Nerina Scarinci, Linda Worrall, and Louise Hickson

1. Family Member Health Condition Significant Other Functioning Significant Other’s Health Condition Functioning & Third-Party Disability Body Functions Activities Participation & Structures Functioning & Disability Environmental Factors Personal Factors Environmental Factors Personal Factors • Measuring third-party disability in spouses of older people with hearing impairment: The Significant Other Scale for Hearing Disability (SOS-HEAR) Nerina Scarinci, Linda Worrall, and Louise Hickson The University of Queensland, School of Health and Rehabilitation Sciences, Communication Disability Centre, Australia • Background • Hearing impairment (HI) is the most common acquired communication disability in older people (Andrews, 2001). • HI affects not only the person with the HI, but also those in his or her environment i.e., family members and friends (Scarinci et al., 2008, Wallhagen et al., 2004). • The impact of HI on others is a “third-party disability”, which is defined by the ICF as the functioning and disability of family members due to the health condition of significant others (WHO, 2001): • The significant other’s HI serves as an environmental factor contributing to third-party disability in a family member/spouse. • Spouses experience activity limitations and participation restrictions as a result of their significant other’s HI, affecting (1) communication, (2) domestic life, (3) interpersonal interactions and relationships, and (4) community, social and civic life (Scarinci et al., 2009a). • There are currently no instruments available to identify and measure third-party disability in spouses of older people with HI. • Aim • To develop and psychometrically test a scale to measure the third-party disability experienced by spouses of older people with hearing impairment. • Participants • 100 spouses of older people with HI completed the scale: • 92% of partners had sought help for their HI; of these, 68% had been fitted with hearing aids, however only 44% reported wearing their hearing aids > one hour per day. • Spouses had been with their partner for an average of 41.6 years (range 1-66 years), the majority were in their first formal relationship (79%), and all were retired from work. • Methods • Development of the Significant Other Scale for Hearing Disability (SOS-HEAR) • The 36-items in the SOS-HEAR were generated from the Scarinci et al. (2008) qualitative study with semi-structured, in-depth interviews. • To ensure face and content validity, the identified categories were developed into simple statements and used the language of spouse participants, for example: • “Because of my partner’s hearing difficulties, I have to repeat myself often” • 0 1 2 3 4 • no problem a mild problem a moderate problem a severe problem a complete problem • Data Analysis • Principle components analysis (PCA) was performed on the 36-item scale to optimise its scaling properties and to determine initial construct validity. • Reliability analysis using Cronbach’salpha was used to determine the internal consistency of each factor. • Test-retest reliability was assessed with 27 participants who completed the questionnaire a second time. • Results • Factor Analysis • PCA of the 36-item scale extracted eight components with eigenvalues greater than 1.0, explaining 73.2% of the total variance in the original set of variables. The scree plot indicated six independent components, which were retained for further study. • The final six-factor solution included 27 questionnaire items and explained a total of 65.2% of the variance, with the rotated solution revealing the presence of simple structure, with all components showing a number of strong loadings. • Reliability • Cronbach’s alpha for the revised scale was 0.94, and for the six subscales was 0.88, 0.89, 0.91, 0.77, 0.85, and 0.71 respectively, demonstrating good internal consistency, and that each of the items reflect the same attribute. • Test-retest reliability of the revised scale was satisfactory, with all but one item demonstrating weighted kappa greater than 0.41 (i.e., moderate or better test-retest reliability). • Discussion • The SOS-HEAR is an appropriate tool for measuring third-party disability in spouses of older people with HI. • The SOS-HEAR measures six domains of third-party disability and functioning: • (1) communication changes • (2) communicative burden • (3) relationship changes • (4) going out and socialising • (5) emotional reactions • (6) concern for partner • These domains are consistent with previous qualitative study (Scarinci et al., 2008) • The mean overall SOS-HEAR score was 0.63, indicating mild third-party hearing disability, however scores on each item ranged from 0 (no problem) to 4 (complete problem), indicating that third-party disability is more problematic for some people than others. • Communication changes are the main contributor to third-party disability in spouses of older people with HI, with spouses reporting mild-moderate problems in having to repeat, raising the volume of their voice, not being able to tell secrets, and having to communicate face-to-face. • The SOS-HEAR may assist clinicians in identifying specific areas of difficulty for the spouse. Clinical use of the SOS-HEAR is recommended. • Third-party disability in spouses also has implications for the functioning and disability of the person with HI. For example, greater third-party disability in a spouse may result in greater perceived disability in the person with HI, especially if the spouse is constantly complaining about the partner’s hearing difficulties. • Future Research • Further research is necessary to confirm the factor structure of the SOS-HEAR with a larger sample of spouses. • The clinical utility of the SOS-HEAR also needs to be investigated. • What are the rehabilitation needs of spouses affected by third-party disability? Family Member Functioning Figure reproduced from Scarinci, Worrall, & Hickson (2009a). References Andrews, G. (2001). Australian longitudinal study of ageing. In G. L. Maddox (Ed.), The encyclopedia of ageing (pp. 107-109). New York: Springer. Scarinci, N., Worrall, L., & Hickson, L. (2008). The effect of hearing impairment in older people on the spouse. International Journal of Audiology, 47, 141-151. Scarinci, N., Worrall, L., & Hickson, L. (2009a). The ICF and third party disability: Its application to spouses of older people with hearing impairment. Disability and Rehabilitation, 31, 2088-2100. Scarinci, N., Worrall, L., & Hickson, L. (2009b). The effect of hearing impairment in older people on the spouse: Development and psychometric testing of the Significant Other Scale for Hearing Disability (SOS-HEAR). International Journal of Audiology, 48, 671- 683. Wallhagen, M. I., Strawbridge, W. J., Shema, S. J., & Kaplan, G. A. (2004). Impact of self- assessed hearing loss on a spouse: A longitudinal analysis of couples. The Journals of Geronology. Series B, Psychological Sciences and Social Sciences, 59B(3), S190-196. World Health Organization. (2001). International Classification of Functioning, Disability and Health, ICF. Geneva: World Health Organization. Acknowledgements The authors would like to acknowledge the participants who willingly gave their time to participate in the study and Dr. Asad Khan for his statistical advice. This research was supported by participants from the 50+ Registry of the Australasian Centre on Ageing at The University of Queensland. Further information regarding this study is reported in Scarinci, Worrall, & Hickson (2009b). For further information, please contact Dr. Nerina Scarinci The University of Queensland n.scarinci@uq.edu.au