Response ID
Progress
Recorded Date
To take part in this research, please confirm that you agree to the following: 1. I confirm that I have read the information sheet for this study in the section before this and I have had the opportunity to consider the information and ask questions.
2. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected.
3. I agree to complete this questionnaire on the understanding that no one will be able to identify me from my answers.
4. I agree to take part in this study.
You are eligible to take part in this study if you are seeking help for your hearing loss and/or experiencing hearing loss, currently living in the UK and aged 16 years and over. Do you have hearing loss?
Are you aged 16 years or over?
Do you currently live in the UK?
Which country in the UK do you currently live?
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I feel confident telling people when I haven’t heard them
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - It is an ongoing struggle to hear others
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I am frustrated by my hearing problems
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I feel lonely when I can’t hear and others can
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - When I speak to people for the first time, I tell them about my hearing
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - There are certain situations where I feel really left out
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I avoid activities I used to enjoy because of my hearing
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I have to concentrate more because of struggling to hear
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I worry what people think of me because I can’t hear everything
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I am confident talking to people in background noise
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I notice the problems caused by not hearing
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - Over the last week, I have worried my hearing will get worse in the future
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - Over the last week, I have felt unsafe when I am out and about because I don’t hear what is going on around me
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - Trying to hear can be exhausting
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - My family and friends support me with my hearing
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I have thought about whether I need support with my hearing such as lip-reading classes, groups, or hearing therapy
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - I have thought about getting devices to help me hear alarms, the phone or TV
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - It is difficult to communicate with organisations, GP surgeries etc because of my hearing
The next questions are about what it is like to live with hearing loss and how it affects your life. Please select the option which is most accurate when thinking your experiences over the last 7 days. - Phone calls are hard for me because of my hearing
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - When I go to health appointments, I have family or friends who help me with my hearing
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - Medical/ healthcare professionals support me with my hearing
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - I feel confident communicating my needs and concerns about my hearing to medical/healthcare professionals
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - I am confident that professionals will listen to my point of view about my hearing
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - I worry about having my hearing tested
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - I understand what hearing testing involves
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - Healthcare professionals/audiologists clearly explain what to expect from audiology tests and results
In the next set of questions, we would like you to think about your experiences with healthcare services and talking to healthcare professionals - I worry about what a hearing test might show
The next questions ask about how your hearing affects communication. Please indicate which opinion best describes your experience by clicking in ONE box for each statement. - The members of my family are annoyed with my loss of hearing.
The next questions ask about how your hearing affects communication. Please indicate which opinion best describes your experience by clicking in ONE box for each statement. - I tend to be negative about life in general because of my hearing loss.
The next questions ask about how your hearing affects communication. Please indicate which opinion best describes your experience by clicking in ONE box for each statement. - Since I have trouble hearing I hesitate to meet new people.
The next questions ask about how your hearing affects communication. Please indicate which opinion best describes your experience by clicking in ONE box for each statement. - I do not enjoy my job as much as I did before I began to lose my hearing.
The next questions ask about how your hearing affects communication. Please indicate which opinion best describes your experience by clicking in ONE box for each statement. - Conversation in a noisy room prevents me from attempting to communicate with others.
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Do you know which options are available to you for your hearing?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Do you know the benefits of each option?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Do you know the risks and side effects of options for hearing?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Are you clear about which benefits matter most to you?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Are you clear about which risks and side effects matter most to you?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Do you have enough support from others to make a choice for your hearing?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Are you choosing without pressure from others?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Do you have enough advice to make a choice about your hearing?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Are you clear about the best choice for you?
The next few questions relate to knowing what options are available for your hearing. Please select the response that best describes how you feel. - Do you feel sure about what to choose for your hearing?
The next few questions will help us to understand how familiar people are with using and reading health information. Please select the option which is most accurate when thinking about your experiences. - How often do you have problems learning about your medical condition because of difficulty understanding written information?
The next few questions will help us to understand how familiar people are with using and reading health information. Please select the option which is most accurate when thinking about your experiences. - How often do you have someone help you read hospital materials?
HLSb - How confident are you filling out medical forms by yourself?
Self-care (e.g. washing or dressing)
Usual activities (e.g. work, study, housework, family or leisure activities)
Pain/discomfort
Anxiety/depression
The questions in this section will ask you about loneliness. How often do you feel lonely?
Please select the option which applies most to you. - How often do you feel that you lack companionship
Please select the option which applies most to you. - How often do you feel left out?
Please select the option which applies most to you. - How often do you feel isolated from others?
Love, friendship and support
Being independent
Achievement and progress
Enjoyment and pleasure
You are now at the last section of the questionnaire which asks questions about yourself and your hearing. This should take you about 5 minutes to fill in Do you have hearing loss in one or both ears?
When have you had hearing loss since?
Do you have tinnitus?
What is your ethnic group? - Selected Choice
What is your ethnic group? - Any other White background, write in - Text
What is your ethnic group? - Any other Mixed or Multiple background, write in - Text
What is your ethnic group? - Any other Asian background, write in - Text
What is your sex?
Is the gender you identify with the same as your sex registered at birth? - Selected Choice
Is the gender you identify with the same as your sex registered at birth? - No, please state your gender identity - Text
How many people do you live with in your household?
What are the first 4 digits of your postcode? (e.g. BS10 or BS6 7. If there is a space, please include it in the correct place). - Selected Choice The first 4 digits of my postcode are...(please state below)
What are the first 4 digits of your postcode? (e.g. BS10 or BS6 7. If there is a space, please include it in the correct place). - Selected Choice Prefer not to say
What are the first 4 digits of your postcode? (e.g. BS10 or BS6 7. If there is a space, please include it in the correct place). - Selected Choice Don't know
What are the first 4 digits of your postcode? (e.g. BS10 or BS6 7. If there is a space, please include it in the correct place). - The first 4 digits of my postcode are...(please state below) - Text
What is your highest educational qualification?
Which of the following describes what you were doing over the last 7 days? - Selected Choice
Which of the following describes what you were doing over the last 7 days? - Other - Text
Did you complete this questionnaire on your own? - Selected Choice
Did you complete this questionnaire on your own? - No. Please state who helped you - Text
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