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  • 1.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin University, England.
    Allen, Peter M.
    Anglia Ruskin University, England; Anglia Ruskin University, England.
    Manchaiah, Vinaya
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar University, TX 77710 USA; Audiol India, India.
    Baguley, David M.
    Anglia Ruskin University, England; University of Nottingham, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Internet-Based Intervention for Tinnitus: Outcome of a Single-Group Open Trial2017In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 28, no 4, p. 340-351Article in journal (Refereed)
    Abstract [en]

    Background: Managing chronic tinnitus is challenging, and innovative ways to address the resulting health-care burden are required. Internet-based cognitive behavioral therapy (iCBT) for tinnitus shows promise as a cost-effective treatment option. The feasibility and effectiveness of iCBT in the United Kingdom are yet to be explored. Furthermore, it is not known if iCBT can be supported by an audiologist rather than a psychologist. Purpose: This study aimed to determine the feasibility of guided iCBT using audiological support on tinnitus distress and tinnitus-related comorbidities. Furthermore, it aimed to establish the feasibility of iCBT for tinnitus distress in the United Kingdom, by determining recruitment, attrition, and compliance rates. Finally, it aimed to identify which aspects of the protocol require refinement for subsequent clinical trials. Research Design: A single-group open trial design was implemented. This study would serve as a prerequisite study, to identify barriers, before undertaking effectiveness trials. Study Sample: Participants consisted of 37 adults (18 males, 19 females), with an age range of between 50 and 59 yr. The mean preintervention tinnitus severity rating was 56.15 (standard deviation = 18.35), which is categorized as "severe tinnitus" as measured by the Tinnitus Functional Index (TFI). Five participants withdrew during the study, and 29 of the remaining participants completed the postintervention questionnaire. Intervention: The guided iCBT intervention ran over an eight-week period and consisted of 16 obligatory modules and five optional modules. The intervention was designed to be interactive, interesting, and stimulating. A key element was the provision of support from an audiologist throughout the program. Data Collection and Analysis: Online questionnaires were used throughout the study. These were administered at baseline and postintervention to determine attrition and compliance rates and to facilitate sample size estimates for further clinical trials. Outcome measures for tinnitus severity, hearing handicap, insomnia, cognitive functioning, hyperacusis, anxiety, depression, and life satisfaction were used to investigate the effects of iCBT with audiological support. In addition, a weekly questionnaire was incorporated to monitor change in tinnitus distress while undertaking the intervention. Results: Feasibility was established using an audiologist to support this guided iCBT intervention, as a significant change postintervention was found for tinnitus severity, as measured by the TFI and the Tinnitus Handicap Inventory, Screening version. The attrition rate was 22% and compliance was variable. Although these results were based on a small sample, they provide encouraging evidence for the feasibility of delivering iCBT treatment for tinnitus symptoms with audiology support in the United Kingdom. Conclusions: An Internet-based intervention of tinnitus appears to be feasible in the United Kingdom when using audiological support. Randomized controlled trials to further investigate the effectiveness of iCBT for tinnitus in the United Kingdom are required.

  • 2.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Abrams, Harvey
    Univ S Florida, FL USA.
    Bailey, Abram
    Hearing Tracker Inc, TX USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss2019In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, no 6, p. 472-481Article in journal (Refereed)
    Abstract [en]

    Background:

    The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use.

    Purpose:

    The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss.

    Research Design:

    The study used a cross-sectional survey design.

    Study Sample:

    Five hundred and twelve participants completed an electronic survey.

    Data Collection and Analysis:

    The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach’s alpha.

    Results:

    Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales.

    Conclusions:

    The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.

  • 3.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Beukes, Eldre W.
    Anglia Ruskin Univ, England.
    Granberg, Sarah
    Orebro Univ, Sweden; Orebro Univ Hosp, Sweden.
    Durisala, Naresh
    GN Hearing Pte Ltd, Singapore.
    Baguley, David M.
    Anglia Ruskin Univ, England; Univ Nottingham, England; Univ Nottingham, England.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification2018In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 29, no 10, p. 936-947Article in journal (Refereed)
    Abstract [en]

    Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model. Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective. Research Design: A cross-sectional survey design was used. Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. Data Collection and Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions. Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor. Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.

  • 4.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar University, TX 77710 USA; Audiol India, India.
    Dockens, Ashley L.
    Lamar University, TX 77710 USA.
    Bellon-Harn, Monica
    Lamar University, TX 77710 USA.
    Burns, Erin S.
    Lamar University, TX 77710 USA.
    Noncongruence between Audiologist and Patient Preferences for Patient-Centeredness2017In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 28, no 7, p. 636-643Article in journal (Refereed)
    Abstract [en]

    Background: Trends in preferences of both healthcare providers and patients to patient-centeredness have been emphasized in research. However, an understanding of the nature of preferences to patient-centeredness within the context of the audiologist patient relationship is needed. Purpose: The purpose of this study is to explore the congruence between audiologist and patient preferences for patient-centeredness. Research Design: A cross-sectional survey design was used to gather data from audiologists and patients with hearing loss. Study Sample: Participants included 75 audiologists and 105 consecutive patients with hearing loss. Data Collection and Analysis: Participants completed the modified Patient Practitioner Orientation Scale (PPOS) and provided selected demographic information. Data were analyzed using an independent sample t test to evaluate the differences between audiologist and patient congruence. Regression analysis was performed to evaluate factors contributing to preferences for patient-centeredness. Results: Patients had significantly lower scores in PPOS full scale when compared to the audiologists [t((170)) = 0.78; p amp;lt;= 0.001] with a very large effect size (Cohens d = 1.43). Patients also had significantly lower scores when compared to the audiologists on both the sharing [t((170)) = 1.01; p amp;lt;= 0.001] and caring [tom) = 0.56; p amp;lt;= 0.001] subscales. Statistically significant lower scores were noted for patients when compared to audiologists on 12 items on the PPOS. No relationship between any demographic factors and preferences for patient-centeredness were found. Conclusions: The current study results indicated noncongruence in preferences for patient-centeredness among audiologists and patients with hearing loss. Results point toward the need for more research considering the nature and impact of patient-centered audiology practice.

  • 5.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Dockens, Ashley L.
    Lamar Univ, TX 77710 USA.
    Flagge, Ashley
    Lamar Univ, TX 77710 USA.
    Bellon-Harn, Monica
    Lamar Univ, TX 77710 USA.
    Azios, Jamie Hartwell
    Lamar Univ, TX 77710 USA.
    Kelly-Campbell, Rebecca J.
    Univ Canterbury, New Zealand.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Quality and Readability of English-Language Internet Information for Tinnitus2019In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, no 1, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Background:

    Because of the wealth of information available on the internet and increasing numbers of individuals relying on websites as a primary source of information for health-related questions, it is important that the readability of their content is within the comprehension level of most readers.

    Objective:

    The study evaluated the quality and readability of English-language Internet information for tinnitus.

    Research Design:

    Analysis of Internet websites on tinnitus.

    Study Sample:

    A total of 134 websites with tinnitus information.

    Data Collection and Analysis:

    Three key words (i.e., tinnitus, ringing in the ear, and buzzing in the ear) were entered in five country-specific versions of the most commonly used internet search engine in August 2016. For each of the 15 searches, the first 20 relevant websites were examined. After removing duplicates, a total of 134 websites were assessed. Their origin (commercial, nonprofit organization, government, personal, or university), quality (Health On the Net [HON] certification and DISCERN scores), and readability (Flesch Reading Ease score, Flesch-Kincaid Reading Grade Level Formula, and Simple Measure of Gobbledygook) were assessed.

    Results:

    Most websites were of commercial (49.3%) or nonprofit organization (38.8%) origin. Their quality and readability was highly variable. Only 13.5% of websites had HON certification. χ2 analysis showed that there was significant association between website origin and HON certification [χ2(4) = 132.9, p < 0.0001]. The mean DISCERN scores were 2.39. No association between DISCERN scores and website origin was found. Readability measures showed that on average, only people with at least 10‐12 yr of education could read and understand the internet information for tinnitus in websites. Almost all the websites exceeded the most stringent reading level recommended for health information.

    Conclusions:

    The results highlight great variability in the quality and readability of health information, specifically for tinnitus in the internet. These findings underscores the need for stakeholders (e.g., web-developers, clinicians) to be aware of this and to develop more user-friendly health information on websites to make it more accessible for people with low literacy.

  • 6.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA; Audiology India, Mysore, Karnataka, India; Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India.
    Hernandez, Barbara Michiels
    Department of Health and Kinesiology, Lamar University, Beaumont, TX, USA.
    Beck, Douglas L.
    Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA; Oticon Inc, Somerset, New Jersey, NJ, USA; Department of Communication Disorders, State University of New York at Buffalo, USA.
    Application of Transtheoretical (Stages of Change) Model in Studying Attitudes and Behaviors of Adults with Hearing Loss: A Descriptive Review2018In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 29, no 6, p. 548-560Article, review/survey (Refereed)
    Abstract [en]

    Health Behavior Change (HBC) refers to facilitating changes to habits and/or behaviors related to health. There are a number of models/theories of HBC, which provide a structured framework to better understand the HBCs of individuals. The Transtheoretical Model (TTM, aka "the Stages of Change" model) is an integrative model used to conceptualize the process of intentional behavior change and is applied to a variety of behaviors, populations, and settings. In the last few years, use of TTM by the profession of audiology has been increasing.

  • 7.
    Manchaiah, Vinaya K. C.
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Pyykko, Ilmari
    Univ Hosp Tampere, Finland.
    Levo, Hilla
    Univ Helsinki, Finland.
    Kentala, Erna
    Univ Helsinki, Finland.
    Impact of Menieres Disease on Significant Others Health and Lives2018In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 29, no 1, p. 63-72Article in journal (Refereed)
    Abstract [en]

    Background:

    Ménière’s disease (MD) is a chronic and, in part, intermittent illness that poses multiple challenges for both the physical and psychological well-being of patients, as well as on those around them. The patients face psychosocial consequences, which include disruptions to life goals, employment, income, relationships, leisure activities, and daily living activities that also influence their family members and friends. However, there is a limited understanding of the impact of MD on significant others (SOs).

    Purpose:

    The current study was aimed at identifying how the SOs of patients with MD respond to different aspects of the impact of the disorder on health and life (i.e., psychological aspects, activities, participation, and positive aspects).

    Research Design:

    The study employed a cross-sectional survey design.

    Study Sample:

    The study sample was 186 SOs of patients with MD who were recruited through Finnish Ménière’s Federation.

    Data Collection and Analysis:

    Participants completed a 25-item structured questionnaire focusing on different aspects of the impact of the disorder on health and life, and also provided some demographic information. Data were analyzed using Kruskal‐Wallis test, Pearson’s correlation, and K-means cluster analysis techniques.

    Results:

    Examination of response patterns suggests that the disorder had, on average, a marginal effect on SOs’ psychological aspects, activities, and participation as the SOs generally focused on complaints. Interestingly, SOs reported some positive consequences as a result of their partners’ condition. The results show a limited association between SOs’ demographic variables and response patterns. The Pearson’s correlation suggested a strong association between the subscales psychological aspects, activity limitations, and participation restrictions. Also, a weak negative correlation was observed among positive aspects and participation restrictions. The cluster analysis resulted in three clusters, namely, (1) “nonengaged,” (2) “supportive,” and (3) “concerned.”

    Conclusions:

    The current study results identify that the SOs’ reaction to patients’ condition varies and this may be from coping with victimization. Although the impact of MD on SOs is limited, some of the SOs may have more severe consequences and may require rehabilitation. The information gathered about SOs’ coping and adjustment in this study can also help while developing management and/or rehabilitation plan for people with MD.

  • 8.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar University, TX 77710 USA; Audiol India, India.
    Zhao, Fei
    Cardiff Metropolitan University, Wales; Sun Yat Sen University, Peoples R China.
    Widen, Stephen
    Örebro University, Sweden.
    Auzenne, Jasmin
    Lamar University, TX 77710 USA.
    Beukes, Eldre W.
    Anglia Ruskin University, England.
    Ahmadi, Tayebeh
    University of Social Welf and Rehabil Science, Iran.
    Tome, David
    Polytech Institute Porto, Portugal.
    Mahadeva, Deepthi
    St Johns Medical Coll, India.
    Krishna, Rajalakshmi
    Audiol India, India; University of Mysore, India.
    Germundsson, Per
    Malmö University, Sweden.
    Social Representation of "Loud Music" in Young Adults: A Cross-Cultural Study2017In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 28, no 6, p. 522-533Article in journal (Refereed)
    Abstract [en]

    Background: Exposure to recreational noise, particularly music exposure, is considered one of the biggest public health hazards of our time. Some important influencing factors such as socioeconomic status, educational background, and cross-cultural perspectives have previously been found to be associated with attitudes toward loud music and the use of hearing protection. Although culture seems to play an important role, there is relatively little known about how it influences perceptions regarding loud music exposure in young adults. Purpose: The present study was aimed to explore cross-cultural perceptions of and reactions to loud music in young adults (18-25 yr) using the theory of social representations. Research Design: The study used a cross-sectional survey design. Study Sample: The study sample included young adults (n = 534) from five different countries (India, Iran, Portugal, the United States, and the United Kingdom) who were recruited using convenience sampling. Data Collection and Analysis: Data were collected using a questionnaire. Data were analyzed using a content analysis, co-occurrence analysis, and also x(2) analysis. Results: Fairly equal numbers of positive and negative connotations (similar to 40%) were noted in all countries. However, the x(2) analysis showed significant differences between the countries (most positive connotations were found in India and Iran, whereas the most negative connotations were found in the United Kingdom and Portugal) regarding the informants perception of loud music. The co-occurrence analysis results generally indicate that the category "negative emotions and actions" occurred most frequently, immediately followed by the category "positive emotions and actions." The other most frequently occurring categories included "acoustics," "physical aliment," "location," and "ear and hearing problems." These six categories formed the central nodes of the social representation of loud music exposure in the global index. Although some similarities and differences were noted among the social representations toward loud music among countries, it is noteworthy that more similarities than differences were noted among countries. Conclusions: The study results suggest that "loud music" is perceived to have both positive and negative aspects within society and culture. We suggest that the health promotion strategies should focus on changing societal norms and regulations to be more effective in decreasing the noise-and/or music induced auditory symptoms among young adults.

  • 9.
    Saunders, Gabrielle H.
    et al.
    Portland VA Med Ctr, OR 56210 USA; Oregon Hlth and Sci Univ, OR 97201 USA.
    Frederick, Melissa T.
    Portland VA Med Ctr, OR 56210 USA.
    Silverman, ShienPei C.
    Portland VA Med Ctr, OR 56210 USA.
    Nielsen, Claus
    Oticon AS, Denmark.
    Laplante-Lévesque, Ariane
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Oticon AS, Denmark.
    Development and Pilot Evaluation of a Novel Theory-Based Intervention to Encourage Help-Seeking for Adult Hearing Loss2017In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 28, no 10, p. 920-931Article in journal (Refereed)
    Abstract [en]

    Background: Health behavior theories can provide an understanding of hearing health behaviors and, more importantly, can be used to develop theoretically based strategies to change these health behaviors. Purpose: To develop a theory-based brief intervention to increase help-seeking for adult hearing loss and to conduct a pilot study to evaluate its feasibility, effectiveness, and impact on hearing beliefs and behaviors. Research Design: An intervention was designed that could be easily administered by a health-care provider who does not have expertise in audiology-such as a primary care physician, community nurse, or social worker. The intervention aims to alter perceived benefit, severity, cues to action, and self-efficacy for seeking help by providing experiential/affective messaging and simultaneously providing intrinsic motivation for the recipient to seek hearing help. To first determine whether this intervention changed beliefs and increased help-seeking behavior, this study was conducted in a hearing research laboratory setting. Study Sample: A total of 101 adults aged 50-89 yr were recruited within 6 months of having attended an appointment at a primary care clinic at the VA Portland Health Care System. All were sent a letter inviting them to participate in a study if they had trouble with their hearing but had not had a scheduled hearing test or worn hearing aids in the prior 5 yr and also had functional oral and written English. Data from 87 individuals were available for analysis. Intervention: The intervention is designed for use in any health-care setting in which a health-care provider can facilitate a conversation about hearing. On arrival at a health-care facility, recipients are provided with nine emotionally evocative color photographs to prompt reflection on ways in which hearing difficulties impact them. A discussion with a health-care provider (facilitator) follows, during which recipients may identify the negative impacts of their hearing loss. If the recipient identifies negative impacts, the facilitator suggests that he or she consider having a hearing test and provides a list of local hearing-health professionals. Data Collection and Analysis: Participants completed baseline questionnaires assessing hearing beliefs and attitudes. They were then randomly assigned either to the group receiving the study intervention or to a control group. Six months after study enrollment, participants reported whether they had sought help for their hearing and completed a second set of questionnaires. Results: Twelve of 41 individuals (29.3%) in the intervention group and 7 of 46 individuals (15.2%) in the control group sought help within the 6-month follow-up period. A chi(2) test showed these numbers did not differ significantly; however, the odds ratio of having had a hearing test were 2.3 times greater for those who received the intervention than for those who did not. Conclusions: Despite not reaching statistical significance, the odds ratio suggests that the theory-based brief intervention is worthy of additional examination. We intend to work with health-care providers to conduct a larger study to investigate whether the intervention has value in the real world.

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