Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Mary Beth Jennings

2nd Supervisor

Margaret F. Cheesman

Joint Supervisor


The purpose of this dissertation was to gain a better understanding of the impact of the client-clinician interaction in the hearing aid adoption process. The specific goals of this dissertation were: 1) to identify factors in client-clinician interactions that were perceived by clients and clinicians to influence hearing aid adoption in first time adult hearing aid candidates, 2) to investigate the importance of the identified factors from clients and clinicians perspectives, and 3) to compare the importance of the identified factors between clients and clinicians. These goals were achieved using a mixed-methods approach.

Three studies were undertaken. In the first study a concept mapping approach was used to explore the collective views of clients and clinicians in identifying factors in client-clinician interaction that influence hearing aid adoption. Ten audiologists and 13 clients generated 122 statements that formed eight conceptually homogenous clusters of factors. The concepts were: 1) ensuring client comfort, 2) understanding and meeting client needs, 3) client-centered traits and actions, 4) acknowledging client as an individual, 5) imposing undue pressure and discomfort, 6) conveying device information by clinician, 7) supporting choices and shared decision making, and 8) factors in client readiness. In the second study, nine audiologists and 11 clients who participated in the first study rated the importance of the 122 statements. Clients rated the concept conveying device information by clinician more important than audiologists. In the third study, a broad and geographically diverse sample of clients and clinicians including audiologists and hearing instrument practitioners rated the importance of the 122 items identified in the first study. The comparison of the client and clinician groups’ ratings revealed discrepancies between the groups’ ratings. The largest discrepancy was between the importance each participant group assigned to the concepts conveying device information by clinician, which was rated much higher by clients and factors in client readiness, which was rated much higher by clinicians.

This work contributes to the literature on client-clinician interaction in the audiological encounter. Results have implications for training of students and clinicians in facilitating the integration of shared decision making and client-centered care in hearing aid adoption process.