Ideas for the Pre-Contemplator “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 Add examples other than “people mumble” I don’t have a loss.” “People today don’t talk as clearly as they used to.”

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. This could depict another macro process in the hearing loss stigmatization. The growing awareness that of his hearing loss. The discussion could focus on has there been any instances of miscommunication that may be attributed to the hearing loss.

Conversational Occurrences Perceived message correctly Received meaningful message that was expected and appropriate (“Where’s the main post office?” – “Two blocks down and turn right.”) 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”) 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