Yes / Aims To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. Design Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012–June 2013. Findings Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. Conclusions The mainstreaming of telehealth hinges on clinical ‘buy-in’. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice. / Technology Strategy Board and the Economic and Social Research Council

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 pilot randomised controlled trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. Methods: A two-arm pragmatic pilot RCT was conducted comparing the standard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT. The co-primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients’ self-reported quality of life. The objectives were to assess the suitability of the methodology, produce a sample size calculation for a full RCT, and to give an indication of cost-effectiveness for both pathways. Results: Sixty three participants were recruited (n = 31 Standard; n = 32 Telehealth); 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm. Recruitment was slow with significant gaps in data collection, due predominantly to an unanticipated 60% reduction of staff capacity within the clinical team. The sample size calculation was guided by estimates of clinically important effects and COPD readmission rates derived from the literature. Descriptive analyses showed that the standard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group. Telehealth was cost-effective only if hospital admissions data were excluded. Conclusions: Slow recruitment rates and service reconfigurations prevented progression to a full RCT. Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team, in this case, challenges arose when resources within the team were reduced by external events. Gaps in data collection were resolved by recruiting a research nurse. This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions, and provides recommendations for the introduction and evaluation of complex interventions within clinical settings, such as prioritisation of research within the clinical remit.

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.

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.

Os aspectos de qualidade técnica e de conteúdo do website Portal dos Bebês Fonoaudiologia, seção Aparelho Auditivo foram verificados por fonoaudiólogos e pais de crianças deficientes auditivas usuárias de aparelho de amplificação sonora individual (AASI). Participaram do estudo: grupo A: 109 profissionais (três homens e 106 mulheres) com idade média de 31,6 anos, residindo nas regiões Sudeste (n=64), Sul (n=23), Norte/Nordeste/Centro Oeste - NNC (n=22) e que atuavam em hospital/clinicas privados (n=37) e públicos (n=29), universidades (n=28) e outros (n=15) e grupo B: 21 pais (seis homens e 15 mulheres), com idade média de 31,4 anos, residentes predominantemente na região Sudeste. Os participantes preencheram anonimamente um formulário online disponível no website com perguntas sobre dados demográficos, uso da internet e orientação fornecida no momento da adaptação do AASI. Também responderam às perguntas sobre a qualidade técnica do website - questionário Emory que compreende as subescalas precisão, autores, atualizações, público, navegação, links e estrutura (grupo A) e conteúdo do website (grupos A e B). Para o grupo A não houve diferenças significantes no que se refere à satisfação com o tempo disponível e desempenho nas orientações na adaptação entre os grupos por região ou local de trabalho. O grupo B estava satisfeito com as orientações recebidas. Materiais informativos foram oferecidos apenas para 52,4% dos pais. A média da pontuação das subescalas do Emory foi superior a 4,5. Diferenças pequenas, mas significativas foram encontradas nas subescalas precisão, autores, público e links externos com a navegação, e autores, público e links esternos com estrutura. Os profissionais avaliaram o conteúdo do site como sendo bom ou muito bom. Houve diferença entre a pontuação atribuída aos conteúdos tipos de AASI e limpeza e cuidados com o AASI. Não houve diferenças da avaliação técnica entre os grupos por região ou local de trabalho indicando a adequação do website para diferentes regiões e populações atendidas em serviços distintos. Diferenças da pontuação dos conteúdos escolha do melhor AASI para a criança, limpeza e cuidados com o AASI, colocar/retirar o AASI da orelha, uso unilateral ou bilateral, partes do AASI e uso do telefone encontradas entre regiões e local de trabalho tornam necessárias suas adequações. Para o grupo B não houve diferença entre as pontuações dos conteúdos do website. A pontuação atribuída ao conteúdo e a satisfação com o website estava relacionada à idade da criança, tempo de uso do AASI e conhecimento prévio a respeito dos tópicos do AASI. O website foi considerado pelos participantes como sendo útil para complementação da orientação aos pais de crianças deficientes auditivas usuárias de aparelhos de amplificação sonora individuais. / Technical quality and content of the website Babies`Portal - Speech, Pathology and Audiology\", \"Hearing Aids\" section were assessed by audiologists and parents of hearing impaired children fitted with hearing aids (HA). Participated in the study: group A: 109 professionals (three men and 106 women) with mean age of 31.6 years, residing in the Southeast (n = 64), South (n = 23), North/Northeast/Midwest - NNC (n = 22) regions, who worked in private (n = 37) and public (n = 29) hospitals/clinics, universities (n = 28) and others (n = 15). Group B: 21 parents (15 men and six women), mean age 31.4 years, the majority of them resident in the Southeast regions. Participants completed anonymously an online questionnaire available on the website. The questionnaire comprised questions about demographics, internet use and the informational counseling provided at the time of hearing aid fitting. It also contained the Emory questionnaire for the assessment of the websites accuracy, authorship, updates, public, navigation, links and structure (group A) as well as questions regarding the websites content (groups A and B). For group A no significant differences were found between regions and workplace with regard to satisfaction with available time and performance in the informational counseling sessions. Group B was satisfied with information counseling provided at the time of HA fitting. Educational materials were provided for only 52.4% of parents. Emory subscales scores were over 4,5. Small but significant differences were found between the navigation subscales and accuracy, authorship, public and external links subscales as well as between structure subscale and authorship, public and external links. There were no differences in technical evaluation between regions or workplace indicating the suitability of the website for different regions and populations served in different services. The professionals evaluated the website\'s content as being good or very good. There were differences between the scores assigned to the contents \"hearing aid types\" and \"hearing aid care and maintenance\". Small but significant differences were found for the contents \"choosing the best hearing aids for your child\", \"hearing aid care and maintenance\", \"hearing aid insertion and removal, unilateral or bilateral hearing aid use, \"hearing aid parts\" and \"telephone use\" between region and workplace, thus indicating the need for their improvement. For group B no differences were found between contents scores. The total content score and overall satisfaction with the website were correlated to the hearing impaired childs age, duration of hearing aid use and prior knowledge about hearing aids. The website was considered by the participants as being useful to complement the informational counseling provided to parents of hearing impaired children at the time of hearing aid fitting.