Development of a functional assessment instrument for youth with unilateral hearing impairment

Abstract

Background: Youth with similar degrees of hearing impairment may not perceive the same level of functional impairment. Once children are able to reliably report for themselves, patient-reported outcomes (PROs) instruments provide a method for health care providers to assess a patient’s perceived functional impairment and assess responsiveness of this impairment to intervention. The aim of this qualitative research study was development of a draft item pool for assessing perceived physical function of youth with unilateral hearing impairment (UHI). Methods: We conducted semi-structured qualitative interviews with youths with UHI. Each interview was audio-recorded, transcribed and excerpted for coding. We developed a codebook based upon review of the first five interviews, and established a final list of 11 codes based upon discussion amongst research team members. Two members of the research team double-coded the first 4 interviews independently, and discrepancies were resolved through consensus between the coders. In cases where discrepancies could not be resolved, Dr. Edwards broke the tie. Remaining transcripts were then single-coded and draft items developed based upon excerpt content. Item development criteria were used to craft items. Results: Semi-structured interviews were conducted with 15 youths with UHI. Age of participants ranged from 11 to 17 years; 60% were male; and 47% used hearing aids. Independent coders were able to achieve greater than 90% agreement by coding of third and fourth transcripts. There were 299 excerpts coded as physical function, from which 100 unique items were generated. Several common themes were found, including 1) Safety concerns related to cars and driving, 2) Difficulties with team-based or fast-paced physical activities, 3) Problems with sound localization, 4) Difficulties with attention, 5) Challenges using television and telephone, and 6) Youth opinions regarding hearing aid utility varied, with some reporting substantial benefit while others felt devices had been detrimental to hearing function. Conclusion: Draft items for assessment of perceived physical function highlight some unique concerns of youths with UHI. Future goals for this project include final item selection and field-testing of the UHI functional assessment instrument.