Seeking best practice for app-based speech perception testing in a longitudinal cochlear implant journey

Introduction Speech perception testing has traditionally played a vital role in determining cochlear implant (CI) candidacy and post-operative monitoring of functional benefits. Service delivery through telepractice can play an important role throughout all stages of the CI journey, yet gaps in evaluating speech perception are evident. Here we present a conceptual framework for the development, piloting, and validation of a digital tool to deliver standardized speech perception assessments. The aim was to maintain best practice of hearing health care through ensuring “gold standard” of service delivery for all stakeholders. Methods This study had two phases. The first phase implemented an iterative approach to develop the myHEARcheck app to evaluate standardized speech perception in real time with a clinician (synchronous) or self-administered and reviewed by a clinician at a later time (asynchronous). The second phase evaluated the effectiveness and efficiency of the app when used by experienced adult CI users ( n = 23). Participants were assigned to three groups, all of whom experienced asynchronous use of the app, whereas two groups had in-clinic sound-booth testing, and synchronous testing. Post-assessment interviews were conducted to understand user experience. Results The myHEARcheck app was successfully implemented on an iPad to evaluate standardized speech perception synchronously and asynchronously. Word perception results with the app tested synchronous ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"> <mml:mover accent="false" class="mml-overline"> <mml:mrow> <mml:mi>X</mml:mi> </mml:mrow> <mml:mo accent="true">¯</mml:mo> </mml:mover> </mml:math> = 47%) and asynchronous ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"> <mml:mover accent="false" class="mml-overline"> <mml:mrow> <mml:mi>X</mml:mi> </mml:mrow> <mml:mo accent="true">¯</mml:mo> </mml:mover> </mml:math> = 42%) were significantly different from traditional testing ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"> <mml:mover accent="false" class="mml-overline"> <mml:mrow> <mml:mi>X</mml:mi> </mml:mrow> <mml:mo accent="true">¯</mml:mo> </mml:mover> </mml:math> = 32%). Synchronous sentence scores ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"> <mml:mover accent="false" class="mml-overline"> <mml:mrow> <mml:mi>X</mml:mi> </mml:mrow> <mml:mo accent="true">¯</mml:mo> </mml:mover> </mml:math> = 80%) were significantly different from the traditional ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"> <mml:mover accent="false" class="mml-overline"> <mml:mrow> <mml:mi>X</mml:mi> </mml:mrow> <mml:mo accent="true">¯</mml:mo> </mml:mover> </mml:math> = 88%) and the asynchronous ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"> <mml:mover accent="false" class="mml-overline"> <mml:mrow> <mml:mi>X</mml:mi> </mml:mrow> <mml:mo accent="true">¯</mml:mo> </mml:mover> </mml:math> = 90%) scores. Participants reported the app was easy to use, irrespective of prior experience with technology. Some participants indicated the absence of clinician assistance during the asynchronous session was a limitation. Conclusion A digital tool, the myHEARcheck app was conceptualized, scoped, built, and implemented to address organizational and psychosocial challenges and barriers to the utilization of health care, including access, affordability, acceptability, and engagement. All participants were able to independently evaluate their speech perception with a high degree of confidence in the use of this approach. The app, as tested, demonstrated the potential for a digital tool to provide a device-agnostic standardized evaluation of speech perception using synchronous and asynchronous telepractice.