Evaluation of Online-Administered Hearing Handicap Inventory: Effects of Item Order and Relation to Auditory Wellness Categories

Background<br/>Self-reported hearing difficulties are often assessed using the Hearing Handicap Inventory (HHI). HHI scores have recently been used to measure auditory wellness. This study investigated whether item order affects HHI scores and whether a 10-item screener version (HHI-S) can be extracted validly from the full 25-item version.<br/><br/>Methods<br/>Participants (n = 168) over 50 years of age and with a wide range of hearing abilities completed the Danish HHI online. Two different orders of the 25-item HHI were compared: (1) the conventional order and (2) an experimental order in which the items were presented in blocks beginning with the 10-item HHI-S. HHI and HHI-S scores were compared for both item orders. Internal consistency and test-retest reliability were also examined. Auditory-wellness grades were determined, and the limits of agreement were calculated for each grade.<br/><br/>Results<br/>No significant differences between different item orders were found for the HHI t[165] = .03, p = .97) or HHI-S (t[165] =.-.16, p = .87). The HHI showed excellent internal consistency (Cronbach’s α = .95; CI: .94 .96) and test-retest reliability (ICC = .89, p &lt; .001), as did the HHI-S (α = .90; CI: .88 .92; ICC = .86, p &lt; .001). The limits of agreement become broader as auditory wellness worsens. <br/> <br/>Conclusion<br/>The online HHI is a reliable tool for assessing self-reported hearing difficulties. The item order does not influence HHI outcome, and the 10-item HHI-S can be extracted validly from the 25-item version.