“We’re just winging it”. Identifying targets for intervention to improve the provision of hearing support for residents living with dementia in long-term care: an interview study with care staff

Abstract

Purpose

Hearing loss and dementia are common in long-term care home (LTCH) residents, causing communication difficulties and worsened behavioural symptoms. Hearing support provided to residents with dementia requires improvement. This study is the first to use the Behaviour Change Wheel (BCW) to identify barriers and propose interventions to improve the provision of hearing support by LTCH staff.

Methods

Semi-structured interviews with 10 staff members were conducted. Transcripts were analysed according to the BCW’s Theoretical Domains Framework alongside reflective thematic analysis. Relevant intervention functions and exemplar interventions were proposed.

Results

Staff believed hearing support to be beneficial to residents ( Beliefs about Consequences) but lacked knowledge of hearing loss management ( Knowledge). Poor collaborations between LTCHs and audiology ( Environmental Context and Resources), led to despondency, and apprehension about traditional hearing aids for residents ( Optimism). Despite feeling responsible for hearing support, staff lacked personal accountability ( Social/Professional Role and Identity).

Conclusions

Future interventions should include staff Training (on hearing support), Education (on the consequences of unsupported hearing loss), Enablement (dementia-friendly hearing devices), Incentivisation and Modelling (of Hearing Champions) and Environmental Restructuring (flexible audiology appointments to take place within the LTCH). Interventions should be multi-faceted to boost the capabilities, opportunities and motivations of LTCH staff.

IMPLICATIONS FOR REHABILITATION

Hearing support for care home residents with dementia:

• Long-term care staff report inadequate knowledge and awareness of how to support residents’ hearing needs and a lack of personal accountability for providing hearing support.

• They also report poor collaborations with audiologists and apprehension about traditional hearing aids.

• Barriers to hearing support stem from gaps in the capabilities, opportunities and motivations of staff, therefore, interventions should be designed to target all three constructs.

• Interventions to aid hearing support provision should target staffs’ education, training, enablement, persuasion, modelling, incentivisation and environmental restructuring to boost staff capabilities, opportunities and motivations to provide hearing support.