Annual progress reports of funded research

Hearing loss, the silent enemy of good health: Effectiveness, cost-effectiveness, and potential economic and social impact of interventions to promote treatment to facilitate improved hearing (2015556)

  • Associate Professor Julia Sarant (Chief Investigator A)
  • University of Melbourne
  • Budget: $541,448.90
  • Funding period: 2022 to 2025

Project Synopsis

Hearing loss impacts adults of all ages. Importantly, 7 in 10 adults aged over 70 years suffer from hearing loss. It is associated with significant psychological, physical, and cognitive health comorbidities (for example, cancer, stroke, higher death risk). Hearing loss is the third leading cause of years lived with disability (higher than diabetes and dementia), the leading cause of disability for people greater than or equal to 70 years, and the largest potentially modifiable risk factor for dementia. However, most Australians are unaware that hearing loss is associated with serious health comorbidities, waiting 10 years on average to seek help. Medical referral rates for hearing care and hearing aid uptake and use are grossly suboptimal. Three out of 1,000 general practice consultations involve hearing management, and 10 to 11% of adults worldwide who would benefit from hearing aids actually use them.

This project will address the issues of low referral and low uptake of hearing aids by identifying barriers to referral in medical practice and hearing aid uptake and use in consumers. Using this information, interventions will be designed to address barriers and their effectiveness and cost effectiveness evaluated. The economic implications of untreated hearing loss for the Australian population will also be evaluated.

New interventions to increase referrals and use of hearing aids and determination of the economic rate of return and cost-effectiveness of these will provide incentives for effective integration of this research evidence into health services and policy, leading to improved physical, cognitive and mental health outcomes for many Australians of all ages.

Final report

Hearing loss is extremely common in older adults and has serious physical comorbidities (for example, balance problems, falls, stroke, diabetes, vascular disease, cancer, and accelerated cognitive decline/dementia), psychological comorbidities (for example, loneliness, social isolation, depression). Despite this, less than 20% of people who would benefit use hearing aids. These studies have identified the top barriers and enablers to both the lack of GP/medical referral of older adults with hearing loss in Australia to hearing care and for older adults with hearing loss to seeking hearing care that could mitigate their risks for the comorbidities of hearing loss.

There is a serious lack of GP training and knowledge about hearing loss and its management, as well as a very low referral rate of older adults to hearing care in this study (0.13%). These problems could be addressed with changes to university degree training, continuing professional development for GPs, and funding support for medical referral of patients to hearing care by universities, the RACGP, and government respectively. Older adults with hearing loss in this study needed and wanted access to unbiased information about hearing loss management and also greater allied health support through the processes of decision-making and trialing of hearing aids. Funding for an online website and changes in audiology clinic service delivery models are required to help older Australians access appropriate treatment and support, and avoid the comorbidities of hearing loss.

Our economic analysis identified negative effects of untreated hearing loss in older Australians on earnings, employment hours, voluntary work, and caring. While objective gains in communication ability and quality of life may not obviously translate into economic gains (for example, earnings, social contributions), the costs of hearing loss identified in this analysis suggest that hearing aid investment is cost-effective. As our economic analysis was based on self-reported hearing loss (often under-reported), our estimates of the impacts of hearing loss on market & socially valuable non-market outcomes are likely to be conservative assessments of the implications of untreated hearing loss.

Publications and other resources

Davine, E. C., Busby, P. A., Peters, S., Francis, J. J., Harris, D., Barbra, & Sarant, J. Z. (2025). Barriers and enablers to referral of older adults to hearing care: a cross-sectional questionnaire study of Australian general practitioners. Australian Journal of Primary Health, 31(3). https://doi.org/10.1071/py24224

‌Davine, E. C., Busby, P. A., Peters, S., Francis, J. J., & Sarant, J. Z. (2025). Barriers and enablers to general practitioner referral of older adults to hearing care: a systematic review using the theoretical domains framework. European geriatric medicine, 16(4), 1507–1518. https://doi.org/10.1007/s41999-024-01124-5

Davine, E. C., Busby, P. A., Peters, S., Harris, D., Timmer, B. H. B., Sanci, L. A., & Sarant, J. Z. (2025). Co-designing interventions to increase referrals from general practice to audiology in Victoria, Australia. International Journal of Audiology, 1–15. https://doi.org/10.1080/14992027.2025.2590560

Sarant, J., Francis, J., Harris, D., Hariname, I., Anderson, C., & Peters, S. (2026). Development and results of a customised theoretical framework-based survey on barriers and enablers to hearing aid uptake and use in older adults. International Journal of Audiology, 65(3), 303–317. https://doi.org/10.1080/14992027.2025.2537689

Sarant, J., Kiley, E., Sloan, E., Timmer, B., & Peters, S. (2026). Investigating barriers and enablers to hearing aid take-up and use by older adults with hearing loss – a focus group study. International Journal of Audiology, 1–17. https://doi.org/10.1080/14992027.2026.2643448

 

Improving access to the hearing services program for people from culturally and linguistically diverse backgrounds (2015700)

  • Professor Piers Dawes (Chief Investigator A)
  • The University of Queensland
  • Budget: $902,757.60
  • Funding period: 2022 to 2026

Project Synopsis

We want all people to have sufficient usable hearing to achieve their goals in life. Untreated hearing loss impacts communication, quality of life, educational and employment opportunities, social engagement, and physical and mental health. Unfortunately, people from culturally and linguistically diverse (CALD) backgrounds are more likely to experience hearing loss and less likely to access hearing services. Because Australia is a diverse country with 30% of people born overseas, hearing health inequality is a serious challenge.

Effective interventions for hearing loss are available via the Australian Government Hearing Services Programme (HSP). A review of the HSP recommended that the Government identify and analyse shortfalls in engagement with, and outcomes from, the HSP for CALD populations. The review recommended a co-design approach, working with CALD communities to address issues impacting on access to the HSP. To address these recommendations we will build on our expertise in hearing services, health inequalities, patient-centred care and co-design to:

  1. Work with people from CALD communities to understand their engagement with, and outcomes from HSP services
  2. Conduct interviews with HSP clinicians to understand barriers and facilitators for culturally responsive practice
  3. Partner with people from CALD communities and HSP audiologists to co-design interventions for access to culturally safe HSP services
  4. Trial and evaluate co-designed interventions in HSP clinics.

This project will inform development and delivery of accessible, equitable and culturally safe hearing services and provide an evidence base for strategies to encourage and promote behaviours that preserve and protect hearing health in vulnerable CALD populations across the life stages. The project will assure providers and consumers that the HSP is based on the best available evidence to adapt to client needs.

Progress report 30 April 2026

This research program was the first of its kind in Australia and provides one of the most comprehensive investigations to date of hearing health and hearing care access among culturally and linguistically diverse (CALD) communities in the world. Spanning evidence reviews, population studies, interviews with community members and healthcare professionals, and international expert consultation, the program identifies key inequities in hearing health and delivers practical solutions for more culturally responsive hearing care.

Main findings

The program began by synthesising evidence from 25 international studies, demonstrating that CALD communities face multiple barriers to accessing hearing healthcare. These include limited awareness of hearing loss and available services, stigma and cultural beliefs surrounding hearing loss, language barriers, inadequate cultural competence among healthcare providers, limited consultation time, and financial constraints. At the same time, the review highlighted effective supports, including translated information, professional interpreter services, culturally responsive care, community outreach programs, and cultural liaison workers.

A major epidemiological analysis using the Longitudinal Study of Australian Children revealed significant hearing health disparities. Children from CALD backgrounds were nearly twice as likely to experience hearing loss as their non-CALD peers (38% versus 21%). Higher rates of hearing loss were associated with lower parental English proficiency, while longer residence in Australia was associated with reduced risk. These findings highlight hearing loss as an important and previously under-recognised health inequity affecting children from diverse communities.

Interviews with people with hearing loss and their families from 15 language backgrounds identified five major factors influencing hearing service use: cultural beliefs and stigma, communication difficulties with healthcare providers, trust in the healthcare system, limited knowledge of hearing loss and hearing care, and the availability of family, community, and financial support. Together, these findings demonstrated that access barriers extend beyond language alone and are shaped by broader social and cultural factors.

The perspectives of hearing care professionals revealed similar challenges. Professionals emphasised the importance of understanding individual cultural needs, building trust, overcoming language barriers, communicating information in culturally and linguistically appropriate ways, involving family members in care, and ensuring clinics have sufficient time and resources to provide culturally responsive services.

The program also addressed a critical but understudied aspect of care: collaboration between hearing care professionals and interpreters. Studies involving more than Australian 240 clinicians and interpreters found that communication can be compromised by limited interpreter access, unfamiliarity with audiology terminology, unclear role expectations, and insufficient training. These challenges can reduce clinicians' ability to obtain accurate case histories and provide effective care. Research on pre-appointment briefings and post-appointment debriefings demonstrated that these practices, which are known to support high-quality interpreted healthcare, are not used consistently in hearing care. Differences in understanding their purpose and value contribute to gaps between best practice and routine care, increasing the potential for misunderstandings, diagnostic errors, and ineffective hearing management.

Building on these findings, the program developed a practical evidence-based checklist for culturally responsive hearing care. The checklist provides actionable recommendations for reception staff and clinicians, including routinely assessing interpreter needs, accommodating patient preferences, involving family members appropriately, checking understanding, providing information in multiple languages, and supporting patient-centred communication.

Lastly, the program undertook a national trial of cultural responsiveness intervention for audiologists and front-of-house staff that included on-line training, reminders and translated materials for clients. Clinicians reported that the training was very useful and equipped them with practical skills and strategies to work with CALD clients from non-English speaking backgrounds.

Impact

The research program has generated a strong evidence base demonstrating that CALD communities experience inequities in hearing health and hearing healthcare access. It has raised awareness of hearing loss as an important issue for diverse communities, particularly among Australian children, and identified the cultural, linguistic, organisational, and systemic factors that contribute to these disparities.

Importantly, the program moves beyond identifying problems to providing practical solutions, developed in partnership with clinicians and CALD community members. The culturally responsive hearing care checklist offers a tangible resource for clinics and practitioners, while the interpreter-related studies provide guidance for improving communication and service quality. The findings support policy and practice changes aimed at improving equity, strengthening clinician cultural responsiveness, enhancing interpreter use, and making hearing services more welcoming and accessible.

Overall, this body of work has advanced understanding of how culture, language, and healthcare systems influence hearing outcomes and has established a foundation for more equitable, person-centred hearing care for diverse populations in Australia and internationally.

Training materials have been made freely available to Hearing Australia (the nation’s largest government-funded provider of hearing services) and private providers (via the Australian College of Audiology) for implementation in professional development assets. Resources for professional interpreters (i.e. and handbook describing audiological terms and concepts) has been provided to the National Association of Australian Translators and Interpreters. Cultural responsiveness training and training materials on working with professional interpreters arising from this project have been integrated into the Audiology curriculum at the University of Queensland and Macquarie University.

We are currently meeting with national and state professional organisations for Speech Pathology, Physiotherapy, Optometry, Occupational Therapy and the umbrella body (Allied Health Professions Australia) to discuss how the cultural responsiveness training developed for audiologists could be translated and applied in other allied health professions.

We have provided lay summaries to the consumer organisations (Migrant and Refugee Health Partnership, National Accreditation Authority for Translators and Interpreters, Multicultural Disability Advocacy Association, Action on Disabilities in Ethnic Communities, AMES Australia, Multicultural Australia, Queensland, Ethnic Communities Council, Queensland, Refugee Health Network, Queensland) who supported this project, and attended in-person events with communities to disseminate findings.

Publications and other resources

Dawes, P., et al. (2024). Developing strategies to improve accessibility of hearing health services for people from diverse ethnic communities in Australia: Research Protocol. Figshare. https://doi.org/10.6084/m9.figshare.26499952.v1

de Silva, D., Dawes, P., Nickbakht, M., Khan, A., & Newall, J. (2025). Hearing Loss in Children From Culturally and Linguistically Diverse Communities in Australia. Ear and hearing, 46(6), 1603–1612. https://doi.org/10.1097/AUD.0000000000001695

Furze, C., Newall, J., Nickbakht, M., Dawes, P., Ching, T. Y. C., & Sharma, M. (2025). A systematic review of barriers and facilitators for ethnically diverse communities in accessing adult and paediatric hearing services. International Journal of Audiology, 1–11. https://doi.org/10.1080/14992027.2025.2477755

Furze, C., Newall, J., Nickbakht, M., Dawes, P., Ching, T. Y., Sharma, M., & Scarinci, N. (2026). An Inductive Qualitative Analysis of Hearing Health Care Professionals' Perspectives on Delivery of Culturally Responsive Care in Australia. Journal of Speech, Language, and Hearing Research, 1-18. https://doi.org/10.1044/2025_JSLHR-25-00388

Nickbakht, M., Nisar, M., Furze, C., Scarinci, N., Newall, J., Hickson, L., Timmer, B., Armitage, C. J., & Dawes, P. (2025). What Does Culturally Responsive Hearing Care Look Like? The Views of Service Users, Clinicians, and Researchers. Ear & Hearing. https://doi.org/10.1097/aud.0000000000001686

Mansoureh Nickbakht, Furze, C., Nisar, M., Waite, M., Scarinci, N., Newall, J., Hickson, L., Armitage, C. J., Teresa, & Dawes, P. (2025). Factors Influencing the Use of Hearing Services by Diverse Ethnic Communities in Australia. Ear and Hearing. https://doi.org/10.1097/aud.0000000000001734

Nisar, M., Nickbakht, M., Orlando, M., Kruger, J. L., Timmer, B., Hickson, L., ... & Dawes, P. (2026). “We can make awful mistakes”: exploring briefing and debriefing practices in hearing care appointments involving spoken language interpreters. International Journal of Audiology, 1-17. https://doi.org/10.1080/14992027.2026.2675571

Nisar, M., Nickbakht, M., Orlando, M., Scarinci, N., Newall, J., Harris-Roxas, B., ... & Dawes, P. (2026). Working With Spoken Language Interpreters: Strengthening Clinician-Interpreter Collaboration for Accessible Hearing Care. Ear and Hearing, 10-1097 https://doi.org/10.1097/AUD.0000000000001597

Implementation and Evaluation of a Co-designed Program Targeting the Psychosocial and Emotional Impacts of Hearing Conditions in Adults (2015711) 

  • Associate Professor Christina Bryant (Chief Investigator A)
  • University of Melbourne
  • Budget: $496,103.00
  • Funding period: 2023 to 2026

Project Synopsis

Despite the considerable psychosocial and emotional consequences of ear and hearing conditions, common clinical interventions, such as hearing aids, do not adequately address these difficulties. There is a paucity of evidence-based services that specifically target the emotional and psychosocial impacts of hearing conditions. The Hearing Wellbeing Program (HWP) was developed using a true co-design methodology informed by people with lived experience of ear and hearing conditions, audiologists, and psychologists. The aim of the HWP is to address the emotional and psychosocial impacts of ear and hearing conditions via an individually tailored program delivered by audiologists.

Given the recent COVID-19 pandemic, increase in digital literacy and number of regional / rural Australians, an online, self-paced version of this program would enable greater accessibility and long-term cost-effectiveness. This research project will therefore adapt the current HWP into an online version, which will be piloted in an initial feasibility study. Outcomes of this pilot will inform further optimisation of the online HWP and a subsequent randomised-controlled trial will assess the clinical effectiveness of the HWP to improve wellbeing for people with ear and hearing conditions. 

The research project will be conducted in 3 phases:

  • Workplan 1: Development of an online version of the Hearing Wellbeing Program utilising co-design with audiologists, psychologists and people with lived experience of hearing conditions.
  • Workplan 2: Feasibility and pilot study of the online HWP to determine the barriers and facilitators to implementation and refining the study protocol for a randomised-controlled trial.
  • Workplan 3: A randomised-controlled trial of the effectiveness and implementation process of the online HWP for people with ear and hearing conditions.

Progress report 30 April 2026

The project has completed the feasibility study and subsequent randomised controlled trial (RCT) of the Luminear digital hearing wellbeing intervention. The feasibility study demonstrated that the program was generally acceptable, appropriate and feasible to deliver, while also identifying areas requiring improvement, including usability, accessibility, participant retention and ongoing engagement.

The RCT did not demonstrate a statistically significant or sustained benefit of the intervention compared with the control group across the primary or secondary quantitative outcomes. However, qualitative findings were positive, with participants reporting that Luminear helped to acknowledge, normalise and validate the broader psychosocial and wellbeing impacts of hearing loss.

Overall, the findings suggest that Luminear addresses an important unmet need and has a strong foundation as a psychosocial support intervention for adults with hearing loss. Further refinement is required to optimise user engagement, implementation and effectiveness before future development and evaluation. The research team is continuing discussions regarding future projects and opportunities to further develop the program.

The following publications are in progress:

  • Human-centred co-design of a digital hearing wellbeing program for adults with hearing loss: Methods and transferable practice guidance
  • Feasibility of Luminear, a digital wellbeing program for adults with hearing loss
  • Implementing Luminear: A qualitative RE-AIM evaluation of a digital hearing wellbeing program for adults with hearing loss
  • Effectiveness of Luminear for improving psychosocial wellbeing in adults with hearing loss: A randomised controlled trial
  • Discussions with team continue with regard to future projects.

Publications and other resources

Emma C Laird, Caitlin M Barr, Zoe Williams Christina A Bryant, Human centred design of a digital wellbeing program for adults with hearing loss, paper under review.

 

Building on newborn hearing screening success: towards national standards and data management (2015735)

  • Associate Professor Valerie Sung (Chief Investigator A)
  • Murdoch Children’s Research Institute
  • Budget: $1,436,994.31
  • Funding period: 2023 to 2026

Project Synopsis

Australian children born with hearing loss are some of the best supported in the world through government-funded universal newborn hearing screening (UNHS), diagnosis, device provision, early intervention and medical services.

However, there is no mechanism to measure progress, track outcomes, or document hearing health needs, especially for children who develop hearing loss later in life and Aboriginal and Torres Strait Islander children who experience hearing loss from chronic middle ear infections.

We will create a prototype Child Hearing health Outcomes Registry (CHOR) in two states, including all deaf or hard-of-hearing 0-18 year-olds, for later national extension. We aim to:

  1. Map Australia’s fragmented hearing-specific services and datasets nationally and by state
  2. Bring datasets into a single system in Victoria and Queensland, linked to universal administrative datasets
  3. Develop a Core Outcome Set to measure what matters to children, families, services and funders
  4. Evaluate the costs/benefits of developing/maintaining an Australian National CHOR (ANCHOR)
  5. Provide proof-of-concept answers to urgent research questions, including:
    1. Do children with UNHS-detected mild / unilateral hearing losses benefit from amplification or early intervention?
    2. Should we re-screen hearing later in childhood?
    3. Can we achieve outcomes equity for deaf or hard-of-hearing children?
    4. Is a whole-population data system possible?

This grant unites researchers, families and stakeholders to facilitate systematic data capture to

  1. ensure the government’s investments into UNHS and child hearing health interventions are improving outcomes
  2. address inequity in service access, particularly Aboriginal and Torres Strait Islander and vulnerable children
  3. track outcomes of ad-hoc post-UNHS screening
  4. provide a national population-based child hearing research platform.

Progress report 30 April 2024

We have built a diverse national collaboration of hearing health stakeholders, meeting regularly to pursue project goals.

We have set up a Consumer Advisory Group, initially formed for project input, that will serve as an ongoing platform for knowledge exchange in child hearing research.

Aim 1 involves mapping Australia's hearing health services and databases. A Comprehensive survey, approved by HREC, will collect data during May and June, with reporting by August 2024.

Aim 2 aims to consolidate datasets into a Vic/QLD system linked to administrative data. Protocol development is underway, aiming for data linkage in late 2024.

Aim 3 focuses on developing a Core Outcomes Set. HREC approval was obtained in 2023 and focus groups and interviews to ascertain family and youth priorities are underway.

Project goals and methodology have been widely disseminated through community publications, conferences, and engagement events, with a methodology paper in progress.

We have achieved many goals in the last year and are confident we will continue to make progress towards completing many more goals in the next year. We have also achieved additional goals which were not originally planned but have been essential to achieve to ensure adequate stakeholder engagement. These include:

  1. ensuring culturally sensitive and appropriate ways to approach the Deaf and Aboriginal and Torres Strait Islander communities
  2. using robust methodological processes to set up the AusChildDeafness-CAG to ensure representativeness of families.

Publications, conference abstracts and other resources

Sung, V., Smith, L., Elliot, K., & ANCHOR investigator Team. (2024, March 8). Australian National Child Hearing Health outcomes Registry (ANCHOR): Innovative solutions for meaningful data collection, storage, and linkage. Annual Scientific Meeting of the Australian Society of Otolaryngology Head and Neck Surgery, Perth, Australia.

Sung, V., Smith, L., Elliot, K., & ANCHOR investigator Team. (2024, May 15). Australian National Child Hearing Health outcomes Registry (ANCHOR): Collaboration and connection across the nation. The 6th International Congress on Family Centred Early Intervention for Children Who Are Deaf or Hard of Hearing, Bad Ischl, Austria

Shepard, E., Porter, A., Pang, A., Porter, H., Elliot, K., Smith, L., & Sung, V. (2024, May 15). Establishing a collaborative Australian Family Research Advisory Group to support children and young people who are deaf or hard of hearing: A Case Study. The 6th International Congress on Family Centred Early Intervention for Children Who Are Deaf or Hard of Hearing, Bad Ischl, Austria

Sung, V., Elliot, K., Smith, L., & ANCHOR investigator Team. (2024, June 7). Australian National Child Hearing Health outcomes Registry (ANCHOR): Collaboration and connection across the nation. Hearing Across the Lifespan, Cernobbio, Italy.

Sung, V. (2024, September 28). Australian National Child Hearing Health Outcomes Registry (ANCHOR): An opportunity to measure educational outcomes that matter for deaf and hard of hearing children. Australian and New Zealand Conference for Educators of the Deaf, Sydney, Australia.

 

Empowering adults with hearing loss by increasing informed choice, accessibility, and uptake of hearing healthcare (2015748)

  • Associate Professor Melanie Ferguson (Chief Investigator A)
  • Curtin University 
  • Budget: $683,027.43
  • Funding period: 2023 to 2026

Project Synopsis

The Problem

Hearing loss is highly prevalent and impacts many aspects of a person’s life including communication, social engagement, employment, general health, and wellbeing. Yet many people do not access hearing healthcare even though help exists and hearing aids, the most common intervention for hearing loss, are clinically effective. Barriers to hearing healthcare include poor understanding of hearing loss and its impact; poor knowledge of help-seeking for hearing healthcare options; no support to help decide which option is best; affordability of hearing healthcare and stigma related to hearing loss.

The Solution

Guided by theories of behaviour change and implementation science, this research will conduct a needs analysis, and then co-develop and evaluate a tailored decision support intervention (HearChoice) to help increase informed decisions, accessibility and uptake of hearing healthcare for adults with hearing loss. The aim is to empower adults with hearing loss by offering them choice and control over their own hearing healthcare, leading to improved individual, societal and economic outcomes.

The Proposed Research

There are 4 work packages (WP):

  • WP1: Identify and understand the needs, barriers and enablers to informed decision-making about hearing healthcare options for adults seeking help for their hearing loss.
  • WP2: Co-develop with consumers and key stakeholders, an online individualised decision support intervention (HearChoice) to facilitate informed decision-making about hearing healthcare. Options will include a comprehensive range of device-based and service-based interventions.
  • WP3: Evaluate the clinical-effectiveness, and perform an economic analysis, of HearChoice using a randomized controlled trial and process evaluation in adults with hearing loss.
  • WP4: Co-develop, with consumer and key stakeholders, an implementation plan to facilitate scaling up of HearChoice for the Hearing Services Program and ensure future sustainability of the intervention.

Progress report 30 April 2026

Since the last reporting period the following achievements have been made:

  1. A better understanding of the perceived barriers and enablers to help-seeking and decision-making in hearing care. A framework of interacting barriers and enablers for hearing care based on the COM-B behaviour change theory and relating to behaviour change factors has been developed. For example, psychological capability (e.g. knowledge; skills), environmental and social opportunity (for example, supportive social circle and health care providers) and automatic and reflective motivation (for example, shame; trust; beliefs about effectiveness of hearing aids). Interventions to facilitate help-seeking and informed decision-making about hearing care options are likely to be most effective if these behaviours are maximised. This framework is aligned with quantitative survey of 150 adults with hearing loss and has informed the development of HearChoice.
  2. An evidence-based digital intervention (HearChoice) has been co-developed that is trusted and unbiased. An iterative, participatory approach taken to co-design HearChoice has resulted in an intervention that user-testing has shown to be usable, useful and impactful. Being brand agnostic, clearly highlighting both pros AND cons, and providing a range of options (n=11) not just hearing aids or do nothing, has resulted in a trusted and unbiased clinical decision tool intervention. HearChoice meets all 6 qualifying criteria the International Personal Decision Aid Standards (IPDAS) criteria, confirming it is a valid decision tool. HearChoice meets all 10 of the (IPDAS) certification criteria, suggesting it is high-quality, evidence-based, and trustworthy.
  3. Preliminary analyses of the online RCT indicate that both HearChoice and the active control Option Grid result in reduced decisional conflict (primary outcome: large effect size). Both groups showed significant improvement in hearing-related empowerment (large effect size) and readiness to take action (small effect size). Adherence to both decision tools was lower than expected, and planned exploratory analyses for those who use, and engage with, the decision tool is ongoing. Formal statistical analyses are currently underway.

Publications and other resources

Ferguson M, Bothe E (2023). HearChoice: targeting online help-seeking and decision-making in hearing healthcare. Audiology Australia. Perth. Australia 

Ferguson M (2024, May, 10). HearChoice: improving help-seeking, informed choice and decision-making in hearing healthcare. Australian College of Audiology National Congress, Cairns, Australia 

Timmer B, Ferguson M et al (2024,June 8). HearChoice Online: improving help-seeking, informed choice and decision-making in hearing healthcare. Hearing Across the Lifespan, Cernobbio, Italy.

Ferguson M (2024, June, 21). From nice-to-have to must-have: the essential role of co-design and participatory approaches in digital hearing healthcare. Computational Audiology VCCA 2024.

Bothe, E., Bennett, R. J., Sherman, K. A., Timmer, B. H. B., Myers, B., & Ferguson, M. A. (2025). “I feel a little bit clueless” perceived barriers and enablers to help-seeking and informed decision-making in hearing care: a qualitative study. International Journal of Audiology, 64(12), 1300–1309. https://doi.org/10.1080/14992027.2025.2493918

Ferguson, M. A., Sherman, K. A., Bothe, E., Timmer, B. H., Dawes, P., Myers, B., … Gyani, A. (2025). Evaluation of a digital health decision intervention to support management decision-making for adults with hearing loss: Protocol for the HearChoice randomised controlled trial. BMJ Open, 15(10), e106751. https://doi.org/10.1136/bmjopen-2025-106751

Ferguson M (2025). HearChoice: a new digital decision aid tool to educate, engage and empower adults with hearing loss. HearChoice: a new digital decision aid tool to educate, engage and empower adults with hearing loss. Phonak Audiology Blog, July 2025.

Bothe E (2025). Why do so many people delay or avoid getting help for hearing loss, and what can we do about it? Why do so many people delay or avoid getting help for hearing loss, and what can we do about it?. Phonak Audiology Blog, August 2025.

Ferguson M (2025). Empowerment in audiological care: advancing decision-making and outcomes through innovative tools. B-Audio Congress, Antwerp, Belgium, 15th November 2025. Keynote speaker.

Timmer B (2026). HearChoice: a digital decision tool to educate, engage and empower adults with hearing loss. World Congress of Audiology, Seoul. S Korea, 25th May 2026.

Ferguson M (2026).  HearChoice: a digital decision tool to educate, engage and empower adults with hearing loss. Hearing Across the Lifespan. Padua, Italy. 5th June 2026.

 

Prevalence of hearing loss in Aboriginal children caused by otitis media from birth to 5 years of age and evidence of the effectiveness of health promotion programs: evidence to inform national policy (2015750)

  • Associate Professor Christopher Brennan-Jones (Chief Investigator A)
  • Curtin University
  • Budget: $1,123,133.74
  • Funding period: 2023 to 2026

Project Synopsis

Aboriginal children are known to be at greater risk of otitis media (OM) and its associated hearing loss than the general population. Despite this, we still do not have reliable estimates of the prevalence of OM and hearing loss for Aboriginal children from birth to 5 years of age. Our team has piloted 2 prospective birth cohorts (one urban, one regional) which have given nation-first estimates of to the prevalence of OM and hearing loss at 2, 6 and 12 months of age. These findings have already had an impact and informed national policy and service delivery. These are the only cohorts in Australia examining the ear and hearing health of Aboriginal infants and children from birth.

This project will follow-up these children to 5 years of age. This will provide the first prevalence estimates for OM and hearing loss for a prospective cohort of children followed from birth to 5 years of age. It will answer key questions relating to the fluctuations of OM prevalence and hearing loss in early life, as well as identifying potential risk and protective factors associated with OM and hearing loss. This project will be crucial for informing service provision nationally. Follow-up of these cohorts will also demonstrate the feasibility and effectiveness of implementing an ear and hearing screening program for Aboriginal infants from 2 months of age, aligned with the national immunisation schedule and with integrated rapid access to specialist ear health care if OM or hearing loss is detected.

This project will also conduct a randomised-controlled trial of a simple, low-cost, family-led health promotion intervention that has been developed to improve resolution of OM and prevent hearing loss without the need for medical or surgical intervention. If effective, this intervention could be implemented in local and national ear and hearing health programs through our established collaboration with national service providers (Hearing Australia and National Acoustic Laboratories).

Progress report 30 April 2024

We are currently following-up participants to the two birth cohorts and recruiting participants for the clinical trial. Follow-up for the birth cohort studies is continuing as expected. Recruitment to the clinical trial component increased in 2023 with stabilised staffing levels, although was still slower than expected. We have gained approval to increase the number of sites in the trial (2 additional metro sites) and currently have some applications in progress that should further increase the number of sites (an additional regional site application in progress). Once implemented, this should help to further increase the recruitment rate to the trial. We are presenting the trial protocol at the 'Hearing Across the Lifespan' conference in Italy, June 2024.

Publications, conference abstracts and other resources

Rich J, Brennan-Jones CG. Healthy Ears: An adaptive clinical trial for otitis media with effusion. Recent Advances in Otitis Media. Milwaukee, WI, USA 19th June, 2023.

 

Pathways For Aboriginal and Torres Strait Islander Hearing Health: The PATHWAY Project (2015793)

  • Dr Jacqueline Stephens (Chief Investigator A)
  • Flinders University
  • Budget: $1,155,685.70 
  • Funding period: 2023 to 2026

Project Synopsis

All children have the right to hear well. Hearing is crucial for language development, which for Aboriginal and Torres Strait Islander children is a central component of identity, passing on history and knowledge, and building relationships with family and country. However, Aboriginal and Torres Strait Islander children continue to have the highest rates of ear disease in the world despite huge efforts to address this. The hearing health patient pathway (from surveillance through to management) can be complex, current strategies are often implemented piecemeal and without integration, and children continue be lost from the patient pathway. The ongoing high rates of ear disease among Aboriginal and Torres Strait Islander children clearly demonstrate current approaches are ineffectual.

Hearing health solutions must be multifaceted strategies, co-designed with community, range of components of the patient pathway, and implemented in culturally appropriate ways to ensure efficacy, sustainability, and success. Our research occurs at the knowledge interface, combining Indigenous research methodologies with western methods, to co-design and implement a strategy which strengthens the evidence base for effective and robust ear health surveillance and management strategies. By utilising yarning methods, systematic literature review, and clinical data collected before, during and after a stepped wedge study, we will produce transformational evidence directly articulated with key Roadmap for Hearing Health actions, including providing evidence of a culturally appropriate approach to ensuring children are not ‘slipping through the cracks’ and missing out on ear health checks.

Our research team brings together early, mid and senior researchers and community members, who identify as both Aboriginal and non-Aboriginal people, and who have a wide range of expertise, skill, and lived experience to ensure our research is community-focused, flexible, and evidence-based.

Progress report 30 April 2024

The Pathways Project has been established over the past 12 months in close collaboration with our key partner organisation, Far West Community Partnerships. Progress includes the finalisation of the research protocol and standard operating procedure documents, receipt of ethical approvals, establishment of an Aboriginal Advisory Group, and commencement of a PhD candidate. Our study artwork was created by a local Aboriginal artist and we have continued to engage across the Far West of South Australia region with other key stakeholder organisations.

In coming months, the research team will commence capacity development and training of local staff employed by Far West Community Partnerships; these staff will be involved in research activities, including participant recruitment, data collection, analysis and reporting. Furthermore, widespread interest in the establishment of this project has lead to acceptance for presentation at several local and international conferences.

Publications and other resources

The study protocol was presented at the Public Health Association Preventative Health Conference in Darwin in May 2024 and will be presented at the OMOZ conference in Newcastle in August 2024. 

A manuscript describing the establishment of the project is in preparation, as well as several systematic reviews which report findings informing the conduct of the project.

 

Hearables and behavioural activation for mental distress and social isolation in hearing impaired older adults (2015794)

  • Dr Andrew Ford (Chief Investigator A)
  • University of Western Australia 
  • Budget: $571,966.00
  • Funding period: 2022 to 2025 

Project Synopsis

Hearing loss (HL) is prevalent in later life and associated with increased risk of depression, social isolation, loneliness, mental illness and reduced quality of life. Additionally, the Covid-19 pandemic has brought about restrictions in social interaction and face to face contact, which has further impacted on the social isolation and mental health status of adults, particularly those with hearing loss.

Treatment of hearing loss can be relatively simple but traditional hearing aids are expensive and uptake is often sub-optimal. Personal sound amplification products (PSAPs - 'hearables') offer a simple, cost-effective alternative to conventional hearing aids, but no current evidence exists to determine if they improve the psychosocial consequences of age-related HL. Psychological therapies can be effective in treating mental distress in the elderly but factors such as availability of suitably trained therapists, cost and difficulties delivering the therapy in a socially isolated, hearing-impaired population pose challenges. Behavioural activation (BA) is a pragmatic and fairly simple psychological intervention aimed at improving mental health by increasing cognitive, physical and social activities.

BA has been shown to be effective in treating depression in the general population but no current evidence exists to determine if BA with or without hearing loss treatment is effective in ameliorating the psychosocial consequences of hearing loss. 

The proposed project will aim to test if hearing amplification with PSAPs with or without a BA intervention program improves mood, relieves mental distress and social isolation, improves quality of life, and reduces health care costs in older adults with hearing loss. We will utilise a 2x2 factorial design to randomise 240 older adults aged 65 years and older with mild-moderate hearing loss to a 6-month clinical trial of hearing amplification and/or BA compared with an education intervention control group.

Progress report 30 April 2026

The trial has shifted the primary location for research activities to the WA centre of Health and Aging in Perth.

Recruitment to the trial has been slower than anticipated but is ongoing. We have implemented the following strategies to try improving recruitment:

  1. Attending community care organisations such as aged care facilities.
  2. Social media campaign.
  3. Reviewing contact lists from our previous media campaigns and contacting potentially eligible participants.
  4. Advertising in print media
  5. Recruitment of new study personnel.

Preliminary analyses have shown a trend towards improved anxiety, mood and a sense of social connectedness in participants.

Publications and other resources

Harvey, B. (2024, August 17). Ben Harvey: Ear Science Institute Australia wants to test your ears for free Hearables. The West Australian; The West Australian. https://thewest.com.au/opinion/ben-harvey/ben-harvey-ear-science-institute-australia-wants-to-test-your-ears-for-free-hearables-c-15698216

 

Improving the psychosocial and emotional well-being of adults with hearing loss through co-designed evidence-based services: ACE2.0 (2015803)

  • Professor Nerina Scarinci (Chief Investigator A)
  • The University of Queensland 
  • Budget: $527,012.40 
  • Funding period: 2023 to 2026

Project Synopsis

Our team’s Active Communication Education (ACE) program, developed 2 decades ago, was a transformative interactive group education program that supported the everyday communication difficulties experienced by adults with hearing loss and their significant others. ACE has a strong evidence base with demonstrated efficacy (improved communication and psychosocial well-being). It has become apparent, however, given contemporary changes to the way we approach research through consumer co-design and contemporary barriers to the provision of hearing health care, there is a need to update ACE. To address this gap, our mixed-method, transdisciplinary study will co-design and implement the next generation of the program (ACE2.0: ACE Your Hearing). Our investigator team unites strong research and clinical expertise with lived experience of hearing loss and its psychosocial and emotional impacts on well-being.

This project will meet the TCR research objective to generate a greater understanding of the psychosocial and emotional impact of hearing loss on the individual and develop strategies to improve their well-being. Thus, the aim of this project is to develop ACE2.0 to address the psychosocial and emotional impacts of hearing loss using a co-design process with key stakeholders (consumers, advocacy groups and hearing service providers) that will enable program refinement and evaluation whilst addressing the challenges of implementation. 

Our OBJECTIVES include:

  • extend the psychosocial and emotional support elements of the program to target the communication driven social challenges that people with hearing loss face; and 
  • optimise the uptake of ACE2.0 by adults with hearing loss, their significant others, and the organisations delivering it, including through the publicly funded Hearing Services program.

Outcomes from our research will inform the nature and delivery of hearing health services, by establishing an evidence base for the development of future hearing policies, service delivery models and supports.

Progress report 30 April 2026

The project has made progress, with implementation barriers identified and addressed using the Behaviour Change Wheel framework. Co-design workshops with consumers and clinicians were completed successfully, and pilot data informed the selection of the final outcome measures.

Recruitment is continuing across multiple sites, with the redesigned modular intervention currently being delivered. To date, 149 participants have completed the program. Preliminary data cleaning has begun, and final analysis will be conducted after all 3 month post-intervention follow-up data have been collected.

Implementation and translation have been embedded throughout the ACE randomised controlled trial through close collaboration with clinical and industry partners. Stakeholders have actively contributed to the co-design, delivery and refinement of the intervention, ensuring it aligns with real-world clinical settings and user needs. These established partnerships provide a strong foundation for ongoing delivery, broader dissemination, and future scale-up through targeted training, implementation resources, and engagement with professional and service networks.

Program resources

https://shrs.uq.edu.au/active-communication-education-ace

Publications and conference presentations

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2023, May 7–10). Improving the psychosocial and emotional well-being of adults with hearing loss through co-designed evidence-based services: ACE2.0 [Conference presentation]. Audiology Australia Conference, Gold Coast, Queensland, Australia.

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2024, May 9–10). Addressing the communication and psychosocial well-being of adults with hearing loss through evidence-based communication rehabilitation [Conference presentation]. Australian College of Audiology National Conference, Cairns, Queensland, Australia.

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2024, August 12–14). Co-designing ACE2.0 to address the communication and psychosocial well-being of adults with hearing loss through evidence-based communication rehabilitation [Conference presentation]. New Zealand Audiological Society National Conference, Christchurch, New Zealand.

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2024, September 19–22). Improving the psychosocial and emotional well-being of adults with hearing loss through co-designed evidence-based communication education programs: ACE2.0 [Poster presentation]. World Congress of Audiology, Paris, France.

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2025, November 20–22). Empowering adults with hearing loss: Co-design and implementation of the Active Communication Education (ACE2.0) program [Conference presentation]. American Speech-Language-Hearing Association Convention, Washington, DC, United States.

Foley, J., Scarinci, N., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2025, April 1–4). Understanding implementation barriers and stakeholder needs: A multi-stakeholder investigation to guide the redevelopment of group audiological rehabilitation [Conference presentation]. Audiology Australia Conference, Adelaide, South Australia, Australia.

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2025, April 1–4). Charting the way forward for adults with hearing loss: Investigating uptake challenges and opportunities for group audiological rehabilitation [Conference presentation]. Audiology Australia Conference, Adelaide, South Australia, Australia.

Meyer, C., Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Haslam, C., & Timmer, B. (2025, November 11–14). Re-envisioning a communication education program for adults with hearing loss using co-design [Conference presentation]. Australian Association of Gerontology Conference, Alice Springs, Northern Territory, Australia.

Scarinci, N., Foley, J., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2026, May 24–27). The value of co-design in hearing healthcare [Conference presentation]. 37th World Congress of Audiology, Seoul, South Korea.

Foley, J., Scarinci, N., Hickson, L., Bennett, B., Ekberg, K., Meyer, C., Haslam, C., & Timmer, B. (2026, May 24–27). Evaluating a co-designed hearing education program ("ACE Your Hearing"): A hybrid effectiveness-implementation trial [Poster presentation]. 37th World Congress of Audiology, Seoul, South Korea.

Foley, J., Meyer, C., Bennett, R. J., Timmer, B. H. B., Ekberg, K., Haslam, C., Hickson, L., & Scarinci, N. (2026). Charting the way forward: Investigating uptake challenges in the Active Communication Education (ACE) program for adults with hearing loss [Manuscript under review]. International Journal of Audiology.

Foley, J., Meyer, C., Bennett, R. J., Timmer, B. H. B., Ekberg, K., Haslam, C., Hickson, L., & Scarinci, N. (2026). Applying the Behaviour Change Wheel to enhance audiological rehabilitation programs for adults with hearing loss [Manuscript under review]. International Journal of Audiology.

Foley, J., Meyer, C., Bennett, R. J., Timmer, B. H. B., Ekberg, K., Haslam, C., Hickson, L., & Scarinci, N. (2026). Revitalising hearing health education: Multi-stakeholder preferences in the redevelopment of the Active Communication Education (ACE) program to enhance the communication and psychosocial well-being of adults with hearing loss [Manuscript under review]. International Journal of Audiology.