Evaluation of audiological rehabilitation services for adults with hearing impairment in Malaysia

Abstract

The effects of hearing impairment on adult patients and their families have been extensively reported (e.g. communication difficulties, emotional distress and social engagement restrictions, and decreased quality of life). Therefore, audiologists have a responsibility to help patients and their families manage activity limitations and participant restrictions that arise from hearing impairment in the context of the International Classification of Functioning, Disability and Health (ICF). This approach is very much in line with the principles of patient-centred care (PCC) that have been extensively promoted as best practice for the healthcare management of older adults. Despite reports of the benefits of PCC for adult patients in Western countries, including adherence to management plans and reduced recovery time, it is not known whether this approach is incorporated into audiological services for adult patients in Malaysia.The aims of this thesis were to investigate (i) the nature of audiological rehabilitation services for adults with hearing impairment in Malaysia, and (ii) the extent of patient-centredness exhibited by audiologists in Malaysia. To address these aims, a mixed methods approach was used. The quantitative measures were utilised to explore the current practice of audiologists in managing adult patients and to identify the preferences for PCC in audiological management from the perspectives of audiologists and adult patients, while the qualitative measures provided an in-depth view of the implementation of PCC in audiological management. The types of methods utilised were online and paper based surveys, individual semi-structured in-depth interviews, and video observation.Chapter 1 describes Malaysia briefly, with a focus on the field of audiology and the services offered. The ICF framework, which structures this thesis, and the PCC approach, which is the focus of this thesis, is presented in this chapter. Chapter 2 describes the audiological management for adults with hearing impairment and their significant others in the context of the ICF, as recommended by established audiology professional associations. Chapter 2 also includes background on PCC in more detail.Chapter 3 explored the nature of audiological services for adults with hearing impairment in Malaysia, with an emphasis on whether current services addressed patients' overall functioning described in the ICF. In general, the audiologists in Malaysia addressed the hearing impairment and its associated activity limitations and participation restrictions in their ii management of adult patients. However, gaps were identified with there being a strong emphasis on addressing impairment-level impacts. Inadequate infrastructure, resources and facilities in the workplace may have contributed to the gaps in service provision and influenced the current practice of audiological management for patients in Malaysia.Chapter 4 identified the preferences of adult patients for PCC and the level of PCC they received from audiologists. Although the...

Conceptualisation of patient- and family-centred care for young adults with hearing loss and their family members

“…Respondents in the present study report much higher levels of patient-centredness of care than in the only other study that could be located applying the MPOC-A in audiological (re)habilitation situations (Ali, 2018). This is heartening, as it suggests that audiologists in A proportion of young people in the current study reported never or rarely wearing hearing devices (14%), and this did not decrease with increased self-reported severity of hearing loss.…”