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Ideas for the PreContemplator “I’m not ready to use hearing aids!” Stage 1: Precontemplation “Who, me? I don’t have a problem. People mumble!” Stage 1: Pre-Contemplation • During the pre-contemplation stage, the patient has no intention of changing within the foreseeable future (6 months) • They may not be aware that they have a problem or they may be unwilling to make a change • Individuals in this stage are often labeled as “in denial”, “resistant” or defensive about their current status • The cons of changing outweigh the pros of changing Processes of Change for Precontemplators • Goal is for precontemplators to acknowledge and/or increase their awareness of the negative aspects of their problem • To move out of this stage, information and feedback are needed Pre-contemplation • Review “Beyond Hearing Loss” video, which gives an overview of hearing loss issues • Give statistical information comparing hearing aid users to non-users • Provide reading materials • Audiologic Assessment • HHIE screening “Beyond Hearing Loss” • 12 minute video • Available from Johns Hopkins Center for Hearing and Balance • 410-955-6680 The Impact of Hearing Aid Usage • Findings of National Council on Aging www.ncoa.org (1999) • Reports results of 2,069 hearing impaired respondents • Significantly higher incidences of anxiety, frustration, and depression, and social withdrawal, even in folks with mild losses Pre-Contemplation • Use drawings of cartoon-like characters to start discussions about various communication issues • Use Erber (1988) “Eight Conversational Occurrences” to initiate discussion about communication problems and hearing loss I Feel Like I Work So Hard I am exhausted from working to hear everyone Pre-Contemplation The boss said he wanted the money, not that it was sunny. Conversational Occurrences 1. Perceived message correctly • • Received meaningful message that was expected and appropriate (“Where’s the main post office?” – “Two blocks down and turn right.”) 2. Perceived incorrect meaningful message • • Received message that fit the conversation, but was incorrect (Bad apples: “They’re not good for anything but chucking!” – actually, “chutney”) 3. Perceived meaningless message confidently • • Perceived message clearly, but did not make sense and did not fit the conversation (“Didn’t she understand?” – “No. I explained it in my typical Garibaldi faction.” Actually, “…typically garbled fashion.”) Conversational Occurrences Continued… 4. Perceived nonsense • • Received syllables and word-like patterns, but could not understand them (“Did you get all your work finished?” – “Mau fitr pekd laimmi aruipeng!”) 5. Perceived fragments • • Received only part of the message (“Why didn’t you buy the tape recorder?” – “Because we saw…………in the shop window”) 6. Perceived (distorted) acoustic cues only • • The speaker’s mouth was not visible (as over the telephone; or his/her mouth was obscured by hair, a hand, or an object) Conversational Occurrences Continued… 7. Perceived (incomplete) visible cues only • The speaker was too far away; the speaker’s voice level was too low; the hearing aids and/or batteries were malfunctioning 8. Perceived nothing • The receiver was distracted or was not paying attention, so the speaker’s utterance was neither heard nor seen (Erber, 1988) Signs and Symptoms • • • • • • Frequently asking people to repeat Inappropriate response to what is said Difficulty understanding in groups Puzzled expression when listening Intently watching the speaker’s mouth Strained expression around eyes » Trychin, 2003 Signs and Symptoms • • • • • • Turning the head to one side to hear better Avoid social situations-withdraws Talk too loudly or very softly Turn up TV or radio much too loud Blame people for not speaking clearly Defensive about communication problems » Trychin, 2003 Problem Situations Reported by HOH • • • • • • Hearing alarm signals Voice from another room Can’t see speaker’s face Poor illumination People whispering Voices on TV or radio » Trychin, 2003 Problem Situations Reported by HOH • • • • • • Conversations in a moving car Family dinners at holidays Understanding conversations on the phone Several people talking Medical situations Outdoors-wind, traffic, etc. Trychin, 2003 Problem Situations Reported by HOH • • • • • • Person whose speech is not clear Misinterpretation of mistakes Unaware person is talking to me Movies, plays, lectures, classes Stopped for traffic violations Dancing and talking » Trychin, 2003 Problem Situations: Family Members Difficulty remembering what to do • • Not knowing whether she/he understands • The variability in his/her ability to understand • Hard to get her/him to understand me • TV or radio is much too loud – Trychin & Albright, 1993 Problem Situations: Family Members • • • • Having to repeat often Having to interpret too frequently When we become frustrated or irritated When she/he doesn’t pay attention – Trychin & Albright, 1993 Problem Situations: Family Members • Not talking as much as before • When he/she is not understanding someone else • Being asked to repeat embarrassing jokes or remarks » Trychin & Albright, 1993 Problem Situations: Family Members • • • • • Becoming too dependent on me Being isolated from friends and family Not doing things we enjoyed previously Having to repeat in pressure situations Not traveling or going new places » Trychin & Albright, 1993 Reactions • Physical • Emotional • Behavioral – Cognitive • Trychin, 2001 Physical Reactions to Communication Problems • • • • • • Muscle tension-shoulders, neck, back Stomach problems Fatigue Head aches Increased blood pressure Appetite changes-eat more, eat less » Trychin, 1991 Behavioral Reactions to Communication Problems • • • • • • Bluffing Withdrawing Blaming Demanding Dominating conversations Guilt tripping » Trychin, 1991 Emotional Reactions to Communication Problems • • • • • • Anger Anxiety Depression Embarrassment Frustration Guilt » Trychin, 1991 Cognitive Reactions to Communication Problems • • • • • • Can’t think straight-confused Hard to focus attention Distracting thoughts Distrustful of others Decreased self esteem Difficult to remember what you did not hear clearly in the first place » Trychin, 1991 • • • • • • Mental Health Risks of Hearing Loss Becoming chronically nervous; Anxious Becoming chronically sad; Depressed Feeling anger much of the time Loss of group identity Feeling marginal in own family Loneliness » Trychin, 1991 Mental Health Risks of Hearing Loss • • • • • • • Becoming distrustful of people Withdrawing from social contact Developing poor self-image Feeling incompetent Feeling unacceptable to others Feeling marginal socially Feeling loss of influence or control » Trychin, 1991