Best Practices in Promoting the Use of Hearing Protection
Madeleine J. Kerr, PhD, RN
Occupational hearing conservationists can provide an important societal benefit by promoting the use of hearing protection to prevent noise-induced hearing loss. What are the best practices for education and motivation to promote hearing health? This article describes a national priority related to hearing protection, theory-based educational interventions, and documentation of education in the electronic health record.
Promoting hearing health through use of hearing protection is a priority in the United States. Recognizing that noise-induced hearing loss is the most common occupational disease, our national Healthy People 2010 initiative has an objective for prevention by increasing the use of appropriate ear protection devices, equipment and practices (Objective 28-16, USDHHS, 2000). This objective has received support for continuation in the Healthy People 2020 objectives now in the public comment phase through fall 2009 (http://www.healthypeople.gov). Health behaviors are notoriously difficult to change, therefore researchers look to theories for guidance in designing interventions.
The most common theoretical framework for studying use of hearing protection behavior has been the Health Promotion Model (Pender, 1987). This model has guided researchers in identifying the predictors of use of hearing protection and designing theory-based interventions to promote use of hearing protection (Kerr, Savik, Monsen & Lusk, 2007; Lusk, Ronis, & Kerr, 1995). In the model, five important factors influence use of hearing protection. Demographic/Experiential Factors such as job category and noise exposure at work are modifying factors. Self-efficacy is confidence in one’s ability to use hearing protection. Benefits refer to the expected positive effects of use. Barriers refer to the potential negative aspects of using hearing protection. Social role models are the significant others who exemplify the behavior. A primary assumption of the Health Promotion Model is that persons value growth in directions which they view as positive. Therefore, in contrast to the Health Belief Model, beliefs of seriousness of a disease and personal susceptibility to it are not emphasized in the Health Promotion Model.
Assessments and interventions
A theory-based assessment is an important way to personalize educational sessions to each worker. Key assessments and examples of interventions are shown in Table 1. A good place to start is assessing workers’ awareness of their noise exposure. Workers in an occupational hearing conservation program may be aware of noise surveys of their work area. However, many workers are in variable working conditions and may not know how to assess their daily noise exposures. A useful rule of thumb to teach them is that you are in loud noise if you have to shout to be heard three feet away. It may also be helpful to refer workers to a wall chart of noise levels or a resource such as the National Institute for Occupational Safety and Health Power Tools Database (http://www.cdc.gov/niosh-sound-vibration/).
Table 1. Assessments and interventions to promote use of hearing protection devices
| Model Factor | Assessment | Intervention |
| Demographic/Experiential factors | Describe your noise exposure at work. | Self-monitor. You’re in loud noise if you have to shout to be heard 3 feet away. |
| Use of hearing protection device (HPD) | When you are in noise, what percent of the time do you wear hearing protection? | Monitor use of hearing protection. Set goal of 100% use when in high noise. |
| Barriers to use of HPDs | What gets in your way of wearing HPDs 100% of the time when in noise? (Inconvenient, uncomfortable, poor fit, difficulty communicating while wearing them) | Address personal concerns, misperceptions about HPDs. Offer choice of HPDs for more convenience, comfort, fit, communication. |
| Benefits of using HPDs | What do you see as benefits to wearing HPDs? (Keeping out harmful noise, lowering stress) | Recommend HPD trials in noise to experience benefits of reducing the hazardous noise |
| Self-efficacy in using HPDs | How confident are you in your use of HPDs? (Knowing how to roll foam plug into a small crease-free cylinder) | Demonstrate hands-on session with HPDs. Teach fit-tests like the hum test: try inserting one plug and humming http://www.e-a-r.com/pdf/hearingcons/earlog19.pdf |
| Social models of HPD use | What percent of the time do coworkers, supervisors; others wear earplugs and earmuffs when exposed to noise? | Be a role model as an OHC by demonstrating how to use HPDs Use peers for behavioral modeling whenever possible |
Next, assess the worker’s use of hearing protection behavior by asking what percent of time he/she wears hearing protection when in noise. Simply monitoring by asking a question can have an impact on behavior.
For workers who use hearing protection less than 100% of the time in noise, assess the next four factors in Table 1 and make a plan to intervene now or in the near future. These assessments and interventions can be incorporated in an audiometric testing session, often considered the ideal teachable moment in hearing conservation practice. Alternatively, these interventions could take place in a group setting by engaging workers in discussion of the model factors and practicing with samples of hearing protection devices under the guidance of an occupational hearing conservationist.
Recordkeeping
The important final step is to record the interventions delivered to each worker. Documentation of occupational health services in an electronic health record (EHR) is an emerging goal in keeping with President Obama’s priority of EHRs for
all by 2014. It is essential to document using a standardized language in order to enable health information exchange across
the continuum of care. An occupational health service could implement their hearing conservation standard of care by
embedding a pathway in their clinical information system. In this way, clinicians can readily follow the pathway to record
assessments, interventions, and outcomes related to promoting hearing protection use. A documentation example will be given
using the Omaha System, a standardized terminology in the public domain that is well suited for community-based care (http://www.omahasystem.org, Martin, 2005).
Table 2. Example of an electronic health record entry
| Domain: Environmental |
| Problem: Neighborhood/Workplace Safety |
| Modifiers: Individual and Actual |
| Sign/Symptom of Actual: Physical Hazard (noise). |
| Intervention Category: Teaching, Guidance and Counseling |
| Target: Behavior modification |
| Client-specific information: use of hearing protection behavior and related noise exposure, barriers, benefits, selfefficacy and social models. |
The example above focuses on the individual worker. However, by changing the modifier from individual to community, the pathway could also serve as a standard for group-level interventions throughout an organization.
Noise-induced hearing loss prevention will continue to be a priority as we move toward Healthy People 2020 objectives. Occupational Hearing Conservationists are sure to play an important role in promoting use of hearing protection with workers at risk for occupational noise exposure. Theory-based interventions recorded in new electronic health records can provide information to evaluate outcomes of quality hearing conservation efforts for occupational health services.
References
- Kerr, M.J., Savik, K., Monsen, K.A., & Lusk, S.L. (2007) Effectiveness of computer-based tailoring versus targeting to promote use of hearing protection. Canadian Journal of Nursing Research, 39(1), 80-97.
- Lusk, S.L., Ronis, D.L., & Kerr, M.J. (1995). Predictors of workers’ use of hearing protection: Implications for training programs. Human Factors, The Journal of the Human Factors and Ergonomics Society, 37, 635-640.
- Martin, K. S. (2005). The Omaha System: A key to practice, documentation, and information management (2nd ed.). St. Louis: Elsevier. http://omahasystem.org
- Pender, N. (1987). Health Promotion in Nursing Practice (2nd ed.). Norwalk, Virginia: Appleton & Lange.
- U.S. Department of Health and Human Services. (2000). Healthy people 2010 (Conference edition, in two volumes). Washington, DC: author. Available http://www.healthypeople.gov