How NALguide is Helping Demystify Hearing Aid Technology for Consumers with NAL’s Padraig Kitterick and Paola Incerti

All right, everybody, and welcome to another episode of this Week in Hearing. I am pumped to be joined today by two great doctors coming from Australia at the National Acoustics Laboratory. Down there, I have Paola and I have Padraig. So thank you two so much for coming on today. Do you want to give a little bit longer background and introduction of yourselves, how long you’ve been working at NAL and what you two are working on right now? I’ll kick it over to you. Sure. Well, thanks so much for having us. So, my name is Padraig Kitterick. I’m the head of Audiological Sciences here at NAL. I’ve been at NAL since late 2021, where I joined from a previous academic position in the UK. And really my role at NAL is not only to have the privilege to lead a fantastic department of research audiologists that work on NAL studies day to day, but also to look after and plan our adult hearing loss strategy. And one of the key things that we’re always focused on with our research on adult hearing loss is what are the things that either we can create or we can evaluate that can lead to real world solutions that can help people who are either supporting those who might have hearing difficulties, those who might be thinking that they might be interested in seeking a solution, or some help with their hearing. And so what we’re going to talk about today sort of really squarely falls into the type of work that we really get excited about it now we’re able to get something out there to people. So with that, I’ll hand over to my colleague, Paola. My name is Paola and I’m a senior Research Audiologist who’s been at now since 2009. And again, like Padraig, I guess the important focus for me is looking at outcomes, improving outcomes for people with lived experience of hearing loss. And some of my research centers around, for example, optimizing devices, prescribing electric and acoustic stimulation in same and different ears, bimodal hybrid to improve outcomes. I was empowerment in the hearing health journey, of which knowledge is quite an important ingredient of that. So it fits in beautifully with the NALguide. And finally, I guess the big area for me now is focusing on supporting the Australian government, department of Health and Aged Care, and a lot of the questions that they want and research to be involved in, of which this is where the NALguide stem from. That’s awesome. Okay, so the bulk of the conversation today will pertain to the NALguide. So let’s just kind of go back to the genesis of Know. It’s interesting that some of this derives from your work with the Australian government. It and the public health sphere there. So just kind of give us a background and some insight into how this came to be and what the overarching intentions of it is. Yeah, sure. So as Paula said, actually the genesis of the Nal Guide was actually a request from the Australian Government Department of Health and Aged Care. Now, we work very closely with them and they support our work because we’re funded by the Australian government and they come to us from time to time with key policy questions where they might need a bit of research on or they need us to help advise. This was a slightly different case where they came to us and know we are providing hearing services to millions of people across Australia through the government funded hearing programs. But we still have real concerns that it’s actually quite difficult, not just for people who are accessing hearing services but for anybody in the public to really sort of decode the information out there about what hearing devices do, what are the differences between different devices. And the request from us is help us try to sort of demystify and decode hearing devices for your average person on the street. Because this wasn’t about something that only gets given to somebody who walks into a hearing service center, for example. This is about saying they were worried that the family members of those who might support somebody to seek help about a hearing loss or just even the very fact that people will go looking for information and sort of get lost in a sea of terminology and different words and different terms and different meanings and different ways of talking about hearing technology. So they came to us and said, hey, can you help us with this? And of course we said, yes, this is exactly the type of work that we love to do. And so we stepped back and we really thought, okay, how are we going to do this? Because we had several sort of design goals from the very start in sort of how we went about this. So the first thing that we were thinking of is that whatever we create, we probably want to create something that’s really nicely structured, it’s easy to digest, so anybody could just pick it up without much background knowledge and really understand it. And the second thing was that we didn’t want to have to create something that would then need to be updated every few months. Right. If we get something out there. If you explain the major features of cars or phones or any other bit of technology that we use in our life, sure, it changes over time, but we don’t want to have consumers to have to get lost in a sea of terms that have to be updated every three months or six months. We really obviously wanted to make it consumer friendly, avoid technical jargon and a key thing that will come on and talk about how we went about creating it is we didn’t want it to be related to any manufacturer, so it had to be manufacturer agnostic is the way we call it. But basically, if. It’s not about trying to use terms that only some manufacturers use. And then probably one of the key things that we wanted to incorporate is how can we link the features of these devices to actually what people care about? Which is you don’t go thinking about what do I want in the device? You think, what do I need help with? Right? What is it that I would like a device to do for me to linking those two things? So that was the sort of genesis of the project. It started off with a request to say, hey, can you give us information we can put on our government website to help all consumers in Australia? And then we really took it from there. And as Paola will bring, you know, once we had that basic guide, we then did a lot more work to really turn it into something that we hope will be useful around the world. So maybe, Paola, do you want to comment on maybe the process we went through to create? So over quite a brief period of three months, a team of nine researchers that included engineers, audiologists and behavioral insights specialists really got together. And we got together and decided on a process. And it was essentially a five stage sort of process whereby we started with scoping. So we first really had to identify the manufacturers that were going to be relevant, the product lines and the devices. And then we took it to the next phase, which was extracting and decoding that sort of information. So really identifying the features in these devices and their underpinning technology as well as intended purpose. So gathering all that information. And then we actually took all of that information and we grouped it and mapped those into feature families. So basically we took the features and said, what’s their intended performance? What are they saying this does? So what we then did was what we called a mapping phase, which was where we grouped features by their intended performance and effect. And then we arranged them into feature families so that we could then take that into the next phase, which was description, and creating this generic description of these feature families and features that were really simple, accessible to digest, and focusing really on the intended purpose of it and listening goals. And then I think the most important part was really the then taking that lexicon or glossary of features and actually going to both our consumers, going to manufacturers and also to clinicians and getting them to look at it, review it and feed it back. So it was really this iterative process that we worked through where we presented, redesigned based on feedback. And I think that was really what gave it its it was the really critical part because of that involvement. It with all our key stakeholders and resulting in what you have today, which is a simple guide and it has both the high level sort of aspect to it. But if you want to dig in, if you’re interested in more information, you can also scan the QR code and dive in and get deeper information about it so it has various levels for different people and how much information they want to absorb and assimilate into knowledge. And then take that guide potentially to your clinician, your hearing, healthcare specialist, and have a conversation and really focus on what are my needs, what’s my daily life like and activities, what sounds are important, what goals are important, and then have that confidence to discuss it with your audiologist, for example. Yeah, there’s a couple of comments here, I think, that I noticed when I looked at it the first time. One of the things that stood out to me right away that it is brand agnostic, I thought that was pretty interesting. And I think it’s important to have an objective sort of non biased or even being perceived in any way by the consumer as there being like a slant to it. And I think that this whole idea of speaking kind of almost reverse engineering of why a lot of these different features exist, which this whole show is kind of geared toward the professionals in the industry. And so I think we all can relate to this fact that we kind of almost get lost in the fact that we live and breathe this world and so we kind of forget why some of these different features exist. So I love that you’re kind of going back at why these matter to people and what kinds of benefits that they would provide. And so I think that it ties into a broader theme that I think we’re seeing everywhere now, which is this more educated consumer patient. There’s so much information online, but kind of the challenge that that can present is that it’s paralysis by too much information. And so it’s really important, I think, to have dedicated resources that help to distill everything down in a way that feels like you’re just sort of getting the essentials and you’re really understanding it so that you feel empowered as a consumer, just like you said, that you can then go have. Maybe it’s a more meaningful, a more worthwhile meeting with the healthcare provider that you’re kind of saying, like, here are the things that matter most to me. And I think we can maybe dovetail that into the different sections that you have, because I noticed there’s about six different sections in the guide. So maybe you want to talk a little bit about that, of how you decided to compartmentalize it the way that you did, why you did the categories in the way that you did. So. Let’s go into that part of it. Yeah, no, absolutely. And just before we jump into that, I just want to agree with what you said. And one of the things that we sort of kicked around as we were developing the guide is one of the purposes is that we really want to turn the consumer into someone who is really opinionated about what technologies they want for their needs. And I feel like with lots of other areas of technology these days, we’ve got very good at that. We handle very sophisticated devices like mobile phones at lots of features and we all sort of are pretty clear on the bits that we really want. Is it the camera, is it the size of the screen? Is it this, is it that? Connectivity? I think that’s one of the key things with this is that we want it to make sure that the consumer is walking in and saying, look, I already understand the basic features of these devices and the different types of features and based on my needs, I think I need this, I think I need that. Let’s have a conversation about it. And what we also hope that does is we recognize that one of the challenges for audiologists and dispensers of hearing aids is also that there is such a breadth of technology and levels of devices and also that relates to pricing as well, sometimes depending on the funding model. So it’s really challenging to have these conversations and figure out how do I get the best for the consumer and make sure that the technology is what’s going to meet their needs and they understand the difference between all these devices. So I think the more that they can come in really feeling like they’ve had an opportunity to digest some of that information, the better. And that’s sort of I like to call it pre-habilitation or pre-conditioning, like we do that for lots of things, surgery. So let’s start talking pre-habilitation and get people thinking about it before coming in. Yeah, no, that’s absolutely right, the assessment. And that’s exactly why we sort of organized the features the way we did. To get back to your question. So as Paola sort of described, we sort of did a bottom up approach where we went out and we looked at all of the various features across all the major manufacturers, all the major product lines. And in that we included both the low level, sort of lower levels of technology devices and the absolute premium higher level of technology devices. And one of the challenges as you do that is even as professionals working in the field, it’s actually quite difficult to figure out what some of the features really are, right? So even we realized how difficult it is. And so as we started to decode them, we had this problem, which is, well, how do we group these features? Like what’s a sensible way to organize them and what we realized is that fundamentally there are key things that we think matter to the users of technology. And that really led a lot of our thinking about how we group them. So one of the most common things is understanding speech in noisy environments or hearing in noisy environments. And a lot of technology has been put into that. Now, we could split that out into multiple smaller categories because there’s so much in that area. But in reality, somebody says, Well, I have problems in noise. So you want to group things under that. And then you’ll see the groupings when you look at them things. Like comfort, personalization sound quality. These are all things really, that from a consumer perspective make a lot of sense. So in many ways, from a technical point of view, we could have organized these features in 20 different ways. So one of the key things we were thinking about when grouping them was really around at that very high level, how do we group them in a sensible way that actually a consumer could read and relate back to their needs and the type of needs they would have? It’s unlikely that somebody’s going to come along, for example, with, I’ve got a really specific need to do with my spatial hearing, so I’m glad there’s a spatial hearing category. It’s more likely they’re going to say, I really struggle when there’s a lot of noise and there’s a lot of things going on. So that’s why, for example, you see a lot of the directional components of features under the speech and noise, for example. So consumer at the top level, and then within that, we also try to be very careful. So one of the challenges of grouping features then, so I’ll give you an example. For example, you might have features like directional microphones and gaining compression and frequency shaping and all sorts of things. One of the challenges that there’s so many terms that manufacturers use that actually trying to find some really clear, simple terms that every professional will understand but doesn’t actually overlap with anything that’s too specific to any manufacturer was a real challenge. And so a lot of what you see in the guide is like really careful choice of terms so that we’re confident that consumers can use that term. And any audiologist, any professional who’s dispensing hearing devices will be able to understand what they mean by those. Right? Now you can delve deeper, right, if you’re really into your tech, as Powell says, you can scan the QR code and go even further, a level deeper, and say, oh, I’m interested in the difference between an adaptive directional microphone and this type of directional microphone. So we’re not trying to hide away detail from those because we know there’s a subset of consumers increasingly who are really interested in the technology, right? So it’s almost like start with that higher level, organize it by need to help the consumer gravitate towards, okay, what types of things should I even ask about? They don’t necessarily even have to really understand the nuts and bolts of it, but at least they know, look, I should ask about things like directionality. I should ask about things like noise suppression. I should ask about things like, what’s this thing about a device where it will learn my preferences over time or be able to automatically adapt in different environments so I don’t need to mess with it because I really don’t want to have to touch the device once it’s set up. So this is the type of thing that we try to organize it around to really help the consumer have that initial engagement with the features. But then from then on, it’s really based on a very careful consideration of the underlying technology behind different features and grouping them appropriately. And one of the things I’ll just say finally is said what you’ll see at each level of the guide is sometimes in the guide we say, hey, look. Look out for terms like this. So when people are googling around or they’re reading different manufacturers, we are giving them the types of terms they might come across. And some of those are manufacturer specific, but chosen, so they’re across all the manufacturers. So people understand that. Look, the same thing can be called ten different things, right? Don’t be confused. Actually, you should go in and really say, I don’t care what you call it. I want you to explain how it’s going to help me. So that was for the thinking. Palate do you want to add anything? Probably. The other thing is, obviously for manufacturers, they didn’t want us to homogenize it so much that you couldn’t differentiate. So that second level really was to try and help people if they wanted to understand those technologies, those different sorts of technology. We know some are more advanced and some are obviously not as advanced. So rather than it being homogenizing, it actually gives the person an opportunity to understand the feature and then allow the audiologist to show what is different about a particular product, perhaps from one, or about a different entry level product. So I think in understanding it, you’re able to actually differentiate what perhaps is beneficial for one product over another. And just to give you an idea of the process, all those terms and descriptions we Googled to make sure it didn’t come back up to one manufacturer. So we had this process to try and make it as, I guess generic as possible in that sense. And the other thing that we did was we will create a booklet that will have how to use it and also allow you to check the features and write notes in the back. So we’ll be producing a free booklet for people to be able to download or order, and then they can just tick and take that physical copy to their clinicians, to their friends and families to discuss. So we’re trying to make it as easy as possible for a person to think about what they want and their needs. It’s probably important to add that it’s not like we think that producing this is going to sort of solve the core challenge, which is that the environment is just really confusing. We understand that manufacturers will want to distinguish their products. They’ll want to have something that is different in the market, and that’s okay, that’s good, that drives new innovation. What’s key is that the consumer can sort of understand that and make informed decisions. So one of the things that we’re sort of constantly hoping will happen is that by really engaging with the consumer to say, hey, let’s start a conversation about how we talk about different features of hearing devices. What we’d love to see is at least manufacturers maybe considering whether they use some of these terms to help guide consumers so they’ll still have their specific name. Means for their technologies. But it would be really helpful, for example, if they said this is actually this type of feature, it’s a special type of feature and we think it’s brilliant and they can give all the evidence for that. But ultimately having the consumer to be able to sort of navigate all of this information using some, let’s say, widely accepted generic terms for these different features at different levels I think would be helpful in the long run for consumer, particularly as now we’ve got even more choice about how you get devices. I know in the US with the introduction of OTC legislation, the different forms of devices coming on the market is increasing every week and the different channels you can get devices. So I think it even puts more of an emphasis on making information about devices accessible so consumers can make relevant choices about which technology suits them. And we actually also passed the guide through a readability checker to ensure that first level was accessible to a reader of a level of grade six to grade eight. So that was another really important thing to make sure it would be understood by the consumers. I think that it’s actually a really pretty brilliant thing, because really what you’re doing is demystifying the whole buying experience here. And I think that the really big upside for that is to eliminate or reduce the buyer’s remorse. Because you think about again, I come from the US. perspective of things, so I know kind of how the points of care and access come and how the distribution model works in the US. And there’s obviously a growing trend of managed care and there’s benefits and stuff like that, but it’s still a large out of pocket cost for a lot of people. And so the last thing you want the statistic that was kind of like going through my head as you were talking was the amount of people that buy a device, maybe reluctantly, and then it ends up in the drawer. And not only did you do a disservice to that person and that patient, but then they’re going to speak negatively about the experience. So you’ve created a negative experience that might radiate in their community and just kind of reflect poorly on hearing technology and then hearing healthcare as a whole. And so I think that if you can think about this as a way in which you can help get people feeling like they made the right decision, because there is probably a feeling of, like, why did I buy something that was premium technology, that had all these different bells and whistles that I had absolutely no idea I did not need? And now I can tell through a guide like this, I can really kind of match myself to like these are the most important things that I need and what are my options for that. And that really is something that I think there is a big gap right now in I don’t want to generalize. I think that it’s obviously a spectrum of the types of way in which these conversations are had in the clinic. And stuff like that. But I think that you are kind of faced with the challenge as a clinician of, okay, I’m kind of like going off of the objective diagnostic measurements and stuff like that. So I have a sense of what this person needs from just like pure the kinds of needs that they have from a prescription standpoint. But what about all the different, different softer needs and things that aren’t as tangible for them, many of which they don’t know how to articulate because they don’t really know where to even begin. So I think it just gives them, again, a level of empowerment to feel as if they know what they’re looking at. I think the analogy to the smartphone is actually pretty brilliant is like over the course of time we’ve all become habituated because we’re all smartphone owners of what we like and what matters. And so it’s become much easier for you to then buy the next smartphone or something like that. I think with Hearing Healthcare, we’re looking at a demographic by and large that even with the amount of people that have kind of come into the cycle today, there’s just the vast majority of people that need this would be first time buyers or first time patients. And so I think that it’s very important to provide resources for a first time buyer so that you ensure that they’re happy and they’re satisfied in the ecosystem and they’re not going to just immediately exit. Yeah. No, look, I couldn’t agree more. And I guess we’re always conscious that and you’ve tapped on it or you’ve touched on it. There. The first device somebody gets could be the last. If they have a bad engagement with hearing technology and the use of hearing technology and it doesn’t help them, it could not only affect them, as you say, but also people they talk to. So that’s really important. And I guess this comes from this idea that we really want people to be thinking about their needs and actually being informed about the technology before they walk in. But also there’s a really important part of this we haven’t yet touched on. And it’s not something that we thought of initially with the guy, but I think it’s something that we’re beginning to think about now, which is if somebody does get some higher level technology device and there’s a lot of different features in it, as you say. We also don’t want people carrying around technology that they don’t also know how to get the most out of. So we also want consumers to be most devices these days. There’ll be an app, you can go in there, you can turn on this feature, that feature. We actually really want to make sure also that people feel comfortable that they’re not going to break anything. These apps are designed to be used by the user of the device and to go in there and make sure that they’re thinking about, how are these different features going to help me and when might I use them? And so one of the sort of knock on consequences we’re hoping is that it might also help people who’ve already got hearing technology to ask questions like, oh, can I turn this? On? Does my hearing aid have that? Can I use this to help me in that situation? And then I think finally, our commitment at Nal is we’ve really got to stay engaged with what’s going to help consumers in this space. So we’ve already engaged with consumers as part of the process, but we continue to ask questions like are there ways that we can make this more useful, more practical ways we can deliver it? Are there use cases that we didn’t visage initially that we can adapt it to support for? And I think it’s just something that if it’s going to help people navigate hearing technology so they get the right technology for their needs and they’re able to use that technology effectively, which is the other piece that we’re now talking about, then this is really important and actually it’s to everyone’s benefit, as you say. The audiologists can have a more productive conversation about which technology is going to help them, but also manufacturers. This can help manufacturers. If the consumer is more conversant about technology, then what we see in things like the mobile phone space and other technology spaces is consumers want manufacturers to offer unique features. So actually this is a really helpful, I think, tool to get the consumer more interested in features that are more personalized to them and then they can sort of make better informed choices. And I think fundamentally, the whole world, we’re moving to a much more technology enabled, digitally connected world and I just think we have to make sure that those who have hearing difficulties and need the support of professionals and hearing devices also get the adequate support to navigate this complex landscape. I feel like if we sit back and we don’t help, then at the very least we’re not making things easier for people. And I don’t think that’s compatible with the thing that we all want was for more people to seek help earlier. And so if this goes in any way towards helping with that, then that’s something that we’ll be really happy about. And I think also this guide is not an end product, it’s evolving. So we welcome feedback, we definitely welcome people looking and connecting and contacting us and saying perhaps there might be some other way or something we’re missing. And we’re looking to obviously look at these products on an annual basis at the very least to make sure we’re keeping it up to always, everyone will always be able to find the latest version for free on NAL’s website. So it’s NAL.gov.au/nalguide You can find our contact details there if you’ve got feedback or reach out to us on social media. And as Paolo said, it’s not a fixed thing, it’s not a living document, it’s not something you have to pay for. We want to know what’s going to be useful. We want to know which bits of it really people find helpful which they don’t. So any feedback from professionals, from consumers, whoever uses this and that’s maybe a group we haven’t talked about as a NALguide user so much. But we’re also hoping that professionals will also find this useful for it to. Have something that they can offer somebody when they’re thinking about what devices or technology might be suitable to them, but also something that maybe they can take and frame a conversation around as well. And if they have particular needs, we’ll be looking to see how we can address those as well. Well, I’ll just make two comments on this. One is I really agree with you Padraig on the point about this actually, I think behooves the manufacturer’s because like you said earlier, you are sort of saying, okay, here’s the generic term and then you’ll have brand specific terms. So look out for these. So if you’ve identified that sound personalization is like the number one feature category that’s most important to you, then I think it at least gives you an idea of like, here are the terms and then you can do your own research to identify. Here are the manufacturers that might specify in that, which again, I think is like it ties into this idea of a more empowered patient, I think is a better patient. And then the last point there that you just made about the professional, I just had a conversation the other day where I was talking to an audiologist about this kind of the same thing, which is one of the biggest challenges that a clinician faces is they don’t have enough time, they don’t have enough bandwidth. And so I think that right now they’re sort of limited to manufacturer specific literature and materials and stuff like that. There aren’t a lot of these kind of third party objective consumer reports, if you will, that are kind of consolidating everything into one. So I do think that this would be something that would be very appreciated, at least by a segment of professionals that would look at this and say, here’s a really good way for you to kind of learn more about what you want prior to you coming in, read this kind of thing. Which dovetails to my last question for you all. How do you plan to kind of disseminate this? You just told me how I can go and access it. But do you have plans of working with the Australian government or public health entities, stuff like that, to get this in the hands of patients and make them aware that it exists? Yeah, that’s a really good question. So it’s already put on the Department of Health website here in Australia, so it’s already live there. We’re starting to produce physical copies and work with organizations here in Australia to start trialing them out. In particular, we work with our partner here in Australia who actually is part of this, to help refine the guide to get feedback from clients and clinicians. So we’ll start introducing those into clinics and we’re working with them also to figure out how do we adapt the guide to fit in with a normal sort of literature that a clinic would give to patients as you say, before they come in. And we will learn things from that that then we can pass on to others. A key thing is we’re constantly trying to think of other ways is to raise the profile of it. So talking to individuals such as yourself, trying to do media. Interviews and get it on social media. We’re also talking to organizations that own chains of hearing stores for example, not just in Australia but around the world. Because if we can make inroads into some of those big networks of stores, considering that it’s a no cost product to provide, that will help, hopefully their consumers have a better experience know, we really hope that that will be another avenue to be able to get good uptake. The other thing is we’re also working with making the manufacturers as well. We’ve been really, actually really I think it’s fair to say and acknowledge that the Hearing Aid Manufacturers Association here in Australia, which contains all the major manufacturers, have actually been really proactive and positive at engaging with us on this and really actually helped us make it manufacturer think, you know, working with all of those partners. But I think the key thing is that we can’t leave it as one thing that just sits still. I think a key part of getting this out there is listening to and getting feedback on how it’s being used both in clinics that we’re working with, giving it to consumers, continuing to innovate. So we’ll be looking at new ways to deliver it all the time to see can we improve it, can we make it easier, can we make it more relevant, more accessible. And I think that’s the key thing, right? We’ll work with all those stakeholders but the key thing is we’ve got to keep working on it, keep improving it, keep getting it out there so that it’s a living thing and we keep finding ways to add value to it and I think that’s going to be the key thing that’s going to drive it. I think the proof will be in the pudding, right? If people pick it up and they find it useful, they’re going to tell people about it, clinicians are going to notice and I think that’s the ultimate test of this and what’s going to really spread it if it’s useful, things spread pretty fast and really that’s what we’re hoping. And I might just add we’re also working with our Australian Audiology, it’s our professional organization specifically for Australia, obviously. And so we’re doing a bit of a show and workshops to try and integrate it into the practice and give practical hints and tips in order to integrate that into it. So the world tour, I guess might start the world tour starts in Australia, but we hope it will adopt a workshop, for example, online for people to do with audiology online, for example, ultimately, and make it practical clinicians as well. And also just encourage anybody who wants to spread the word and if they find it useful and they want to spread the word about it, then please go ahead. I mean this is the whole point that the value for us in it is that it gets out there and gets used, right? Not that we’re the ones necessarily talking about it. So I think that’s the key message is get out there, use it. If you got some feedback, we want to hear about it. We’ll make it better. 100%. That’s fantastic. Well, thank you two so much for coming on today. Really learned a lot. I’m excited to watch the NALguide be disseminated and evolve over time. I think it’s going to be a great resource for the industry and then, more importantly, for the consumer. So thank you too. Thanks for everybody who tuned in here to the end. We’ll chat with you next time. Cheers.