title: Client labor: adults with hearing impairment describing their participation in their hearing help-seeking and rehabilitation.
abstract: BACKGROUND
  The uptake and use of hearing aids is low compared to the prevalence of hearing impairment. People who seek help and take part in a hearing aid rehabilitation process participate actively in this process in several ways.
  
  
  OBJECTIVE
  In order to gain more knowledge on the challenges of hearing help-seeking and hearing aid use, this qualitative study sought to understand the ways that people with hearing impairment describe themselves as active participants throughout the hearing aid rehabilitation process.
  
  
  METHODS
  In this qualitative interview study we examined the hearing rehabilitation process from the perspective of the hearing impaired. In this article we describe how the qualitative interview material was interpreted by a pragmatic qualitative thematic analysis. The analysis described in this article focused on the efforts, initiatives, actions, and participation the study participants described that they had engaged in during their rehabilitation.
  
  
  METHODS
  Interviews were conducted with people with hearing impairment in Australia, Denmark, the United Kingdom, and the United States. The 34 interview participants were distributed equally between the sites, just as men and women were almost equally represented (56% women). The average age of the participants was 64. All participants had a hearing impairment in at least one ear. The participants were recruited to represent a range of experiences with hearing help-seeking and rehabilitation.
  
  
  METHODS
  With each participant one qualitative semistructured interview ranging between 1 and 2 hr was carried out. The interviews were transcribed verbatim, read through several times, and themes were identified, defined, and reviewed by an iterative process.
  
  
  RESULTS
  From this thematic focus a concept called "client labor" has emerged. Client labor contains nine subthemes divided into three overarching groups: cognitive labor, emotional labor, and physical labor. The participants' experiences and meaning-making related to these conceptual types of efforts is described.
  
  
  CONCLUSIONS
  The study findings have implications for the clinical encounter between people with hearing impairment and hearing health-care professionals. We suggest that a patient-centered approach that bears in mind the client's active participation could help toward improving clinical dispensing, fitting, and counseling practices with the end goal to increase hearing aid benefit and satisfaction.
authors.affiliation: Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark. linevestegaardknudsen@gmail.com
authors.forename: Line V
authors.initials: LV
authors.lastname: Knudsen
authors.forename: Claus
authors.initials: C
authors.lastname: Nielsen
authors.forename: Sophia E
authors.initials: SE
authors.lastname: Kramer
authors.forename: Lesley
authors.initials: L
authors.lastname: Jones
authors.forename: Ariane
authors.initials: A
authors.lastname: Laplante-Lévesque
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012048:Correction of Hearing Impairment / Q000191:economics / Q000379:methods*; D003657:Decision Making; D004644:Emotions; D005260:Female; D005382:Financing, Personal; D006310:Hearing Aids / Q000191:economics; D034381:Hearing Loss / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010358:Patient Participation; D017060:Patient Satisfaction; D011340:Problem Solving