hearing aids and quality of life sergei kochkin, ph.d. better hearing institute

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Hearing Aids and Hearing Aids and Quality of Life Quality of Life Sergei Kochkin, Ph.D. Sergei Kochkin, Ph.D. Better Hearing Institute Better Hearing Institute

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Page 1: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Hearing Aids andHearing Aids and Quality of Life Quality of Life

Sergei Kochkin, Ph.D.Sergei Kochkin, Ph.D.

Better Hearing InstituteBetter Hearing Institute

Page 2: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Sad TruthSad Truth The industry (HIA) spent $100,000 on the The industry (HIA) spent $100,000 on the

NCOA Quality of Life Study – a landmark NCOA Quality of Life Study – a landmark study. The study demonstrated the real value study. The study demonstrated the real value of hearing aids.of hearing aids.

No major marketing interventions instituted to No major marketing interventions instituted to leverage these findings by any of the key leverage these findings by any of the key associations.associations.

Business as usual :Business as usual :– Sluggish growth with naturally growing customer base.Sluggish growth with naturally growing customer base.– Marketing to an aging customer base our newest technology.Marketing to an aging customer base our newest technology.– Complacently living off the increased margins from advanced Complacently living off the increased margins from advanced

technology versus bringing in new and younger customers.technology versus bringing in new and younger customers.

Page 3: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

AgendaAgenda

Present executive summary of Present executive summary of NCOA Quality of Life study (Ref. NCOA Quality of Life study (Ref. 1/2000 Hearing Review)1/2000 Hearing Review)

Some ideas for leveraging the Some ideas for leveraging the quality of life findings in your quality of life findings in your practice.practice.

Optimizing the consumer’s Optimizing the consumer’s experience with hearing aids.experience with hearing aids.

Page 4: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

The NCOA Quality of Life The NCOA Quality of Life Study Study

From Executive Summary:From Executive Summary:Quantifying the Obvious: The Impact of Quantifying the Obvious: The Impact of Hearing Aids on Quality of Life. Kochkin & Hearing Aids on Quality of Life. Kochkin & Rogin, Rogin, The Hearing ReviewThe Hearing Review, January 2000., January 2000.

Page 5: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

IntroductionIntroduction

The incidence of hearing loss in the U.S. The incidence of hearing loss in the U.S. is approximately 10% - 31.5 millionis approximately 10% - 31.5 million

Market growth in U.S. low despite Market growth in U.S. low despite positive demographics and improved positive demographics and improved technology.technology.

Hearing aids still positioned in market Hearing aids still positioned in market place as for “old people”.place as for “old people”.

Page 6: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

IntroductionIntroduction

Majority of hearing impaired non-Majority of hearing impaired non-owners and their physicians have owners and their physicians have negative view of hearing aids:negative view of hearing aids:– Low valueLow value– Poor benefitPoor benefit– Do not perform in noisy situationsDo not perform in noisy situations

Even a few years ago : FDA did not Even a few years ago : FDA did not permit “quality of life” claims in U.S. permit “quality of life” claims in U.S. advertising and marketing.advertising and marketing.

Page 7: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Research ObjectivesResearch Objectives

Assess the impact of aided hearing Assess the impact of aided hearing loss on multiple dimensions of quality loss on multiple dimensions of quality of life.of life.– Psychological Psychological – EmotionalEmotional– SocialSocial– General healthGeneral health– Family interactionFamily interaction– Life satisfactionLife satisfaction

Page 8: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Market Development Market Development ObjectivesObjectives

Use the quality of life study to Use the quality of life study to demonstrate “value of hearing aids” demonstrate “value of hearing aids” to the consumer and medical to the consumer and medical segments.segments.

Use an independent third party to Use an independent third party to carry this message to the press:carry this message to the press:– National Council on Aging (NCOA)National Council on Aging (NCOA)

Page 9: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Market Development Market Development ObjectivesObjectives

Overall GoalsOverall Goals– increase awareness of increase awareness of

importance of hearingimportance of hearing– show that hearing aids are the show that hearing aids are the

treatment of choicetreatment of choice– stimulate sales of hearing aidsstimulate sales of hearing aids

Page 10: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

MethodologyMethodology

Page 11: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Method - Method - Knowles MarkeTrak VKnowles MarkeTrak V

National family opinion panelNational family opinion panel– Hearing loss screening 80,000 householdsHearing loss screening 80,000 households– Balanced to 9 key U.S. census variablesBalanced to 9 key U.S. census variables– 13,492 hearing-impaired households 13,492 hearing-impaired households

identified.identified.

Detailed questionnaire 2,720 hearing Detailed questionnaire 2,720 hearing aid owners (MarkeTrak).aid owners (MarkeTrak).– Response rate 83%Response rate 83%

Page 12: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

MethodMethod

HIA commissioned National Council on HIA commissioned National Council on Aging to conduct quality of life study using Aging to conduct quality of life study using MarkeTrak V hearing loss panel.MarkeTrak V hearing loss panel.– Seniors Research Group (Michigan) - detailSeniors Research Group (Michigan) - detail– Knowles Electronics - Executive summaryKnowles Electronics - Executive summary

Large nationally representative sample:Large nationally representative sample:– Individuals with hearing lossIndividuals with hearing loss

Aided and unaided - 1,500 surveyed eachAided and unaided - 1,500 surveyed each And their significant other (spouse)And their significant other (spouse) Ages 50 and aboveAges 50 and above

Page 13: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

MethodMethod

Hearing-impaired - 8 page surveyHearing-impaired - 8 page survey Family member - 4 page surveyFamily member - 4 page survey Response rate of 79% to mail surveyResponse rate of 79% to mail survey Match aided and unaided respondents Match aided and unaided respondents

based on a simple screening test.based on a simple screening test.– Frequency distribution of hearing test into Frequency distribution of hearing test into

quintiles (five groups 20% - 100%).quintiles (five groups 20% - 100%).– Cohort analysis within the five hearing loss Cohort analysis within the five hearing loss

groups.groups.

Page 14: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Method Method Screening Instrument Screening Instrument

American Academy of Otolaryngology 5 American Academy of Otolaryngology 5 minute hearing test (Revised)minute hearing test (Revised)

– 15 question unidimensional hearing test 15 question unidimensional hearing test (principle components factor analysis (principle components factor analysis with eigenvalues set to one)with eigenvalues set to one)

– 5 point Likert scale (Strongly agree to 5 point Likert scale (Strongly agree to Strongly disagree)Strongly disagree)

Page 15: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Method Method Screening Instrument ItemsScreening Instrument Items

TelephoneTelephone Multiple speakersMultiple speakers TelevisionTelevision Background noiseBackground noise Missed calls/doorbellMissed calls/doorbell DirectionalityDirectionality Ask people to repeatAsk people to repeat High frequency High frequency

soundssounds People mumblePeople mumble

Large reverberant Large reverberant roomsrooms

People annoyed by People annoyed by misunderstandingsmisunderstandings

Avoid social situationsAvoid social situations Inappropriate Inappropriate

responseresponse Family and friend Family and friend

perceptionsperceptions Strain to hearStrain to hear

Page 16: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Method Method Screening Instrument Screening Instrument

Significantly correlated (Koike, Hurst & Significantly correlated (Koike, Hurst & Wetmore 11/94) with objective hearing Wetmore 11/94) with objective hearing loss data:loss data:

Pure tone (highest)Pure tone (highest) Air conduction thresholdsAir conduction thresholds Speech discrimination scores (SDS)Speech discrimination scores (SDS) Speech reception thresholds (SRT)Speech reception thresholds (SRT)

Page 17: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Method Method Screening InstrumentScreening Instrument

Modal respondent subjective evaluation Modal respondent subjective evaluation of their hearing loss in quintiles based of their hearing loss in quintiles based on the five minute test:on the five minute test:

– Quintile 1 (20%) - Mild/Moderate (=)Quintile 1 (20%) - Mild/Moderate (=)– Quintile 2 (40%) - Moderate/mild Quintile 2 (40%) - Moderate/mild – Quintile 3 (60%) - Moderate/severeQuintile 3 (60%) - Moderate/severe– Quintile 4 (80%) - Severe/Moderate (=)Quintile 4 (80%) - Severe/Moderate (=)– Quintile 5 (100%) - Severe/profoundQuintile 5 (100%) - Severe/profound

Page 18: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

AnalysisAnalysis Goal is to discern trends across the five Goal is to discern trends across the five

hearing loss groups: aided vs unaided.hearing loss groups: aided vs unaided.

Calculate composite scores (e.g. Calculate composite scores (e.g. emotional instability) in Z scores with a emotional instability) in Z scores with a mean of 5 and standard deviation of 2 mean of 5 and standard deviation of 2 (Stanine normal curve method).(Stanine normal curve method).– e.g. 5=average, 3=16%, 7=84%e.g. 5=average, 3=16%, 7=84%

Or % scores (e.g. % depressedOr % scores (e.g. % depressed))

Page 19: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

AnalysisAnalysis

Compare for significant differences:Compare for significant differences:– ** 95% or 99% or better confidence level** 95% or 99% or better confidence level– * 85% or 90% level * 85% or 90% level (trends only especially (trends only especially

at Q1 and Q5 where sample sizes are at Q1 and Q5 where sample sizes are smaller)smaller)

Test of significance:Test of significance:– Attitudinal indices: T-test Attitudinal indices: T-test – Percents (%) : Z test for differences in Percents (%) : Z test for differences in

proportionsproportions

Page 20: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

DemographicsDemographics

Page 21: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Final sample sizesFinal sample sizes

050

100150200250300350

Sam

ple

(n)

1 2 3 4 5

Hearing Loss QuintileUsers Non-users

Respondents: 1,037 Users : 1,032 Non-users

Family members: 873 Users : 837 Non-users

Page 22: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Age of respondentsAge of respondents

75 74 73 73 7470 71 72 73 73

50

60

70

80

1** 2** 3 4 5

Hearing Loss Quintile

Age

(Mea

n)

Users Non-users

Page 23: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Household Income Is Related to Household Income Is Related to

Severity Hearing LossSeverity Hearing Loss

$20,000

$22,000

$24,000

$26,000

$28,000

$30,000

$32,000

$34,000

$36,000

$38,000

House

hold

Inco

me (

Mean)

1 2 3 4 5

Hearing Loss Quintile

Page 24: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Household IncomeHousehold Income

$20,000$22,000$24,000$26,000$28,000$30,000$32,000$34,000$36,000$38,000$40,000

House

hold

Inco

me (

Mean)

1 2 3** 4 5**

Hearing Loss QuintileUsers Non-users

Page 25: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Discretionary Income Discretionary Income

(%”plenty”)(%”plenty”)

05

10152025303540

% "

Ple

nty

"

1 2* 3** 4 5**

Hearing Loss QuintileUsers Non-users

Page 26: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Gender (% Male)Gender (% Male)

0

10

20

30

40

50

60

70

% M

ale

1 2 3 4 5*

Hearing Loss QuintileUsers Non-users

Page 27: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Employment (% retired)Employment (% retired)

01020304050607080

% R

eti

red

1 2 3** 4 5*

Hearing Loss QuintileUsers Non-users

Page 28: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Demographics: Demographics: Marital Status (% married)Marital Status (% married)

0

10

20

30

40

50

60

70

% M

arr

ied

1 2 3 4 5*

Hearing Loss Quintile

Users Non-users

Page 29: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

DemographicsDemographics Groups reasonably matched:Groups reasonably matched:

– Age Age (slightly older in two “milder hearing loss user (slightly older in two “milder hearing loss user groups)groups)

– Marital statusMarital status– GenderGender– Income Income (favors 2 user groups)(favors 2 user groups)– Employed status Employed status (favors 2 non-user groups)(favors 2 non-user groups)– Segmented based on hearing loss as measured by Segmented based on hearing loss as measured by

five minute test (quintiles).five minute test (quintiles).

No major systemic differences between No major systemic differences between user & non-user groups.user & non-user groups.

Page 30: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ResultsResults

Health StatusHealth Status

Page 31: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Health Status: Overall self-Health Status: Overall self-assessment of health and absence assessment of health and absence

of painof pain

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1 2 3** 4* 5**

Hearing Loss Quintile

Users Non-users

Page 32: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Health Status: Health Status: Percent “Very Good” or Percent “Very Good” or

“Excellent”“Excellent”

56.3

4649.5

43.4

34.3

43.7 44.8

36.7 36.3

19.1

0

10

20

30

40

50

60

1** 2 3** 4 5**

Hearing Loss Quintile

Per

cent

Users Non-users

Page 33: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Health StatusHealth Status

Did not find significant Did not find significant differences on specific disease differences on specific disease states:states:

– ArthritisArthritis– High blood pressureHigh blood pressure– Heart problemsHeart problems

Page 34: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ResultsResults

Social & Solitary ActivitiesSocial & Solitary Activities

Page 35: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ActivitiesActivities

Self-measure of monthly incidence:Self-measure of monthly incidence:– Solitary (e.g. reading, TV, hobby) - 6 itemsSolitary (e.g. reading, TV, hobby) - 6 items

– Social (e.g. attend church, organized social Social (e.g. attend church, organized social events) - 7 itemsevents) - 7 items

No significant differences on solitary No significant differences on solitary activitiesactivities

But, significant differences on social But, significant differences on social activities.activities.

Page 36: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Activities: Organized social Activities: Organized social eventsevents

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1* 2** 3** 4 5**

Hearing Loss Quintile

Users Non-users

Page 37: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ActivitiesActivities

3/5 groups attend senior center more.3/5 groups attend senior center more.– Might be related to small age differences Might be related to small age differences

between groups.between groups. No systematic significant differencesNo systematic significant differences

– attendance at church (2/5 user groups)attendance at church (2/5 user groups)– Sport events (1)Sport events (1)– Theatre,movie (0)Theatre,movie (0)– Volunteering/civic groups (2)Volunteering/civic groups (2)– Shop with family (1)Shop with family (1)

Page 38: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ResultsResults

Relationship with Family & Relationship with Family & FriendsFriends

Page 39: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Relationship with Family & Relationship with Family & FriendsFriends

12 items on interpersonal relationship12 items on interpersonal relationship– ““How much can you relax and be How much can you relax and be

yourself around them” (A lot - Not at all)yourself around them” (A lot - Not at all) 12 items on negativity in relationship12 items on negativity in relationship

– ““How often do they argue with you” How often do they argue with you” (Often - never)(Often - never)

5 items on monthly incidence of 5 items on monthly incidence of contact (phone and in person)contact (phone and in person)

Page 40: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Lack of Interpersonal Warmth in Lack of Interpersonal Warmth in RelationshipsRelationships

(high scores are worse)(high scores are worse)

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2* 3* 4 5

Hearing Loss Quintile

Users Non-users

Page 41: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Low negativity in family Low negativity in family relationshipsrelationships

(e.g. arguments, tenseness, criticism)(e.g. arguments, tenseness, criticism)(High scores are better)(High scores are better)

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2** 3 4 5

Hearing Loss Quintile

Users Non-users

Page 42: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Contacts with friends and Contacts with friends and familyfamily

Found no systematic significant Found no systematic significant differences on incidence of:differences on incidence of:– Phone contactsPhone contacts– Meeting in personMeeting in person– Total contactsTotal contacts

Page 43: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Results

Social EffectsSocial Effects

Page 44: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social EffectsSocial Effects

Stigma (2 items)Stigma (2 items) Difficulty in Communication (4 items)Difficulty in Communication (4 items) Discrimination (4 items)Discrimination (4 items) Rejection (2 items)Rejection (2 items) Overcompensation for hearing loss (5 Overcompensation for hearing loss (5

items)items) Withdrawal (2 items) - family (6 items)Withdrawal (2 items) - family (6 items) Negative impact on family (6 items)Negative impact on family (6 items) Family accommodation (3 items)Family accommodation (3 items)

Page 45: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects: StigmaSocial Effects: Stigma“e.g. embarrassment wearing hearing aids”“e.g. embarrassment wearing hearing aids”

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2** 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Page 46: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects:Social Effects: Overcompensation for hearing Overcompensation for hearing

lossloss“e.g. Pretend I understand what people say”“e.g. Pretend I understand what people say”

3.25

3.75

4.25

4.75

5.25

5.75

6.25

6.75

Mean S

core

s

1** 2** 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Page 47: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects: DiscriminationSocial Effects: Discrimination“Accused of hearing only what they want to “Accused of hearing only what they want to

hear”hear”

3.5

4

4.5

5

5.5

6

6.5

7

Mean S

core

s

1 2** 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Page 48: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects: Social Effects: Difficulty in CommunicationDifficulty in Communication

“e.g. Trying to hear in some situations takes more effort than “e.g. Trying to hear in some situations takes more effort than it’s worth.”it’s worth.”

3.253.754.254.755.255.756.256.75

Mean S

core

s

1 2 3 4** 5**

Hearing Loss Quintile

Users Non-users

Page 49: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects: Social Effects: Safety Concerns from Family MembersSafety Concerns from Family Members

“e.g. Have made mistakes because of hearing loss”“e.g. Have made mistakes because of hearing loss”

3.5

4

4.5

5

5.5

6

6.5

7

Mean S

core

s

1** 2** 3** 4 5

Hearing Loss Quintile

Users Non-users

Page 50: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects: Social Effects: Non-significant variablesNon-significant variables

Negative effects of hearing loss on family Negative effects of hearing loss on family members.members.– e.g. “I find it exhausting to cope with their e.g. “I find it exhausting to cope with their

needs”needs” Family accommodation of hearing loss.Family accommodation of hearing loss.

– e.g. “I have to use signs and gestures a lot of e.g. “I have to use signs and gestures a lot of the time”the time”

WithdrawalWithdrawal– e.g. They tend to withdraw from social e.g. They tend to withdraw from social

activities where communication is difficult”activities where communication is difficult”

Page 51: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Social Effects: Social Effects: Non-significant variablesNon-significant variables

RejectionRejection– e.g. “They tend to get left out of e.g. “They tend to get left out of

social activities because of their social activities because of their hearing loss”.hearing loss”.

All non-significant variables All non-significant variables however, significantly related to however, significantly related to degree of hearing loss.degree of hearing loss.

Page 52: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ResultsResults

Emotional EffectsEmotional Effects

Page 53: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional EffectsEmotional Effects Emotional instability (12 items)Emotional instability (12 items) Denial (2 items)Denial (2 items) Anger & frustration (6 items)Anger & frustration (6 items) Paranoia (3 items)Paranoia (3 items) Sense of Confidence (2 items)Sense of Confidence (2 items) Sense of independence (4 items)Sense of independence (4 items) Depression (9 items)Depression (9 items) Anxiety (8 items)Anxiety (8 items) Phobias or unusual fears (6 items)Phobias or unusual fears (6 items)

Page 54: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: Emotional Instability Emotional Effects: Emotional Instability “e.g. Described as: fearful, tense, insecure, unstable, nervous, “e.g. Described as: fearful, tense, insecure, unstable, nervous,

etc)”etc)”

3.5

4

4.5

5

5.5

6

6.5

7

Mean S

core

s

1** 2* 3** 4* 5**

Hearing Loss Quintile

Users Non-users

Page 55: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: Emotional Effects: % Depressed Last 12 months% Depressed Last 12 months

11 10.1

16

20.8

27.7

18.7 19.8

26.7

31.733.7

0

5

10

15

20

25

30

35

1** 2** 3** 4** 5

Hearing Loss Quintile

Perc

ent

Users Non-users

Page 56: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: Depression Emotional Effects: Depression SymptomsSymptoms

“e.g. Tired, lose 10 pounds, insomniac, think of death”“e.g. Tired, lose 10 pounds, insomniac, think of death”

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2** 3** 4* 5**

Hearing Loss Quintile

Users Non-users

Page 57: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: Anger/frustrationEmotional Effects: Anger/frustration “e.g. I get annoyed and irritated more easily than I used “e.g. I get annoyed and irritated more easily than I used

to”to”

3.54

4.55

5.56

6.57

7.5

Mean S

core

s

1 2* 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Page 58: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: Emotional Effects: Anger/frustration (Family assessment)Anger/frustration (Family assessment)

“e.g. They get annoyed and irritated more easily than they “e.g. They get annoyed and irritated more easily than they used to”used to”

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2** 3** 4* 5**

Hearing Loss QuintileUsers Non-users

Page 59: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: ParanoiaEmotional Effects: Paranoia“e.g. I am often blamed for things which are not my fault”“e.g. I am often blamed for things which are not my fault”

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1 2** 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Page 60: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: DenialEmotional Effects: Denial“e.g. My hearing loss is not as bad as other people say it “e.g. My hearing loss is not as bad as other people say it

is.”is.”

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2** 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Page 61: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects: PhobiasEmotional Effects: Phobias“e.g. Speaking in public, going to social outing”“e.g. Speaking in public, going to social outing”

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1* 2* 3 4 5**

Hearing Loss Quintile

Users Non-users

Page 62: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Emotional Effects:Emotional Effects:Non-significant FactorsNon-significant Factors

Sense of Confidence Sense of Confidence Sense of independence Sense of independence Incidence of AnxietyIncidence of Anxiety

– Some indication of higher anxiety Some indication of higher anxiety symptoms for non-users in 3 groups.symptoms for non-users in 3 groups.

Page 63: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ResultsResults

Cognitive EffectsCognitive Effects

Page 64: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Cognitive EffectsCognitive Effects

Assessed by family member.Assessed by family member.

Cognitive/personality changes (4 Cognitive/personality changes (4 items) e.g. items) e.g. “they often appear “they often appear confused and disoriented”confused and disoriented”

Page 65: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Cognitive EffectsCognitive Effects(Family member perception)(Family member perception)

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1 2 3 4** 5**

Hearing Loss Quintile

Users Non-users

Page 66: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ResultsResults

Personality DifferencesPersonality Differences

Page 67: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

PersonalityPersonality

Locus of control (internal/external - 8 items)Locus of control (internal/external - 8 items) Powerful others (2 items)Powerful others (2 items) Emotional reliance/dependency (5 items)Emotional reliance/dependency (5 items) Assertion of autonomy ( 2 items)Assertion of autonomy ( 2 items) Interpersonal conformity (2 items)Interpersonal conformity (2 items) Sense of self control (6 items)Sense of self control (6 items) Self criticism (2 items)Self criticism (2 items) Self Esteem (5 items)Self Esteem (5 items)

Page 68: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

PersonalityPersonality

Active coping style (7 items)Active coping style (7 items) Fatalism (3 items)Fatalism (3 items) Justice (2 items)Justice (2 items) Introversion/extroversion (10 Introversion/extroversion (10

items)items) intellectual openness (9 items)intellectual openness (9 items)

Page 69: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Personality Assessment: IntrovertedPersonality Assessment: Introverted(Family member assessment)(Family member assessment)

e.g. Private, passive, shy, quiet, easily embarrassed”.e.g. Private, passive, shy, quiet, easily embarrassed”.

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1** 2 3 4** 5**

Hearing Loss Quintile

Users Non-users

Page 70: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1 2 3** 4** 5**

Hearing Loss Quintile

Users Non-users

Personality Assessment: Personality Assessment: External Locus of ControlExternal Locus of Control

“Believe they have little control over the events in their lives”.

Page 71: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Personality: Self-criticalPersonality: Self-criticale.g.“I dwell on my mistakes more than I should”.e.g.“I dwell on my mistakes more than I should”.

3.5

4

4.5

5

5.5

6

6.5

Mean S

core

s

1* 2 3** 4 5*

Hearing Loss Quintile

Users Non-users

Page 72: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Respondent & Family Respondent & Family Assessment of Benefit Assessment of Benefit

of Hearing Aidsof Hearing Aids

Page 73: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Respondent & Family Respondent & Family AssessmentAssessment

Hearing aid owner respondent and family Hearing aid owner respondent and family asked to rate asked to rate “the changes you have “the changes you have experienced in the following areas, that you experienced in the following areas, that you believe are due to using your hearing aids”.believe are due to using your hearing aids”.

5 point Scale : “A lot better” to “A lot worse”5 point Scale : “A lot better” to “A lot worse” 16 areas assessed.16 areas assessed. Analysis : % “somewhat better” or higher.Analysis : % “somewhat better” or higher. Quintiles 1 & 5 presentedQuintiles 1 & 5 presented

Page 74: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Perceptions of Hearing Aid Perceptions of Hearing Aid Benefit: Respondent & FamilyBenefit: Respondent & Family

(Quintile 1 & 5)(Quintile 1 & 5)

0 10 20 30 40 50 60 70 80

Relationships at home

Feelings about myself

Life overall

Mental health

Percent

Q1-SelfQ1-FamilyQ5-SelfQ5-Family

Page 75: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Perceptions of Hearing Aid Perceptions of Hearing Aid Benefit: Respondent & FamilyBenefit: Respondent & Family

(Quintile 1 & 5)(Quintile 1 & 5)

0 10 20 30 40 50 60 70 80

Confidence

Relationship-Child

ParticipateGrp Act.

Independence

Percent

Q1-SelfQ1-FamilyQ5-SelfQ5-Family

Page 76: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Perceptions of Hearing Aid Perceptions of Hearing Aid Benefit: Respondent & FamilyBenefit: Respondent & Family

(Quintile 1 & 5)(Quintile 1 & 5)

0 20 40 60 80

Sense of safety

Play card/ board games

Social life

Physical health

Percent

Q1-SelfQ1-FamilyQ5-SelfQ5-Family

Page 77: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Perceptions of Hearing Aid Perceptions of Hearing Aid Benefit: Respondent & FamilyBenefit: Respondent & Family

(Quintile 1 & 5)(Quintile 1 & 5)

0 10 20 30 40 50 60 70 80

Dependence on others

Relationships at work

Ability to play sports

Sex life

Percent

Q1-SelfQ1-FamilyQ5-SelfQ5-Family

Page 78: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions

Page 79: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions Treatment with hearing aids is Treatment with hearing aids is

related to:related to: Improved interpersonal relationships with family.Improved interpersonal relationships with family. Reduction in hearing loss compensation behaviors.Reduction in hearing loss compensation behaviors. Reduction in discriminatory behaviors toward the Reduction in discriminatory behaviors toward the

person with hearing loss.person with hearing loss. Reduction in anger & frustration.Reduction in anger & frustration. Reduction in depression & depressive Reduction in depression & depressive

symptoms.symptoms. Improved $$ earning power. Improved $$ earning power. Improved emotional stability.Improved emotional stability.

Page 80: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusionsTreatment with hearing aids is Treatment with hearing aids is

related to:related to:

Reduction in introverted behavior.Reduction in introverted behavior. Belief that subject is in control of their Belief that subject is in control of their

lives (locus of control).lives (locus of control). Reduced paranoid feelings.Reduced paranoid feelings. Reduced self-criticism.Reduced self-criticism. Enhanced group social activity.Enhanced group social activity. Improved overall-health & pain Improved overall-health & pain

reductionreduction

Page 81: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions Strong evidence for the “value” of Strong evidence for the “value” of

hearing aids in improving the hearing aids in improving the quality of life from mild to severe quality of life from mild to severe hearing loss levels.hearing loss levels.

Design of study was correlational. Design of study was correlational. Findings are compelling & Findings are compelling & suggestive of causation:suggestive of causation:

Page 82: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions

Findings suggestive of causation:Findings suggestive of causation:– some consistent findings across cohorts.some consistent findings across cohorts.– supportive of smaller experimental studies.supportive of smaller experimental studies.– large nationally representative study.large nationally representative study.– corroboration within study (self & family).corroboration within study (self & family).– positive halo or acquiescence not present.positive halo or acquiescence not present.– consistent with theoretical literature.consistent with theoretical literature.– findings hold up under multivariate analysis findings hold up under multivariate analysis

controlling for minor demographic controlling for minor demographic differences.differences.

Page 83: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions

Hearing Health Industry needs to reach Hearing Health Industry needs to reach younger more active customers with younger more active customers with hearing loss.hearing loss.

Effective public relations on quality of Effective public relations on quality of life findings key to:life findings key to:– improved image of hearing aid “value”improved image of hearing aid “value”– reinventing or repositioning the hearing reinventing or repositioning the hearing

aid industry.aid industry.– developing the market for hearing aids.developing the market for hearing aids.

Page 84: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions Best time ever for collaborative Best time ever for collaborative

market development:market development:– BHI is being rebuiltBHI is being rebuilt– Industry has superb technology.Industry has superb technology.– FDA battles behind us.FDA battles behind us.– Powerful new findings on hearing aid Powerful new findings on hearing aid

benefit which need to be leveraged.benefit which need to be leveraged.– Integrated HIA and BHI & market Integrated HIA and BHI & market

development thrust development thrust – Positive demographics.Positive demographics.

Page 85: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

ConclusionsConclusions

Time for a new message about our Time for a new message about our product and industry.product and industry.

Time to reinvent our industry to the Time to reinvent our industry to the public and medical communities.public and medical communities.

Need effective communication to three Need effective communication to three key segments:key segments:– DispensersDispensers– PhysiciansPhysicians– Potential consumersPotential consumers

Page 86: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Leveraging the Quality of Leveraging the Quality of Life Study FindingsLife Study Findings

Page 87: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Leveraging the FindingsLeveraging the Findings

Must change our selling consciousness.Must change our selling consciousness. We are not in the business of selling We are not in the business of selling

hearing aids.hearing aids. We are in the business of meeting deep We are in the business of meeting deep

seated human needs.seated human needs. Reposition the entire hearing aid Reposition the entire hearing aid

industry.industry. Necessitates:Necessitates:

Greater counseling focusGreater counseling focus More benefit selling versus feature sellingMore benefit selling versus feature selling Communicating our role to societyCommunicating our role to society

Page 88: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Fundamental Consumer Needs Fundamental Consumer Needs Met with Our Product & ServiceMet with Our Product & Service

To improve speech intelligibilityTo improve speech intelligibility To improve hearing in all listening situationsTo improve hearing in all listening situations To improve communicationTo improve communication To enhance belongingnessTo enhance belongingness To facilitate acceptanceTo facilitate acceptance To reduce free-state anxietyTo reduce free-state anxiety To increase comprehensionTo increase comprehension To enhance enjoyment of life To enhance enjoyment of life To enhance psychological well-beingTo enhance psychological well-being sometimes even SAVE LIVESsometimes even SAVE LIVES

Page 89: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Quality of Life Benefits Quality of Life Benefits Associated with Hearing Aids Associated with Hearing Aids

>Interpersonal >Interpersonal relationshipsrelationships

<Hearing loss <Hearing loss compensationcompensation

<Anger & frustration<Anger & frustration <Depression<Depression >Earning power>Earning power >Emotional stability>Emotional stability <Introversion<Introversion >Control of life>Control of life

<Self-criticism<Self-criticism <Paranoia<Paranoia >Overall health>Overall health >Cognitive >Cognitive

functioningfunctioning <Discrimination<Discrimination <Anxiety<Anxiety <Social phobias<Social phobias >Social activity>Social activity

Page 90: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Proposed ActionsProposed Actions Develop a Mission Statement for Your practice:Develop a Mission Statement for Your practice:

Involve all staff & make sure they Involve all staff & make sure they understand and buy into the mission.understand and buy into the mission.

Make it idealistic.Make it idealistic.

Talk from your heart.Talk from your heart.

Display it prominently.Display it prominently.

Give to each customer as if a contract.Give to each customer as if a contract.

Page 91: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Sample Simple Mission Sample Simple Mission StatementStatement

Our mission is to improve the quality of your Our mission is to improve the quality of your life, to improve the relationship between you life, to improve the relationship between you and your family, to enhance your ability to and your family, to enhance your ability to belong and contribute to your community. belong and contribute to your community. We will do everything possible to assure your We will do everything possible to assure your satisfaction with our service and benefit from satisfaction with our service and benefit from our product. If you are not completely our product. If you are not completely satisfied we are not satisfied.satisfied we are not satisfied.

The staff of XYZ Audiovestibular ServicesThe staff of XYZ Audiovestibular Services

Page 92: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Proposed ActionsProposed Actions Become very familiar with the executive Become very familiar with the executive

summary of the NCOA studysummary of the NCOA studyKochkin & Rogin. Quantifying the Obvious : The impact of Kochkin & Rogin. Quantifying the Obvious : The impact of

hearing hearing aids on quality of life (Hearing Review, Jan. 2000)aids on quality of life (Hearing Review, Jan. 2000)

Counsel your potential clients on the benefits Counsel your potential clients on the benefits of hearing aids.of hearing aids. Talk about the powerful human benefits.Talk about the powerful human benefits. Spend less time selling technology or sizeSpend less time selling technology or size

Develop a presentation of the key results (e.g. Develop a presentation of the key results (e.g. Powerpoint). Use parts of my Powerpoint Powerpoint). Use parts of my Powerpoint presentation if you want presentation if you want

Page 93: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Proposed ActionsProposed Actions Spend more time exploring quality of life Spend more time exploring quality of life

changes desired by the customer in the changes desired by the customer in the pre-fitting stage:pre-fitting stage: COSICOSI Pre-fitting questionnairesPre-fitting questionnaires Structured interviewsStructured interviews

Potential consumer may not know impact Potential consumer may not know impact hearing loss has on their healthhearing loss has on their health Important to share research based impact in Important to share research based impact in

counseling sessions.counseling sessions.

Page 94: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Proposed ActionsProposed Actions Develop a small quality brochure on the key Develop a small quality brochure on the key

benefits of hearing aids:benefits of hearing aids: Your businessYour business Local Association (Hearing HealthCare Alliance of..)Local Association (Hearing HealthCare Alliance of..) National Association (AAA, IHS, ADA, BHI)National Association (AAA, IHS, ADA, BHI)

Begin collecting powerful human interest Begin collecting powerful human interest stories from your practice which are related to stories from your practice which are related to quality of life changes and use them to "sell":quality of life changes and use them to "sell": Part of your counseling protocolPart of your counseling protocol Radio/public appearancesRadio/public appearances Quotes in direct mail pieces or videosQuotes in direct mail pieces or videos

Page 95: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Proposed ActionsProposed Actions

Develop 10-15 minute professional Develop 10-15 minute professional video on "real" quality of life video on "real" quality of life changes using your State and changes using your State and National Organizations.National Organizations.CNN type human interest vignettesCNN type human interest vignettesKey findings of NCOA studyKey findings of NCOA studyMulti-function videoMulti-function video

Physician educationPhysician education Consumer outreachConsumer outreach Local media outreachLocal media outreach

Page 96: Hearing Aids and Quality of Life Sergei Kochkin, Ph.D. Better Hearing Institute

Proposed ActionProposed Action Especially share the information with Especially share the information with

physicians and managed care facilities who physicians and managed care facilities who refer to you.refer to you.– In person In person – Direct MailDirect Mail– Business newsletterBusiness newsletter

Use the information in your community Use the information in your community speeches.speeches.

Ask your National and state organizations Ask your National and state organizations (ASHA, IHS, AAA) to develop market (ASHA, IHS, AAA) to develop market development programs on the Quality of Life development programs on the Quality of Life theme.theme.