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The role of communication partners in the audiological

enablement/rehabilitation of a person with hearing impairment: An overview

Article  in  Audiological Medicine · February 2012

DOI: 10.3109/1651386X.2012.655914

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 Audiological Medicine, 2012; 10: 21–30

REVIEW ARTICLE

The role of communication partners in the audiological

enablement/rehabilitation of a person with hearing
impairment: an overview

VINAYA K. C. MANCHAIAH1,2, DAFYDD STEPHENS3, FEI ZHAO4

Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12

& SOPHIA E. KRAMER5

1Centre for Long Term and Chronic Conditions, College of Human and Health Sciences, Swansea University, Swansea, UK,
2Linnaeus Centre HEAD, The Swedish Institute for Disability Research, Department of Behavioural Science and Learning,
Linköping University, Linköping, Sweden, 3Department of Psychological Medicine and Neurology, School of Medicine, Cardiff
University, Cardiff,Wales, 4Centre for Hearing and Balance Studies, University of Bristol, Bristol, UK, and 5Department of
ENT/Audiology, EMGO ⫹ Institute,VU University Medical Centre, The Netherlands

Abstract
For personal use only.

Objective: Hearing impairment is known to have various effects upon both the person with hearing impairment (PHI) and
their communication partners (CPs). In addition, CPs are reported to play an important role in making the decision to
seek a consultation and the acceptance of intervention by the PHI. The overall aim of this paper is to provide a compre-
hensive overview of the role of the CP in the audiological enablement/rehabilitation of the PHI keeping clinical practice in
focus. Method: A literature review was conducted using a number of resources including electronic databases, books and
websites. Results: An overview of the literature was presented in the following sections: 1) Factors influencing the audio-
logical enablement/rehabilitation of the PHI; 2) Effect of the PHI’s hearing impairment on their CPs; 3) CPs’ influence
on their PHI’s audiological enablement/rehabilitation; 4) Positive experiences reported by CPs of the PHI; 5) Models to
represent CPs within the social network context of the PHI; and 6) CP involvement in the audiological enablement/reha-
bilitation. This paper also identifies gaps in the literature and provides recommendations for further research. Conclusion:
It is clear that involvement of the CP in the audiological enablement/rehabilitation can result in mutual advantages for both
the PHI and their CPs.

Key words: hearing impairment, hearing loss, communication partner (CP), significant other, person with hearing impairment
(PHI), rehabilitation, enablement

Introduction
Hearing impairment is a common chronic condi-
tion in middle-aged and elderly adults and is often
poorly recognized and rarely acknowledged. Hear-
ing impairment may be associated with poor health-
related quality of life due to consequences in the
physical, mental and social domains (1⫺3). This is
due to the wide range of limitations and restrictions
they experience as a result of the hearing impair-
ment. In addition, the person’s hearing impairment
may have various effects on their significant others.
The term ‘communication partner’ (CP) refers to
an individual communicating with a person with
hearing impairment (PHI) on a regular basis (4) and
is preferred by many hearing healthcare profession-
als to refer to significant others, which may include
spouse, siblings, children, other family members
and friends (5).
There is a considerable literature on the impact
of hearing impairment on the individual with hear-
ing impairment. However, the effect of hearing
impairment on CPs due to their partners’ hearing
impairment has been largely ignored (6). Such an
effect of hearing impairment on the spouse is
considered as a third-party disability according to
the World Health Organization⫺international
Classification of Functioning, Disability, and
Health (WHO-ICF) (7).

Correspondence: V. K. C. Manchaca, Centre for Long Term and Chronic Conditions, College of Human and Health Sciences, Swansea University, Room
167 Glyndwr Building, Swansea SA2 8PP, UK. Tel: ⫹ 01792602179. Fax: ⫹ 01792295487. E-mail: V.K.C.Manchaiah@swansea.ac.uk
(Accepted 6 January 2012)
ISSN 1651-386X print/ISSN 1651-3835 online © 2012 Informa Healthcare
DOI: 10.3109/1651386X.2012.655914
 22 V. K. C. Manchaiah et al.
In this discussion paper, the aim is to provide an
overview of the role of CPs in the audiological enable-
ment/rehabilitation of the PHI. We shall discuss:
• Factors influencing the audiological enable-
ment/rehabilitation of the PHI;
• Effect of the PHI’s hearing impairment on CPs;
• CPs’ influence on their partner’s audiological
enablement/rehabilitation;
• Positive experience reported by CPs of the PHI;
• Models to represent CPs within the social net-
work context of the PHI;
• CP involvement in the audiological enablement/
rehabilitation.
Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12
In addition, this paper also highlights gaps in the
literature and provides recommendations for further
research.
Rationale and search strategy
This article was inspired by attendance at the Ida
Institute’s ‘Enabling communication partnership’
seminar in 2009 (http://www.idainstitute.com/). In
the seminar, by interacting with other expert hearing
For personal use only.
healthcare specialists from various countries it was
evident that, in general, the role of CPs in the audi-
ological enablement/rehabilitation has been largely
ignored. In addition, we were unable to find any stan-
dardized approach to the involvement of CPs in the
audiological enablement/rehabilitation process of
PHI. This led us to consider the need for providing
an overview of the literature in this area, mainly keep-
ing clinical practice in focus.
A number of resources, including a few main
electronic databases (Medline, Cinhal and Google
Scholar), books and websites, were searched. Search
words included significant others, communication
partners, hearing impairment AND significant oth-
ers, hearing impairment AND communication part-
ners, factors influencing AND hearing impairment,
person with hearing impairment AND audiological
rehabilitation. A significant number of references
Table I. Main reasons for PHI not wearing a hearing aid.
• Perceived benefit
• Cost
• Fit and comfort
• Negative side-effects
• Stigma
• Influence of environmental and lifestyle factors
• Denial of hearing loss
• Sound quality
• Hearing aid no longer working
• Difficulty handling the aid
• No self-reported hearing difficulty
• Access to conveniently located clinic and confidence in
clinicians’ expertise
were also found by looking through the reference list
of the papers identified through the search engines.
Abstracts of the identified papers were reviewed to
see the relevance to the current paper, and full texts
of potentially relevant articles were retrieved. The
literature used in this article was limited to those
papers that are available in the English language.
Factors influencing the audiological enablement/
rehabilitation of PHI
Patients with similar audiological characteristics may
display different degrees of communication problems
(8). However, the rehabilitative approaches are usu-
ally based on the audiometric investigations (e.g.
audiogram). Some researchers in recent years have
argued that audiological enablement/rehabilitation
should be based on the perceived or experienced dif-
ficulties of the patient rather than the severity or level
of hearing impairment (5).
In general, the main avenue of treatment and/or
rehabilitation offered to the majority of PHIs com-
prises hearing aids. Studies have demonstrated
improvement in the quality of life of the individuals
and their CPs with the use of hearing aids (9,10).
However, many hearing aid studies have shown that
only one in four to five people with hearing impair-
ment actually use a hearing aid (11⫺13). There have
been several reasons identified for people with hear-
ing impairment not wearing hearing aids and Table
I summarizes some of these reasons (14⫺19). More-
over, studies demonstrate that the help-seeking
behaviour of the PHI can be influenced by such per-
sonal factors as gender (20), age (21), self-esteem
(22), confidence (23), and perception of disability
(24). A systematic literature review by Knudsen et
al. (25) identified three major groups of factors
including personal factors (e.g. source of motivation,
expectation, and attitude), demographic factors (e.g.
age, gender) and external factors (e.g. cost, counsel-
ling) contributing to outcome variables such as help-
seeking behaviour for hearing loss, hearing-aid
uptake, and hearing-aid satisfaction. However, they
found that self-reported hearing disability was the
major factor positively affecting all four outcome
variables and that CPs acted as a source of motiva-
tion for help-seeking.
A recent study by Rawool and Kiehl (26) showed
that informational counselling can increase the num-
ber of PHIs accepting their hearing loss and asking
for help. In recent years, patient-centred (or client-
centred) approaches have been used in rehabilitative
audiology to achieve better outcomes (27⫺31). In
addition, approaches such as ‘motivational interview-
ing’ (27) have been used to address the patient group
who may not accept the hearing loss and who are not
 Communication partner in audiological enablement/rehabilitation
ready to seek help. Even though several attempts
have been made, in general the situation has not
improved greatly. Moreover, it is believed that some
of these issues relating to acceptance of the problem,
help-seeking, hearing-aid uptake and success of an
audiological rehabilitation programme, can be
addressed by involving the CPs in the audiological
enablement/rehabilitation process.
Effect of the PHI’s hearing impairment on CPs
There may be various psychosocial effects on the CP
due to the PHI’s hearing impairment. Table II sum-
marizes such effects. In addition, in various situations
Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12
such as face-to-face conversation, group conversa-
tion and while watching television the CPs may expe-
rience the same difficulty as their partners with
hearing impairment (32). For various reasons, includ-
ing some of those listed in Table II, people who deny
their hearing loss may create conflict with their CPs.
Even though acquired hearing impairment may not
be the main cause of the relationship problems
between the patient and the CP, it can add to the list
of problems or exacerbate the problem. Nevertheless,
some positive experiences have also been reported by
For personal use only.
CPs due to their partner’s hearing impairment (dis-
cussed in another section). It might be surprising to
find such positive experiences reported by CPs con-
sidering the large amount of reported negative con-
sequences. However, we believe this may be related
to the temperament of CPs and their attitudes
towards hearing impairment and its effects.
CPs’ influence on their partner’s audiological
enablement/rehabilitation
Only a small number of PHIs are self-motivated to
seek help. Many end up in audiology clinics due to
Table II. Effect of PHI’s hearing impairment on CPs.
Effect of partner’s hearing impairment on communication partner
Negative impact on the intimate relationship
Anger and frustration towards partner’s unwillingness to take the responsibility towards
consequences of hearing impairment
Communication partners developing coping strategies to deal with partner’s denied
hearing loss
Reduced quality of life, embarrassment in public, social withdrawal
Confusion, sadness, irritation, anger, frustration, embarrassment, psychological stress
Blame, misunderstanding, stigma
Constantly adapting to their partner’s hearing impairment
Activity restrictions
Feeling of restricted life and loneliness
23
pressure from CPs persuading them to seek help
(6,44⫺46). It is therefore reasonable to assume that
the behaviour of the CP may play an important role
in the decision of the PHI to seek a consultation
and accept intervention. In addition, it is also
believed that when patients’ expectations with hear-
ing aids are not met, they become disappointed and
frustrated. Often the CPs take over the role in bridg-
ing the gap between the partner’s expectations and
hearing aid performance by acting as an interpreter
and also by providing appropriate support and
encouragement. In addition, studies have suggested
that the strategies of the spouses influence the
outcome of audiological rehabilitation (33,36,47).
However, if the CP does not understand the impact
of hearing impairment on the PHI’s life, it is very
unlikely that they will be able to support them. For
this reason, it is very important to involve CPs
during the audiological enablement/rehabilitation
process (48,49).
Stephens and Kramer (50) explain that the
process of audiological enablement/rehabilitation
should focus on enhancing the activities and partici-
pation of individuals with hearing impairment,
improving their quality of life, and minimizing the
effects on significant others. Their recommended
approach included four main stages: 1) evaluation; 2)
integration and decision making; 3) short-term reme-
diation); and 4) ongoing remediation. This approach
can be successfully adopted in clinical practice by
gaining deeper understanding of the consequences of
hearing impairment on the individual and their CP’s
lives, positive and negative experiences reported and
the journey they go through during the course of their
condition. They suggest that the key components of
the non-instrumental intervention strategy should
involve goal setting, involvement of communication
partners and hearing tactics.
Key references
Hallberg (33)
Hampton (34)
Armero (35); Hallberg and Barrenas (36)
Stephens and Hétu (37)
Beck (38);
Brooks et al. (32);
Stephens et al. (39)
Hétu et al. (40)
Scarinci et al. (41)
Brooks et al. (32);
Morgan-Jones (42)
Brooks et al. (32);
Hétu et al. (40);
Tye-Murray and Schum (43)
 24 V. K. C. Manchaiah et al.
Positive experience reported by CPs of PHI
In general, hearing impairment may most likely lead
to negative consequences. However, even though it
may seem a surprising concept, in recent years there
have been reports published on positive experiences
reported by the people with acquired hearing impair-
ment (51⫺54) and their CPs (55). Some of the com-
mon positive experiences reported by the people with
acquired hearing impairment include reduced dis-
turbances from unwanted noise, successful commu-
nication strategies, affinity to people with hearing
impairment and other disabilities, perceived self-
development, and using hearing impairment to self-
advantage.
Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12
Stephens et al. (55) studied the positive experi-
ences reported by the CPs of people with acquired
hearing impairment. Their study showed that about
45% of those who completed the questionnaire
reported at least one positive experience, and they
reported that a higher percentage of communication
partners reported one or more positive experiences
than the patients themselves. The most common
responses included: development of patience and tol-
erance, understanding and awareness of hearing
For personal use only.
problems, improved communication skills, and the
ability to do things without the PHI hearing. Other
positive experiences reported include increased
awareness of importance of their own hearing, appre-
ciation of help received, increased emotional ties,
humour and help for the future. Interestingly, the
children and grandchildren reported more positive
experiences than the spouses or partners.
It appears that identifying the positive experi-
ences reported could potentially contribute to the
enablement/rehabilitation process. This can be done
by strengthening or boosting the positive aspects
during counselling sessions. The main advantages
would be in identifying the components for inclusion
in the rehabilitation programme, identifying outcome
indicators, and integrating recent theoretical devel-
opments.
Models to represent CPs within the social network
context of PHI
The PHI may have several CPs within their social
network depending on various personal, cultural and
psychosocial factors. A model to represent the CPs
within the social network context of the PHI can be
useful in clinical situations to provide an under-
standing of the role of CPs within the life of the
PHI and also to make the PHI aware of how the
hearing impairment may be affecting their interac-
tions with CPs.
The Ida Institute has developed ‘Communication
Rings’ that can be used as a tool to represent the CPs
in the social network context of a PHI (56,57). These
Communication Rings are based on the previously
developed model to represent social networks in an
adult’s life by Antonucci and Akiyama (58). The cen-
tre represents the PHI. The inner circle represents
the most important CPs with whom the PHI spends
much time, the middle layer represents CPs who are
important but not as much as those in the inner
circle, and the outer circle represents less important
CPs with whom the PHI meets on a regular basis.
Manchaiah and Stephens (59) argued that, even
though the Communication Rings have several
advantages they might be too simple to represent the
complexity and dynamic nature of CPs in the life of
a PHI. They proposed a new model of the PHI
‘Communication World’ based on the analogy of the
solar system. Figure 1 provides an example of the
Communication World of the PHI. This model could
help represent three main aspects, which include:
1. Frequency of communication represented by
the size of the planet (circle);
2. Emotional closeness/importance of the individual
– distance from the centre; and
3. Communication ease/breakdown – with solid or
dotted lines.
The main advantage of the new model is to pro-
vide a visual representation of such information,
which could potentially make it easier for the PHI
and their CPs to understand the different elements
and their interactions. It is suggested that such a
model could be useful for hearing healthcare special-
ists in opening a dialogue with the PHI to discover
more about their CPs, and to create awareness about
the way they interact with their CPs. This could be
the starting point for the clinician to help develop
strategies to deal with any communication difficulties
the PHI and their CPs might be experiencing.
CP involvement in the audiological enablement/
rehabilitation
Several approaches have been used in hearing health-
care to involve CPs in the audiological enablement/
rehabilitation of the PHI. Studies suggest that group
audiological rehabilitation programmes can be effec-
tive in addressing the residual hearing loss related to
quality of life effects that remain after hearing aid
fitting (60⫺62). Other approaches such as Clear
Speech for CPs (63), Conversation therapy (43,64)
and home-based education programmes (65) also
involve CPs during the audiological rehabilitation
process. Moreover, simple things such as synchro-
nization of gaze and attention during face-to-face
 Communication partner in audiological enablement/rehabilitation
Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12
Figure 1. Example of the Communication World of the PHI.
For personal use only.
conversation between the PHI and their CPs could
potentially maximize understanding and help them
develop necessary repair strategies to deal with com-
munication breakdowns (66). In general, these
approaches mainly focus on facilitating the smooth
communication between PHI and CPs by reducing
the frequency of communication breakdown. A
recent randomized controlled study by Preminger
and Meeks (67) investigated the effectiveness of
training communication strategies and psychological
exercises for spouses of PHIs through a group train-
ing programme. The results showed a clear benefit
of these training programmes in terms of significant
improvements in health related quality of life.
Questionnaires such as the Significant Other
Assessment of Communication (SOAC), Hearing
Handicap Inventory for Elderly Screener for Spouse
(HHIE-SP), The Significant Other Scale for Hearing
Disability (SOS-HEAR), and/or open-ended ques-
tionnaires can be used to collect the information
from CPs of the PHI (39,68⫺70). The information
provided by the CPs can be used in counselling (71)
and also during the audiological enablement/reha-
bilitation goal setting process.
The Ida Institute has developed a ‘Goal-sharing
for Partners Strategy (GPS)’ that can be used as a
step-by-step guide by audiologists to involve the CP
in the audiological enablement/rehabilitation process
(72,73). Figure 2 represents the GPS. This also has
25
a questionnaire that can be downloaded from the Ida
Institute website: http://www.idainstitute.com/tool_
room/tools/goal_sharing_for_partners_strategy/.
The development of GPS is based on the Client
Oriented Scale of Improvement (COSI) (74) and the
method of Goal Attainment Scaling (75). It allows
both the PHI and the CP to express their views on how
hearing loss has affected them and also provides an
opportunity for their partners to listen to each other’s
views. This process could allow both the PHI and their
CPs to understand the extent to which the hearing loss
is impacting on them, mainly in terms of commu-
nication, and can be used to make them realize their
roles in communication, how hearing loss affects these
roles, and what steps they can take to improve their
roles in communication in order to achieve effective
communication in various environments.
The questionnaires and the clinical tools men-
tioned above can be very useful for hearing health-
care specialists in exploring more about the
psychosocial effect on CPs of the PHI. There is no
structured questionnaire to explore the positive expe-
riences reported by the CPs. However, open-ended
questions can be used. It is important for the clini-
cian to obtain a better understanding of both positive
and negative aspects of the experiences of hearing
impairment reported by the PHI and their CPs, in
order to develop an effective audiological enable-
ment/rehabilitation plan.
 26 V. K. C. Manchaiah et al.
Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12
For personal use only.
Figure 2. Goal-sharing for Partners Strategy (GPS) (72).
Discussion
It is clear from the previous discussion that CPs may
play an important role in the personal and emotional
adjustments which the PHI goes through while
adapting to new life situations. Considering the large
amount of literature on the negative consequences of
hearing impairment on PHIs and their CPs, it appears
that the experiences of the PHI may influence their
CP’s experiences and the converse. However, we did
not come across any studies that focused on studying
such an interaction. Moreover, considering the chal-
lenges faced by the CPs due to the PHI’s hearing
loss, it appears that they may well be candidates for
rehabilitation services in their own right. Although
our understanding of difficulties faced by the CPs
has improved over the years, there have been few
attempts to systematically involve the CPs in the
audiological enablement/rehabilitation process, and
currently there is no structured model/approach. We
believe that involvement of a CP in the audiological
enablement/rehabilitation process could increase the
chances of the PHI accepting their problems and
seeking help. It could increase the client/patient sat-
isfaction and reduce the return rate of hearing aids
(62), potentially making the audiological enable-
ment/rehabilitation process more successful and
cost-effective. Moreover, involving both PHIs and
their CPs in the audiological enablement/rehabilita-
tion process can provide hearing healthcare special-
ists with an opportunity to discuss any difficulties
they are encountering and to develop appropriate
strategies to deal with them.
Hearing healthcare specialists need to consider
various personal and psychosocial aspects of hearing
loss on both PHI and their CPs in order to form an
effective enablement/rehabilitation plan for the PHI.
These should include positive as well as negative
aspects. Some of the main areas that may need con-
sideration include: consequences of hearing loss and
its effects on quality of life, the journey through hear-
ing loss, and new positive experiences reported.
Clinical tools such as Communication Rings, Com-
munication World of PHI, GPS, and other question-
naires such as SOAC, HHIE-SP and SOS-HEAR
can be useful for helping hearing healthcare special-
ists to involve CPs in the audiological enablement/
rehabilitation process.
However, the main aim should be towards plan-
ning strategies to deal with the negative consequences
reported and to boost the positive aspects of both
PHIs and their CPs. A recent study by Southall et al.
(76) highlights the importance of positive and
 Communication partner in audiological enablement/rehabilitation 27
Tables III. Main areas of understanding required in both PHI and the CP domains for the effective audiological enablement/rehabilitation
of the PHI and the key references in the literature.

Person with hearing impairment Communication partner (or Significant other)

Consequences of hearing
impairment and its effects
on quality of life
Journey through hearing
impairment (stages and/or
milestones the patients
experience)
Positive experiences reported
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Arlinger (1); Cacciatore et al. (84); Carmen (14);
Dalton et al. (85); Helvik et al. (86); Morgan-Jones
(42); Morgan et al. (87); Scherer and Frisina (88);
Stark and Hickson (10); Stephens (89); Stephens
and Zhao (90); Wallhagen (91); Wallhagen et al. (19)
Professionals’ perspectives: Ida Institute (77) Patients’
perspectives: Manchaiah et al. (78); Manchaiah and
Stephens (79,80)
Kerr and Cowie (51); Kerr and Stephens (52,53);
Armero (48); Ask et al. (92); Beck (38);
Brooks et al. (32); Hallberg (33); Hétu
et al. (40); Hallberg and Barrenas (36);
Hampton (34); Kent et al. (93); Morgan-
Jones (42); Scarinci et al. (41); Stark and
Hickson (10); Stephens et al. (39);
Stephens and Hétu (37);Tye-Murray and
Schum (43); Wallhagen et al. (19)
Professionals’ perspectives: Ida Institute (81)
Communication partners’ perspectives:
NONE identified
Stephens et al. (55)

Stephens and Kerr (54)

Denied hearing loss/hearing
aid abandonment and its
effect on quality of life
Involvement in the
audiological enablement/
rehabilitation (either on
individual or group basis)
For personal use only.
Armero (35); Knudsen et al. (25); Lockey et al. (94);
Luterman (95)
Beck et al. (27); Charles et al. (28,29); Ida Institute
(77); Laplante-Lévesque et al. (30,31); Preminger
and Yoo (98)
Armero (48); Hallberg and Barrenas (36);
Hallberg (36,96); Lormore and Stephens
(97); Stephens et al. (39)
Brooks and Johnson (99); Caissie et al. (63);
Getty and Hétu (60); Hallberg (96);
Hallberg and Barrenas (36); Kramer et al.
(65); Miller (47); Tye-Murray and Schum
(43); Preminger (61,62); Preminger and
Meeks (67)

negative influences in the social and physical envi-
ronment of the PHI, influencing help-seeking behav-
iour. We believe this approach could help achieve
better acceptance of the problem and the develop-
ment of effective communication tactics to reduce the
occurrence of communication breakdown. In general,
this approach may facilitate conversation and com-
munication between the PHI and their CPs.
Furthermore, the journey of both PHIs (77⫺80)
and their CPs (81) through hearing loss can provide
useful information about the stages and the mile-
stones they go through during the course of their
condition. However, the journey of CPs due to the
PHI’s hearing loss needs to be explored further.
Studying the PHI’s and the CPs’ journey could help
clinicians to step into their shoes and understand the
unique experiences they might encounter. It would
also be interesting and useful to study how these
experiences can influence each other’s journey.
In addition, there has been a trend in recent
years in the healthcare profession to move towards
patient-centred care. Hearing healthcare profes-
sionals are making efforts to individualize treatment
by using such a tailored approach. However, we
would argue that relationship-centred care (RCC)
could be a key component in the effective manage-
ment of a PHI. RCC is based on the principle in
which all the participants appreciate the importance
of their relationships with each other (82). The clin-
ical philosophy of this approach emphasizes partner-
ship, careful attention to the relational process,
shared decision-making, and self-awareness (83).
There is clear need to develop a model/approach
to involve CPs in the audiological enablement/
rehabilitation process using the philosophy of RCC,
which will result in mutual advantages for both PHIs
and their CPs. Such an approach, with joint goal
planning between clinician, PHI and the CP, could
improve the likelihood of effective management.
Although the importance and usefulness of the
role of CPs has been highlighted, there is limited
scientific evidence to support their involvement.
Table III shows the main areas of understanding
required in both the PHI and CP domains for effec-
tive audiological enablement/rehabilitation of the
PHI and the key references in the literature. It also
indicates that there has been limited research in cer-
tain areas such as the patient journey, positive expe-
riences, denial of hearing loss and hearing aid
abandonment in relation to both PHIs and their CPs.
Moreover, the clinical effectiveness for the use of
some of the tools mentioned above (e.g. Communi-
cation Rings, Communication World and GPS) needs
to be further investigated.
Therefore, it is important that there be more research
in the following areas:
• Development of a structured questionnaire to
study the positive experiences reported by
CPs due to the PHI’s hearing loss and investiga-
tion of the clinical utility of such a structured
questionnaire;
 28 V. K. C. Manchaiah et al.
• How the negative consequences reported by
PHI and their CP interact and may influence
each other’s experiences;
• Understanding of the CP’s journey through the
PHI’s hearing loss;
• Effects of denial of hearing loss and hearing aid
abandonment on the CP’s life;
• Development of a model/approach to involve
CPs in the audiological enablement/rehabilita-
tion process based on the relationship-centred
care (RCC) and studying the clinical utility of
the new model/approach.
Audiol Med Downloaded from informahealthcare.com by University of Wales Swansea on 02/10/12
Acknowledgements
The authors acknowledge the Ida Institute for letting
us use the Goal Sharing for Partners figures. Some
parts of the manuscript from the section ‘Positive
experiences reported by communication partners of
the PHI’ were presented at an Ida Institute seminar
during November 2009 by Dafydd Stephens.
Declaration of interest: The authors report no
conflict of interest. The authors alone are responsible
For personal use only.
for the content and writing of this paper.
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