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Ideas for the Pre-Contemplator

Ideas for the Pre-Contemplator. “I’m not ready to use hearing aids!”. Stage 1: Precontemplation. “Who, me? I don’t have a problem. People mumble!”. Stage 1: Pre-Contemplation.

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Ideas for the Pre-Contemplator

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  1. Ideas for the Pre-Contemplator “I’m not ready to use hearing aids!”

  2. Stage 1: Precontemplation “Who, me? I don’t have a problem. People mumble!”

  3. Stage 1: Pre-Contemplation • During the pre-contemplation stage, the patient has no intention of changing within the foreseeable future (6 months) • They may not be aware that they have a problem or they may be unwilling to make a change • Individuals in this stage are often labeled as “in denial”, “resistant” or defensive about their current status • The cons of changing outweigh the pros of changing

  4. Processes of Change for Precontemplators • Goal is for precontemplators to acknowledge and/or increase their awareness of the negative aspects of their problem • To move out of this stage, information and feedback are needed

  5. Pre-contemplation • Review “Beyond Hearing Loss” video, which gives an overview of hearing loss issues • Give statistical information comparing hearing aid users to non-users • Provide reading materials • Audiologic Assessment • HHIE screening

  6. “Beyond Hearing Loss” • 12 minute video • Available from Johns Hopkins Center for Hearing and Balance • 410-955-6680

  7. The Impact of Hearing Aid Usage • Findings of National Council on Aging www.ncoa.org (1999) • Reports results of 2,069 hearing impaired respondents • Significantly higher incidences of anxiety, frustration, and depression, and social withdrawal, even in folks with mild losses

  8. Pre-Contemplation • Use drawings of cartoon-like characters to start discussions about various communication issues • Use Erber (1988) “Eight Conversational Occurrences” to initiate discussion about communication problems and hearing loss

  9. I Feel Like I Work So Hard I am exhausted from working to hear everyone Pre-Contemplation

  10. The boss said he wanted the money, not that it was sunny.

  11. Conversational Occurrences • Perceived message correctly • Received meaningful message that was expected and appropriate • (“Where’s the main post office?” – “Two blocks down and turn right.”) • Perceived incorrect meaningful message • Received message that fit the conversation, but was incorrect • (Bad apples: “They’re not good for anything but chucking!” – actually, “chutney”) • Perceived meaningless message confidently • Perceived message clearly, but did not make sense and did not fit the conversation • (“Didn’t she understand?” – “No. I explained it in my typical Garibaldi faction.” Actually, “…typically garbled fashion.”)

  12. Conversational Occurrences Continued… 4. Perceived nonsense • Received syllables and word-like patterns, but could not understand them • (“Did you get all your work finished?” – “Mau fitr pekd laimmi aruipeng!”) 5. Perceived fragments • Received only part of the message • (“Why didn’t you buy the tape recorder?” – “Because we saw…………in the shop window”) 6. Perceived (distorted) acoustic cues only • The speaker’s mouth was not visible • (as over the telephone; or his/her mouth was obscured by hair, a hand, or an object)

  13. Conversational Occurrences Continued… 7. Perceived (incomplete) visible cues only • The speaker was too far away; the speaker’s voice level was too low; the hearing aids and/or batteries were malfunctioning 8. Perceived nothing • The receiver was distracted or was not paying attention, so the speaker’s utterance was neither heard nor seen (Erber, 1988)

  14. Signs and Symptoms • Frequently asking people to repeat • Inappropriate response to what is said • Difficulty understanding in groups • Puzzled expression when listening • Intently watching the speaker’s mouth • Strained expression around eyes • Trychin, 2003

  15. Signs and Symptoms • Turning the head to one side to hear better • Avoid social situations-withdraws • Talk too loudly or very softly • Turn up TV or radio much too loud • Blame people for not speaking clearly • Defensive about communication problems • Trychin, 2003

  16. Problem Situations Reported by HOH • Hearing alarm signals • Voice from another room • Can’t see speaker’s face • Poor illumination • People whispering • Voices on TV or radio • Trychin, 2003

  17. Problem Situations Reported by HOH • Conversations in a moving car • Family dinners at holidays • Understanding conversations on the phone • Several people talking • Medical situations • Outdoors-wind, traffic, etc. Trychin, 2003

  18. Problem Situations Reported by HOH • Person whose speech is not clear • Misinterpretation of mistakes • Unaware person is talking to me • Movies, plays, lectures, classes • Stopped for traffic violations • Dancing and talking • Trychin, 2003

  19. Problem Situations: Family Members • Difficulty remembering what to do • Not knowing whether she/he understands • The variability in his/her ability to understand • Hard to get her/him to understand me • TV or radio is much too loud • Trychin & Albright, 1993

  20. Problem Situations: Family Members • Having to repeat often • Having to interpret too frequently • When we become frustrated or irritated • When she/he doesn’t pay attention • Trychin & Albright, 1993

  21. Problem Situations: Family Members • Not talking as much as before • When he/she is not understanding someone else • Being asked to repeat embarrassing jokes or remarks • Trychin & Albright, 1993

  22. Problem Situations: Family Members • Becoming too dependent on me • Being isolated from friends and family • Not doing things we enjoyed previously • Having to repeat in pressure situations • Not traveling or going new places • Trychin & Albright, 1993

  23. Physical Emotional Behavioral Cognitive Trychin,2001 Reactions

  24. Physical Reactions to Communication Problems • Muscle tension-shoulders, neck, back • Stomach problems • Fatigue • Head aches • Increased blood pressure • Appetite changes-eat more, eat less • Trychin, 1991

  25. Behavioral Reactions to Communication Problems • Bluffing • Withdrawing • Blaming • Demanding • Dominating conversations • Guilt tripping • Trychin, 1991

  26. Emotional Reactions to Communication Problems • Anger • Anxiety • Depression • Embarrassment • Frustration • Guilt • Trychin, 1991

  27. Cognitive Reactions to Communication Problems • Can’t think straight-confused • Hard to focus attention • Distracting thoughts • Distrustful of others • Decreased self esteem • Difficult to remember what you did not hear clearly in the first place • Trychin, 1991

  28. Mental Health Risks of Hearing Loss • Becoming chronically nervous; Anxious • Becoming chronically sad; Depressed • Feeling anger much of the time • Loss of group identity • Feeling marginal in own family • Loneliness • Trychin, 1991

  29. Mental Health Risks of Hearing Loss • Becoming distrustful of people • Withdrawing from social contact • Developing poor self-image • Feeling incompetent • Feeling unacceptable to others • Feeling marginal socially • Feeling loss of influence or control • Trychin, 1991

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