NATIONAL CENTER Series 2For HEALTH STATISTICS Number 12

VITAL and HEALTH STATISTICS

DATA EVALUATION AND METHODS RESEARCH

Methodological Aspects

of a Hearing Ability

Interview Survey

Development and use of a set of scale questions to measure

functional hearing ability in an interview survey.

DHEW Publication No. (HRA) 74-1272

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

Health Resources AdministrationNational Center for Health Statistics

Rockville, Maryland

____ —-._—— ——— —

Vital and Health Statistics-Series 2, No. 12

Reprinted as DHEW Publication No. (HM) 74-1272

August 1973

First issued in the Public Health Service Publication Series No. 1000, October 1965

1For sale by the Superintendent of Documents, U.S. Government Printing Office,

Washington, D. C., 20402-Price 25 cents i

Lihrary o/ Congress Catalog Card Number 65-62271

PREFACE

The Health Interview Survey, National Cen-ter for Health Statistics, collects informationby means of household interviews on illness, ac-cidental injuries, hospitalization experience andvarious measures of disability, and on socialand economic impact due to episodes of mor-bidity.

If viewed from the standpoint of cliniciansor epidemiologists, the precision of diagnosticinformation that can be obtained from lay house-hold respondents may leave much to be desired.However, these same respondents are the bestsource of information, at the present time, onthe amount of disability and other forms of im-pact due to illness and injury. Information onthe degree of severity of certain physical im-pairments (e.g., visual and hearing loss) presentin the population are of extreme importance topersons engaged in rehabilitation and other pro-grams of assistance to the physically handicapped.If Iay respondents can describe the severity ofthese impairments in meaningful, functional termsand, particularly, if these functional terms can becorrelated to standard clinical measures or tests,data from interview surveys can be of great valuein describing the extent of the problems of the pop-ulation of the United States with impaired hearingor vision.

This reportHealth Interview

describes the experience of theSurvey in the development and

use of a series of items designed to serve as afunctional scale of hearing loss. GallaudetCollege, a federally sponsored institution and theonly institution in the world that provides highereducation exclusively for persons with severelyimpaired hearing, was asked by the Division ofHealth Interview Statistics of the National Centerfor Health Statistics to participate in this project.Under a contract with the division of HealthInterview Statistics, Mr. Stanley K. Bigman, whowas at tha~ time Director of the Office of Soci-ological Research at Gallaudet College, developeda set of items to be used as a hearing abilityscale and conducted some pretests of the scale.Dr. Jerome D. Schein succeeded Mr. Bigman atGallaudet and conducted additional methodologicalstudies of the scale items. Dr. Schein also pro-vided technical assistance during all phases ofthe nationwide hearing ability survey in which thescale items were used, and he is a coauthor ofthis report. Mr. Kenneth Haase, Statistician,Survey Methods Branch, and Mr. AugustineGentile, Chief, Survey Methods Branch, rep-resented the Division of Health Interview Sta-tistics and collaborated in the analysis andpreparation of this report.

CONTENTSPage

Preface ------------------------------------------------------------- -

htrduction --------------------------------------------------------- -

The Hearing Scale ----------------- ------- ------- ---------- --------- ---

Description of the HearingScale --------------------------------------

Evaluation oftheScale -----------------------------------------------

Evidence ofUnidimensionality ----------------------------------------

Factors Affecting Scalkg --------------------------------------------

Scale Responses and Other Measures of HearingAbility -----------------

Classificationof Hearing Scale Scores -----------------------------------

Conclusions -----------------------------------------------------------

Appendix I. Procedures Used in This Survey and Level and QualityofResponse ------------------------------------------------------------

Methods Usedto Obtain Respondents ----------------------------------

The Hearing Ability Questionnaire ------------------------------------

Utilization of the Basic Health Interview Questionnaire as aScreening Rvice -------------------------------------------------

Level of Response --------------------------------------------------

Quality of Response ------------------------------------------------

Appendix II. Hearing Ability Survey Questiomaire -------------------------

i

1

2

2

3

3

4

7

10

10

11

11

11

11

12

13

16

THIS ISA REPORT on the development and use of a sem”es of itemsdesigned to serve as a scale to measuve the degree of hearitg loss, infunctional terms, in an interview suvvey of the geneyal population.

Results of the use of the scale in several samples of persons are given.Evidence of the logic of the scale, factors affectiwg an individual’s abilityto respond to the scale logz”cally, and the relationship of responses tothe scale to other measures of hearing loss, includi~ audiometric ex-aminations, are discussed.

Methods used in the survey and factors affecti~ the general levels andquality of responses obtained in the Sumey are. discussed in Appendix I.

It is concluded that for general statistical puvposes the hearing scale isa satisfactory instrument for measuving the degree of heaving loss ofthe #o@dation by means of an interview survey. Recommendations forimprovements to the scale and for obtaini~ a higher level and betterquality of vesponse fov jivtwe studies are also @“ven in the report.

SYMBOLS

Data not available ------------------------ ---

Category not applicable ------------------ . . .

Quantity zero ---------------------------- -

Quantity more than O but less than 0.05----- 0.0

Figure does not meet standards ofreliability or precision-- ---------------- *

METHODOLOGICAL ASPECTS OF A HEARINGABILITY INTERVIEW SURVEY

IX. Jerome D. Schein, Directov, Office of Psychological Resea~ch, Gallaudet CollegeAugustine Gentile, Chief, and Kenneth Haase, Statistician, Smwey Methods BYanch,

Division of Health Interview Statistics

INTRODUCTION

Although a sizable proportion of the pop-ulation suffers impairment of hearing, there hasbeen little current, descriptive data avaiIableabout this health problem. The National Centerfor Health Statistics has responded to requestsfor more information about this problem by con-ducting a special hearing ability survey. Thisreport describes some of the methodologicalaspects of this speciaI nationwide survey whichtook place July 1962-June 1963, and it serves asa background to the substantive results of thestudy.

National estimates of hearing loss for earlieryears have been obtained from three principalsources. From 1830 to 1930 the U.S. Bureau ofthe Census enumerated the number of personswith severe hearing losses of early onset (referredto as “deaf mutes’’ l). At the conclusion of the 1930census, the Bureau announced that it wouldno longer attempt to collect data on persons withhearing impairments. As shown by the followingquotation, this decision reflected discontent with

lAlthough the Bureau used the term “deaf mutes, ” it islikely thatmany of these people did have usable speech sincein some years the Bureau used the term to describe personsfor whomthe age of onsetof deafness was as late as 16 years.Persons who lose their hearing after speech has been devel-oped can retain their ability to speak and usually do, and eventhose who are not able to hear at birth can usually developsome speech when properly taught.

the results of the 11 enumerations already done.

“No high degree of accuracy is to be expectedin a census of the blind and of deaf-mutescarried out by the methods which it has beennecessary to use thus far in the United States.The reasons for this are that even with care-ful definitions of the groups to be includeda large element of personal judgment entersinto the decision of an enumerator as towhether a given individual should be re-ported as blind or as a deaf-mute; and in-consistencies follow from the varying degreesof intelligence and persistence of enumer-ators. Added to this, there is a tendency onthe part of relatives to conceal the presenceof blind persons or deaf-mutes in theirfamilies, especially in the case of children.Because of these conditions, and of changesmade from time to time in definitions, aswell as in the administrative methods usedin taking the census, the enumeration of theblind and of deaf-mutes has doubtless alwaysbeen mzore or less inaccurate and incom-rdete.”The next attempt to collect national data on

hearing impairments was made by the NationalInstitute of Health in the National Health Survey

2U.S. Bureau of the Census: The Blind and Deaf-Mutee inthe United States, 1930. Washington. lJ. S. Government Print-ing Office, 1931. p. 2.

1

of 1935-1936. ‘This Survey avoided the narrowconfines of definition used by the Bureau of theCensus in the earlier decennial enumerations;and instead of concentrating exclusively on deaf-ness of early onset, it concerned itself withthe full range of hearing impairment. In additionto broadening the scope of its investigation, theSurvey combined the sample survey with a clinicalinvestigation. Samples of persons with and with-out hearing impairment were given audiometrictests, the results of which were compared with thesurvey findings. This ad hoc effort provided theonly nationwide data on hearing impairment untilthe current National Health Survey was establishedin 1956.

In 1959 the Health Interview Survey issued apublication containing estjmates for the N:tion onvarious types of physical impairments; theseestimates were based on data collected in house-hold interviews during the period July 1957 -June1958. Included in this publication were estimatesthat there were in the United States 109,000totally deaf persons and 5.7 million persons withlesser degrees of hearing loss. Similar estimatesof the prevalence of hearing loss have been madefor succeeding years. These estimates were basedon affirmative responses to the question, “Doesanyone in the family have deafness or serioustrouble with hearing?” No effort was made to as-sess the degree of hearing impairment. However,when a respondent volunteered information aboutthe degree of hearing loss, the information wasrecorded and taken into consideration during thecoding process. This dependence upon volunteeredinformation to describe the hearing ability of thesepersons probably resulted in an underestimate ofthe totally deaf and provided very little informationabout the degree of loss for other hearing im-paired persons. The principal objective of thisSurvey therefore was to develop a method of

3National Institute of Health: Signi~icance, Scope andMethod of a Clinical Investigation of Hearing in the GeneralPopulation. The National Health Survey, 1935 -1936, prelim-in ary report. Hearing Study Series Bulletin No. 1. PublicHealth Service. Washington, D. C., 1938.

4u.s. National Health Survey: Impairments by tYPe> ‘ex,

and age. Health Statistics. PHS Pub. No. 584-B9. PublicHealth Service. Washington, D. C., April 1959.

classifying persons with hearing problemsaccording to the extent of hearing loss in termsthat would serve a useful purpose.

Because members of the Health InterviewSurvey staff had a limited knowledge of ‘thesubjectmatter in this field, Gallaudet College 5was askedto develop a plan for conducting a survey of per-sons with impaired hearing. After consultationwith Gallaudet and several other interested groupsand after consideration of various alternatives, itwas determined that the only practical method ofmeasuring hearing loss in an interview survey wasto devise a series of items that would serve as ascale and make it possible to describe the amountof hearing loss in functional terms. Such a scalewas developed and compared with audiometricexaminations in three test groups. The results ofthese tests of the hearing ability scale and the effi-cacy of the scale as determined by the HearingAbility Survey are presented in this report. Adescription of the methods and procedures usedin the Survey and information about the quality andlevel of response obtained are given in Appendix I.

THE HEARING SCALE

Description of the Hearing Scale

It has been indicated that previous estimatespublished by the Health Interview Survey of thenumber of persons with impaired hearing assignedsuch persons to one of two categories —deaf orlesser degree of impairment. It was recognizedthat Imth the means of assessing hearing loss andthe two-category limit on the degree of impairmentwere inadequate. To determine the degree ofhearing impariment in better-defined, functionalterms, the items in figure 1 were developed forthis survey.

Preliminary research indicated that state-ments a, b, c, e, and g approximate a unidi-mensional scale; i.e., once a person respondsnegatively to any one of these items his re-sponse to succeeding items will also be negative.

5Gallaudet College, located in Washington, D. C., is a fed-erally sponsored institutionworId dedicated exclusivelyseverely impaired hearing.

and is the &dy” colle”ge in theto tbe education of persons with

2

SECTION A

Yes No. WITHOUT using o heoring aid, whet can you

hear?

(P2ease check the “Yes” or “No” box aftereach statement.)

a. I can hear loud noises.

b. Most of the time I can tell one kind ofnoise from another.

c. If I hear a sound, most of the time I cantell if it is a person’s voice or not.

d. I can hear and understand a few words aperson says if I can see his face and lips.

e. I can hear and understand a few words aperson says without seeing his face andlips.

f. I can hear and understand most of thethings aperson says if I can see his faceand lips.

g. I can hear and understand most of thethings a person says without seeing hisface and lips.

h. Mostof the time I can hear and understanda discussion between several people with-out seeing their faces and lips.

i. I can hear and understand a telephone con-versation on an ordinary telephone (thatis a telephone without an amplifier).

Figure 1, The hearing scale as it appeared in theHearing Ability Survey Questionnaire.

In other words, the items are in order byanticipated difficulty in hearing—ranging ”frommerely hearing loud noises to hearing andunder-standing most speech.

Evaluation of the Scale

Several things have tobeconsidered inevalu-ating the merits of thehearingscale. First, do the

items represent a unidimensional hierarchy ofhearing ability? Second, what factors other thanthe degree of hearing loss have aneffectonre-sponses to the scale statements; and, finally,what is the relationship between positions on thescaIe and other measures of hearing ability?

Evidence of Unidimensionality

With regard to the first question, a seriesof studies was conducted to determine whether thehearing scale (fig. 1) had the properties associatedwith a psychological scale. Logically, the order-ing of the statements makes good sense (facevalidity) in that a person who answered “No”to statement a—” I can hear loud noises’’—wouldbe expected to answer “No” to all other statementsabout his hearing. Similarly, a ‘No” response toany of the statements b, c, e, or g would beexpected to preclude a ~sitive answer to the state-ments following it.

In the paragraphs that follow, respondents orquestionnaires providing answers to the scaleitems which followed this logicaI pattern are re-ferred to as “persons who scaled” and “scaledresponses, ” respectively. Conversely, the terms“persons who failed to scale” or “nonscaled re-sponses” are used to describe persons or question-naires that did not follow this logical pattern.

Empirical tests confirm the logic of the scale.Table A summarizes the results of the use of thescale in five samples of persons with impairedhearing. Sample I consists of 214 GallaudetCollege students to whom the scale question wasmailed; sample II consists of 171 GallaudetCollege students who were given the scale questionin a group session; sample HI consists of 534

Gallaudet College students who were asked thescale question in individual interviews; sample IVconsists of 1,132 deaf adults from the MetropolitanWashington, D.C., area who were administered thescale question in individual interviews; and sampleV consists of 4,431 persons who were given thescale question as part of the questionnaire usedin the Health Interview Hearing Ability Survey.Respondents in sample V who did not completestatements a, b, c, e, and g of the scale are notincluded in this analysis because their responsescould not contribute pertinent data on scalability.

3

Table A. Results of the use of the hearing scale in five samples of persons with im-paired hearing

Percent ofNumber of persons

Type of administration persons in givingsample scaled

responses

Sample I, Gallaudet students, mail interview-------------- 214 91,6Sample 11, Gallaudet students, group interview------------- 171 91,8Sample III, Gallaudet students, individual interview--------Sample IV,

534 90,3Deaf adults from D.C. area, individualinterview-------------------------------------- 1,132 92.6

Sample V, Health Interview Hearing Ability Surveyrespondents----.----------.-------------------- 14,431 88.9.

!tncludesonly respondentswho completed statements a, b, c, e, and g of the scale.

The measure of scalinggivenin tableAis

thepercentscaled;i.e.,thenumber ofpersonswho gave scaledresponsesdividedby thetotalnumber of persons who completedthe scale.Regardlessof the mode of administrationandsample characteristics,thepercentageof per-

sons givingscaledresponses(about90 percent)is essentiallythe same for the fivegroups,ranging from 88.9 percent to 92.6 percent.

An inspectionof the 10 percentof non-scaledresponses showed no consistentpatternwhich would suggestthatthesepersonsmight

have some specialtype of hearingproblem.Considerationwas then given to otherfactorsthatmight affecttheperson’sabilitytoanswerthescaleitemsintheexpectedpatterns.

Factors Affecting Scaling

Use ofheaving aid.-Three ofthefivesamplesofpersonsmentionedalmve-samples 111,IV,andV—were usedtoobtaininformationonthe”useof

hearingaids.Responseswere obtainedfromeachindividualin thesamples,and theproportionofscaledresponsesby useofhearingaiclisshownin tableB. Those personswho were atthetimeof the ,Surveyusers of hearingaidstendedtogivescaledresponseslessfrequentlythanthose

who hadnever usedahearingaidand,generally,lessfrequentlythanthosewho had usedahearingaidbutwho were notusingoneatthetimeofthesurvey.Thisfindingwouldsuggestthateither(a)usersofhearingaidswere lessabletodetermine

Table B. Percent of respondents giving scaled responses to the hearing scale, by useof hearing aid

Respondents

Gallaudet College students(Sample III)-----------------------

Deaf adults in D.C. area(Sample IV)------------------------

Health Interview Survey respondents(SampleV)-------------------------

Numberof

personsin

sample

534

1,132

14,045

Use of hearing aidAll

personsin Uses Used

sample Nevernow p::t used

90,3 87.0 87.3 95.5

92,6 85,1 93.6 94.6

88.8 I 80.6I 85.3 / 90.7

lExcludes 386 persons for whom information about use of hearing aids is ‘nkn’o~-

Table C. Number and percent distribution of persons with impaired hearing in Sample Vwho scaled and who failed to scale, according to age

AgeFailed Failed

Total Scaled to Total Scaled toscale scale

Under17-2425-3435-4445-5455-6465-74

Number of personsl

All ages ---------------------l===

4,431

17 years --------------------- 317years ------------------------ 128years ------------------------ 293years ------------------------ 511years ------------------------ 594years ------------------------ 763~ears------------------------ 927

3,939

282115273459540683826

492

Percent distribution

=4-4===100.0 89.0100.0 89.8100.0 93.2100.0 89.8100.0 90.9100.0 89.5100.0 89.1

11.010.26=810.2

1::;10.9

75+ yekrs ------------------------ -- I 898 ]] 761 ] 137] Ioo*o\] 84.7] 15.3

lBased on total that responded to all of the items in the hearing scale.

the true condition of their hearing ability, (b)instructions for answeringthehearingscaleques-tion did not make sufficiently clear thatthe state-ments were to be responded to as one hearswithout the use of a hearing aid, or (c) the useof a hearing aidsignificantly altered thepattemofhearing for some, thoughnotall,usersof hear-ing aids. It is also possible that this significantresult (chi-square for each of the samples ex-ceeds that which corres~nds to a probability of

0.001)arises from a combination ofall three ofthese factors.

Age.-The age of the person with impairedhearing is another factorthatmight affectscaling.Age, number, and percent of persons who scaledand of those who failed to scale are givenintable C. Only two of the age groups show anymarked difference in the proportion that failed toscale. Persons aged 25-34 years scaled signifi-cantly more often and persons aged 75years and

Table D. Number and percent di.stributionof persons in Sample V who returned question-naires but who failed to answer one or more of the scale questions, according to age

I All persons who returned Persons who failed to answerquestionnaires one or more scale questions

Age I

I Number I PercentI

Number I Percentdistribution distribution

I IAll ages ----------- 5,404 I 100.0 I 9731 100.0

I I I

Under 17 years ----------- 370 6.817-24 years --------------

5.4151 ;: 2.4

25-34 years -------------- 313 ;::35-44 years -------------- 566 10.5 R ;:;45-54 years -------------- 683 12.6 89 9.155-64 years -------------- 940 17.4 177 18.265-74 years -------------- 1,220 22.6 293 30.175+ years ---------------- 1,161 21.5 263 27.0

5

over scaled less often than those in other agegroups.

An indication that older persons might havehad some difficulty in understanding the scaleor estimating their hearing ability in terms ofthe scale items is obtained from data in table D.Of the 5,404 persons who returned questionnaires,2,381 (or 44.1 percent) were 65 years and over;and of the 973 who failed to answer one or moreof the scale items, 556 (or 57.1 percent) were inthis age group.

Unassisted and assisted wspondents.-one ofthe items on the Hearing Ability Questionnaire isfor the signature of the person who actually com-pleted the questionnaire. In the case of children, aparent or guardian was expected to complete andsign the form. Upon examination, however, it wasfound that of the total persons 17 years of ageand over who returned a form with a signature,28 percent were signed by someone other than theperson with impaired hearing (table E). In tables

E and F persons with impaired hearing who re-turned questionnaires with their own name signedare called “unassisted respondents. ” Those whoreturned questionnaires with another name signedare called “assisted respondents ,“ even thoughthe person who assisted probably consulted theintended respondent to obtain the required an-

swers. The term “assisted respondent” is usedwhen any form of assistance in compl@ing thequestionnaire could be detected on the returnedquestionnaire. It is not known how many questionn-aires signed with the name of the person withimpaired hearing were in fact completed byanother person. However, the number of question-naires with the names of persons other than thoseof the persons to whom they were addressed isknown, and the magnitude is somewhat surprising.The data in table E again reflects the difficultypersons in the older age groups may have had inanswering the questionnaire.

Table E. Number and percent distribution of unassisted and assisted respondents inSample v 17+ years who returned signed questionnaires, according to age

Age Totall Unassisted Assistedrespondent respondent

Number of respondents

All ages.17+ years --------------- 4, fj7fj 3,352 1,324

17-24 years ------- ------- -------------- 144 106 3825-34 years -------- -------- ------------ 301 24235-44 years ---------------------------- 537 437 1;:45-54 years ---------------------------- 645 514 13155-64 years ---------------- ------------ 880 669 21165-74 years -------- -------------------- 1,111 816 29575+ years -------- -------- -------- ------ 1,058 568 490

17-2425-3435-4445-5455-6465-74 IT‘

Percent distribution

All ages 17+ years --------------- 100.0 71.7 28.3

years -------- ----.--- ------------ 100.0 73.6 26.4years ----------------- -------- ---- 100.0 80.4 19.6years ---------------------------- 100.0 81.4 18.6years ---------------- -------- ---- 100.0 79.7 20.3years ---------------------------- 100.0 76.0 24.0years ---------------------------- 100.0 73.4 26.6

75+ ye&s ------- ------- ------- ------- -- I 100.O/l 53.7 ] 46.3

lExcludes 358 persons who returned questionnaires without signatures.

Because of the large number of “assisted”persons, scale responses of the “assisted” and“unassisted” groups were examined. The data intable F show that generally “assisted” personsfailed to scale more frequently than the “un-assisted” persons and that for persons in theolder age groups the failure to scale was markedlyhigher for “assisted” persons. The causal re-lationships involved here are unknown, but onemight speculate that any or all of the followingfactors are involved:

1. The person completing the form wasusing his own judgment as to the afflict-ed person’s ability to hear.

2. The fact that the afflicted person requiredassistance might indicate thata.

b.

c.

He lacked an interest in the study andtherefore was not sufficiently motivat-ed to provide precise answers to the“assistant.”He was unable to understand the ques-tions even with assistance.He was too old or too ill to providean accurate assessment of his hearingability.

Scale Responses and Other Measures

of Hearing Ability

Internal consistency of the hearing scale. —After answering the hearing scale question, re-spondents in the Survey were requested to ratetheir hearing ability separately for each ear.The question asked is reproduced in figure 2.

Further understanding of the hearing scalecan be gained by comparing responses to thescale with self-estimates of hearing ability foreach ear. This comparison yields a measure ofthe consistency, rather than validity, between twoways of inquiring alxmt hearing ability. TableG compares the hearing scale responses withgroupings of the estimates for the individual ears.

The contingency coefficient calculated fortable G yields a value of 0.62, with the maximumpossible contingency coefficient being 0.89 and theprobability that the relationship does arisefrom chance alone being less than 0.001. Eventhough the contingency coefficient has limitationsas a measure of correlation, the obtained relation-ship suggests substantial consistency between thetwo self-estimates of hearing ability.

Table F. Percent distribution of unassisted and assisted respondents in Sample V whoscaled and who failed to scale, according to age

I Unassisted >espondent I Assisted respondent

Age Failed FailedTo tall Scaled to Total* Scaled to

scale scale

I Percent distribution

All ages-17+ years -----------

l==

100.0

17-24 years ------------------------25-34 years ------------------------35-44 years ------------------------45-54 years ------------------------55-64 years ------------------------65-74 years ------------------------75+ years --------------------------

100.0100.0100.0100.0100.0100.0100.0

90.71 9.3

I

187.8 12.293.490.2 :::91.290.8 :::91.5 8.588.6 11.4

‘Excludes 358 persons who returned questionnaires without

E14!lsignatures.

7

Please describe how well you con heor, without using(

hearing aid, by checking oneofthe statements belowfol

eoch ear. For exomple, a person who is deaf in his Ief!

ear and hasgoodheoring in his right ear would checkthcfollowing: Inleftear- box(d) ;inright eor-box (e).

In Iefteor

(a) ❑ Myhearing is good

(b) ❑ Ihavealittle trouble bearing

(c) ❑ Ihavealot of trouble hearing

(d) ❑ Iam deaf

In right ear

(e) ❑ My bearing is good

(f) ❑ Ihavealittle trouble hearing

(g) ❑ Ihavealot of trouble hearing

(h) ❑ Iam deaf

Figure 2. Question 2of the Hearing Ability Sur-

vey Questionnaire.

The estimatesof hearing ability for eachearhave a further use in conjunction with thehearingscale. Individualshavinganimpairment inonlyone

ear should respond to the scale astheyhear withboth ears, which would mean obtaining a scale

score of 5 since their hearing in general would

permit good reception and understanding ofspeech. In fact, only 134 (9.2 percent) of the 1,462

persons who indicated a unilateral hearing loss

(one ear good, other ear worse) obtained scalescores of less than 5 (table G). This finding lends

some support to the contention that most re-

spondents answered the scale in terms of the

overall functioning of their hearing. For thosewho apparently did not respond in this way, the

relation of their scale scores to their hearing

estimates derived from question 2 suggests that

they tended to refer the scale items to theirimpaired ear. Thus, by the conjoint application

of questions 1 and 2, errors in estimating func-tional hearing impairment can be substantially

reduced—i.e., those with scale scores of less

than 5 who indicated on question 2 that they

could hear well with one ear can be assumed tohave near-normal hearing for most situations.

Table G. Comparison of hearing scale positions for those persons who scaled with com-bined self-estimates for each ear for the Health Interview Hearing Ability SurveySample

Hearing scale positiongCombined estimates of hearing loss for

each earTotall

o 1 2-3 4 5

Number of persons

Totall ------------------------------ 3,728 100 99 278 441 2,810

Deaf in both ears ------------------------- 92 55 19 10 1 7One ear severe loss, other ear same

or worse -------- -------- -------- -------- 508 35 60 140 139 134.One ear some loss, other ear same or

worse ----------------------------------- 1,329 7 14 89 209 1,010One ear good hearing, other ear worse ----- 1,462 3 6 34 91 1,328Hearing good in both ears ----------------- 337 - - 5 1 331

‘Excludes the 211 persons who failed to provide estimates of hearing loss.20 = Unable to hear loud noises.

1 = Able to hear loud noises, but unable to distinguish between different kindsof noises.

2-3 = Able to distinguish between different kinds of sounds, including voice, butunable to hear and understand speech.

4 = Able to hear and understand a few words, but unable to hear and understnadmost of what is spoken.

5 = Able to hear and understand most of the words spoken.

8

Audiometric equivalents of the lzeari?&scale.—The evidence presented thus far suggeststhat in terms of scalability the hearing scaleitems might be adequate in distinguishing thedegree of hearing loss for general statisticalpurposes. However, if it could be demonstratedthat responses to these items were highly corre-lated with audiometric measurements for the samepersons, the meaning and utility of the scalewould be greatly enhanced. It was not possibleto conduct audiometric examinations for thepersons h. the Health Interview Survey, buttests were conducted for persons in the I, II,and III samples previously described.

The mean pure-tone-average losses (better-ear average loss for the frequencies 500, 1,000,

and 2,000 cycles per second) for each position onthe hearing scale are given in table H. Several

precautions should be taken in interpreting thesedata. It should be noted first that this group con-sists only of persons with severe hearing losses(Gallaudet College students), the smallest averageloss being 56 decibels. Second, since this group isnot a random sample of the total population withhearing impairment, no attempt should be madeto apply these average losses to those in theHealth Interview Survey sample having similarpositions on the hearing scale. What the tabledoes illustrate is an orderly progression of degreeof hearing loss for each scale step, with aminimum degree of overlap between each positionas illustrated by the small standard errors.

Table H. Number of personsard error for s te~s

, mean pure-tone-average loss (PTA)l in decibels, and stand-on the hearing scale. based on scores of three samples of

Gallaudet College s~udents.

Scale position

Item

Combined samples (872 students)

Number ------- -------------- ------- ------- ------- --pure-tone-average loss ----------------------------

Standard error ------- ------- ------- -.----- ------- -

Samrile 1. mail interview (194 students)

Number --------------------------------------------Pure-tone-average loss ------------------------ ----

Standard error ------------------------------------

Sample 11, group interview (157 students)

Number ---------------- -------- -------- -------- ----pure-tone-average loss -------- --------------------

Standard error ------- ------- ------- ----.-- ------- -

Sample 111, individual interview (521 students)

Number ..------- ----------------- -------- -------- ----pure-tone-average loss ----..--- --------------------

Standard error ------------------------------------

o

12898

0.7

%

1.3

1%

1.8

;:

1.0

1

34891

0.8

;;

0.9

E

1.1

18492

0.7

2

16183

1.0

4878

1.8

;:

2.3

%

1.3

3

10275

1.4

1069

4.8

1280

4.2

;;

1.6

4

10766

1.5

%

3.2

1873

3.2

7765

1.7

5

2663

2.7

52

7.0

6;

5.8

1564

3.3

lBetter-ear average for frequencies 500, 1,000, 2,000 cycles per second; 105 deci-bels assigned to nonresponse at limits of audiometer.

9

CLASSIFICATION OF HEARING

SCALE SCORESWhile specific audiometric values should not

be assigned to the various scale scores for reasonsdiscussed above, the data gathered so far wouldjustify considering that all those who occupy thesame scale position have a similar degree of hear-ing that is distinct from that in the other fivecategories. Furthermore, the scale score in-dicates the relative degree of impairment fromO (worst) to 5 (best). While the evidence (see,especially, table H) might support the treatingof each of the six scale positions separately, amore conservative attitude is recommended forany publication of the substantive results of theSurvey. The following classification is suggested:

Category 1. Unable to heav andundevstandspeech (scores from O to 3 on the heayi~scale) .— Persons in this group deny beingable to both hear and understand speechwithout a hearing aid. They range in impair-ment from inability to even perceive loudnoises to just being alie to distinguish thesound of speech from other sounds.

Category H. Limited speech perception(scale of 4) .– These persons can hear andunderstand only a little of what is said to them.

Category III. Can hear and understand mostspeech (scale stove of 5) .—This group con-tains persons with only slight hearing impair-ment.

Category IV. Unilateral heaving loss. —Persons in this group have one normallyfunctioning ear and should be able to hearwell, except under conditions in which thehearing of the good ear is masked by noise.Of course, spatial localization of sounds andsome other aspects of hearing will be affect-

ed by a unilateral loss. For communication,however, one good-hearing ear can serveadequately; hence this group is regarded aslesser impaired.

A fifth category arises by implication—thosepersons for whom information was insufficientto permit classification. Persons in this groupdid not respond to the Hearing Ability Ques-tionnaire or did so to such a limited extentthat classification was precluded.

CONCLUSIONS

While it is believed that the evidence pre-sented indicates that the hearing scale is a satis-factory instrument for use in morbidity surveys,certain limitations must be pointed out. It is neces-sary m obtain more data from a sample of thegeneral population, including those withn?l~hearingimpairment. Such data should include hearing testswhich would permit a more precise determinationof the meaning of the scale positions in terms ofaudiometric measures. Further considerationshould be given to the fact that little is knownabout those who obtained the highest position onthe scale. As it now stands, the hearing scaleis like a measuring stick that is 72 inches long.For measurements of those over 6 feet, such ameasuring stick permits no further differentia-tion beyond stating that the individual is “morethan 6 feet tall. ” In the same sense, ‘those whoobtain scores of 5 on the hearing scale are in-ferred to have the best hearing, but this couldnow include those who have no hearing loss atall. It is apparent, then, that in future develop-ment of this scale attention must be given toproviding increased differentiation at the better-hearing end of the scale. And, finally, someeffort should be directed toward obtaining ahigher rate and a better quality of response frompersons in the older age groups.

000

10

PROCEDURES

APPENDIX I

USED IN THIS SURVEY AND LEVEL AND QUALITY OF RESPONSE

The basic Health Interview Survey Questionnaireseeks to obtain information on a variety of health-related topics. In order to avoid extending the lengthof the interview unreasonably, the number of questionsthat can be devoted to a given topic must be limited.One method of probing a specific topic or condition thatavoids the problem of extending the length of the originalinterview is to have the basic interviewer screenrespondents for followup interviews. By this procedurepersons who are reported in the original interview ashaving experienced the event or as having had the con-dition which is to be the subject of more intensive studyare selected for additional interviewing at a later time.The Hearing Ability Survey, which was conducted for a12-~onth period ending June 1963, was the first attemptby the Health Interview Survey to utilize this type ofprocedure. A description of the procedures used, somecomments on these procedures, and some data on thelevel and quality of response obtained in the survey aregiven in this appendix.

Methods Used to Obtain Respondents

During the basic interview respondents were askedto report the existence of hearing problems in one orboth ears. Most of the reported cases of hearing im-pairment were elicited from responses to the question:Does anyone in the family have serious trouble hearingwith one or both ears? A relatively few cases werepicked up from responses to some of the other illness-probe questions used in the basic interview question-naire.

Persons reported as having hearing problems weremailed a copy of the Hearing Ability Survey Question-naire. Adults were asked to fill out the questionnairefor themselves, and a parent or guardian was askedto complete the questionnaire for children.

In order to obtain the maximum level of responseto the survey, persons who failed to respond to theinitial inquiry were sent a reminder letter followed bya second reminder letter and finally by a personalvisit when necessary. As a result of these procedures,responses were obtained from 93 percent of the per-sons who were sent questionnaires. Further detailsabout response rates follow in the section entitledLevel of Response.

The Hearing Ability Questionnaire

A facsimile of the Hearing Ability Questionnaire isshown in Appendix II. In addition to the hearing abilityscale (question 1) and to the estimate of hearing abilityin each ear (question 2) which have been discussedpreviously, the questionnaire was designed to providethe following information: (a) age at onset and pro-gression of hearing difficulty, (b) cause of hearing loss,(c) associated orological condition, (d) mode of com-munication to and by the person with the hearing loss,(e) special training, (f) hearing aid ownership and use,and (g) hearing tests.

Utilization of the Basic Heaith interview

Questionnaire as a Screening Device

An important feature of the Hearing Ability Surveywas the utilization of the basic health interview question-naire as a screening device to elicit reports of hearingproblems that later were followed up to obtain more de-tailed information. Since followup questiomaires weresent only to persons for whom some loss of hearing hadbeen reported in the original interview, the complete-ness of the followup data is limited by the accuracy ofreporting in tie original interview. Ageneral discussionof the response problems in interview surveys is notfeasible here.6 However, some comments on res~nseproblems that were encountered in this survey may bepertinent.

The first type of response problem is an implicitone. It involves the failure to repxt in the original irl-terview the existence of hearing loss for an unknownnumber of persons. Because of the need to limit thescope and objectives of this study, no effort was madeto obtain additional information about persons for whomno hearing loss was reported. Such an effort might haveyielded some information on the extent of underreportingof hearing impairments.

Some data on a second type of respmse problem,the reporting of hearing impairments in the original in-terview which later were not reported in the followup

6For ~e~ul~ of studies related to the problems of resPOnse e~rs,see U.S. National Health Survey, Health Statistics, PHSPub. Nos.584-I?4, -D5, and -D6, Public Health Service, U.S. (iove~ment Print-ing Office, 1961.

11

interview, is available from the survey. Of the 4,978persons who were reported to have a hearing impair-ment on the basic questionnaire and who responded toquestion 2 on the supplement, 482 (almost 10 percent)reported that their hearing was good in both ears. There-fore, either the reporting in the original interview wasincorrect for these persons or the supplementaryquestiomaire yielded false negatives. No procedureswere used in this study to resolve these apparent in-consistencies in reporting. One source of these in-consistencies may be the use of a proxy respondentin the original interview, while the supplement was com-pleted by the person for whom the hearing loss wasreported. It is probable that many individuals relate theirhearing ability to their age. Therefore, a 70-year-oldperson with hearing loss may consider his hearing“good” in comparison with other persons his age,whereas a younger proxy respondent who reported forhim might recognize and report the hearing loss.Another s,ource of these inconsistencies is probably theuse of different terms and the interpretation of theseterms by different people. ln the original interview,respondents were asked to report persons who had“serious trouble” hearing; in the supplement respon-dents were asked to describe their hearing in the follow-ing terms:

1 am deaf1 have a lot of trouble hearingI have a little trouble hearingMy hearing is good

Aside from the type of response problems indicatedabove, the Hearing Ability Survey results indicate thatthe basic interview can be successfully used to screenconditions or events for subsequent detailed interviews.

Level of Response

One of the major problems inherent in using a mailinterview instead of a direct interview is the inability to

Tab le 1. Number and percent distribution ofpersons who responded and who did not respondto the hearing ability supplement

L

Number PercentItem of dis-

persions tribut ion

Total persons towhom a supple-ment waa sent-- 5,830 100.0

Responded ------------- 5,404 92.7Did not respond ------- 426 7.3

No supplementreturned ----------- 302 5.2

B~~:$plement----------- 124 2.1

get all of the sample persons to respond. As shownin table I, 7.3 percent of the 5,830 persons who weresent a hearing ability supplement didnotrespon~ 5.2percent never returned the supplement; and2.lpercentreturned a blank questionnaire.

Table H presents the percent responding and notrespmtding according to age. These figures fail to reflectany relationship of age to response rates. Thehighestresponse rate is evident for the persons under 17years of age and those between the ages of 65and 74.The lowest response rates were reported for thosepersons aged 17-44 and 75 yeara and over.

In addition to the 5,830 persons who were sent asupplementary questionnaire, there were 17;! personsreported as having a hearing loss inthebasic interviewwith no supplement available for final analysis. Thiswas primarily caused by a clerical failure to send asupplement to the person with the hearing loss. (Theseerrors were essentially randomly distributed, andtherefore these losses should have no effect on thedata.) When the number of nonrespondents is added to the

Table II. Number of persons who were sent a hearing ability supplement and percent distributionof those who responded and who did not respond, according to age

NumberAge of Total Responded Did not

persons respond~

Percent distribution

All ages ---------------------------- ------ 5,830 100.0 92.7 7.3

Under 17 years ------------------------ ---------- 390 100.0 94.917-44 years -------------------------------------

5.11,127 100.0 91.4

45-64 years -------------------------------------8.6

1,749 100.0 92.865-74 years -------------------------------------

7.21,293

75+ years ---------------------------------------100.0 94.4 5.6

1,271 100.0 91.3 8.7

lIncludes those persons who failed to return the supplement and those who returned the supple-ment but did not answer any of the questions.

12

Table 111. Number and percent distribution of responses to the hearing ability supplement, ac-cording to quality of response

Quality of response

Total responding --------------------------------------------

No omissions or inconsistencies -----------------------------------A few on_Assi.ons or inconsistencies --------------------------------Many omissions or inconsistencies ---------------------------------—

Number Percentof responses distribution

number of persons for which no supplement was sent,supplementary information ismissing for approximately10percent of the tota16,002 persons whowere reportedas having hearing impairments in the household inter-view.

Quality of Response

Since these data were obtainedby aself-enumera-tionformandthe q~estionnaire wasmoderately complex,coding procedures were adopted to reflect the qualityof the responses. These procedures were devisedtorecapture most of the data as itwasoriginally re~rtedand also to record the various types of errors thattherespondents made infilling outthe form. Codingprocedures of this type have several advantages: (1)in analyzing the results of the study, knowledge of thequality of response to a particular question can bevaluable in determining the inferences that can bedrawn from the data obtained from that question;(2) evaluation ofthequali~ ofresponses will bebene-ficial in designing future questionnaires and in decidingthe procedures to be used, e.g., direct interview or mailquestionnaire.

A detailed analysis of the quality of response tothe individual question is beyond the scope ofthisre-

port. However, the range of acceptable responsestotheindividual questions varied from 70 to 98 percent.

In addition to coding the errors for each individualquestior., an attempt was made toevaluate the overallaccuracy of responses to the entirequestionnaire. Eventhough some basic criteria were established for ratingthe quality of response of each questionnaire, it shouldbe emphasized that a substantial amount of subjectivejudgment entered into these decisions. Consequently, ininterpreting the results of this rating procedure, whichare shown in the tables that follow, much more im-portance should be attached totherelationships betweenquality of response ’and characteristicsof therespon-dents than totheabsohtte levels ofquality indicatedinthe tables. Even though about20percentofthe question-naires were categorized as having many omissions orinconsistencies, theycontainedclearandusableanswersto many questions. Furthermore many of the errors ofomission or commission occurred in sections of thequestionnaire that hadno effecton theprimaryobjectiveof this study, i.e., to classify persons with impairedhearing according to degree ofloss.

The results of this evaluation are shown in table HI.Perhaps the only inference that should be drawn fromthese figures is that some of the questions and “skippatterns’’ were too complex for use in a mail question-

Table IV. Number of persons responding to the hearing ability supplement and percent distributionof the quality of response, according to age

Quality of response

Number

Age ofpersons No or few Many

responding Total omissions omissionsresponding or or

inconsistencies inconsistencies

Percent distribution

All ages ------------- 5,404 100.0 80.5 19.5

Under 17 years ------------- 370 100.0 92.217-44 years --------------- 1,030 100.0 91.4 w45-64 years----=----------- 1,623 100.065-74 years----------------

82.9 17.11,220 100.0 72.6 27.4

75+ years ------------------ 1,161 100.0 72.0 28.0

13

Table V. Number of persons responding to the hearing ability questionnaire and percent distribu-tion of the quality of response, according to type of respondent

Type of respondent

Total-----------------------------------

Unassisted respondent -------------------------Assisted respondent ---------------------------

Numberof

personsl

5,029

3,3881,641

Quality of response

Total

Omissions orinconsistencies

II None I Few I Many

Percent distribution

===4 38”6144”’!‘“6100.0 I 33.0 47.0 20.0100.0 50.0 40.5 9.5

lExcludes 375 questionnaires on which the respondent was unidentified.

naire. This may be particularly true inthis study whiqhincluded many persons in the older age groups. Thedifficulty that older persons had with thisquestionnaireis reflected by the data intableIV,which shows that thequality of response decreased asage increased.

Another interesting related fsctor is shown intableV. The quality of response appears to be better whensome other person assisted in completing thequestion-naire. Twenty percent of the unassisted respondents

returned questionnaires withmanyomissions , whilelessthan 10 percent of the assisted respondents returnedquestionnaires with frequent errors.

These findings are different from the comparisonof the assisted and unassisted respondents in relationto the hearing ability scale that was discussed pre-viously in this report. The ability of theassistedre-spondent to provide a better overall quality ofresponseto thesupplementary questionnaire while having apoorer

Table VI. Number of persons responding to the hearing abili,ty supplement and percent distribu-tion of the quality of response , according to type of respondent and age

Type of respondent and age

Unassisted respondent

All ages---------------.----------------

Under 17 years --------------------------------17-44 years -----------------------------------45-64 years -----------------------------------65-74 years -----------------------------------75+ years -------- -------- -------- -------- -----

Assisted respondent

All ages --------------------------------

Under 17 years --------------------------------17-44 years -----------------------------------45-64 years -------- ------.- -------- ---.---- ---65-74 years-----------------------------------75+ years -------------------------------------

Numberof

persons

3,388

7%1,183

816568

1,641

317197342295490

Quality of response

Omissions or

Total inconsistencies

None Few Many

Percent distribution

100.0

100.0100.0100.0100.0100.0

100.0

100.0100.0100.0100.0100.0

33.01 47.01 20.0

I I

36.1 61.1 2.849.6 43.134.2 49.0 1;:;25.0 47.1 27.918.8 47.4 33,8

mlExcludes the 375 questionnaires on which the respondent was unidentified.

14

ability to respond to the scale statements in question 1may be explained as follows: Since a person is calledupon to assist in completing thesupplement, he couldbe expected to be more competent in following thequestionnaire instructions and providing the answers tothe factual questions. However, the ability to interpretthe subjective impressions required for completing thescale in question 1 may be more difficult for the personwho is lending his assistance.

Table VI shows the relationship between age, theneed for assistance to complete the questionnaire, and

the quality of response. It is readily evident that theolder unassisted respondents experienced considerabledifficulty in trying to answer the survey questionnaire.

The data presented here on quality of responsepoints up the need for exercising considerable cautionin using complex mail questionnaires, especially if thestudy involves many persons in the older age brackets.Furthermore, these data indicate that the quality of thedata may be improved if assistance in preparing thequestionnaire is available or given to elderly respon-dents.

15

APPENDIX II

HEARING ABILITY SURVEY QUESTIONNAIRECON FI DENTIAL - l%is information is collected for the U.S. PubIic Health Service under authority of PublicLaw 652 of the 84th congress (7o .%at 4S% 42 U.S.C. 305). AH information which wOuld Pe~it identifica-tion of & individual will be held strictly confidential, will be used only by persons engaged in and for the

PIMPO=S of Cbe =WY and wiIl not b= disclOs=d Or releas=d tO O*ers fOr any o*er PIX’POSCS(22 FR l@7).

FORM NHS-D-1 U.S. DEPARTMENT OF COMMERCE(5-2S-62) BuREAU OF THE CENSUS

ACTING AS COLLECTING AGENT FOR THEU.S. PUBLIC HEALTH SERVICE

NATIONAL HEALTH SURVEY(Hearing Ability)

I Name of person for whom this form should be filled out IGENERAL INSTRUCTIONS

Please answer aH of the questionsin this form tba apply co you. Most of the questions -an be

dmswered by cbeckingonc of the boxes, like this: @ In some ofchequestions, more tban onebox may rechecked for your answer. In a few questions, anumber (such asage)is asked for. Ina few others, a written description or explanation is required.

If the person for whom the information is requested is a child, a parent or guardian should -answerthe aue scions for him or her.

SECTION A(Please do not omit any part ./ Questions I and 2 even tbougb one or more of fbe statements may not

appear to be directly related to your present ability to bear. )

1. WITHOUT using a hearing aid, what can you how

(Please check the “Yes’” or “No” box after each statement. )

I can hear loud noises.

Most of the time 1 can tell one kind of noise fmm another.

If 1 hear a sound, most of the time 1 can tell if it is a person’s voice or not.

I can hear and understand a few words a person says if I can see his face and lips.

I I cm hear and understand a few words a person says without seeing his face and lips. Ill\,h can ear and understand most of tbe things a person says if I cart see his face and lips. Ill

I I can ha r and understand most of the things a person says without seeing his face and lips. I I IMost of the time I can ham and understand a discussion between severaf people withoutseeing cbeir faces and Iips,

, !I can hear and undwstand a telephone conversation on an ordinary telephone (that is atelephone without m amplifier).

2. Please describe how well you can hear, without using a homing aid, by checking ona of the statementsbelow for -ch car. For example, a person who is deaf in his left car and has good hearing in his rightear would check the following In left ear - box (d); In right ear - box (e).

IIn I*ft -r t In right oar

(a) ❑ My hearing is good,I (e) n My hearing is good

(b) ❑ I have a little trouble hearing ~ (f) ❑ I have a little trouble hearingI

(c) ❑ I have a lot of trouble hearing ~ (g) ❑ I have a lot of trouble hearing

(d) ❑ I am deaf i (h) ❑ I am deaf

If you have checked that your hearing is good in both ears-(a) and (e) checked, skip the questions cm Pages 2and 3 and turn co tiction D on Page 4.

IIf you have any trouble hearing at all, please go on and answer the F estions that follow on Pages 2 and 3.

1

16

I SECTION B I

3. How old were you when you beg.. to have hearing trouble or grow deaf?

(Please check tbe first box that applies and enter year as appropriate. )

❑ At birth ❑ I W,S abollt_ years old

❑ I was less than one year old. ❑ : ~..ot sure, but I know it w.. before_ YC2C$ old.

4. (a) Since your hearing trouble began, has your hearing g.a!trn WORSE, has it improved, or is it iust aboutthe same? (Please check one box. )

❑ My hearing is now wore than when I first began to have bearing trouble.

❑ My hearing is now bdt.r than when I first began to have hearing trouble.

❑ My hearing is just about the same as when I first began to b.ve hearing trouble.

(1/ you have checked that your hearing has gotten worse, please answer tbe following question. )

(b) Hew old were you when it got as poor as it is now?(Please check the /irst box that applies and enter year as appmpria!e. )

❑ I WLS about — YCZLS oId.

❑ I am not sue, but I know it was before I was _ years old.

❑ Neither of the above applies--it is getting worse all the time.

5. What was tho caust of your hmring trouhlo or deofncss?

❑ It was caused by a sickness, illness or disease. ❑ ~~r”om deaf or with pool

What illness?

❑ It was caused by an accident or injury.❑ %mething else caused it.

(Please describe ii)

Wot kind of iniury wos it?

❑ I don’t know wi-iat caused it.How did it happen?

6. Basid*s your htoring troubla or deafrmss, do you hove any othm troublo with your ars?

❑ Yes D No

If ‘“Yes, ”

What kind of trouble? (Please check as many bezes as a~ly. )

D Noises or ringing in the head or ear 0 Dizziness

❑ Earaches or pains i. the ear ❑ Any ocher uo.ble. Wh.t kind?

I ❑ Running earsI

7. (a) At work or school and at horns, what arc cdl tht ways you usc to toll etfmr psoplo what you wont?

(Please check each way that you use. J

❑ I talk to them ❑ I usc sign languaxe.

❑ I write notes. •l Some ocier WI;. HOW?

•l I spell with my fingers

(b) PI.OSQ put a circl. around tho way you US* the most.

8. (a) At work or school and at home, what arc all the ways ethar PWPIO US* to tall YOU what th-y want?

(Please check each way that they use. )❑ l%ey tdk to me. ❑ 1’hey use sign 18nguage.

❑ lllmy write notes. ❑ %me other way. HOW?

❑ l%ey spell with their fingers.

(b) P1.aso put a circla around the way they US* the most.

I 9. Have YOUcvw attmdad a school or CIOSSfor them withpoor hearing or a school or class for tho deaf? IJ Yes ❑ No I

10. Have you ●VW had any training in lip reading(spocch reading)? ❑ Yes ❑ No

11. HIJVOyou ●ver had any training in spo-h or sp-chcorrection because of your poor hexing or doaftwss? •l Yes ❑ No I

12. Have you ●ver had any training in haaring (Iossons tohelp you understand bettar what you hear)? IJ Yes ❑ No

17

SECTION C

(The questions in this section re/er t o the use of hearing aids. )

3. Have you ever tried a hearing aid? ❑ iYes ❑ No (l~’:N$J “ skip to Section D on

4. Have you ever had o hearing aid for your own use? •1 Yes ❑ No (1/ “No, “ skip to Sectioti D onPage 4)

5. (a) If you have a hearing aid NOW, please check here - •1AND check one of the boxes below to indicate when you got it.

If you do NOT have a headng aid NOW, please check here ~ •1AND check one of the boxes below b indicate when you got the last one you had.

When did you get it?

❑ This year (1962) ❑ 6-10 years ago

❑ Last year (1961) ❑ More than 10 years ago

II 2-5 years ago

The remaining parts of Question 15 apply to your present hearing aid if you have one now. If YOUdo nothave a hearing aid now, they apply to the lost hearing aid you had.

(b) What kind of hearing aid is (was) it? (Please check one hoxl

{

❑ Fits into one ear

{

❑ Fits against one side

Air conduction Bone conductionof the head

•1 ::~tl::::;:s ❑ Fi:h:~i:t&~$:$t~m:f

(.) Where are (were) the amplifier and batteries worn when you us. (used) the hearing aid?.(Please check one box)

❑ Above the neck ❑ Below the neck

(d) Why did You choose this (that) particular kind of hearing aid?(Please check one box)

❑ It was prescribed by a medical doctor ❑ It was advised by a hearing aid dealer

❑ It was prescribed by a hearing clinic ❑ Some other reason (Please explain)

❑ A friend or relative told me about it

❑ I saw it advertised

(e) Abo.t how long did it tak. to get used to it? (please check one box)

❑ Less than . . . mod ❑ More than six months

❑ One to six months D Never have gotten used to it

6. (a) Do you use a hearing aid now? ❑ Yes ❑ No (1/ “No,” skip to Section D onpage 4)

(b) How much do you use it? (Please check one box on each line) Does(If you do not work, go to school, etc., check tbe “Does not Most Once

notapply” column. )

of the in a Never

aPPIY time while

Artwork ? . . . . . . . . . . . . . . . . . . . . ..OO

At school? . . . . . . . . . . ...*. . . . . ...*-

At church? . . . . . . . . . . . . . . * ~........

Atthemovies? . . . . . . . . . . . . . . . . . . . . . .

Listening toradio or TV? . . . ...” . . . . . . . . .

Ac home? . . . . . . . . . . . . . . . . . . . . . . . . .; ::..;:.!,.,, \),,j&

,, .?;,,,,;/

(c) How well sati.fied or. you with the hearing old you are now using? (Please check one box)

❑ Very well satisfied ❑ Fairly well satisfied ❑ Not satis~ed at all

Question 17 of Section Con Page 4

18

SECTION C - Continued

17 WITH your hearing aid, what can you hear? (PIease cLeck the “Yes” or “No” box a/rerYes No

each sfafemenf)

I can heax loud noises.

llosc of the time 1 can tell one kind of noise from anocimr.

If 1 hear a sound, most of cinc time I can rell if it is a person’s voice or not.

I can hear and understand a few words a person says if I can see his face and lips.

I can hear ❑nd understand a few words a person says without se+g his face and lips.

I can hear and understand most of the things a person says if I can see his face and Iips.

I can hear and understand most of the things a person says without seeing his face and lips.

Most of the time I can hear and understand a discussion becm.een several people without

seeing their faces and lips.

1 can hear and understand a telephone conversation on any cetephone.

SECTION D

1S. Has your hearing ever been tested by a medical doctor? Yes •l No (1/ “No.” go to Question 19)

(o) About how long ago was your hearing LAST tested by a medical doctor? (Please check o.. box)

❑ This year (1962) •1 4-5 years ago

❑ Last year (1961) U 6-10 years ago

•l 2-3 years ago ❑ ?.fore than 10 years ago

(b) Y!os the doctw who last tested your hearing an ear specialist or was he a general family doctor?(Please check one box)

HMCCOI who was an em specialist a I don’t know

❑ General family doctor

(c) About how old were you wk.. your hewing was FIRST tested by . medical doctor?

I was abOur— YGuS old

I don’t know, but it was before I was _yCNS old.

19. Is your hearing testad regulorly,’for example, once orc1 Yes ❑ No

twice a yrnr?

20. Has your hearing ever been tested with an audimeter

(with earphones)? c1 Yes ❑ No

Comments - (Please use this space or attach an additional sheet 01 paper for any additional remarks you mayhave about your bearing. )

Name of person who filled out this form Telephone No.

19

* U. S. GOVERNMENT PRINT~G OFFICE :1973 54 3-978/10

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS

Public Health Service publication No. 1000

Series 1.

Series 2,

Series 3.

Sem”es 4.

Series 10.

Series 11.

Series 12.

Series 20.

Series 21.

Series 22.

Programs and collection procedures. —Reports which describe the general programs of the NationalCenter for Health Statistics and its offices and divisions, data collection methcds used, definitions, andother material necessary for understanding the data.

Reports number I-4

Data evaluation ad methods research. —Studies of new statistical methodology including: experimentaltests of new survey methods, studies of vital statistics collection methcds, new analytical techniques,objective evaluations of reliability of collected data, contributions to statistical theory.

Reports number 1-12

Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health sta-tistics, carrying the analysis further than the expository types of reports in the other series.

Reports number 1-4

Documents and committee repo~ts .—Final reports of major committees concerned with vital and healthstatistics, and documents such as recommended model vital registration laws and revised birth anddeath certificates.

Reports number 1 and 2

Data From the Health Interview Survey. —Statistics on illness, accidental injuries, disability, use ofhospital, medical, dental, and other services, and other health-related topics, based on data collected ina continuing national household interview survey.

Reports number 1-23

Data From the Health Examination Survey.— Statistics based on the direct examination, testing, andmeasurement of national samples of the population, including the medically defined prevalence of spe-cific diseases, and distributions of the population with respect to various physical and physiologicalmeasurements.

Reports number 1-11

Data From the Health RecoYds Swvey. —Statistics from records of hospital discharges and statisticsrelating to the health characteristics of persons in institutions, and on hospital, medical, nursing, andpersonal care received, based on national samples of establishments providing these services andsamples of the residents or patients.

Reports number 1 and 2

Data on mo?tality. —Various statistics on mortality other than as included in annual or monthly reporta-special analyses by cause of death, age, and other demographic variables, also geographic and timeseries analyses.

No reports to date

Data on natality, marm”age, and divoyce. —Various statistics on natality, marriage, and divorce otherthan as included in annual or monthly reports-special analyses by demographic variables, also geo-graphic and time series analyses, studies of fertilfty.

Reports number 1-6

Data FYom the National Natality and Mortality Surveys. —Statistics on characteristics of births anddeaths not available from the ;itsl records, b~sed on-sample surveys stemming from these records,including such topics as mortality by socioeconomic class, medical experience in the last year of life,characteristics of pregnancy, etc.

Reports number 1

For a list of titles of reports published in these series, write to: National Center for Health StatisticsU.S. Public Health ServiceWashington, D.C. 20201