Design+&+Construction+of+the+Measure


 * The Design and Construction of the Measure**


 * Method**: The method of assessment will be a self-report, pen and paper questionnaire (group test, screening test). This is the only measure of assessment possible, and was stipulated in the assignment instructions. Never-the-less, the purpose of the measure is to provide a quick and cheap way of identifying those who are at risk of suffering from hearing loss in the future, and those who have hearing loss. The hearing tests used currently are expensive and require professional personnel. Any other method would compromise the cost-effectiveness of the measure. For example, we considered involving a computerised auditory test. However, the participants/patients would have to attend a computer lab to ensure all of the apparatus was standardised. This would sacrifice the measure’s ability to be cheap. Other methods include observations and interviews. Again, such method would cost more (observers and interviewers), limit the number of tests that could be administered and struggle with objectivity and examiner influence.

Methods of scaling that can be excluded are expert rankings; such a method would be costly and impractical for group testing. Such limitations also prevent the use of method of equal-appearing intervals because they too involve experts.
 * Scaling:** Most items were conceptualised as Likert, or Likert-type scales that captures how strong a responder is in agreement with the item. Such scales have the benefit of a continuum. Thus, the items will be applicable to the wide variety of responders and gives a more accurate picture of risk factors. For example, if a person plays an instrument, the frequency and amplitude (dBs, i.e. how loud the noise exposure is) can be recorded. If a person plays in a band once a week, that is less of a risk factor than if they play three times a week. Hence, a continuum conveys more information. It is also useful for testing attitudes, and can be administered in a group test format. Guttman scales also capture the same continuum and would be advantageous for certain factors, such as hobbies/activities.

As mentioned, Likert scales and Guttman scales will predominantly be used.
 * Item format:** In order to capture potential hearing loss, multiple choice formats would be impertinent, since it might imply that there is a correct answer which responders should select. The exceptions are demographical information: age, medication use and gender. Age will be categorical to encourage honest and accurate responses.

Likewise, method of rational scaling would work because it is based empirically, not on expertise (although this isn’t as important during item selection as it doesn’t have to be repeated).
 * Item selection/scaling**: A method of expert keying would be appropriate. Those who have diagnosed hearing loss (homogenous group matched on confounding variables) would answer provisional items. Differences between the answers of those with hearing loss and a normative sample on items suggests that those items are pertinent.


 * Item Content:** Several risk factors for noise exposure were discussed and addressed. Given that the aim of the measure is to explore exposure-related hearing loss, some factors were flagged as less important. These include genetics/family history, diet, drug usage (including alcohol and tobacco) and illnesses. These variables have been examined extensively in the literature and influence the onset of age-related hearing loss. However, they are not directly related to noise exposure and so were not explored further as risk factors. These do become relevant when assessing current hearing loss, but would be captured by items targeting a responder's experiences of hearing difficulties (whether they percieve any symptoms of hearing loss).

The five factors captured by the measure include: age, gender, attitudes towards hearing loss and auditory protection, workplace environment (occupation) and hobbies or interests. Research has shown that hearing deteriorates with age (Arvin, Prepageran & Raman, 2011). However, the prevelance of hearing loss in adolescents seems to be increasing (Shargorodsky, Curhan, Curhan & Eavey, 2010). Obviously, then, age is likely to have relevance to both risk factors and whether they have hearing loss. Males seem to be more likely to develop hearing loss, although it maybe be exposure related (i.e. are males exposed to more noise due to occupation, hobbies etc.?). Hence, gender relates to both risk factors and presence of hearing deficits. To illustrate, a 50 year old male would be at an increased likelihood of having hearing loss compared to a 50 year old female. Attitudes toward hearing loss may serve to mitigate risk factors. If attitudes were not assessed, the chances of the measure producing false positives would increase. For instance, a man who enjoys playing in a band three times a week and who works in a factory with loud machinery would score highly on items assessing risk factors. However, if this person had a proactive approach to ear protection (e.g. wears noise attenuating ear plugs at work and whilst playing his instrument), the influence of his environment on his hearing ability would be substantially less. As implied already, a person’s workplace and hobbies may render them vulnerable to auditory damage. Sound volume and duration of sound causes damage. Activities involving music, loud tools or machinery, or even a home cinema can involve sound at excessive volumes and put people at risk, particularly if practiced frequently and in the absence of hearing protection. Careers in the military, or those who use firearms, and jobs requiring frequent use of power tools have similar risks.

(Files attached).

Some preliminary work, has bearing on validity also:


 * The HSI**

Coren and Hakstian (1992) developed the Hearing Screening Inventory (HSI) to assess hearing sensitivity. Their main contention was that many previous attempts to develop questionnaires pertaining to hearing loss and hearing sensitivity had relied upon face validity. The authors’ diverged from such a trend by testing validity against laboratory tests.

The developers initially attained a large item-pool (216 items) that were selected from frequently reported situations in which diminished hearing impairs performance. Half of these items were removed on the basis of their experiential specificity, overlap and tendency to be misinterpreted (given a pilot sample of university students). The developers’ then gave the inventory to a large sample in addition to objective measures of pure-tone thresholds. Scaling involved numerically coding responses from 1 to 5, where 1 corresponds to “never” or “good” and 5 “always” or “very poor”. Items exhibiting the greatest correlations with pure-tone thresholds were retained. Furthermore, items that seemed to overlap too closely or that seemed inappropriate for a wider general population were then eliminated. The Furnival-Wilson algorithm (Furnival & Wilson, 1974) was used to isolate subsets of items which formed the highest regression with pure-tone threshold testing. These subsets were subsequently tested for criterion-validity and internal consistency; 12 items resulted. Such a methodology illustrates how item selection is an intergral part of forming a valid and reliable measure, and a similar approach seems pertinent for the current scale development.

Cronbach’s Alpha for the sample of 384 Canadian community members was .91. Criterion-related validity: correlation of .83 (p<.001) between HIS total score and mean pure-tone AMA score (for both ears combined). A further measure of validity was obtained by how well the scale classified those with hearing loss (-25dB) from those without. The scale correctly detected 92.6% of normal hearing responders (sensitivity) and 86.7% of hearing impaired. Overall sensitivity deemed to be 91.4%.

Thus the HSI was found to have good internal consistency, validity and sensitivity. Test-re-test reliability was also found to be good; the HSI was stable. Notably, “ the resulting HSI is brief, requiring only a few minutes to complete and to score. It could easily be administered by mail or in large group settings. It could be administered by itself as a simple auditory screening measure or as a brief hearing assessment component in larger health-related surveys. Since there are no requirements concerning any kind of audiometric apparatus, specific printing formats, controlled and quiet environments, or other testing-session desiderata, the HSI should be very attractive for studies in which the assessment of hearing ability of large samples of individuals is desirable for normative, epidemiological, or health monitoring reasons. The high test-retest reliability of the HSI may make it useful for detecting systematic changes in auditory sensitivity in targeted groups over extended periods of time, because a 5-point change in the HSI score exceeds the 99% confidence interval for retest reliability. Thus the HSI provides a potentially useful tool for researchers and clinicians who desire a quick, valid, and inexpensive method to estimate hearing sensitivity”. Never (or almost never), Seldom, Occasionally Frequently, Always (or almost always) Simply circle the letter that corresponds to the first letter of your choice. (If you normally use a hearing aid, answer as if you were not wearing it.) Answer these questions using Good, Average, Slightly below average, Poor, Very poor (Circle the first letter corresponding to your choice) Scoring instructions: Responses are scored 1 for "Never," 2 for "Seldom," 3 for "Occasionally," 4 for "Frequently," and 5 for "Always" (or "Good" = 1 to "Very Poor" = 5). The total score is simply the sum of the 12 responses. (Items 2, 3, 4, 7, and 8 are reverse-scored.)
 * 1) Are you ever bothered by feelings that your hearing is poor? N S O F A
 * 2) Is your reading or studying easily interrupted by noises in nearby rooms? N S O F A
 * 3) Can you hear the telephone ring when you are in the same room in which it is located? N S O F A
 * 4) Can you hear the telephone ring when you are in the room next door? N S O F A
 * 5) Do you find it difficult to make out the words in recordings of popular songs? N S O F A
 * 6) When several people are talking in a room, do you have difficulty hearing an individual conversation? N S O F A
 * 7) Can you hear the water boiling in a pot when you are in the kitchen? N S O F A
 * 8) Can you follow the conversation when you are at a large dinner table? N S O F A
 * 9) Overall I would judge my hearing in my RIGHT ear to be G A S P V
 * 10) Overall I would judge my hearing in my LEFT ear to be G A S P V
 * 11) Overall I would judge my ability to make out speech or conversations to be G A S P V
 * 12) Overall I would judge my ability to judge the location of things by the sound they are making alone to be G A S P V

The Development and Cross-Validation of a Self-Report Inventory to Assess Pure-Tone Threshold Hearing Sensitivity. ** Authors: ** Coren, StanleyHakstian, A. Ralph ** Source: ** Journal of Speech & Hearing Research; Aug92, Vol. 35 Issue 4, p921, 8p ** Document Type: ** Article ** Subject Terms: ** *HEARING*HEARING disordersSELF-report inventoriesPERSONALITY tests

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Next job is to look at questions used for the different risk factors (attitudes have some research). Many of the attempts to self-report measure have used few items or face validity.h