Arm 1. Training, Education, Enablement and Persuasion |
Training | Psychological Capability. Audiologists require knowledge of how to detect signs and symptoms for emotional and psychological distress | Ask | 4.1 Instruction on how to perform behaviour | In-person workshop. Provide information on the signs and symptoms of emotional and psychological distress in adults with hearing loss. |
Training | Psychological Capability. Audiologists require knowledge of how to discuss treatment/management options for emotional and psychological distress, and how to provide reliable information regarding funding and access for psychological services | Manage | 4.1 Instruction on how to perform behaviour | In-person workshop. Audiologists viewed a video recorded by a local clinical psychologist describing various treatment/management options and pathways for emotional and psychological distress. Self-directed learning. The recording was made available after the training session. |
Training | Psychological capability. Audiologists require knowledge of how to refer for mental wellbeing support | Manage | 4.1 Instruction on how to perform behaviour | In-person workshop. Audiologists viewed two videos recorded by (i) a local clinical psychologist and (ii) a local GP describing referral processes for psychological support in Australia. audiologists were shown how to use the newly developed report templates assisting report writing to GPs and psychologists for wellbeing support. The importance of aligning wording in reports with the exact wording used by clients was emphasised. |
| | Manage | 8.1 Behavioural practice / rehearsal | Self-directed learning. A video recording informed audiologists on the newly developed report templates assisting report writing to GPs and psychologists for wellbeing support, with instruction provided on how to use the new templates within the existing database system. During this video, the importance of aligning wording in reports with the exact wording used by clients was emphasised. audiologists were asked to practice generating reports with the new templates in their own time. |
Training | Psychological Capability. Audiologists require language skills for discussing mental health-related topics | Inform | 4.1 Instruction on how to perform behaviour | We co-developed flash cards with the audiologists. Prior to the training, audiologists were asked to put forward phrases that their clients have said that they found difficult to respond to (e.g., All my friends are dead now, I've got no one left). In partnership with clinical psychologists and audiologists, we developed a deck of training flashcards, each stating a "challenging" client statement followed by a few suggested responses that demonstrate empathy and understanding. In-person workshop. Provided information on the language to use when asking about and providing information on mental wellbeing during clinical consultations, including provision of a deck of flash cards each and demonstration on how to use them to develop the required skills. Self-directed learning. Participants were each given a deck of training flashcards for ongoing personal practice. |
| | Ask, Inform & Manage | 6.1 Demonstration of the behaviour | In-person workshop. During the group training session presenters demonstrated how one might (i) ask about mental wellbeing, (ii) provide information on the mental wellbeing impacts of hearing loss, and (iii) provide information on mental wellbeing treatment/management strategies. Participants were invited to discuss what was good and bad about the examples provided, and to devise their own scripts for how they would feel most comfortable asking these questions and providing this information in the future. |
Training | Reflective motivation. Audiologists need to develop confidence in their ability to ask about mental wellbeing and respond with empathy when clients describe their challenges | Ask | 8.1 Behavioural practice/rehearsal | In-person workshop. Instruction on how to respond with empathy, followed by practice responding to difficult statements (using flashcards) and roleplay / rehearse different ways to respond to 'tricky' situations. |
Education | Psychological capability. Audiologists require knowledge of who to refer to for mental wellbeing support | Manage | 4.1 Instruction on how to perform behaviour | In-person workshop. Audiologists were provided with a list of local referral partners, including identification of those who specialise in psychological support for people with hearing loss. |
Education & Persuasion | Reflective Motivation. Audiologists need reassurance that clients are open to receiving information on the mental wellbeing impacts of hearing loss | Inform | 6.3 Information about others’ approval | We developed an educational resource wherein adults with hearing loss described how they cope with the mental wellbeing impacts of hearing loss and how grateful they were to receive this information and support from their audiologist. (https://www.youtube.com/watch?v=rmu4e4hNlKs) In-person workshop. Audiologists viewed the video within the training session and then reflected as a group on how receptive clients are to these conversations within general clinical appointments. Self-directed learning. The recording was emailed to staff after the training session. |
Education | Reflective motivation. Audiologists need reassurance that asking about mental wellbeing is within their scope of practise | Ask | 6.3 Information about others’ approval | In-person workshop. We provided information on the Australian Scope of Practice guidelines, as well as the USA guidelines to emphasise that provision of wellbeing support is within current practice guidelines. |
Enablement | Social opportunity. Audiologists need to feel supported by peers in their workplace | Ask, Inform & Manage | 3.2 Social support (practical) | In-person workshop. The Chief Operating manager and clinical manager attended the training workshop emphasising the importance of supporting clients’ mental wellbeing needs. |
Persuasion | Reflective motivation. Audiologists need to feel responsible for (i) asking about mental wellbeing, (ii) providing information on the mental wellbeing impacts of hearing loss, and (iii) providing information on mental wellbeing treatment/management strategies | Ask, Inform & Manage | 5.1 Information about health consequences | We developed a persuasive resource wherein adults with hearing loss described their personal experiences of living with hearing loss, how this impacted on their mental wellbeing and how they wish their audiologist had helped them to better understand and address these mental wellbeing impacts of hearing loss. (https://www.youtube.com/watch?v=zQbM2NPmU_Y) In-person workshop. Audiologists viewed the video within the training session and then reflected individually on how often they provide mental wellbeing support to their clients. Self-directed learning. The recording was emailed to staff after the training session. |
Persuasion | Reflective Motivation. Audiologists require reassurance that clients are open to receiving information on mental wellbeing treatment/management options during audiological appointments | Inform & Manage | 9.1 Credible sources | To address audiologists’ insecurities regarding how clients would react to being given information on mental wellbeing, we developed a video of clients describing positive stories of how their audiologists helped them to gain an understanding of how wellbeing is impacted by hearing loss, how they are interested to learn more about psychological treatment/management options during audiological appointments, and that management strategies are effective (https://www.youtube.com/watch?v=rmu4e4hNlKs) In-person workshop. Audiologists viewed the video within the training session and then reflected as a group on how receptive clients are to these conversations within general clinical appointments. Self-directed learning. The recording was emailed to staff after the training session. |
Persuasion | Reflective motivation. Audiologists need reassurance that GPs would react positively to receiving a referral from an audiologist regarding concerns for a client’s mental wellbeing | Manage | 9.1 Credible sources | We developed a video interviewing three local GPs on their views regarding the role of the audiologist in detecting the mental wellbeing impacts of hearing loss, and how GPs and audiologists can work together to provide multidisciplinary care. Within these videos the GPs explicitly stated how they would be pleased to accept referrals from audiologists regarding the mental wellbeing needs of their clients. In-person workshop. Audiologists viewed the video within the training session. Self-directed learning. The recording was emailed to staff after the training session. |
Persuasion | Reflective motivation. Audiologists need reassurance that psychologists have the skills required to address the psychological needs of adults with hearing loss seeking psychological support | Manage | 9.1 Credible sources | We developed a video interviewing a local clinical psychologist describing the many ways that psychologists can support the mental wellbeing needs of adults with hearing loss. We also generated a list of local psychologists with experience in working with adults with hearing loss so that audiologists can confidently refer. In-person workshop. Audiologists viewed the video within the training session. Self-directed learning. The recording was emailed to staff after the training session. |
Arm 2. Environmental Restructuring | | | |
Environmental restructuring | Psychological capability. Audiologists require knowledge of who to refer to and how to refer for mental wellbeing support | Manage | 12.5 Adding objects to the environment | audiologists were provided with a list of local psychological services, specifically those who indicated that they would accept referrals from audiologists, and that they had experience working with older adults and'/or adults with hearing loss. |
Environmental restructuring | Social opportunity. Audiologists require reassurance that clients will be receptive to them asking about mental wellbeing | Ask | 12.5 Adding objects to the environment | We developed a clinical resource, an animated explainer video, wherein an adult with hearing loss describes his experience of hearing loss and it impacts on his mental wellbeing. It then prompts adults with hearing loss to talk with their audiologist about how they are feeling to get mental wellbeing support. This video is emailed to all clients prior to their first appointment so that audiologists can be reassured that clients are 'primed' to being asked about their wellbeing. (https://www.youtube.com/watch?v=8CXMeU6oECU) In-person workshop. Audiologists viewed the video within the training session and then reflected as a group on how clients might respond to the video and what they might now be expecting from their first appointment. |
Environmental restructuring | Physical opportunity. Audiologists require clinical resources to assist with (i) asking about wellbeing, (ii) providing information on the wellbeing impacts of hearing loss, and (iii) providing information on wellbeing treatment/management strategies | Ask, Inform & Manage | 12.5 Adding objects to the environment | In partnership with the target audiologists, we developed a series of clinical tools, including (i) two discussion tools incorporated into the existing flip chart used to aid client discussion (one facilitating asking about and discussing wellbeing in relation to hearing loss; one facilitating discussion on the stepped care approach to mental wellbeing management); (ii) a series of three client information sheets (describing the “Emotional impacts of hearing loss”, “Social impacts of hearing loss”, and how “Hearing loss affects relationships”); (iii) a client brochure to assist discussion and information provision relating to mental wellbeing management options (including what the management options entail, access and funding); and (iv) development of clinical protocols to assist with ongoing use of these resources and training for future staff. To embed the factsheets within the audiologists’ workflow, we altered the customer management software used by the clinic staff to set up an automated factsheet printing system. As the audiologists enter their case notes, they can select which factsheets they want printed (including these three new ones as well as all of the existing factsheets previously used by audiologists, but manually printed or photocopied). |
Environmental restructuring | Social opportunity. Audiologists require reassurance from their managers that provision of mental wellbeing support is a vital part of their service provision despite it not being a claimable service. | Ask, Inform & Manage | 12.2 Restructuring the social environment | We updated the clinic’s Clinical Procedures Documentation to describe the use of these new resources, emphasising the importance of considering client’s mental wellbeing needs within appoints. In-person workshop. To reinforce this message, the clinical managers addressed the staff highlighting that provision of mental wellbeing support is a vital part of their service provision despite it not being a claimable service, during the in-person training session. |
Environmental restructuring | Automatic motivation. Audiologists need reminders/prompts to help them remember to ask clients about mental wellbeing | Ask | 7.1 Prompts/cues | To improve remembering and habit forming for asking clients about their mental wellbeing, we added a question on wellbeing to the electronic client case history form and in the clinical case notes (1st appointment and annual recall appointment templates). We also modified the client goals template to promote inclusion of goals relating to mental wellbeing impacts of hearing loss. To embed the new goal setting template within the audiologists’ workflow, we altered the customer management software used by the clinic staff to set up an automated printing system. After the audiologist completes the goals within the data management system, they can now easily print the goals to assist discussion with the client. Ongoing support. Audiologists were sent bimonthly emails promoting specific aspects of the intervention. For example, reminders on how to use the new factsheets or the referral templates. |
Environmental restructuring | Social opportunity. Audiologists need to feel supported by peers in their workplace | Ask, Inform & Manage | 3.2 Social support (practical) | Ongoing support. Senior audiologists with advanced skills in providing mental wellbeing support were identified as team leaders, creating an environment where they can provide support and training to less experienced and new staff members. |
Arm 3. Modelling | | | |
Modelling | Social opportunity. Audiologists need to see their managers and senior staff role modelling provision of mental wellbeing support | Ask, Inform & Manage | 9.1 Credible sources | Ongoing support. After the in-person training day, senior and well-respected audiologists from the partner clinic were engaged to record themselves describing which of the new clinical resources were their favourite to use and why, including a demonstration of how they use the tool within their routine workflow. |