Accessibility statement

ACE To Hear – A feasibility trial of delivering the Active Communication Education programme to unsuccessful new hearing-aid users

Active Communication Education (ACE) along side hearing aid use may improve quality of life for those with impaired hearing; but it was unclear if a trial would be feasible. We found that ACE appeared acceptable and feasible to deliver, but it was not feasible to identify and recruit participants.

Why did we do this research?

Hearing aid use can reduce the negative impact of age-related hearing impairment on quality-of-life, but it is estimated that up to 30% of UK adult hearing aid owners do not use them regularly or at all. The Active Communication Education (ACE) programme trains participants to develop solutions to their own specific difficult communication scenarios that commonly lead to their avoidance of, or reduced participation in, daily activities. The effect of ACE to enhance hearing aid benefit had not been evaluated.

What did we do?

We carried out a randomised controlled, open feasibility trial with embedded economic and process evaluations. Participants were randomised to ACE and usual care or usual care only. The primary outcomes were related to feasibility: recruitment, retention, treatment adherence, acceptability to participants and fidelity of treatment delivery. Secondary outcomes included use of hearing aids, and quality of life.

Who was involved?

Recruitment was from two participating centres: York Hospital, York Teaching Hospitals NHS Foundation Trust, and Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust. Twelve hearing aid users aged 18 years or over who reported moderate or less than moderate benefit from their new hearing aid and six significant others consented to take part. Of these, eight hearing aid users were randomised: four to each group. Four significant others participated alongside the randomised participants.

What did we find?

Recruitment to the study was very low and centres only screened 466 hearing aid users over the 15-month recruitment period, rather than the 3500 anticipated. ACE could be delivered and appeared acceptable to participants. We were unable to robustly assess attrition and attendance rates due to the low sample size.

While ACE appeared acceptable to hearing aid users and feasible to deliver, it was not feasible to identify and recruit participants struggling with their hearing aids at the 3-month posthearing aid fitting point.


Watson J, Coleman E, Jackson C, Bell K, Maynard C, Hickson L, Forster A, Fairhurst C, Hewitt C, Gardner R, Iley K, Gailey L, Thyer NJ. Randomised controlled feasibility trial of an active communication education programme plus hearing aid provision versus hearing aid provision alone (ACE To HEAR). BMJ Open. 2021 Apr 7;11(4):e043364. . PMID: 33827834.

Thyer NJ, Watson J, Jackson C, Hickson L, Maynard C, Forster A, Clark L, Bell K, Fairhurst C, Cocks K, Gardner R, Iley K, Gailey L. Randomised controlled feasibility trial of the Active Communication Education programme plus hearing aid provision versus hearing aid provision alone (ACE to HEAR): a study protocol. BMJ Open. 2018 Aug 1;8(7):e021502. . PMID: 30068614.

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Department of Health Sciences, University of York, York


  • Cath Jackson

Valid Research Ltd, Wetherby


  • Christina Maynard
  • Nicholas J Thyer

Leeds Institute of Cardiovascular & Metabolic Medicine, Univerity of Leeds, Leeds


  • Louise Hickson

School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane


  • Anne Forster

Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford


  • Rob Gardner

Audiology Department, Bradford Royal Infirmary, Bradford


  • Kate Iley

Audiology Department, York Teaching Hospital NHS Foundation Trust, York


  • Lorraine Giley

Hearing Link, Eastbourne


The research was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0215-36147). The project was started in February 2017 and completed in January 2019.

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