Development of a theory-based, multi-level, low-intensity, low-cost intervention to improve long-term hearing aid use in adult auditory rehabilitation.

Poorly managed hearing loss can lead to cognitive decline, depression and reduced quality of life. Using a hearing aid can help but evidence suggests up to 40% of people who are fitted with a hearing aid do not use it. While there are many reported reasons for non-use, research suggests that audiologist behaviour in the fitting consultation could play a key role in supporting hearing aid use. Following a systematic review of interventions to improve hearing aid use, this research used the steps of the Behaviour Change Wheel to identify four audiologist behaviours that might influence hearing aid use. An observational study and structured interviews with audiologists using the COM-B model as a framework identified potential determinants of the target behaviours. The COM-B model describes how capability (C), opportunity (O) and motivation (M) combine and influence behaviour (B). This analysis was used to select intervention functions and behaviour change techniques likely to affect behaviour change in this context. The intervention functions of education, training, persuasion, coercion, environmental restructuring, modelling and enablement were selected and combined to develop the I-PLAN; a complex intervention combining prompts, information and a behaviour plan for hearing aid use. This is the first study to use the COM-B model and Behaviour Change Wheel to develop a complex intervention in the context of audiology. Use of the COM-B model to analyse patient and professional behaviour has facilitated a consideration of implementation at the development stage of intervention design. The systematic, theory-based development of the I-PLAN intervention will facilitate a thorough evaluation of its feasibility and effectiveness over the next phases of this work