Yes / The increasing prevalence and associated cost of treating Chronic Obstructive Pulmonary Disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a qualitative study embedded within a feasibility and pilot Randomised Controlled Trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. The aim of the study was to qualitatively explore the experiences of patients with COPD who had received either a Telehealth-supported or a specialist nursing intervention following their discharge from hospital after an admission for a COPD exacerbation. Methods: Patients were invited to either participate in semi-structured interviews or to complete a semi-structured self-administered questionnaire on completion of the intervention. Nine patients were interviewed (67 % female) and seventeen patients completed the questionnaires. In addition, three clinicians responsible for the delivery of both interventions were interviewed to obtain their perspectives on the new services. Results: Seven underlying themes emerged from the patient interviews and were further explored in the questionnaires: (1) patient demographics; (2) information received by the participants; (3) installation of the Telehealth technology; (4) Telehealth service functionality; (5) visits; (6) service withdrawal; and (7) service perceptions. Recipients of both services reported feelings of safety derived from the delivery of an integrated, community-based service. Conclusions: Although recipients of the Telehealth service received 50 % fewer home visits from the clinicians than recipients of a more traditional community-based nursing intervention, the patients were enthusiastic about the service, with some describing it as the best service they had ever received. This suggests that a Telehealth intervention is an acceptable alternative to a more traditional home nursing visit model for monitoring community-based patients with COPD following their discharge from hospital.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that presents many challenges for parents and service providers. Unfortunately, there are limited examples of parent-mediated interventions for parents of children with ASD that can help manage behavioral problems, especially those that can be implemented in both urban and rural communities. COMPASS for Hope (C-HOPE) is an 8-week parent-mediated intervention that enhances parent knowledge, behavior management skills, and supportive strategies. Telehealth-based interventions can be especially effective for rural communities due to its ability to address common barriers of geographic location and lack of resources. When implementing this intervention, the ability to decrease child problem behaviors as well as increase parental activation, self-management, perceived competence, and knowledge are essential to determine the efficacy of this treatment. The purpose of the current study is to evaluate these outcomes in the implementation of C-HOPE via telehealth in rural versus urban communities. 20 parents with children from 3-12 years of age with a diagnosis of ASD were sampled from two rural sites and two urban sites in Kentucky. Few differences were noted between the participants in the rural versus urban group at pre-treatment. Following C-HOPE, in the urban area, there were significant treatment effects in parent knowledge outcomes. In the rural areas, a significant effect was found in change of parent self-management skills of toileting issues. Future directions for telehealth treatments for this population are discussed. / M.S. / ASD is a developmental disorder that presents many challenges for parents and providers. Unfortunately, there are limited behavioral treatment options for parents of children with ASD, especially those that can be utilized in both urban and rural communities. COMPASS for Hope (C-HOPE) is a parent intervention that improves parent knowledge, management, and supportive strategies. Technology-based interventions can be especially effective for rural communities due to its ability to address barriers of geographic location and lack of resources. In this intervention, the ability to decrease child problem behaviors as well as increase parental activation, self-management, competence, and knowledge are essential for this treatment to be effective. The current study evaluates these outcomes in C-HOPE using technology in rural versus urban communities. 20 parents with children with ASD, ranging from 3-12 years of age, were sampled from rural and urban areas in Kentucky. Few differences were noted between the participants in the rural versus urban group before treatment. After treatment, in the urban area, there were significant effects in parent knowledge outcomes. In the rural areas, a significant effect was found in change of parent self-management skills. Future directions for technology treatments for this population are discussed.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that presents many challenges for parents and providers while impacting a child's developmental trajectory across several domains, including disruptive behaviors. Unfortunately, due to limited access and affordability of care, especially during the pandemic or other situations that require people to stay at home, in-person services are not always feasible. Rural or underserved communities may face additional barriers, such as geographic isolation and lack of ASD resources. Accessibility of ASD treatment may be expanded through telehealth supports, such as mobile applications. When implementing these supports for autistic children, decreasing child problem behaviors while improving parent stress, knowledge, and competence is crucial. The current study investigated the feasibility and preliminary efficacy of a behavior consultation mobile application, Treks, to improve telehealth support for 26 parents (male = 2) of autistic children (3-13 years). Participants were randomly assigned to a one-session telehealth consultation with 1) the enhancement of the Treks app over the course of one month (TH) or 2) with access to mobile resources comparable to Treks for one month (CC). They were then administered measures at baseline, pre-Treks, and post-Treks to assess changes in parenting stress, knowledge, competence, and child behaviors as well as feasibility metrics. Results indicated that the mobile app was received positively across groups, showing significant improvement in participants enrolled in the TH group from pre- to post-Treks on parenting and child outcomes, in addition to moderate to high satisfaction. Future directions should examine the use of mobile supports to supplement parent training consultations for caregivers of autistic children who present with a range of behavioral difficulties. / Doctor of Philosophy / Autism spectrum disorder (ASD) presents with many challenges for parents and providers. Unfortunately, due to limited access and affordability of care, especially during the pandemic or other situations that require people to stay at home, in-person services are not always feasible. Rural or underserved communities may face additional barriers, such as geographic isolation and lack of ASD resources. Accessibility of ASD treatment can include telehealth (e.g., mobile applications), and should focus on decreasing child problem behaviors while improving parent stress, knowledge, and competence. The current study investigated the feasibility and preliminary efficacy of a behavior consultation mobile application, known as Treks, to improve telehealth support for 26 parents of autistic children (3-13 years). Participants were randomly assigned to a one-session telehealth consultation with access to 1) Treks for one month (TH) or 2) mobile resources comparable to Treks for one month (CC). They were then administered measures at baseline, pre-Treks, and post-Treks to assess changes in parenting stress, knowledge, competence, and child behaviors as well as feasibility. Results indicated that the mobile app was received positively across groups, showing significant improvement in participants enrolled in the TH group from pre- to post-Treks on parenting and child outcomes, in addition to moderate to high satisfaction. Future research should examine the use of mobile apps to supplement parent training for caregivers of autistic children who present with a range of behavioral difficulties.

Since the start of the COVID-19 pandemic, tele-based methods of autism assessment have been relied upon to a previously unparalleled degree; however, the need for such advancements is not new. Observation-based measures are a crucial component of face-to-face autism diagnostic evaluations, but few validated observation tools exist for remotely assessing autism across childhood, particularly for older children and adolescents, providing minimal guidance in this arena. Sanchez and Constantino (2020) previously validated a brief, face-to-face, clinician-facilitated observation coded according to the Childhood Autism Rating Scale, Second Edition (CARS-2). During the pandemic, this measure was adapted as a remote observation (rCARS2 Observation), but has yet to be validated in this format. The current study validated the rCARS2 Observation against the "gold-standard," in-person Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In this sample of 30 children ages 1.97 to 16.66 years (M = 7.35, SD = 4.00), ADOS-2 and rCARS2 Observation total scores were highly correlated (ρ = .644, p < .001). Receiver operating characteristic (ROC) curves optimized rCARS2 Observation cutoff scores to maximize sensitivity and specificity in predicting possible diagnostic classification (88.9% sensitivity, 80% specificity) and ADOS-2 classification (83.3% sensitivity, 70.6%, specificity). At optimal cutoffs, the rCARS2 Observation predicted the correct diagnosis in 82.8% of cases and the same classification as the ADOS-2 in 75.9% of cases. Validation of this instrument provides support for an accessible and efficient remote autism observation. This is crucial in ensuring uniform training and clinical procedures for tele-assessment of autism, to help mitigate long-standing barriers to service access (e.g., geography, cost, availability). / Doctor of Philosophy / During the COVID-19 pandemic, many in-person services, including assessments for an autism diagnosis, were forced to shift to telehealth. When an autism assessment is completed in-person, it requires an "observation-based" measure, meaning that a clinician directly observes a child's behavior, in addition to an interview with a parent or caregiver. Families have faced barriers to accessing in-person autism assessments even prior to the pandemic, including geography, transportation difficulties, shortage of autism-specific providers, and high cost of services. As such, tele-assessment of autism is an important tool to consider in helping families to access these services. However, observation-based autism assessment measures that can be completed through telehealth from families' homes are few and not well-understood. The current study explores a brief telehealth observation tool (the rCARS2 Observation) and compares it to the "gold-standard" autism observation-based tool (the ADOS-2) that is typically used during in-person assessments of autism. This study found that scores on this remote measure and the in-person measure were strongly related and the remote observation measure showed great promise for predicting a diagnosis of autism in this study. This is the first study to explore the rCARS2 Observation to understand how well it can evaluate children's autism characteristics from home as compared with an in-person assessment tool. The success of this remote observation measure in the current study is promising and suggests that this may be one remote tool that clinicians can use in combination with a parent- or caregiver-interview to evaluate a child for an autism diagnosis as a shorter and more accessible tool to overcome many barriers to accessing services.

Bakgrund Kranskärlssjukdom är ett av världens stora hälsoproblem där både insjuknandet och dödligheten är hög.Det finns god evidens för att träningsbaserad hjärtrehabilitering minskar mortaliteten och behovet avsjukhusvård. Trots detta är det i Sverige endast 20% av patienterna som deltar i träning inomcenterbaserad hjärtrehabilitering. En vanlig orsak till lågt deltagande är långa avstånd. Träning förmedladvia E-hälsa har potential att kunna öka tillgängligheten till hjärtrehabilitering. Innan implementeringbehöver effekten utvärderas. Syfte Syftet är att genom en systematisk litteraturöversikt jämföra effekten av träningsbaseradhjärtrehabilitering i klink med träningsbaserad hjärtrehabilitering på distans med hjälp av digital teknik. Metod Den systematiska litteraturöversikten utfördes genom artikelsökningar från databaserna PubMed ochCinahl. Söksträngarna formulerades enligt PICO-modellen. Därefter granskades artiklarna och bedömdesför bias enligt SBU:s formulär ”Bedömning av randomiserade studier”. Resultat Tretton artiklar uppfyllde inklusionskriterierna. De former av E-hälsa som användes varmobilapplikationer, websidor, telefonkontakt, SMS, mail och videomöten. Syreupptagningsförmåga mätt iVo2 peak eller Vo2 max var likvärdig eller bättre i interventionsgrupperna (E-hälsa) jämfört medkontrollgrupperna (sedvanlig vård). Följsamhet till träningen rapporterades vara bättre iinterventionsgruppen än kontrollgruppen och den självskattade livskvalitén som lika god iinterventionsgrupperna jämfört med kontrollgrupperna. Konklusion Resultaten tyder på att träningsbaserad hjärtrehabilitering förmedlad via E-hälsa kan vara lika effektivsom centerbaserad hjärtrehabilitering. Att använda E-hälsa som ett kompletterande hjälpmedel skullekunna göra träning inom hjärtrehabilitering mer lättillgänglig och öka både deltagande och följsamhet.

In the UK angina affects 2 million people (BHF, 2010b) and unfortunately secondary prevention interventions such as Cardiac Rehabilitation (CR) are not widely available for this population (NACR, 2011). This doctoral research project examined the effectiveness and feasibility of an alternative intervention for this population; CR delivered via the internet. The programme was interactive and comprised personalised goal setting orientated around exercise, diet, emotions, and smoking with support available through an online email link or synchronised chat room. A randomised controlled trial (RCT) and semi-structured interviews were used to evaluate the intervention. Primary care patients with angina were randomised to either an intervention group (n=48) or to a control group that did not receive any intervention other than treatment as usual (n=47). Outcome measures were taken at baseline, 6 week and 6 month follow ups. The primary outcome measure was daily steps (measured objectively using Sensewear Pro 3® accelerometer technology). Secondary outcome measures included daily energy expenditure (EE), daily duration of sedentary activity (DDSA), daily duration of moderate activity (DDMA), daily duration of vigorous activity (DDVA), weight, diastolic blood pressure (DBP), systolic blood pressure (SBP), body fat %, fat intake, fibre intake, anxiety, depression, self-efficacy, and health related quality of life (HRQOL). At the 6 week follow up the intervention group had greater improvements than the control group in daily steps, daily EE, DDSA, DDMA, weight, self-efficacy, emotional quality of life and frequency of angina symptoms. In addition, at the 6 month follow up there were significantly greater improvements in anxiety, and frequency of angina symptoms among the intervention group compared to the control group. Semi-structured interviews were also conducted with a subsample of intervention group participants at the 6 week follow up (n=16). Themes resulting from these interviews indicated a high level of programme acceptability and feasibility; ‘self reported improvements’ and ‘programme facilitators’. However, the theme labelled ‘programme barriers’ illustrated intervention related challenges which should be taken into account when delivering the programme. Overall the study demonstrated that a new web based CR programme was effective at improving lifestyle related cardiac risk factors for a primary care angina population in both the short-term (significantly improved daily steps, DDSA, DDMA, weight, self-efficacy, emotional QOL and frequency of angina) and medium-term (significantly improved anxiety, and frequency of angina). These findings on the whole suggest that the programme could be offered to a primary care angina population who are not routinely included within conventional CR. However, there is a need to consider the factors described to affect engagement of the programme; family and work commitments, bad weather, older age, receiving the programme late in angina diagnosis and levels of self-motivation.

Telephone nursing (TpN) care is delivered in a wide range of settings and provides a variety of services to individuals and populations across the age span. Although a viable specialty practice, there is little evidence regarding how the process of care delivery contributes to successful outcomes. To study the effects of TpN care, and to develop appropriate clinical and education interventions, a solid understanding of the process is needed. This study utilized grounded theory method to identify and describe the core concepts of the TpN process, the relationships among these concepts, and the factors influencing the process. Study findings were validated through peer and participant review. Based on interviews with ten telephone nurses from four sites, the following components were identified and organized into a conceptual model of the TpN process. The process generally proceeds through three phases, gathering information to cognitive processing to output. Throughout these phases, the nurse engages in a goal oriented parallel process focusing on both explicit (e.g., verbal, physical) and implicit (non-verbal, contextual) dimensions. Inherent to this parallel process is a two-way interpreting process in which information from the caller is translated into health care language for processing and then health care information is translated back into the language of the caller to identify and meet their needs. Factors influencing the process include prioritization and the level of complexity of the call, resources of the nurse and the organization, and the nurse's desire for validation of the service and the appropriateness of the output. The model highlights the need for research further delineating how implicit information is gathered and processed and how it influences output. Research is also needed on the value of implicit output and on the effects of feedback regarding output on nurse performance and satisfaction. The model suggests that more nursing education should be focused on the sub-processes within the three phases, the interpreting process, and implicit aspects of the process. Finally, the model suggests that formal feedback regarding the quality of call output should be provided and the value of implicit nursing output should be recognized.

Regular physical activity (PA) participation and fruit and vegetable (FV) consumption confers numerous positive health outcomes for cancer survivors, including prevention of cancer recurrence, second primary cancers, and other non-communicable chronic diseases. Rural-living young adult cancer survivors (YAs) possess unique barriers and concerns that influence their ability to participate in traditional face-to-face behaviour change interventions. Few researchers have explored alternative means for delivering behaviour change interventions grounded in theory utilizing a mixed-methods approach to assess processes of change and behavioural outcomes. To fill this gap and provide recommendations for future interventions and services focused on positive health behaviours in this population, the objective of the research presented in this thesis was to explore the feasibility and acceptability of a 12-week theory-based telehealth behaviour change intervention aiming to improve PA and FV consumption using a single-arm, mixed methods pilot trial. Over a 7-month period, 14 YAs self-referred. Of these 14, 5 were eligible and consented to participate with 3 completing the study. Retention to the study was 73% and adherence to the health coaching program ranged from 66.67-100% with a 40% attrition rate. Inquiry into the acceptability of the intervention offered insight into participants experiences, which was summarized within five themes: (1) the more time the better, (2) the human factor, (3) supporting access, (4) influencing the basic psychological needs, and (5) finding motivation. Collectively, the findings suggest the methods used require minor modifications before being deemed feasible despite the general acceptability of the intervention. Importantly, they highlight the necessity of more expansive recruitment strategies and a need to explore participants’ underlying intentions for participating in behaviour change interventions. Further, recommendations are made based on the findings to improve this style of intervention, including testing stepped down models of support because it may help some YAs maintain behaviour change post-intervention.

O ruído ocupacional é considerado o problema que mais atinge o sistema auditivo do trabalhador brasileiro, perturba o trabalho, o descanso, o sono e a comunicação nos seres humanos; prejudica a audição e pode causar ou provocar reações psicológicas, fisiológicas e talvez até patológicas, afetando diretamente a qualidade de vida. A perda auditiva induzida por níveis de pressão sonora elevados (PAINPSE) é considerada uma entre as dez principais etiologias de perdas auditivas populacionais, sendo que, de todas as causas de lesão auditiva, é a que apresenta maior possibilidade de prevenção. Os efeitos auditivos encontrados em trabalhadores portadores da PAINPSE imitam a funcionalidade auditiva, provocando alteração de sensibilidade auditiva, alterações na seletividade de frequências, na resolução temporal e espacial, recrutamento e zumbido. Tais alterações influenciam diretamente a discriminação auditiva, dificultando a percepção, principalmente, dos sons da fala, podendo, também, alterar o padrão de fala de acordo com o grau da perda. O investimento em implantação de programas de conservação auditiva possibilita minimizar os problemas de saúde geral e auditiva, assim como a ocorrência da PAINPSE, promovendo melhor qualidade de vida ao trabalhador. Um trabalho intensivo de promoção da saúde auditiva ou prevenção de perdas auditivas deve ser enfatizado, principalmente para trabalhadores expostos a níveis elevados de ruído ocupacional, além da utilização, de forma adequada, de equipamento de proteção auditiva individual. Sendo assim este estudo teve por objetivo elaborar um material multimídia em tele-educação sobre prevenção de perdas auditivas de origem ocupacional para ser disponibilizado pelas equipes de profissionais do Centro de referência em saúde do trabalhador (CEREST), Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST) e agentes comunitários, em consonância com os objetivos do CEREST. A elaboração do CD-ROM contribuirá para os programas de educação em saúde auditiva fornecendo informações a respeito dos riscos causados por níveis de pressão sonora elevada (NPS). / Occupational noise is considered the issue that most affects the hearing system of the Brazilian worker, disrupts work, rest, sleep and communication in humans, impairs hearing and may cause or provoke psychological reactions, physiological and maybe even pathological, affecting directly to quality of life. Hearing loss induced by high sound pressure levels (PAINPSE) is considered one of the top ten causes of hearing loss population, and of all-cause hearing damage, it has the greatest possibility of prevention. Hearing loss induced by high sound pressure levels (PAINPSE) is considered one of the top ten causes of hearing loss population, and of all-cause hearing damage, it has the greatest possibility of prevention. Auditory effects found in workers with PAINPSE mimic the functionality of the hearing, causing changes in hearing sensitivity, alterations in frequency selectivity, the temporal and space resolution, recruitment and tinnitus. These changes directly affect hearing discrimination, making the perception, especially speech sounds, it can also change the default speech according to the level of loss. Investment in implementation of hearing conservation programs enables minimizing the general health problems and hearing, as well as the occurrence of PAINPSE, promoting better quality of life to the worker. A intensive work health promotion hearing or hearing loss prevention should be emphasized, especially for workers exposed to high levels of occupational noise, and the use, as appropriate, of individual hearing protection equipment. Therefore, this study had the objective elaborate a multimedia teleducation materials on prevention of occupational hearing loss to be provided by teams of professionals from health reference center worker (CEREST), National Network of Integrated Healthcare Workers (RENAST) and community, in line with the objectives of CEREST. The development of the CD-ROM will help education programs in hearing health providing information about the risks caused by high sound pressure levels (SPL).

Foi realizada a elaboração e verificação da eficácia de um conteúdo multimídia online Ouvir bem, viver melhor para aconselhamento informativo aos novos usuários quanto ao uso e cuidados com o aparelho de amplificação sonora individual (AASI). Participaram do estudo 60 indivíduos (26 do sexo feminino, 34 do sexo masculino) com idade entre 29 e 94 anos (média de 69,7 anos), com deficiência auditiva neurossensorial de graus variados, sem experiência prévia com o uso do AASI. Os participantes foram divididos (randomização) em grupo controle (n=30), que passaram pela sessão de aconselhamento informativo e receberam informações por escrito (manual de instrução do AASI) quanto ao uso e cuidados com o dispositivo, e grupo experimental (n=30) que passaram pelo aconselhamento informativo e acessaram o conteúdo multimídia online. Durante o aconselhamento informativo foram utilizadas estratégias facilitadoras para retenção da informação fornecida. O Inventário de Evocação Auxiliada sobre o AASI - HAPRI (Reese e Smith, 2006) foi aplicado para avaliar a evocação da informação a respeito do uso e cuidados com o AASI em três intervalos distintos: (1) antes da sessão de aconselhamento, (2) imediatamente após a sessão de aconselhamento e acesso ao conteúdo online ou manual de instrução do AASI e (3) na consulta de retorno, cerca de uma semana após a adaptação do AASI. A avaliação do manuseio do dispositivo foi realizada por meio do TestePrático das Habilidade de Manipulação do AASI PHAST (Desjardins e Doherty, 2009) nos intervalos 2 e 3. Estas avaliações foram filmadas e pontuadas por um juiz, cego quanto à distribuição dos participantes nos grupos. Os participantes também preencheram um questionário para avaliação do conteúdo Ouvir bem, viver melhor e do manual de instrução do AASI. A pontuação total do HAPRI nos três intervalos de avaliação foram, nesta ordem: 25,3%, 69,7%, 71,2% (experimental) e 25,4%, 68,1%, 71,7%(controle). Para ambos os grupos houve aumento significativo (teste de Friedman) da pontuação total e dos itens do HAPRI entre os intervalos de avaliação 1 e 2 e intervalos 1 e 3. Não houve diferença significativa (teste de Mann Whitney) da evocação da informação entre os grupos experimental e controle, excetuando-se o intervalo 2 onde o grupo controle evocou maior informação sobre como lidar com o AASI quando o dispositivo não estiver em uso. A pontuação total do PHAST nos dois intervalos de avaliação foram, nesta ordem: 76,6%, 83,1% (experimental) e 78,7%, 82,6% (controle). Houve aumento significativo (teste de Wilcoxon) da pontuação total e de algumas tarefas individuais do PHAST entre os intervalos 2 e 3. Não houve diferença das pontuações entre os grupos. Os participantes atribuíram pontuações acima de oito (escala de 0 a 10) quanto ao auxílio fornecido pelos materiais informativos na compreensão das informações quanto ao uso e cuidados com o AASI. Maior pontuação foi obtida para o material online quanto ao conteúdo manipulação do controle de volume. Cerca de 80% dos participantes do estudo relataram que gostariam de ter acesso a um material informativo via computador, em suas residências. Em conclusão, a complementação do aconselhamento informativo por meio de um material multimídia não aumentou a evocação da informação quanto ao uso e cuidados com o AASI ou as habilidades de manipulação do dispositivo. As implicações quanto ao uso de estratégias facilitadoras da compreensão e retenção da informação quanto ao uso e manuseio do AASI são discutidas. / It was carried out the elaboration and efficacy assessment of an online multimedia content (\"Listening well, living better\") for informational counseling to new hearing aid (HA) users regarding use and care of their devices. The study included 60 subjects (26 females, 34 males) aged between 29 and 94 years (mean 69,7 years) with sensorineural hearing loss of varying degrees and no prior experience with HA use. Participants were divided (randomization) into control group (n=30), who went through informational counseling session and received written information (HA instruction manual) regarding the use and care of the device, and the experimental group (n=30) who went through informational counseling and accessed the multimedia content. During informational counseling strategies were used to facilitate retention of the information provided. The \"Hearing Aid Probed Recall Inventory - HAPRI\" (Reese and Smith, 2006) was applied to evaluate information recall regarding the use and care of the hearing aids in three distinct intervals: (1) before the counseling session, (2) immediately after the counseling session and access to online content or HA manual and (3) at the follow-up visit - about a week after the HA fitting. Assessment of how participants handled the devices was carried out via the \"Practical Hearing Aid Skills Test - PHAST (Desjardins and Doherty, 2009) in the intervals 2 and 3. These assessments were videotaped and scored by a judge blinded to the distribution of participants in the groups. Participants also completed a questionnaire to evaluate the content displayed in the \"Listening well, living better\" and HA manual. The HAPRI total scores for the three assessment intervals were, in this order: 25,3%, 69,7%, 71,2% (experimental) and 25,4%, 68,1%, 71,7% (control). For both groups the HAPRI total and item scores increased significantly (Friedman test) between intervals 1 and 2 as well as 1 and 3. There was no significant difference (Mann Whitney) in information recall between the experimental and control groups, except for the interval 2, where the control group recalled more information on how to deal with the hearing aid when the device was not in use. The total PHAST scores for the two evaluation intervals were, in this order: 76,6%, 83,1% (experimental), 78,7%, 82,6% (control). A significant increase (Wilcoxon test) for the PHAST total score and for some of its individual tasks were found between intervals 2 and 3. There was no difference in scores between groups. Participants assigned scores above eight (in a scale of 0 to 10) on the help provided by instructional materials in understanding information regarding the use and care of the hearing aids. Highest score was obtained for material online about the content \"manipulation of volume control.\" About 80% of study participants reported that they would like access to HA informational materials via computer, in their homes. In conclusion, the access to an instructional multimedia material did not increase the recall of information regarding the use and care of the hearing aid, neither the device handling skills. The implications for the use of strategies that facilitate comprehension and retention of information regarding hearing aid use and care are discussed.