Communication Strategies and Conversational Styles

Successful communication for individuals with hearing loss depends on:
- Listening device effectiveness
- Speechreading skills
- Residual hearing
- Effective use of communication strategies
A communication strategy is a course of action to:
- Facilitate conversation
- Rectify conversational problems
Communication strategies training enhances patients’ abilities to manage listening problems.

Conversation

Conversation is vital for human relationships.
Reasons for conversation:
- To share ideas
- To create meaning
- To relate experiences
- To tell stories
- To express needs
- To effect a result
- To instruct
- To influence
- To establish intimacy
- To build understanding
Conversational rules are implicit and culturally established.
When people converse, they:
- Share interests and commit mental resources.
- Share speaking turns.
- Participate in choosing and developing topics.
- Take turns in an organized fashion (turn-taking or overlapping).
- Maintain topic coherence.
- Provide enough information without being verbose.
Turn-taking:
- One person finishes speaking before the next begins.
- Interruptions are infrequent.
Overlapping:
- Acceptable for partners to speak simultaneously.
- Acceptable for one partner to start before another finishes.
- More common in intimate, spontaneous, and energetic conversations.
Topic coherence:
- Relevance to the conversation topic.
- Sequential ordering of utterances.

Impact of Hearing Loss on Conversation

Conversational rules may need modification when someone has hearing loss.
Quality of conversations differs for those with hearing loss.
Emotional nuances and subtle meanings may be lost.
Keying: A talker’s tone, cadence, lexical emphasis, and prosody imbue an emotional stance to an utterance.
Conversations with hearing loss may include:
- Disrupted turn-taking due to missed cues.
  - When someone comes to an end of a speaking turn, the person often begins to speak slower and his or her intonation contour begins to fall. The person with hearing loss may not hear these signals, and thus, inappropriate silences may occur because he or she does not initiate a conversational turn on cue.
  - In addition, if the person has not understood the message, he or she may be unable to formulate a response or be slow in doing so, and so again, silence ensues.
- Modified speaking and listening styles (slower, precise articulation, more nonverbal cues).
- Modified conversational style (less overlapping).
- Less rich imagery due to omitted details.
- Inappropriate topic shifts.
- Superficial content to avoid difficult vocabulary.
- Frequent clarification.
- Violation of implicit social rules (talking too loudly).
- Disrupted grounding (difficulty establishing common ground).
Grounding: Establishing shared common ground in a conversation.

Commonalities with Older Persons

Conversations with older persons may be slow-paced and repetitive.
Patronizing speech style may be adopted, including:
- Talking about restricted topics
- Using directive speech
- Using childlike expressions
- Speaking very slowly
- Exaggerating nonverbal signals
- Paraphrasing frequently
- Decreasing grammatical complexity
- Talking about fewer topics

Facilitative Communication Strategies

Facilitative strategies influence:
- The talker
- The message
- The environment
- The listener
Instructional strategies: influencing the talker's behavior.
- Example: "Could you face me, please?"
Message-tailoring strategies: influencing message construction.
- Requires metacommunication skill.
- Example: "Did you go swimming or biking last night?"
Acknowledgment gestures: providing feedback to the speaker.
Constructive strategies: enhancing the communication environment.
Adaptive strategies: Counteracting maladaptive behaviors.
- Adaptive strategies serve to counteract maladaptive behaviors and include relaxation techniques and other means of dealing with emotions and negative behaviors that stem from hearing loss.
Maladaptive strategies: inappropriate coping mechanisms.
- Maladaptive strategies include: Bluffing and pretending to understand. Social withdrawal to avoid communication difficulties, dominating conversations so as to be aware of what is being talked, succumbing to feelings of anger, hostility, or self-pity.
- People who characteristically use these kinds of maladaptive strategies have a high incidence of depression $(Williams, Falkum, \& Martinsen, 2015)$ .
Anticipatory strategies: preparing for communication interactions.

Repair Strategies

Repair strategies are used to rectify communication breakdowns.
Receptive repair strategies: used when the listener doesn't understand.
- Repeat repair strategy example: “Could you say that again?”.
- Answer a question repair strategy example: “Who is going to give you a ride?”.
- Key word repair strategy example: “I missed that completely; what are you talking about?”.
Expressive repair strategies: used when the speaker's utterance is unintelligible.
- Expressive repair strategies are used when the sender produces an unintelligible utterance and the communication partner cannot understand it.

Stages of Communication Breakdown

Stages of communication breakdown:
- Detection
- Choosing a course of action
- Implementation
Breakdowns may not be immediately recognized.
Metacommentary: A metacommentary is a comment about the talk or conversation.
Breakdowns are usually repaired with one or two strategies.
Extended repair: multiple exchanges are required.
Repair strategies should not cause topic stagnation or inappropriate shifts.
Bluffing: pretending to understand, which can have negative consequences.
Reasons for bluffing include:
- Avoiding acknowledgment of hearing loss
- Personal vanity and perceived social stigma or self-stigma.
Social stigma is having a condition that is devalued because it deviates from a societal norm and results in a negative status being placed upon a person or group of persons.
People may change the topic to mask incomprehension.
Maxims of conversation (for the listener):
- Maxim of Receive Readily: Pay attention and do not let your mind wander or let yourself be distracted from listening.
- Maxim of Recognize Genuinely: Care enough about what your communication partner is saying that you will make the necessary effort to ensure understanding.

Research on Repair Strategy Usage

Dynamic conversation affects when breakdowns occur.
Topic shading: a new topic is introduced but is a direct offshoot of something that was just being discussed, as in the following example.
Topic shading more disruptive than topic changing.
Topic shading occurs when a new emphasis is derived from an ongoing topic of conversation such that the topic remains the same but the relevant details shift.
Frequency of Bluffing: $(67\%)$ of respondents in classic study likely to pretend to be understanding while keeping silent.
Use of Nonspecific Repair Strategies: research suggests that most individuals are more likely to ask their communication partners to repeat a message following a communication breakdown than to simplify it, restructure it, or elaborate it
- Nonspecific repair strategy: indicates a lack of understanding without providing instruction or other feedback to the communication partner
  - Specific repair strategy: provides explicit instructions to the communication partner about how to repair a communication breakdown
Adjacency pairs: linked speaking turns.
- Adjacency pairs are linked speaking turns. Examples of adjacency pairs include question–answer (e.g., “Who asked?”— “Bob asked.”), greeting–reciprocation (e.g., “Hey there.”— “Hi.”), and summons–acknowledgment combinations (e.g., “Can you come over here?”— “Sure.”).
* Particular repair strategy–response adjacency pairs often emerge when a person with hearing loss interacts with a person who has normal hearing.
Consequences of Using Repair Strategies
Communication partners typically repeat the original message verbatim when nonspecific repair strategies are used.
Restructuring the message is more effective than simply repeating it when communication partners either paraphrased or confirmed the message.
Repeating the message one time was almost equally effective.
repeating the message, people tend to increase loudness, pitch, and duration, so their communication partners with hearing loss are more likely to hear what they say
When people often say “What?” or “Huh?” during a conversation to rectify communication breakdowns, their communication partners are more likely to perceive them unfavorably and to enjoy the interaction less

Tendency to Disclose Hearing Loss

Factors influencing reluctance to disclose a hearing loss:
- Perceived importance of the situation
- Perceived sense of control
- Community affiliation
- Burden of communication
Consequences of Disclosure: Positive or negative consequences of disclosing depend on the communication partner and situation.