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Innovation & evaluation of hearing health care

Current project(s)

  1. Vocational rehabilitation for employees with hearing impairment: a cost-effectiveness study.

  2. Development of an integrated ICF Intake for Otology and Audiology

  3. Addition of a SUpport PRogramme (SUPR) to usual hearing aid care – Effectiveness in adult hearing aid users


Vocational rehabilitation for employees with hearing impairment: a cost-effectiveness study.

A.H.M. Gussenhoven


 Project leaders:  S.E. Kramer, PhD / J.R. Anema, PhD
 Researcher:  A.H.M. Gussenhoven
 Period:  1-10-2010 – present


Hearing impairment is one of the most prevalent chronic disabilities. In the Netherlands about 1.5 million people suffer from auditory difficulties. Hearing impairment has significant negative effects on work performance and is associated with high levels of need for recovery after work, sick leave and early retirement. These consequences are related to high costs for the individuals, companies and society. Common problems in the workplace are lack of control, mental distress, fatigue, concerns about job safety, environmental noise and lack of knowledge. Recently, the Vocational Enablement Protocol (VEP) has been developed to manage the specific difficulties of employees with hearing loss. The VEP is a transmural multidisciplinary care protocol aimed at maintaining, facilitating, or improving the employment situation for people with hearing loss. An economic evaluation is relevant to help policy makers decide whether investing in this intervention is worthwhile.

The first aim of this study is to determine the effectiveness of the VEP program on the primary and secondary outcomes: Need for Recovery after work (NFR), sick leave, Communication Profile for the Hearing Impaired (CPHI), work productivity, self-efficacy, job content and general health status.

The second aim is to determine whether the VEP program is cost-effective for reducing Need for Recovery after work (NFR) compared with usual care.

The purpose of this study includes a description of the study protocol (design article) as well as a process evaluation.

In a randomized controlled trial (RCT), a total of 160 employees are expected to participate in the study at baseline. Employees will be assigned to either the intervention group (N=80) or the control group (N=80) according to a pre-stratified and randomized procedure. Participants in the control group will receive care as usual (through the Occupational Physician (OP) with or without referral) and participants in the intervention group will receive the VEP.

Outcome measures will be assessed using questionnaires at baseline, and after 3, 6, 9 and 12 months. The cost-effectiveness analysis will cover both the societal and company perspective. KLM, Corus and VU university have confirmed their participation in this study.


The results of this process evaluation suggest a good performance of the VEP protocol. Furthermore, 31% of the recommendations delivered by the professionals were perceived as implemented by the employees. The results of the process evaluation indicated that both, employees and professionals were satisfied with the visit to the VEP (7.9 (standard deviation (SD) 1.1) and 7.1 (SD 0.9), respectively). This paper has been submitted for publication.

Results on the effectiveness and cost-effectiveness study will be expected in summer 2014.


Development of an integrated ICF Intake for Otology and Audiology

L.M. van Leeuwen


 Projectcode:  WC2013-067
 Project leaders:  S.E. Kramer, PhD; S.T. Goverts, PhD;
P. Merkus, PhD
 Researcher:  L.M. van Leeuwen
 Period:  1-11-2014 – present


Hearing loss is a lived experience influencing the physical, social and emotional status of a person. Therefore, a multidisciplinary approach is requisite within the clinical audiology setting. Professionals should closely cooperate in striving for high quality care that is based on the functional limitations, participation needs and (positive and negative reinforcing) contextual factors of the patient. Currently the care for adults with ear and/or hearing problems as well as the monitoring of their hearing health status is often fragmented. Moreover, a wide variety of available outcome measures in audiology exists and there is poor consensus on adequate definitions of functioning and disability in relation to hearing loss, resulting in ambiguities of what to measure.
The International Classification of Functioning, Disability and Health (ICF), adopted by the World Health Organization (WHO) in 2001, offers a framework for a comprehensive understanding of health and health-related states of adults with hearing loss. The ICF is based on the bio-psychosocial-model, where bodily dimensions of functioning, aspects of activities and participation, and the influence of contextual factors are recognized as important features of human functioning and health. To facilitate the use of the ICF in the audiology setting, the Core Sets for Hearing Loss were developed. In total, 117 ICF categories were selected for inclusion in the Comprehensive ICF Core for hearing loss. These categories can be taken into account when conducting a comprehensive, multidisciplinary assessment. The present project is part of the validation phase of the Core Sets for Hearing Loss through field trials.

The aim of this project is to develop an integrated method for mapping patients with hearing problems using a comprehensive and standardized approach based on the ICF Core Set HL. The instrument will be structured in a digital format.

The development and validation of the instrument consists of four studies:

  1. Development of the intake instrument based on the ICF Core Set HL;
  2. Testing the psychometric properties of the instrument;
  3. Description and comparison of subpopulations with hearing complaints who visited an audiology clinic;
  4. Description and comparison of subpopulations of patients who visited an Otolaryngologist.


Addition of a SUpport PRogramme (SUPR) to usual hearing aid care – Effectiveness in adult hearing aid users

Janine Meijerink


 Projectcode:  WC2015-027
 Project leaders:  S.E. Kramer, PhD; M. Pronk, PhD
 Researcher:  Janine Meijerink, MSc
 Grant:  Grant and in collaboration with: AudioNova/Schoonenberg
 Period:  1-5-2015 – present



Usual hearing health care is mostly restricted to audiologic assessment and hearing aid fitting. There is growing evidence showing that to increase a hearing impaired individual’s communication in daily life, more than hearing aid fitting alone is needed. Training of communication strategies is an example of an intervention that may improve a person’s communication in daily life. Recently, an (online) audiologic rehabilitation support programme (SUPR) was re-developed in collaboration with hearing care professionals. The support programme follows a holistic approach. Main elements are an instruction book including exercises, frequent contact by email with a hearing expert, training modules covering short films with instructions for daily life situations and testimonials consisting of experiences from other hearing aid users.


The first aim of this project is to study the effectiveness of the support programme (SUPR) in hearing impaired (50+) hearing aid users and their communication partners. The following outcomes will be considered: coping (primary outcome), self-efficacy in using the hearing aid, actual use of the hearing aid, satisfaction with the hearing care professional service, hearing disability, and stage of behavior change (secondary outcomes).

The second aim is to study the effectiveness of solely one element of the support programme, i.e., the instruction book including exercises. Furthermore, effects will be determined separately for first time- and experienced hearing aids users.


In this randomized controlled trial (RCT), approximately 1000 hearing aid dispenser customers will be included at baseline. Participants in the control group will receive care as usual and participants in the intervention group will receive either the support programme, or only the instruction book. Measurements will be performed at baseline, after 6 months and after 12 months (long-term effect).

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