MICA: Understanding and alleviating hearing disability: A cognitive-behavioural model of miscommunication in everyday conversation

By 2050 there will be 2.5 billion people worldwide with hearing loss, mostly of older age. Untreated hearing loss is linked to greater cognitive decline with age, possibly because of the role hearing loss plays in social isolation. Difficulty engaging in conversation is the most often-reported problem of hearing loss, but currently treatment with hearing aids does not adequately fix this. There is a clear and unmet need for understanding why and how older adults with hearing loss experience problems in conversation. With such understanding, better treatments will become possible, improving the social participation of people with hearing loss. In this programme we will develop an in-depth explanation of how miscommunications happen in everyday conversation, and how people behave in response to them. That is, we will unravel the connections between the basic mishearings experienced by those with hearing loss in everyday conversation and the emotional (and hence social) consequences that limit their quality of life. The results will provide inspiration for treatments that limit these miscommunications and promote greater health through the lifespan.

Conversation is much more than an exchange of perfect messages; most often it is actually a gradual process of coming to mutual understanding. Words matter, but so does behaviour: timing, gesture, gaze, facial expression, and incidental signals ("uh-huh").
We focus on three key aspects of everyday conversation that have not yet been adequately addressed - especially for people with hearing loss.
The first is that when miscommunication occurs, conversational partners typically adjust how they behave or speak, to overcome the obstacle. Hence it is not only the person with hearing loss who experiences consequences.
The second is that flowing conversation depends on very rapid comprehension, formulation, and prediction of opportunities to speak. If any of these go too slowly, the result is a 'bottleneck', and one is left out of the conversation.
The third is that conversational context (e.g., acoustical environment, type of conversation, group composition) affects the way people communicate, and how they respond to difficulty. This means there is no single universal mechanism in action, nor a single solution.

In previous work we have identified a diverse array of communication behaviours and their potential functions. Crucially, we found initial signs that all the above aspects operate differently for people with vs. without hearing loss.
We therefore propose a comprehensive series of studies to reveal the mental processes and behaviours that take place in conversation, focussing on how hearing loss affects the occurrence and negotiation of miscommunication. The final result will be a conceptual 'model' linking hearing loss itself to social consequences through a chain of explanatory mechanisms.

In order to create such a model, we will apply multiple approaches, all relying on natural conversation, to illuminate key aspects in different ways. We will map out the scope and emotional cost of miscommunication through in-depth interviews and surveys. We will quantify the occurrences and effects of miscommunication in the real world through novel mobile assessment techniques. We will identify the specific patterns of behaviour that lead to and follow from miscommunication through state-of-the-art laboratory measurements. We will test under what time constraints miscommunication happens. The model will combine all these insights to span perceptual, mental, behavioural and emotional aspects of miscommunication.
The in-depth understanding provided by this model will inspire novel, personalised hearing rehabilitations and technologies to support problem-free communication. By so doing, it will advance the maintenance of social engagement in an ageing population, improving mental health, employment prospects, and quality of life for millions of older adults.

Our primary objective is to develop a cognitive-behavioural model of miscommunication in everyday conversation for people with hearing loss. To develop this model, we will (1) identify which behaviours trigger accommodation in their communication partners, (2) study the impact of the temporal demands of conversation, and (3) investigate how behavioural responses to difficulty change according to the conversation context.
We will use a variety of methodologies. We will use interviews and surveys to understand the experience of challenging conversations for people with hearing loss, their significant others, normal-hearing cohorts, and clinicians. Second, we will conduct field studies using ecological momentary assessment coupled with expanded data-logging from hearing aids, gathering real-world contexts, behaviours and affective responses. Third, we will conduct laboratory studies recording video, audio, body and eye tracking of trios holding conversations, while manipulating conversation type, acoustical environment and group composition to examine the context dependence of cognitive processes and behaviour. As the work progresses, we will accumulate and combine the insights gained to build and refine a cognitive-behavioural model, finally verifying the model through observer ratings of the same data.
We will use reflexive thematic analyses for qualitative data, a combination of appropriate standard (e.g., multivariate LMM) and novel (e.g., ICA-based pattern similarity) analyses for the behavioural field and lab data, and will additionally use state-of-art machine learning (e.g., automatic relevance determination) to model miscommunication phenotypes.
Primary fields of application are in hearing devices and clinical counselling. Results will be published in general and field-specific journals, conveyed at workshops for patients, clinicians and academics. Anonymised datasets will be released for use by the academic and industrial research community.