APPENDIX B:
Please Check a Box:
☐ Mother
☐ Father
Who gave you the information? (mark all that apply)
Information About Hearing Loss and Hearing Aids
Audiologist
Other
provider
A parent
Not Provided
1. Hearing loss (e.g., causes, degrees, types)
2. Referrals (e.g., medical, intervention)
3. Monitoring (e.g., hearing, progress)
4. Child developmental milestones (e.g., speech, behavior)
5. Access to hearing aids (e.g., funding sources, loaner hearing aids)
6. Hearing aid loss prevention and safety (e.g., clips to secure aids, tamper proof battery doors)
7. Daily hearing aid wear schedule
8. Tools for hearing aid maintenance
9. Hearing aid warranty information
10. Other types of hearing devices (e.g., personal FM system, cochlear implant candidacy)
Delivery of Information (mark all that apply)
11. I like to get information in the following ways
12. I was given information in the following ways
Amount of Information
Explained to me
In writing
A demonstration
A video
Strongly
Disagree
Disagree
Not Sure
Agree
Strongly
Agree
13. I was overwhelmed by the amount of information I was given
1
2
3
4
5
14. I wanted to have all the information on hand from the beginning
1
2
3
4
5
15. I wanted to get information gradually
1
2
3
4
5
16. I was not given enough information, I wanted more details
1
2
3
4
5
(Circle the number that best describes how much you agree with each statement)
17. What other information would have been helpful?
Parent Hearing Aid Management Inventory (PHAMI)
1
How confident do you
feel in doing each skill?
Who taught you the skill?
(mark all that apply)
Hearing Aid Management Skills
Audiologist
Other
provider
A parent
I was
not
Taught
0 = Not confident at all
100 = Totally confident
1. How to change hearing aid batteries
2. How to insert earmolds
3. How to clean earmolds
4. How to clean hearing aids
5. How to tell when new earmolds are needed
6. How to re-attach earmold tubing to hearing aid
7. How to keep hearing aids on my child
8. How to troubleshoot problems
9. How to do the LING sound check
10. How to do a daily listening check with the listening stethoscope
11. To teach others how to do a listening check of the hearing aids
12. To teach others how to put my child’s hearing aids on
13. To emphasizing to others the importance of keeping the hearing aids
on your child
When learning new skills: (mark all that apply)
14. I like to be taught new skills in the following ways
Explained to me
In writing
A demonstration
A video
15. I was taught hearing aid management skills in the following ways
16. What other support would have been helpful in learning hearing aid management?
Parent Hearing Aid Management Inventory (PHAMI)
2
The audiologist helped me know what to expect related to:
Strongly
Disagree
Disagree
Not Sure
Agree
Strongly
Agree
1. My emotions about hearing loss
1
2
3
4
5
2. My child’s reaction to sounds
1
2
3
4
5
3. My child’s reactions to wearing hearing aids
1
2
3
4
5
4. Demands of daily management
1
2
3
4
5
5. Monitoring my child’s progress
1
2
3
4
5
6. How spoken language development is affected
1
2
3
4
5
7. What hearing aids can provide
1
2
3
4
5
8. Ongoing hearing testing needs
1
2
3
4
5
9. Frequency of earmold replacement
1
2
3
4
5
10. Ongoing intervention needs
1
2
3
4
5
11. How progress would be determined
1
2
3
4
5
12. How degree of hearing loss affects communication
1
2
3
4
5
13. How hearing aids can benefit my child
1
2
3
4
5
14. What my child’s hearing aids cannot provide (e.g., ability to connect with an FM system)
1
2
3
4
5
Strongly
Disagree
Disagree
Not Sure
Agree
Strongly
Agree
1. I am concerned with the appearance of my child’s hearing aids
1
2
3
4
5
2. I am concerned about what others think
1
2
3
4
5
3. I am concerned about how I will manage how my child feels about wearing hearing aids
1
2
3
4
5
4. I think my child is benefiting from using hearing aids
1
2
3
4
5
5. I accept my child’s hearing loss
1
2
3
4
5
6. My child does not need hearing aids
1
2
3
4
5
7. I think occasional hearing aid use is enough for my child to learn
1
2
3
4
5
8. I feel frustrated with the daily management of the hearing aids
1
2
3
4
5
9. I feel confused about how to keep the hearing aids on my child
1
2
3
4
5
10. I feel confident I can tell when my child’s hearing aids are not working correctly
11. I listen to my child’s hearing aids every day
12. Talking with other parents helps me mange the hearing aids
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
(Circle the number that best describes how much you agree with the statement )
My Feelings and Habits
(Circle the number that best describes how much you agree with the statement )
Parent Hearing Aid Management Inventory (PHAMI)
3
When I meet with the audiologist he/she:
Strongly
Disagree
Disagree
Not Sure
Agree
Strongly
Agree
1. Respects my perspective
1
2
3
4
5
2. Asks for my opinions
1
2
3
4
5
3. Includes me in planning and decision-making
1
2
3
4
5
4. Includes me in evaluating progress
1
2
3
4
5
5. Is understanding of my challenges
1
2
3
4
5
6. Is sensitive to my needs
1
2
3
4
5
7. Supports my family’s priorities
1
2
3
4
5
8. Helps me learn to recognize problems
1
2
3
4
5
9. Encourages my efforts
1
2
3
4
5
10. Recognizes the positives
1
2
3
4
5
11. Is truthful about expectations
1
2
3
4
5
12. Supports my ongoing learning needs
1
2
3
4
5
13. Recognizes the strengths of my family
1
2
3
4
5
14. Does not judge my decisions
1
2
3
4
5
15. Assists me in problem solving
1
2
3
4
5
16. Helps me to be confident in my abilities
1
2
3
4
5
17. Helps me understand my emotions
1
2
3
4
5
18. Addresses my concerns
1
2
3
4
5
19. Helps me manage my emotions
1
2
3
4
5
20. Provides me enough time to talk about my emotions
1
2
3
4
5
21. Helps me accept my child’s hearing loss
1
2
3
4
5
22. Listens to me
1
2
3
4
5
23. Helps me know how to talk to others about my child’s hearing loss
1
2
3
4
5
24. Makes me feel I can trust him/her
1
2
3
4
5
25. Makes me feel comfortable asking questions
1
2
3
4
5
26. Talks to me using language I can understand
Comments:
1
2
3
4
5
(Circle the number that best describes how much you agree with the statement)
Parent Hearing Aid Management Inventory (PHAMI)
4
Hearing Aid Use
1. Each day my child typically uses his/her hearing aids:
____ all waking hours
____ most of the day (8-10 hours)
____some of the day (5-7 hours)
Currently my child’s hearing aid use is affected by:
____ a portion of the day (less than 5 hours)
Strongly
Disagree
Disagree
Not Sure
Agree
Strongly Agree
2. Distractions and needs of other children in the home
1
2
3
4
5
3. Activities (e.g., playing outside, riding in car)
1
2
3
4
5
4. My child’s behavior
1
2
3
4
5
5. Difficulty getting a set routine
1
2
3
4
5
6. Long wait time to get an appointment with the audiologist
1
2
3
4
5
7. Other caregivers’ ability to manage the hearing aids
1
2
3
4
5
8. The audiologist’s lack of response when I have questions
1
2
3
4
5
9. Difficulty paying for hearing aid costs (e.g., repairs)
1
2
3
4
5
10. Difficulty paying for new earmolds
1
2
3
4
5
11. Difficulty paying for batteries
1
2
3
4
5
12. Difficulty coping with the demands of managing the hearing aids
1
2
3
4
5
13. Frequent ear infections
1
2
3
4
5
14. Frequent feedback (whistling/squealing) from the hearing aids
1
2
3
4
5
15. My insecurities with the appearance of my child’s hearing aids
1
2
3
4
5
16. The hearing aids not working correctly
1
2
3
4
5
17. My child’s reaction to sounds when wearing the hearing aids
1
2
3
4
5
(Circle the number that best describes how much you agree with the statement)
18. My feelings of frustration with trying to keep the hearing aids on
19. What is other reasons hearing aid use is difficult?
Parent Hearing Aid Management Inventory (PHAMI)
5