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| Phases | Stages identified only by CPs | Stages identified only by professionals | Stages identified by both CPs and professionals |
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| Contemplation (or what is going on?) | Noticing the PHI’s communication difficulties | Is the PHI losing interest in their relationship? | Confusion with cognitive impairment; accommodation made to the PHI’s hearing loss; less social interaction leads to frustration and anger; embarrassment by inappropriate PHI responses; feeling of embarrassment, anger, and frustration |
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| Awareness | Recognising the PHI’s dependency on other senses (e.g., visual)
| Observe declining relationships with family members | Nagging and mocking or encouragement and support; changes in the PHI’s communication behaviour; changes in family dynamics and fosters dependency; acting as an interpreter may become overwhelming; concerns for the safety of PHI (smoke alarm, telephone, etc.) |
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| Persuasion | Exploring the information about hearing loss and its treatment; act of persuasion changing relationship dynamics | Implications considered of moving forward (cost, time, etc.) | Helping PHI to become aware of hearing loss, for example, encouragement and persuasion |
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| Validation | | Consider attending a hearing test | Understanding the implications of hearing loss (or not); commitment to facilitate enablement; PHI’s hearing assessment; reactions to results of hearing test |
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| Rehabilitation | Helping the PHI with their hearing instruments; Realising that hearing instruments do not solve all the problems | Hearing aids make the impairment public | Roles in enablement process—whose hearing loss is it? feeling sorry about the PHI’s difficulties |
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| Adaptation | Exploring new ways of dealing with the PHI’s communication difficulties; adapting to regular role sharing to act as an interpreter for the PHI; noticing hearing difficulties themselves and comparing this to the PHI’s difficulties; recognising and reflecting on positive and negative experiences of hearing loss | | |
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| Resolution (or maintenance) | Continued difficulties in communication during social situations; noticing and adapting to gradual progression of hearing loss of PHI | Realizing that life has changed and adaptation is not easy; joy and relief | Realizing that crises are not necessarily hearing related; changes in family dynamics; satisfactory/disappointing outcome |
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