1. Ideas for the Pre-Contemplator
“I’m not ready to use hearing aids!”

2. Stage 1: Precontemplation
“Who, me? I don’t have a problem. People mumble!”

3. 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.”

4. 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

5. 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

6. “Beyond Hearing Loss” 12 minute video
Available from Johns Hopkins Center for Hearing and Balance

7. The Impact of Hearing Aid Usage
Findings of National Council on Aging (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

8. 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

9. I Feel Like I Work So Hard
I am exhausted from working to hear everyone
Pre-Contemplation

10. 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.

11. 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.”)

12. 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)

13. 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)

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Reactions
Physical
Emotional
Behavioral
Cognitive
Trychin, 2001

24. 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

25. Behavioral Reactions to Communication Problems
Bluffing
Withdrawing
Blaming
Demanding
Dominating conversations
Guilt tripping
Trychin, 1991

26. Emotional Reactions to Communication Problems
Anger
Anxiety
Depression
Embarrassment
Frustration
Guilt
Trychin, 1991

27. 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

28. 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

29. 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