Commentary on (1) 'Application of the health belief model: Development of the hearing beliefs questionnaire (HBQ) and its associations with hearing health behaviors' (International Journal of Audiology, 2013; 52, 558 - 567), and (2) 'Development and evaluation of a questionnaire to assess...
Title continued - knowledge, attitudes, and behaviors towards hearing loss prevention' (International Journal of Audiology, 2014; 53, 209-218). Saunders et al recently published two manuscripts regarding the use of the Health Belief Model (HBM) to develop a survey capable of addressing hearing health behaviors - particularly those associated with hearing loss prevention. (Saunders et al, 2013, 2014). Both of these are fine articles but we also call your attention to earlier reports describing the use of the Health Belief Model and the development and application of a survey tool in a program designed to positively influence attitudes, beliefs, and behavioral intentions regarding hearing health behaviors. Given those earlier efforts, statements from Saunders et al (2013, 2014) that they were the first to have developed a psychometrically valid survey in the context of a comprehensive application of the HBM might mislead some readers. NIOSH initiated a research program in this area in the early 1990s, focusing on the application of health communication/health promotion theory to prevent noise-induced hearing loss. The program includes research (partly funded by NIOSH grants) by Dr. Sally Lusk and her colleagues regarding the use of Health Promotion models to prevent occupational hearing loss (Lusk et al, 1994, 1995, 2003; Kerr et al, 2002) along with an extensive body of intramural research conducted by NIOSH scientists. In 1993 NIOSH began a series of intramural efforts to develop a hearing conservation program for underserved workers, i.e. workers not currently covered by the OSHA hearing conservation amendment, and for whom the use of hearing protection was expected to be the principle means for reducing noise exposures. While the HBM was the backbone of these efforts, they also employed other health promotion models, including the Theory of Reasoned Action and the Transtheoretical Model. The research was focused on interventions capable of positively influencing workers' attitudes, beliefs, and behavioral intentions to adopt healthy hearing behaviors - particularly those behaviors associated with hearing protector use. The program included development of a psychometrically-validated survey instrument designed to formally assess the following constructs: perceived severity of occupational hearing loss, perceived benefits of taking recommended preventive actions, perceived susceptibility to occupational hearing loss, perceived barriers to preventive action self-efficacy, social norms, past behaviors, present behaviors, and behavioral intentions. This survey was used to assess how the relevant constructs needed to be addressed as we developed training and educational tools, and to help us evaluate intervention effectiveness after initial training and after follow-on refresher training. We employed an extensive iterative process to develop this survey in order to ensure appropriateness of factors such as test-retest reliability, parallel form equivalence, and survey item validity. The initial survey development was completed in 1994 (McDaniel, 1994). After field-testing the survey, we were able to shorten the final form from 61 items to 28 items. The application of the Health Belief Model along with the use of an associated survey instrument was presented in 1996 at the annual conference of the National Hearing Conservation Association (Stephenson, 1996).
Mark R. Stephenson Ph.D., National Institute for Occupational Safety and Health (NIOSH), DART, 5676 Columbia Parkway, Mail Stop C-27, Cincinnati, OH 45226-1998 USA