Chapter 4 98 The outcome Need For Recovery (NFR) has been suggested to be a valuable tool for evaluating the effects of aural rehabilitation services in employees with hearing loss, because of its predictive value of occupational or health problems (Danermark & Gellerstedt, 2004;DeCroonet al., 2003;Mohr et al., 2000;Nachtegaal et al., 2012; Sluiter et al., 2003). NFR is a generic outcome measure that represent the need to recuperate from work-induced fatigue (Van Veldhoven et al., 2015). It is a multidimensional construct that is influenced by personal and work-related factors, such as copingbehavior (Machin & Hoare, 2008) and work demands (Sonnentag & Zijlstra, 2006). Specifically for employees with hearing loss, hearing-related coping behavior was shown to be associated with the NFR (Van der Hoek-Snieders et al., 2020). So far, three studies evaluated the effect of aural rehabilitation services on the NFR of employees with hearing loss (Gussenhoven et al., 2017; Van der Hoek-Snieders et al., 2022; Van Leeuwen et al., 2021). One study did assess the effect of hearing aid uptake only (Van Leeuwen et al., 2021) and the other two studies assessed a multidimensional approach. An individual speech reading training was incidentally offered (Van der Hoek-Snieders et al., 2022) and individual counselling was offered in 14 percent (Gussenhoven et al., 2017) and 31 percent of the included employees (Van der Hoek-Snieders et al., 2022). A positive effect on the NFR was only reported in the last study. It was concluded that the NFR can be improved by aural rehabilitation, although this was only the case in part of the employees. An analysis of the change scores that were associated with change in the NFR revealed that especially interventions that affect personal adjustments (PA) may be promising to reduce the NFR. PA are part of the hearing-related coping behavior and include selfacceptance, acceptance of hearing loss, and having little stress and withdrawal. Instruction or counselling on coping behavior can also be provided in a groupsetting of a communication training. This training includes a speech reading training and instruction or counselling on effective communication strategies (CS) and PA. A group-training might be more effective than individually tailored instruction or counselling, because usually, it takes more time to participate in a group training (‘higher dose of the intervention’) and a group training provides the opportunity to interact with other employees with hearing loss and share experiences (Hawkins, 2005).This training is part of the routine clinical practice of most Dutch audiological centers. In some centers, the communication group-training is provided in separate groups for employees with hearing loss. In other centers, employees with hearing loss participate in this training together with non-working adults. The effects
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