General discussion 159 as a health domain, although communication restrictions are one of the most important consequences of hearing loss. Another difficulty is that there is no consensus about what generic questionnaire should be used in employees with hearing loss. The reported prevalence of generic questionnaires for employees with hearing loss was shown to be extremely low, which was even true for established questionnaires, such as the SF-36 (Ware, 1993) and the Health Utility Index Mark III (HUI3) (Feeny et al., 1995). In the studies of this thesis, we focused on hearing- and/or work-specific questionnaires. Many hearing-specific questionnaires are available (Bentler & Kramer, 2000; Granberg, 2015), but again, the reported prevalence of these questionnaires is very low (Granberg et al., 2014). This may reflect a lack of consensus regarding the most appropriate questionnaires for adults with hearing loss. At the audiological centers that participated in the studies of this thesis, the Speech, Spatial, and Qualities of hearing scale (SSQ) is used to inventory the extent of listening difficulties during several daily life activities (Gatehouse & Noble, 2004). This questionnaire has been developed and validated for adults with hearing loss, and not specifically for employees with hearing loss. At the participating centers in the studies of this thesis, the NFR scale from the QEEW(Van Veldhoven&Broersen, 2003) was used to assess the need to recuperate from work-induced fatigue. This scale is easy to administer and the outcome is a predictor of occupational and subjective health problems, such as stress complaints. In chapter 3, the NFR of employees with hearing loss was significantly lower after receiving aural rehabilitation, which suggests that the NFR scale might be sensitive to detect change in employees with hearing loss who receive aural rehabilitation. Although the content validity of the scale is sound, only limited research has been performed regarding the longitudinal validity of the scale. The Dutch ACHW includes questions that are related to the participation of employees with hearing loss, such as the six questions about the effort and concentration it takes toperformsix hearing-related auditory job tasks.The questions have good internal consistency (Kramer et al., 2006; Van der Hoek-Snieders et al., 2020), but the scale has not been standardized and validated. As far as we know, a validated, hearing specific, and work specific questionnaire is currently not available (Granberg & Gustafsson, 2021; Tufts et al., 2009).
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