (Wilson et al., 1999) Korea [Kanghwa-do] (Kim et al., 2000) ( 45 db BEHL) ( 25 db BEHL) (>25 to 40 db BEHL) 17 (>40 db BEHL) 1999 > ( 45 db BEHL) ( 41 db both ears) ( 25 db BEHL) 43.4 ( 27 db both ears) U.S. [BOSS] (>25 db WEHL) Singapore (Lim & Yap, 2000) (screening at 40 db - Singapore (Wu et al., 2004) BEHL) (screening at 50 db HL) 83 (screening at 30dB HL)
6 Hearing aids in Singapore Hearing aid adoption rate in Singapore in 2010: 1-3% (according to National Health survey) Acquisition of amplification by individuals with disabling hearing loss in Singapore (Tang, 2015). Hearing aid adoption rate: 61% This was taken from a hearing aid clinic in a hospital What about the hearing loss population that has not sought help?
7 The Transtheoretical Model RELAPSE Maintenance: Consistently using hearing aids Precontemplation: Feels that there is no hearing problem Contemplation: Have a hearing problem and considering to do something about it Action: Bought hearing aids Preparation: Taking steps like seeing a doctor
8 Aims 1. Document the prevalence of hearing loss among an adult population 50 years old in Singapore using WHO definitions 2. Identify factors affecting help seeking behaviour for hearing loss
9 Hypotheses for factors that could influence help-seeking behavior 1. Degree of hearing loss 2. Recognition of hearing loss 3. Stage of change in the Transtheoretical Model 4. Attitudes towards hearing aids
10 Initial study 1. Site: Ghim Moh Sub-Planning Zone 2. Random selection of 2800 housing units 5. Out of these 594 respondents: 235 individuals agreed to go for a hearing test The hearing test also included counseling and hearing rehabilitation options 3. Inclusion criteria: Adults 50 years old Singaporean / Permanent Resident 4. Obtained: 594 respondents Answered questionnaire A to obtain: (1) Demographics (2) Hearing status, HHIE-S The 235 individuals who went for the hearing test were categorized as POPULATION 1, PHASE 1
11 Went for hearing test: 122 had at least mild hearing loss (>25 db HL) in the better ear Follow-up study 154 individuals included Did not go for hearing test: 32 had significant selfreported hearing handicap Obtained: 117 participants Answered questionnaire B to find out: (1) Did they consult medical help for hearing after Phase 1 (2) Reasons that would convince them to consult medical help / acquire hearing aids (3) Attitudes towards hearing aids and Staging Algorithm The 117 individuals who participated in the follow-up study were categorized as POPULATION 2, PHASE 2
12 POPULATION 1, PHASE 1 Hearing loss percentages for the better ear 1. Adults 50 years old: Mild HL: 34.5% At least moderate HL: 17.4% Total HL: 51.9% 2. Men 50 years old: Mild HL: 31.9% At least moderate HL: 24.5% Total HL: 56.4% 4. Elderly 65 years old: Mild HL: 40.5% At least moderate HL: 23.8% Total HL: 64.3% 3. Women 50 years old: Mild HL: 36.2% At least moderate HL: 12.8% Total HL: 48.9%
13 Country Year published Age (years) Hearing loss prevalence using 4FAHL (%) Mild HL At least moderate HL Total HL ELDERLY POPULATION (26-40 db BEHL) (>40 db BEHL) (>25 db BEHL) Singapore [current study] WHO estimates U.S. [NHANES] UK [National Study of Hearing] Sweden (Johansson & Arlinger, 2003) Australia (Hickson et al., 1999) Australia (Wilson et al., 1999) Singapore (Lim & Yap, 2000) Singapore (Wu et al., 2004) (>25 db BEHL) ( 45 db BEHL) ( 25 db BEHL) (>25 to 40 db BEHL) 17 (>40 db BEHL) 1999 > ( 45 db BEHL) (screening at 40 db BEHL) (screening at 50 db HL) ( 25 db BEHL) - 83 (screening at 30dB HL) When using the WHO definitions of hearing loss, the prevalence of hearing loss in the elderly in Singapore was comparable to that reported in other countries
14 POPULATION 2, PHASE 2 20% consulted medical help for hearing after Phase 1 Reasons for consulting medical help for hearing No response 4% Routine checkup 11% Self-perceived hearing problem 15% Others 11% Medical conditions of the ear 26% Referred from hearing test 22% Others recommend 11%
15 POPULATION 2, PHASE 2 Factors significantly associated with consulting medical help for hearing: 1. HHIE-S 2. Stage of change at Phase 1 3. Social pressure (p<0.001) 4. Living status may be related to Recognition of hearing loss Family and friends tell me I have hearing loss. Family and friends encourage me to use hearing aids. Recognition of hearing loss Social pressure
16 POPULATION 2, PHASE 2 Reasons that would convince participants to consult medical help for hearing No response 3% Others 7% No reason will convince 22% Hearing deteriorate 34% Routine checkup 5% Self-perceived hearing problem 29%
17 POPULATION 2, PHASE 2 Reasons that would convince participants to use hearing aids No response 1% Others recommend 1% Hearing aid properties 4% No reason will convince 18% Cheaper hearing aids 11% Doctor recommend 15% Self-perceived hearing problem 35% Hearing deteriorate 15%
18 POPULATION 2, PHASE 2 Factors significantly associated with HHIE-S (self-reported hearing handicap): 1. Stage of change at Phase 1 (p<0.001) 2. Social pressure (p<0.001) 3. Degree of hearing loss
19 Discussion on applying the Transtheoretical Model to hearing rehabilitation The Transtheoretical Model is an intrapersonal theory Social pressure is indicative of interpersonal factors influencing behaviors more than intrapersonal factors Use interpersonal theories to come up with management strategies to deal with help-seeking behavior Eg. Social Cognitive Theory: Reciprocal determinism
20 Limitation of using the Transtheoretical Model in this study Different ways were used to chart the stages of change in Phase 1 and Phase 2 Used a defining step in the area of hearing rehabilitation that relates to the Transtheoretical Model: Consulting medical help for hearing
21 Conclusion Standard definitions of hearing loss should be used when reporting prevalence. Social pressure and recognition of hearing loss are two main factors of help-seeking behaviour for hearing loss in Singapore.
22 Future work 1. How does social pressure affect help-seeking behaviour? Socially active vs not socially active 2. What factors affect maintenance of hearing rehabilitation?
23 THE END Thank you for your attention
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