DESCRIPTION (provided by applicant): Eighty percent of hearing-impaired adults fail to treat their hearing loss in the initial 5-10 years after its detection, despite the many negative consequences of not doing so. This is not unique to audiology - similar data exist for many other chronic health conditions. Further, the factors that influence hearing health care (HHC) behaviors are similar to those that affect health behaviors for other chronic conditions. It is thu appropriate to examine HHC behaviors within the framework of health behavior theory. In this investigation three established health behavior theories will be used to identify the critical attitudes and beliefs underlying HHC behaviors, so that in the future theory-based behavior change interventions can be developed. This approach is promising because while some variables that influence HHC behaviors cannot be changed (e.g. severity of hearing loss, age, income level), it is possible to modify attitudes and beliefs through education and counseling. This study will therefore provide the foundation for the development of theory-based education and counseling behavior change interventions to increase HHC behaviors among adults with mild-to-moderate hearing loss. This study will (1) Determine which HHC attitudes and beliefs best explain the HHC behaviors of help seeking and intervention uptake in adults with hearing loss. (2) Determine whether attitudes and beliefs underlying help seeking differ from those underlying intervention uptake. (3) Determine whether short form health behavior assessments that would be practical for use in the clinic are as effective at predicting HHC behaviors as long form assessments that will provide the necessary detail for developing an education and counseling behavior change program. A mixed methods longitudinal study will be conducted in which HHC attitudes and beliefs will be evaluated using long form and short form health behavior assessments that measure constructs of the Transtheoretical Model, Health Belief Model and Theory of Planned Behavior. Participants will be 587 individuals who fail a community-based hearing screening. They will be contacted at 6-monthly intervals to determine whether they have sought help, and if so, whether they have followed the audiologist's recommendations regarding rehabilitation. Health behavior assessments will be completed at the start and end of the study. Additional explanatory variables (measured and self-rated hearing, health literacy, general health, and auditory lifestyle) will also be examined, and participants will take part in a structured interview so we can learn about interpersonal and psychosocial influences on HHC behaviors. This study will be the first to prospectively examine HHC behaviors within the framework of multiple health behavior theories. By understanding the underpinnings of HHC behaviors, behavior change strategies can be developed that will increase help seeking and intervention uptake by people with hearing loss thus, improving speech understanding and communication, and ameliorating the secondary negative effects of hearing loss.

PUBLIC HEALTH RELEVANCE: People with hearing loss wait about ten years between noticing hearing difficulties and getting help for those difficulties. This is problematic because untreated hearing loss has many serious consequences, such as depression, isolation and decline in cognitive function. The purpose of this study is to increase our knowledge and understanding of the factors, such as attitudes, beliefs and readiness for behavioral change, that influence decisions to treat hearing loss. In the future, the findings will be used to develop an education and counseling program to modify the attitudes and beliefs that inhibit people from getting help for their hearing so that a greater proportion of people with hearing loss will seek help, and will obtain and use hearing rehabilitation.