Measuring third-party disability in spouses of older people with hearing
impairment: The Significant Other Scale for Hearing Disability (SOS-HEAR)
Nerina Scarinci, Linda Worrall, and Louise Hickson
The University of Queensland, School of Health and Rehabilitation Sciences, Communication Disability Centre, Australia
Background
Data Analysis
Discussion
 Hearing impairment (HI) is the most common acquired communication disability in older
 Principle components analysis (PCA) was performed on the 36-item scale to optimise its scaling properties and to
 The SOS-HEAR is an appropriate tool for measuring third-party disability in spouses
determine initial construct validity.
people (Andrews, 2001).
 HI affects not only the person with the HI, but also those in his or her environment
i.e.,
family members and friends (Scarinci et al., 2008, Wallhagen et al., 2004).
 The impact of HI on others is a “third-party disability”, which is defined by the ICF as the
functioning and disability of family members due to the health condition of significant others
Family Member Functioning
(WHO, 2001):
Family Member
Health Condition
 Reliability analysis using Cronbach’s alpha was used to determine the internal consistency of each factor.
 Test-retest reliability was assessed with 27 participants who completed the questionnaire a second time.
(1) communication changes
Results
(2) communicative burden
Factor Analysis
(3) relationship changes
 PCA of the 36-item scale extracted eight components with eigenvalues greater than 1.0, explaining 73.2% of the total
(4) going out and socialising
variance in the original set of variables. The scree plot indicated six independent components, which were retained for
(5) emotional reactions
further study.
(6) concern for partner
 These domains are consistent with previous qualitative study (Scarinci et al., 2008)
 The mean overall SOS-HEAR score was 0.63, indicating mild third-party hearing
rotated solution revealing the presence of simple structure, with all components showing a number of strong loadings.
Significant Other’s Health
Condition
Functioning & Third-Party Disability
Body Functions
& Structures
Activities
disability, however scores on each item ranged from 0 (no problem) to 4 (complete
Participation
Environmental
Factors
Personal Factors
SOS-HEAR factor
Factor 1:
Communication
changes
Functioning & Disability
Personal Factors
Figure reproduced from Scarinci, Worrall, & Hickson (2009a).
 The significant other’s HI serves as an environmental factor contributing to third-party
disability in a family member/spouse.
Factor 2:
Communicative
burden
 Spouses experience activity limitations and participation restrictions as a result of their
significant other’s HI, affecting (1) communication, (2) domestic life, (3) interpersonal
interactions and relationships, and (4) community, social and civic life (Scarinci et al., 2009a).
 There are currently no instruments available to identify and measure third-party disability in
spouses of older people with HI.
Factor 3:
Relationship
changes
Aim
To develop and psychometrically test a scale to measure the third-party disability
experienced by spouses of older people with hearing impairment.
Factor 4:
Going out and
socialising
Participants
 100 spouses of older people with HI completed the scale:
Participant
 The SOS-HEAR measures six domains of third-party disability and functioning:
 The final six-factor solution included 27 questionnaire items and explained a total of 65.2% of the variance, with the
Significant Other Functioning
Environmental
Factors
of older people with HI.
Gender
Age
Better ear pure-tone average dB HTL
Female
Male
Mean
SD
Range
Mean
SD
Range
Spouse
78
22
69.65
7.68
49-87
16.71
5.8
2.5-25
HI partner
22
78
72.08
7.73
56-92
41.02
13.2
25-90
Factor 5:
Emotional
reactions
 92% of partners had sought help for their HI; of these, 68% had been fitted with hearing aids,
however only 44% reported wearing their hearing aids > one hour per day.
 Spouses had been with their partner for an average of 41.6 years (range 1-66 years), the
majority were in their first formal relationship (79%), and all were retired from work.
Methods
Development of the Significant Other Scale for Hearing Disability (SOS-HEAR)
Factor 6:
Concern for
partner
Total
 The 36-items in the SOS-HEAR were generated from the Scarinci et al. (2008) qualitative
study with semi-structured, in-depth interviews.
 To ensure face and content validity, the identified categories were developed into simple
statements and used the language of spouse participants, for example:
“Because of my partner’s hearing difficulties, I have to repeat myself often”
0
1
2
3
4
no problem a mild problem a moderate problem a severe problem a complete problem
SOS-HEAR item: “Because of my partner’s hearing difficulties.....”
Loading
Mean (SD)
Range
1. I have to repeat myself often
0.81
1.65 (0.88)
0-4
2. I have to raise the volume of my voice
0.73
1.43 (0.95)
0-4
3. We do not communicate spontaneously or have as many conversations about
trivial things as often as I would like
0.72
0.98 (1.03)
0-4
4. I cannot whisper secrets
0.69
1.32 (1.21)
0-4
repeat, raising the volume of their voice, not being able to tell secrets, and having to
5. I have to make sure I am face-to-face when talking
0.62
1.33 (1.04)
0-4
communicate face-to-face.
6. We do not communicate as often as I would like
0.64
0.98 (0.90)
0-4
7. I have to answer the phone for him/her
0.80
0.40 (0.88)
0-4
8. I have to answer for him/her during group conversation
0.71
0.50 (0.70)
0-2
9. I have to make phone calls for him/her
0.71
0.42 (0.89)
0-3
10. I have to ‘coach’ or ‘cue’ him/her during group conversations by telling him/her
when someone is speaking to him/her
0.67
0.73 (0.74)
0-3
11. I have to act as an interpreter during group conversations by repeating others’
comments/questions
0.65
0.84 (0.84)
0-3
12. I have to listen into his/her conversations as well as my own to make sure
he/she responds appropriately
0.57
0.76 (0.85)
0-3
13. My partner’s hearing difficulties have an effect on our intimate/physical
relationship
0.85
0.17 (0.47)
0-2
14. I withdraw from my partner and do things alone
0.77
0.26 (0.60)
0-3
 The clinical utility of the SOS-HEAR also needs to be investigated.
15. I am less satisfied with the relationship
0.75
0.31 (0.65)
0-2
16. I worry that he/she doesn’t hear warnings such as shouts or alarms
0.73
0.84 (1.02)
0-4
 What are the rehabilitation needs of spouses affected by third-party disability?
17. I do not go to as many social gatherings as I would like
0.71
0.21 (0.56)
0-3
18. I do not go to the movies and/or the theatre as often as I would like
0.70
0.18 (0.59)
0-4
References
19. I do not go to noisy environments (e.g., restaurants) with my partner as often as
I would like
0.70
0.44 (0.82)
0-4
20. It makes me upset that I have to adapt
0.84
0.58 (0.87)
0-4
21. I am constantly thinking about my partner’s hearing difficulties
0.80
0.46 (0.78)
0-4
22. I have had to accept the situation as it is and learn to ‘live with it’
0.73
0.37 (0.66)
0-3
23. It makes me angry when I have to tolerate the loud volume of the television
0.48
0.93 (1.05)
0-4
24. I feel frustrated
0.44
1.07 (0.98)
0-4
25. I worry about what people think of him/her when he/she doesn’t respond to
questions or conversations
0.73
0.44 (0.80)
0-4
26. I have to explain my partner’s hearing difficulties to friends and family to
protect him/her from embarrassing situations
0.70
0.31 (0.55)
0-2
27. I feel sorry for my partner because of his/her hearing difficulties
0.52
0.88 (1.01)
0-4
Andrews, G. (2001). Australian longitudinal study of ageing. In G. L. Maddox (Ed.), The
encyclopedia of ageing (pp. 107-109). New York: Springer.
Scarinci, N., Worrall, L., & Hickson, L. (2008). The effect of hearing impairment in older
people on the spouse. International Journal of Audiology, 47, 141-151.
Scarinci, N., Worrall, L., & Hickson, L. (2009a). The ICF and third party disability: Its
application to spouses of older people with hearing impairment. Disability and
Rehabilitation, 31, 2088-2100.
Scarinci, N., Worrall, L., & Hickson, L. (2009b). The effect of hearing impairment in older
people on the spouse: Development and psychometric testing of the Significant Other
Scale for Hearing Disability (SOS-HEAR). International Journal of Audiology, 48, 671683.
Wallhagen, M. I., Strawbridge, W. J., Shema, S. J., & Kaplan, G. A. (2004). Impact of selfassessed hearing loss on a spouse: A longitudinal analysis of couples. The Journals of
Geronology. Series B, Psychological Sciences and Social Sciences, 59B(3), S190-196.
World Health Organization. (2001). International Classification of Functioning, Disability and
Health, ICF. Geneva: World Health Organization.
than others.
 Communication changes are the main contributor to third-party disability in spouses
of older people with HI, with spouses reporting mild-moderate problems in having to
 The SOS-HEAR may assist clinicians in identifying specific areas of difficulty for the
spouse. Clinical use of the SOS-HEAR is recommended.
 Third-party disability in spouses also has implications for the functioning and disability
of the person with HI. For example, greater third-party disability in a spouse may
result in greater perceived disability in the person with HI, especially if the spouse is
constantly complaining about the partner’s hearing difficulties.
Future Research
 Further research is necessary to confirm the factor structure of the SOS-HEAR with a
larger sample of spouses.
* Bolded items indicate items with highest mean scores and therefore areas with
greater third-party hearing disability
0.63
Reliability
 Cronbach’s alpha for the revised scale was 0.94, and for the six subscales was 0.88, 0.89, 0.91, 0.77, 0.85, and 0.71
respectively, demonstrating good internal consistency, and that each of the items reflect the same attribute.
 Test-retest reliability of the revised scale was satisfactory, with all but one item demonstrating weighted kappa greater than
0.41 (i.e., moderate or better test-retest reliability).
problem), indicating that third-party disability is more problematic for some people
Acknowledgements
The authors would like to acknowledge the participants who willingly gave their time to
participate in the study and Dr. Asad Khan for his statistical advice. This research was
supported by participants from the 50+ Registry of the Australasian Centre on Ageing at The
University of Queensland. Further information regarding this study is reported in Scarinci,
Worrall, & Hickson (2009b).
For further information, please contact Dr. Nerina Scarinci
The University of Queensland
n.scarinci@uq.edu.au