General discussion 163 and a speech perception test in noise. The associations between the outcomes of these hearing tests and LE were significant and stronger, although still only moderate. Since themajority of the study population had amoderate degree of hearing loss, this finding suggests that the influence of hearing loss on work functioning does not depend on small differences in the measured degree of hearing loss. These findings imply that for the diagnosis of employees with hearing loss, only performing hearing tests does not suffice. It seems to be important to consider how employees perceive their hearing and their functioning, as well as how they cope with associated difficulties. Part II: Evaluation of professional functioning The study in chapter 3 is the first study showing that the NFR of employees with hearing loss can significantly improve after aural rehabilitation, although the NFR of only part of the employees was improved. Therefore, there seems to be a need to enhance aural rehabilitation practices to accomplish a greater effect on work functioning in employees with hearing loss. Since the change in NFR and LE could significantly be explained by the change in PA, interventions stimulate effective use of PA might be effective for this purpose. In chapter 4, communication group-trainings were under study. These interventions were hypothesized to be effective to improve the PA and the Communication Strategies (CS) of employees with hearing loss, which might also result in improvement of the NFR of these employees. Due to the COVID-19 pandemic, many communication group-trainings were cancelled, which resulted in the inclusion of only 9 employees. Therefore, the statistical power of this study is relatively low. Nevertheless, the descriptive results showed that most employees usedmore adequate CS after the group-training and pointed out to differences in the improvement in PA between the centers. However, no trend towards improvement in the NFR was observed. The results of these studies show that it is still challenging to reduce the difficulties in work functioning encountered by employees with hearing loss. Employees may benefit from a broader intervention that combines sensory management interventions with instruction and counselling, but the effective ingredients of aural rehabilitation remain unclear. There is a need for knowledge on what rehabilitation
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