To Örebro University

Introduction: To address communication barriers, minimise social isolation, prevent psychosocial illness and increase the independence of Deaf older adults, a mobile care team consisting of Deaf assistant nurses using sign language was initiated and developed by a nongovernmental organisation in a region in southern Sweden.

Aim: To describe Deaf older adults’ experiences receiving support from an NGO-initiated mobile old-age care team for Deaf and sign language-speaking older adults in Sweden.

Methods: A series of 15 individual interviews with four Deaf older adults were analysed via content analysis.

Results: Support from the mobile care team was appreciated, as illustrated by the following categories: support in everyday activities, communication supported and enabled and support for psychosocial well-being. The care team facilitated communication using sign language. For example, they enabled in-depth communication and information sharing and supported older adults in expressing opinions and thoughts to authorities and regular care staff. Increased communication supported psychosocial well-being, independence, and feelings of safety.

Conclusion: A sign language mobile care team that is well familiar with Deafness as a culture rather than a hearing disability is highly valued by Deaf older adults in need of home or residential care later in life. It also shows that access to a sign language mobile care team leads to increased psychological wellbeing and happiness among Deaf older adults, as well as to their increased participation in decision-making concerning various aspects of their lives.

OBJECTIVES: Hearing loss is among the most common chronic conditions worldwide, substantially affecting daily life. Its management typically involves person-centered rehabilitation focusing on hearing aid fitting and active client participation. The Empowerment Audiology Questionnaire (EmpAQ) is a self-report instrument assessing empowerment, available in 15- and five-item versions. The EmpAQ was recently translated into Swedish (EmpAQ SWE), with satisfactory content validity, convergent validity, and reliability. This study aimed to further evaluate the EmpAQ SWE by examining its construct validity.

DESIGN: Adults with hearing loss (pure-tone average > 20 dB HL in the better ear) were invited to complete a digital survey (n = 1,176); 152 participants responded. The survey included demographic questions and both EmpAQ-15 and EmpAQ-5. Rasch analysis was applied to assess item targeting, threshold ordering, item fit, differential item functioning (DIF), local dependency (LD), unidimensionality, and reliability.

RESULTS: The EmpAQ SWE demonstrated acceptable measurement properties with adequate item targeting, covering most individuals in the sample and distinguishing approximately three clinically meaningful empowerment levels. Unidimensionality was supported, confirming that the instrument measures a single underlying construct. DIF was identified for Item 1 of the EmpAQ-5 between working and nonworking participants, while Item 6 of the EmpAQ-15 showed misfit and weak discrimination. LD was observed within empowerment dimensions but without broader residual correlations. The person separation index (PSI) was 0.77 for the EmpAQ-15 and 0.55 for the EmpAQ-5. Mean person locations were 1.6 (SD = 1.1) and 1.1 (SD = 1.3), respectively.

CONCLUSIONS: The EmpAQ SWE demonstrated acceptable psychometric properties, supporting its validity for assessing self-reported empowerment among individuals with hearing loss in Sweden. Findings align with results from the original English version, reinforcing its clinical relevance. Future research should address item-level refinements to further enhance the instrument.

PURPOSE: The study investigated which hearing-related patient-related outcome measures (PROMs) are available for use within the Swedish hearing health care system. The study also investigated the translation process and psychometric evaluation of the identified PROMs.

METHOD: A two-step method, including a literature review and an online survey, was used. The respondents of the online survey represented public and private hearing-related health care systems in Sweden. Thirty-three hearing health care clinics participated, representing 20 of 21 counties in Sweden.

RESULTS: Within Swedish hearing-related health care, a variation in the applicable PROMs was found. Usually, PROMs were used for adult patients but also can be applied to children. PROMs were primarily used for post-rehabilitation evaluations or prior hearing rehabilitation for diagnostics and/or hearing need assessment. Most PROMs measured hearing aid benefit and tinnitus-related issues. Overall, the study identified 29 PROMs available in Swedish for which all but two were validated with the translation process described in 12 studies.

CONCLUSIONS: In Sweden, 29 hearing-related PROMs are available. Differences in PROM use between the hearing health care units were found, indicating a need for consensus and national guidelines.

OBJECTIVE: The overall aim of this study was to evaluate the construct validity, internal consistency and test-retest reliability of the Swedish version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ-SWE). The aim was to investigate how adults with hearing loss experience their everyday functioning from the perspective of hearing, using the HFEQ-SWE.

DESIGN AND STUDY SAMPLE: A quantitative cross-sectional survey study with 628 adults, aged 30-96 years (mean 74.4, SD = 10.3) recruited from audiological clinics in three counties of Sweden. The factor structure of the HFEQ was examined by confirmatory factor analysis via comparisons with the 6 subscales of the HFEQ: health, hearing, communication, participation in society, individual resources and societal support. HFEQ ratings were compared for the following variables: sex, level of education, employment and hearing aid usage.

RESULTS: With some modifications of the original HFEQ structure, a CFA showed sufficient model fit and confirmed the HFEQ construct. The internal consistency for the total score was satisfactory, and the correlations between repeated measurements showed stability over time for the total score. There were variations at item level and subscale levels. We identified broad variations in HFEQ ratings and found that the experience of everyday functioning is associated with factors such as age, gender, level of education, employment, and hearing aid usage. Significant correlations were found between self-reported hearing loss and 79% of the HFEQ items.

CONCLUSION: The overall study results strengthen the validity and reliability of the HFEQ and indicate satisfactory construct validity, internal consistency and test-retest reliability for the total score. Some items need further attention. Differences in the HFEQ rating were found at the item level for the variables of age, gender, education, employment, and hearing aid use, suggesting that these factors affect everyday functioning in addition to hearing loss.

PURPOSE: Hearing loss affects communication and participation. Empowerment initiatives support individuals to manage their condition and facilitate patient-centered care. The Empowerment Audiology Questionnaires (EmpAQ-15/5), recently translated and validated in Swedish (EmpAQ SWE), were evaluated for convergent validity, internal consistency, and test-retest reliability. This study evaluates the convergent validity, internal consistency, and test-retest reliability of EmpAQ SWE.

METHOD: A total of 136 adults with hearing loss completed an online survey twice. The survey consisted of EmpAQ-SWE and five measures assessing hearing disability, everyday functioning, hearing aid benefit, and general disability. For analysis, Spearman's correlation coefficient and Cronbach's alpha were used.

RESULTS: There were significant correlations between the EmpAQ SWE and measures of hearing disability (r = -.389), everyday functioning (r = -.350), and hearing aid benefit (r = .542 and r = -.326). There were no significant correlations between the EmpAQ and general disability. The test-retest results for the EmpAQ-SWE indicated strong reliability (r = .760) and moderate internal consistency (α = .678).

CONCLUSIONS: EmpAQ SWE demonstrated positive associations with everyday functioning and hearing aid benefit and negative associations with hearing disability. Although causality cannot be established, the findings support the convergent validity and reliability of EmpAQ SWE, underscoring its potential utility in clinical and research contexts.

PURPOSE: The aim of the current study was to translate the English original version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) to Swedish, evaluate the translation in terms of comprehensibility and relevance from a patient perspective, and culturally adapt the Swedish version (HFEQ-SWE).

METHOD: A six-step methodology including translation into Swedish according to best practice methodology, evaluation, and cultural adaptation of the HFEQ-SWE using qualitative focus group interviews was used in this study. Thirteen adults with hearing loss were recruited from the audiological clinic in Örebro, Sweden. Their mean age was 57 years, and the four-frequency pure-tone average for the best ear ranged from 5 to 115 dB HL.

RESULTS: The results demonstrated that most of the items in the HFEQ-SWE were viewed as relevant by the informants. Not all items were considered relevant for all people, which also reflect the individual variability of everyday functioning. Most items were recognized as comprehensible without any changes needed.

CONCLUSIONS: Overall, the results indicate that the translation is semantically and culturally valid from the patient's perspective. Some revisions were suggested that need to be addressed in the further validation process of the HFEQ, and one item was removed.

Purpose: Objective audiological assessments provide valuable insights on physiological dimensions of hearing loss (HL), but not on lived experiences and functional limitations perceived by individuals. This study employed the multidimensional ICF framework to explore how demographic and diagnostic variables predict self-reported disability in adults with HL.

Method: This cross-sectional study included 571 participants from India (94), South Africa (79), Sweden (219), and the USA (179). Responses from structured interviews based on the ICF were measured against demographic and diagnostic variables.

Results: 74.6% of the participants were hearing aid (HA) users with moderate-to-severe HL. Five statistically significant predictors were identified; HA usage, degree of HL, level of education, age, and income bracket. The predictors were associated with the ICF components; body functions (b126, b210, b230, b240), activity and participation (d310, d350) and environmental factors (e125, e250, e310, e355, e410, e460).

Conclusions: This study emphasises that an individual's experience with HL is significantly influenced by various factors beyond the severity of the HL itself. This underscores the ICF's utility in capturing the complex interplay of biopsychosocial factors on HL. Identifying significant predictors could aid in tailoring interventions to improve health outcomes and quality of life for individuals with HL.

PURPOSE: The aim of the current study was to explore the construct validity and internal consistency reliability of the International Classification of Functioning, Disability and Health (ICF)-based original English version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) and to revise the HFEQ based on the results.

METHOD: This study used a cross-sectional survey design. The data were collected using an online survey. Adults with self-reported hearing disability (n = 513) from the United States were included. The ICF components of body functions, activity and participation, and environmental factors were tested as the underlying structure of the HFEQ using confirmatory factor analysis and then adjusted by triangulation with previous content validation.

RESULTS: The results of the current study confirmed the ICF components of body functions, activity and participation, and environmental factors as underlying constructs of the HFEQ. However, after triangulation with previous content validation, fine adjustments were made. The revised version of the HFEQ includes two removed items and a fine-tuned factor structure.

CONCLUSION: The results confirm that the structure of the HFEQ aligns with the ICF, and the overall results indicate that HFEQ has acceptable construct validity and internal consistency.

The effects of hearing loss on adults’ everyday life can be pervasive and far-reaching. Adults with hearing loss may experience difficulties with interpersonal communication, psychosocial well-being, quality of life, and even economic independence. This chapter will focus on adults with acquired permanent hearing loss and will utilise the International Classification of Functioning, Disability and Health (ICF) framework to assist professionals in considering the client holistically during clinical and rehabilitation encounters. Three fictitious cases are presented to illustrate the opportunities and challenges faced by three adults with acquired hearing loss living in varying circumstances. The information presented, along with these cases, provides practical guidance for professionals who are not experts in supporting these individuals and their families in accessing equitable services. The authors aim to inspire the adoption of the proposed tools and communication strategies to bridge the communication gap between professionals and clients in clinical and rehabilitation settings.

OBJECTIVE: Translating the newly developed Empowerment Audiology Questionnaire, EmpAQ-15 to Swedish, and performing content validation on the Swedish version.

DESIGN: Best-practice principles using forward and back translations which were revised by a committee prior to field testing. Field testing was conducted by cognitive interviews with hearing-aid users talking through and rating the items in the translated questionnaire. Content validation was assessed by examining equivalence, accessibility, acceptability, comprehensiveness, and relevance of interview data. Questionnaire introduction and scoring instructions were evaluated by Swedish audiologists.

STUDY SAMPLE: Ten adult native speaking Swedish hearing aid users, recruited with purposive sampling. Maximum variation based on age, gender, hearing aid usage, and degree of hearing loss. Seven Swedish audiologists assessing instructions for result calculations.

RESULTS: The conceptual equivalence between the Swedish translation and the English original questionnaire was judged to be high overall. The instructions and majority of items were experienced as accessible, acceptable, comprehensive, and relevant. The audiologists showed that they could follow scoring instructions and reason about the results.

CONCLUSIONS: This content validity study was the first step towards a Swedish version of a self- report measure of Empowerment for people with hearing loss.