Chapter 4 106 their communication needs and encouraged to use CS in their lives. Also, although the intensity of the counseling was not described in these earlier studies, it can be assumed that this intensity was lower than in the current study. Therefore, our results suggests that a communication group-training might be effective for improving the CS used by employees with hearing loss. Regarding the PA, the scores remained relatively stable or improved, although there seems to be a slight difference between the two centers. The PA score of a greater number of employees improved at AC2 compared to AC1 and the improvement accomplished was also greater at AC2. The PA change scores differed from -5 to 12 at AC1 and from -1 to 24 at AC2 with positive scores representing improvement. Especially the change scores of the employees at AC2 seem to be higher than the mean improvement of 4.78 that was reported in a previous study evaluating the effect of aural rehabilitation strategies, including sensorymanagement interventions, perceptual training, and/or individual instruction or counselling (Van der HoekSnieders et al., 2022). The difference between the two centers in the effect of the communication grouptraining on PA might be explained by differences in the contents of the trainings. The training of AC2 is more intensive than the training of AC1, respectively 22 hours versus 10.5 hours. Also, the individual sessions of AC2 before and after the group training do not take place at AC1. Another difference lies in the homogeneity of the participants. At AC1, employees participated in the training together with nonworking participants, often elderly, whereas at AC2 only employees participated. Lastly, the counselling focused on PA themes at AC2, such as acceptance of the hearing loss and empowerment, whereas this focus was less strong at AC1. Our results suggest that greater improvement in PA might be achieved with a higher training intensity, including only participants that have a job, and including counselling that specifically focuses in PA themes, such as empowerment and acceptance of the hearing loss. For the employees of both centers, no trend towards a decrease in the NFR was observed. This might imply that the NFR of employees with hearing loss does not improve after a communication group-training. Although the sample size of our study was too small to rule out a true effect, our study adds to the body of evidence that current rehabilitation strategies might fail to reduce the difficulties encountered at work by most employees with hearing loss (Gussenhoven et al., 2017; Jennings
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