Table 3. Items Generated From All Sources Organized According to the Original Conceptual Framework Adapted From ICF Brief Core Set for Hearing Loss.

ICF categorya	Itemsb	Additional items identified by expert focus group
Body functions
Temperament and personality functions	Social confidence, sense of belonging, feelings of inadequacy, and self-image	None
Attention functions	High level of effort to hear, fatigue due to listening effort, and effort interfering with speech processing	None
Memory functions	None	Grocery list recall, remembering to pick up children, and remembering scheduled events
Emotional functions	Worry, anger, upset, denial, boredom, embarrassment, stress, loneliness, shame, confidence, rejection, depression, anxiety, and fear
Seeing functions	Improved vision due to increased reliance
Hearing functions	Hearing warning sounds (general), fire alarms, emergency sirens, telephone ring, doorbell, television and radio sounds, distant sounds, footsteps, traffic sounds, environmental or nature sounds, speech sounds, high and low pitches, a door open, or water drip; hyperacusis; sound localization; tinnitus affecting hearing; hearing in noise; sound quality; sound discrimination; benefits of hearing loss; and hearing sounds on both sides	Hearing household animals, an elevator arrive, or items drop on the floor
Sensations associated with hearing and vestibular functions	Tinnitus; tinnitus affecting relaxation, headache, and balance	None
Voice functionsc	Voice volume modulation, speech production	None
Motivationc	Motivation	None
Onset of sleepd	Tinnitus affecting sleep onset	None
Activities and participation
Listening	Listening to speech on the telephone, speech in noisy environments, birdsong, music, whispering, speech (general), speech in a group of talkers, speech in a traveling vehicle, speech in quiet environments, or television or radio; listening in the dark or in a lecture hall; and identifying familiar voices	None
Handling stress and other psychological demands	Autonomy, ability to care for dependents, and ability to multitask	None
Communication with (receiving) spoken messages	Asking others to repeat, understanding speech with accents, misunderstandings, understanding social conversational cues, and pretending to understand speech	Interpreting emotions
Conversation	Communicating, general conversation, spontaneous conversation, and conversing in a group of talkers	None
Using communications devices and techniques	Conversing on the telephone; reliance on written communication, lip reading, or interpreter	None
Family relationships	Relationships with family members and maintaining long-distance relationships	None
School education	None	Appropriateness of accommodations at school, willingness to use accommodations at school, and academic performance
Remunerative employment	Listening to speech at work, communicating at work, ability to perform duties at work, opportunities at work, fear of termination, and changing job	None
Community life	Volunteer work	None
Informal social relationshipsc	Social withdrawal, social isolation, and altered social interactions	None
Recreation and leisurec	Pleasure of listening to music and environmental sounds and not going to restaurants or noisy social events	None
Intimate relationshipsc	Effects on relationship intimacy	Finding new intimate relationships and selection of partner (hearing vs nonhearing)
Environmental factors
Products and technology for communication	Technical problems with assistive hearing device, battery life, expectations of rehabilitation, empowerment to control hearing, and comfort of assistive device	None
Sound	Strategies to improve listening in distracting sound and strategic seating in noisy environments	None
Immediate family	Expectations of family members	Capacity to support
Health professionals	Quality or support of health care professionals	None
Individual attitudes of immediate family members	Feeling of being a burden to others	None
Societal attitudes	Stigma of hearing loss, societal expectations of hearing, stigma of assistive hearing device, and others thinking you are rude or incompetent	Willingness to make accommodations
Health services, systems, and policies	Quality of health care system and access to health care system	None

Abbreviation: ICF, International Classification of Functioning, Disability and Health.

^aUnless otherwise specified, categories listed are from ICF brief core set for hearing loss.

^bUnless otherwise specified, source of identified item was systematic literature search.

^cAdded categories from ICF comprehensive core set.

^dAdded categories from ICF category not included in either hearing loss core set.