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This thesis describes a cluster randomized controlled trial (cRCT) which aimed to evaluate the effectiveness of a web-based self-management SUpport PRogam (SUPR) for hearing aid users (PHLs) aged 50+, and for their communication partners (CPs). SUPR consisted of four main elements: 1) Practical Support Booklet 2) online materials: three instruction videos, five videos on communication strategies, and three testimonial videos; 3) optional email-contact with the hearing aid (HA) dispensing practice, and 4) involvement of a CP throughout SUPR. This cRCT study was combined with a process evaluation (PE) study. Chapter 2 includes the study protocol (ISRCTN77340339). Thirty-six HA dispensing practices and their clients were randomized to the intervention (SUPR recipients) and 34 to care as usual (HA fitting only). The primary outcome for PHLs was the use of communication strategies. For CPs, outcomes included third-party disability and intervention outcomes. Effect measurements occurred at baseline (before the PHL had obtained HAs), immediately-, six months-, and 12 months post-intervention. PE measures included: Context of the implementation, recruitment, and SUPR’s: reach, implementation fidelity, dose delivered and received, satisfaction, and benefit. Both quantitative and qualitative methods were used. CPs’ PE measures included: SUPRs’ dose-received, satisfaction and benefit. For CPs, only quantitative data were collected. Chapter 3 reports on the results of the cRCT for PHLs. In total, 343 PHLs were randomized to SUPR (n=180 PHLs) or to care as usual (n=163 PHLs). SUPR did not lead to more frequent use of communication strategies. Effects on the secondary outcomes were: long-term improvements in self-efficacy for advanced HA handling and HA satisfaction, i.e, 12 months, and greater HA use in the short term (immediately after completion of SUPR). Adding SUPR to standard HA dispensing care is recommended but further research is needed to establish effectiveness on psychosocial outcomes. Chapter 4 describes the PE study for PHLs. PHLs and dispensers were generally satisfied with SUPR’s usefulness. Viewing rates of SUPRs’ videos ranged between 7-37%. Half of the dispensers encouraged their PHLs to watch the videos or informed them about SUPR. Some PHLs’ found the intervention materials suboptimal. Changes in personnel and limited dispenser-training were contextual barriers. These factors are important to consider in any further development of SUPR. Chapter 5 reports on results of the cRCT and PE for CPs. In total, 72 CPs were randomized to SUPR and 57 to care as usual. There were no significant effects for third-party disability and items ‘use’, ‘satisfaction’, and ‘quality of life’. CP’s watching rates of educational videos were ranging between 15-22%. Low baseline disability (floor effect) and low watching rates may explain the findings. Future research should indicate if inviting CPs directly may increase their engagement. In Chapter 6 we reflect on the lessons we learned throughout this SUPR-project. In the developmental phase, perspectives of relevant stakeholders were taken into account. However, the developmental phase may have been more theory-based and may have deserved more systematic testing. In the implementation phase we learned that in real-life unforeseen factors can influence successful implementation such as unanticipated cuts in personal and policy changes. In the evaluation phase, results of the PE showed that it is relevant to consider any barriers to and enablers of uptake and use that are specific to web-based interventions. Chapter 7 provides a general discussion. Overall, this thesis shows that despite suboptimal intervention use and implementation, SUPR showed beneficial effects in the HA use domain. SUPR can thus be considered a useful addition to current care provided in HA dispensing practices. Nonetheless, additional research on the optimization of SUPR materials and ways of delivering the program is needed, to establish positive effects on self-management more broadly. |
