Audiology, slow to implement practice guidelines, must explore solutions

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Hearing Journal





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A multifaceted approach to change audiologists' practice behavior, long touted as key to implementation of best practice guidelines, failed to work in a small study we conducted, suggesting that the field must develop new ways to support adoption of the latest recommendations.

The need for guidelines is particularly acute because widespread implementation of newborn hearing screening has led to a demand for pediatric audiologists who can provide services for infants. Needless to say, children with hearing loss will have significant developmental benefits if timely and appropriate services are provided. (Ear Hear 2009;30[1]:128.; Pediatrics 1998;102[5]:1161; Arch Otolaryngol Head Neck Surg 2004;130[5]:570.) Professional practice guidelines are developed periodically to help professionals remain up to date with current standards of care, and audiology has guidelines specifically for pediatric services. (Pediatrics 2007;120[4]:898; American Speech-Language Hearing Association's Guidelines for the Audiologic Assessment of Children From Birth to 5 Years of Age.) Guidelines tend to languish somewhere between creation and implementation, a phenomenon that is widespread and not unique to audiology. (Lang Speech Hear Serv Sch 2006;37[4]:268.)

Lack of compliance to professional guidelines may arise in part from different influences on professionals and the environments in which they work. A framework for increasing adherence to guidelines was recently developed within public health, representing the complex interactions of variables that can influence practice — capability, opportunity, and motivation. (Implement Sci 2011;6[42]:1.) These conditions are influenced by the professional's and the patient's personal psychological, social, and physical factors.

Nine interventions (education, restrictions, and modeling) and seven policy categories (guidelines, legislation, and regulation) influence the process. Moodie suggested that a multifaceted approach when planning professional development activities that targets the three behavior conditions identified in the framework can more effectively transfer evidence-based practice recommendations into audiology services. (Can Hear Rep 2011;6[3]:23.)

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