Issues in Motivation British Academy of Audiology Monday Nov 18, 2013 Manchester, England

Transcription

1 Issues in Motivation British Academy of Audiology Monday Nov 18, 2013 Manchester, England Douglas L. Beck Au.D. Director of Professional Relations Oticon Inc. Somerset, NJ

2 The numbers. 1 in 10 have hearing loss. 1 in 4 will seek diagnosis/treatment. 1 in 2 (who come thru the door) do nothing. (Of those with SNHL, 10%, 2.5%, 1.25%)

3 3 1.25%? ARE YOU KIDDING ME?

4 Amlani AM. (2013) Influence of Perceived Value on Hearing Aid Adoption and Re- Adoption Intent. Hearing Review Products March:8-12. Hearing aid adoption rates have been flat for 25 years. FIRST TIME USERS have decreased, 53 percent in percent in Fewer than half re-adopt their previous brand. Purchase and re-purchase intent is predicated on perceived price, perceived quality, and, most importantly--perceived value. As perceived value increases, so, too, does likelihood of purchase (and re-purchase).

5 Insanity Doing the same thing over and over and expecting a different result

6 What ISSUES do MODERN PATIENTS identify as IMPEDIMENTS?

7 Galston & Stevens (2013) Clinical Topics in Hearing Aid Research Chapter titled What Motivates Hearing Aid Use? Refer to Jenstad & Moon (2011) Systematic Review of Barriers and Facilitators to Hearing Aid Uptake in Older Adults. In Audiology Research Investigate studies with more than 50 subjects, over age 65 yrs, never worn hearing aids. 14 papers met inclusion criteria. Stigma was predictive of hearing aid uptake, but was inconsistent. Degree of hearing loss was a significant factor, influenced by gender (more females willing to wear Has as h loss increased). Gender NOT strong factor. Personality and Psychology mattered HA seekers were more open, less neurotic and more agreeable Cost was an issue sometimes, not consistently. DISCUSSING these factors at the outset Good idea!

8 Amlani AM. (2013) Influence of Perceived Value on Hearing Aid Adoption and Re-Adoption Intent. Hearing Review Products March:8-12. Negative perceptions in VALUE preclude purchase intent. (i.e., pts don t think HA are worth it! (it = time, trouble, money )

9 Kochkin, S (2012): MarkeTrak VIII: The Key Influencing Factors in Hearing Aid Purchase Intent. Hearing Review,. VIEWPOINTS OF NON -ADOPTERS: Half of non-adopters, no hearing test last 10 years. Online hearing checks (BHI validated), could influence people. Reducing out-of-pocket cost. Insurance coverage & less than $500 hearing aids, rank high (#1 and #4, respectively). HOWEVER, hearing aids are price-inelastic, even if hearing aids were free, only 56% of the non-adopters would become hearing aid users (PROVIDED TO YOU FOR FREE, Hugs, NHS!) Guarantees. Money-back guarantee (#2) is the top product feature sought by potential consumers of hearing aids, and a 90-day trial period (#14) also ranks high! Increasing reliability and reducing repairs. Higher reliability (#3) and reduced cost of repairs (#6) would influence significantly more people to adopt hearing aids.

10 Kochkin, S (2012): Perceived Shortcomings. The image of hearing aids among non-adopters comes from the literature and the media, as well as talking to or observing people who use hearing aids. Non-adopters rate the se features very high: No feedback or whistling (#7), comfortable to wear (#8), volume control (#9), and much better sound quality (#10). Physicians as significant influencers. The most important social influencer of those presented in the consumer's life is the family physician (#33); the least important influencer is an admired celebrity who wears a hearing aid (#53). Reducing perceived stigma. The top psycho-social issue is the stigma of wearing aids (#15), and thus CIC and IIC make very good sense.

11 Kochkin, S (2012) Audibility of "soft sounds" and telephone conversation. When presented with seven listening situations, potential consumers rate the ability to hear soft sounds first (#12), followed by hearing aids working perfectly on the phone (#19). Less-important factors. Product enhancements with very low ratings are: built into fashionable eyeglasses (#44), an implanted hearing aid (#47), wireless connection to MP3 player (#50), foreign language translator in hearing aid (#51), and FM radio built into hearing aid (#52). Financial well-being. Improvements in the value of stock and bond valuation would not improve demand for Has. However, significant improvements in the economy would.

12 THE FINAL WORD: Better Methods for Helping People Help Themselves June 2013 Dennis Van Vliet, AuD Hearing Review We (audiologists) need to adapt our methods rather than assume we can continue on a model that hasn t changed much in the last 40 years. The new user will have a life experience repertoire that will allow them to use interactive tools so they can do more to adapt to and maintain their hearing aids. We should embrace this so we can spend our time helping patients get started with the process.

13 How to fit hearing instruments to challenging people. Influence Motivational Interviewing

14 Robert B. Cialdini Ph.D. Influence: Science and Practice

15 Reciprocation Giving back, shaking hands, salutations, charitable groups sending trinkets. trial periods with amplification

16 Scarcity Scarcity Wanting more of what you can only have less of. The perception of scarcity increases demand and desirability. Combine products and skills, dentists, optometrists

17 Authority Knowing the professional is an authority, display credentials, certificates etc

18 Commitment & Consistency People want to be consistent. Words predict behaviors. Important part of Motivational Interviewing

19 Liking People like to work with people they like. Genuine two way street. Friendly, not threatening.

20 Consensus, Proof... Seek others JUST LIKE ME, scrapbooks, testimonials

21 How to fit hearing instruments to challenging people. Influence Motivational Interviewing

22 Ambivalence

23 Ambivalence: Freud: All major decisions involve ambivalence. The co-existence of opposing thoughts. Love/Hate, Yin/Yang, Yes/No, Good/Bad, Right/Wrong.

24 Motivational Interviewing William R. Miller and Stephen Rollnick 2002 The Guilford Press

25 Motivational Interviewing: Used with drug addicts, smokers, obesity, alcoholics. To elicit an intrinsic motivation to change.

26 From: Building Motivational Interviewing Skills A Practitioner Workbook Rosengren, DB. (2009): The Guilford Press Our goal is to move them along the readiness continuum.

27 Change Is Really Hard. Increasing the severity of the negative outcome doesn t alter the negative behavior. People don t always do what s in their own best interest.

28 Motivational Interviewing The audiologist sets up a context in which the patient states the reasons for change.

29 MI Rules of Engagement: Ask the RIGHT questions. Don t ask the WRONG questions.

30 Is this REALLY the best question to ask an alcoholic? Do you have a problem drinking?

31 Nope. I drink, I fall down, no problem.

32 KEYS TO MI: Ask the right questions. Don t ask the wrong questions.

33 Wrong Question Do you think you have hearing loss?

34 Wrong Question Do you think you need hearing aids?

35 Wrong Question Does your hearing loss cause problems?

36 Wrong Question Are you concerned about your hearing loss?

37 The Ultimate WRONG QUESTION

38 How does that sound?

39 RIGHT QUESTION What caused your hearing loss?

40 Right Question Has your hearing loss gotten worse?

41 Right Question How long have you had hearing loss?

42 Right Question Which is worse, a noisy cocktail party or a noisy restaurant?

43 Right Question Many of my patients with similar hearing loss tell me women s and children s voices are very difficult Is that true for you, too?

44 Right Question: How long have you difficulty hearing?

45 Do not wrestle When you push, they pull Don t challenge them, don t draw a line in the sand, don t back them into a corner.

46 Do not use the audiogram as a weapon!

47 Mother Theresa Before you speak, it is necessary to listen. They may not remember what what you said or did, but they will remember how you made them feel.

48

49 Why can t I save time and administer a questionnaire? It s important for your patient to tell you their story. RAPPORT, TRUST, LIKING.

50 Don t think of it as SELLING hearing aids, sell the outcomes patients seek!

51