Refinement and psychometric evaluation of the attitudes toward loss of hearing questionnaire

Objective: To refine and statistically validate the Attitudes Toward Loss of Hearing Questionnaire (ALHHQ) so that it will be appropriate for clinical application and to understand some of the personality attributes underlying attitudes toward hearing loss. Design: An American-English version of an ALHQ, originally designed by Brooks (1989), was completed by 226 men; a subset of 80 also completed personality questionnaires. All subjects underwent pure-tone testing and speech audiometry. Factor analysis was used to extract scales from the ALHQ. Reliability analyses using Cronbach's alpha were carried out on each scale. Test-retest reliability was evaluated from questionnaires completed 6 to 18 mo after initial administration. Multiple regression analysis was used to examine the audiometric and personality determinants of attitudes. Results: Five reliable scales were extracted from a 24-question version of the ALHQ: 1) Social and Emotional Impact of Hearing Loss, 2) Acceptance/Adjustment to Hearing Loss, 3) Perceived Support from Significant Others, 4) Hearing Aid Stigma, and 5) Awareness of Hearing Loss. Audiometric data explained little of the variance in attitude scores; age and other demographic factors did not correlate with attitudes either. The personality traits of extroversion, self-esteem, and anxiety/neuroticism played a larger role in determining attitude. Conclusions: The ALHQ is psychometrically acceptable and is a potentially useful clinical tool. It is quick and easy to complete and to score and could be used as a basis for counseling and for following attitude change in patients over time.