The development of Inventori Laporan Masalah Pendengaran (ILaMP)

Abstract

Self-reported hearing loss questions can serve as an alternative hearing screening tool when other standard hearing tests (e.g., Pure Tone Audiometry) are unavailable or impractical. However, a comprehensive self-reported hearing loss survey in Malay is currently lacking. Therefore, this study aims to develop and validate Inventori Laporan Masalah Pendengaran (ILaMP), and to investigate its psychometric properties. This is a cross-sectional study with four stages: 1) Scoping review, 2) Development of ILaMP, 3) Validation of ILaMP, and 4) Measurement of its psychometric properties. The scoping review was conducted using five databases with keywords such as "Self-reported hearing loss," "hearing screening," "pure tone audiometry," "questionnaire," and "survey." The scoping review aimed to map the extent, range, and nature of the literature, as well as to identify the themes of self-reported hearing loss questions from previous literatures, and determine the performance of self-reported hearing loss questions based on various factors, including the operational definition of hearing loss, single versus multiple questions, scoring systems, and frequency averages. For the development of ILaMP, self-reported hearing loss questions were filtered from the scoping review and other sources using specific criteria, adapted them into Malay, and grouped them by themes. To validate ILaMP, six experts involved for content validation and 15 laypeople for face validation and pre-testing. Subsequently, 187 subjects completed the initial ILaMP questionnaire and their pure-tone hearing thresholds and ILaMP scores were recorded to finalize ILaMP and assess its psychometric properties. Based on the scoping review of 54 self-reported hearing loss articles, the results showed that operational definition of hearing loss >25 dBHL, multiple questions, a frequency average of 0.5, 1, & 2kHz, and a scoring system of a 3-, 4-, and 5-Likert scale showed better performance in terms of sensitivity, specificity, and accuracy for screening hearing loss. During the initial stage of development, 369 self-reported hearing loss questions were compiled (320 from the scoping review and 49 from grey literature). After the expert review, 61 questions with 15 themes were included in the first draft of ILaMP. The first draft of ILaMP showed good content validity (S-CVI = 0.995) and content validity index for the item (I-CVI) ranging between 0.83 to 1.00. Face validity results showed that 100% of the subjects agreed that ILaMP was suitable to be used as a self-reported hearing loss survey. Pre- testing showed that the majority of the subjects agreed that the items were readable (100%), suitable to be asked (99.5%), the sentences were clear (98.6%), and had a good sentence structure (99.1%). The final ILaMP version consisted of 18 questions. Rasch Analysis revealed fair and acceptable person reliability (separation index of 1.68; person reliability of 0.74), good internal consistency (Cronbach's Alpha: 0.88), and good item reliability (separation index of 4.23; item reliability of 0.95). Receiver Operating Curve (ROC) analysis yielded an AUC of 0.923 for a >7 cut-off score, with 90.3% sensitivity, 83.3% specificity, and 84.6% accuracy for screening hearing loss >25dB. Pearson correlation analysis showed a strong positive correlation between ILaMP scores and PTA threshold averages (0.5, 1, & 2 kHz) (r=0.70; p:< 0.01), indicating good concurrent validity. ILaMP consists of 18 items, with a cut-off score of >7 yielding good sensitivity, specificity, and accuracy for screening hearing loss of >25dB. It has shown good content validity, face validity, pre-testing results, internal consistency, item reliability, and acceptable person reliability. It has the potential to be used as an alternative hearing screening tool due to its performance, ease of administration, and cost- and time-efficiency.