The development and validation of Program Latihan Auditori Melayu (PLAM) for individuals with post-lingual hearing impairment [EMBARGOED]

Abstract

Auditory Training (AT) is an intervention that emphasises on the listening skills development to improve the recognition and interpretation of speech sounds among people with hearing impairment. However, fewer than 10% of audiologists worldwide offer AT to patients with hearing loss due to limited assessment and rehabilitation tools (e.g., in Malay). This study aimed to develop a Malay AT program (Program Latihan Auditori Melayu; PLAM) for individuals with post-lingual hearing impairment, establish its validity and measure the effectiveness. This study adopted a quasi-experimental research design which involved four stages; 1. Scoping Review, 2. Development of PLAM, 3. PLAM Validation, 4. Measurement of the PLAM’s effectiveness. Pubmed, Science Direct, Scopus and Pro Quest (medical and health) databases were searched using English keywords; hearing loss, AT, hearing aids, cochlear implants, perceptual learning, aural rehabilitation, auditory rehabilitation, adult. A total of 24 papers (from 2007-2017) were accepted and reviewed. The PLAM was carefully designed based on the Malay language and covered all AT parameters found from scoping review. Content validity was conducted on six experts. Picture validity, pre-testing and pilot study were conducted on 10 subjects with normal hearing. The effectiveness of PLAM was measured on 20 individuals with post-lingual hearing impairment (10 training subjects and 10 control subjects). The training subjects received a 45-minute PLAM training weekly by trainers for six weeks. Eight trainers underwent two-hour classes, and a 30-minute quiz prior to the training. Score for pre and post training was obtained using PLAM screening (PLAM-S), Malay Hearing Handicap Inventory for adult (HHIA-M) and Malay Auditory-Visual Matrix Sentence Test (MMST-AV) to measure the PLAM effectiveness. The scoping review results described AT programs to have an exceptional design but shared practically the same parameters. The development of PLAM included; 1. PLAM manual and 2. PLAM Training. Content validity yield the Item-Content Validity Index (I-CVI) value of 0.833 to 1 for each section, and the Scale-Content Validity Index/Average (S-CVI/Average) value of 0.997. Picture validity showed 99.19% responses agreed that the picture used are guessable and translucent. Pre-testing score showed 100% subjects agreed PLAM instructions is suitable, understandable and the training is feasible. From the pilot study, the normal subjects obtained >80% score for all sections in PLAM module with a minimum score of 88.7%. The training group showed significant improvement of post-training score for MMST-AV (p=0.007), PLAM-S: (p=0.005) and HHIA-M (p<0.005) as compared to the pre-training score. A significant greater normalised gain was observed in training group as compared to control group for HHIA-M (p =0.049) and PLAM-S (p <0.001), but no gain difference was observed between training and control group for MMST-AV (p=0.821). 100% of the trainers perceived PLAM module is sufficient and performances of PLAM documents are good. 97.5% of trainers’ responses agreed that their knowledge regarding AT has improved. The power of study was 99.73%. In conclusion, the PLAM has been comprehensively developed, has achieved good content validity and picture validity, and good pre-testing results, and was proven effective in improving the subjects’ speech-perception and hearing handicap-perception.