The word meaning of empathy, which originates from the Greek word “empathia”, is the ability to understand. Understanding empathy can facilitate the relationship building phase in initiating the therapeutic process, maximizing personal interactions with others, and developing diagnostic and treatment materials. In this context, it is inevitable to have positive returns for both the patient and the healthcare worker. When the literature is examined, studies evaluating empathic skills in our country were mostly conducted with nurses and student groups, and no study examining the empathic skills of audiologists was found. For this reason, this study was carried out to determine the empathic skill levels of audiologists who provide health services in many different fields and are in constant communication with patients or healthy individuals. 130 audiologists working in different fields were included in this study in order to evaluate the empathic tendencies of audiologists. Personal information form including occupational information, Empathic Tendency Scale (ETS), Empathic Skills Scale (ESS) and Rosenberg Self-Esteem Inventory (RSI) were applied to the participants. The questionnaires were sent to the participants electronically with Google Forms and the answers were analyzed using the SPSS program. As a result of the study, ETS and ESS scores of female audiologists were significantly higher than the mean of ETS and ESS scores of male audiologists (p<0.05). It was observed that as the education level increased, the empathic tendency and self-esteem scores increased. ETS mean scores of audiologists with doctorate degrees were significantly higher than those of undergraduate audiologists (p<0.05). As a result of the study, it was determined that audiologists have a high empathic tendency, but they are less successful in their empathic skills. Educational programs should be implemented in a way that will strengthen students' personal and social skills and enable them to communicate effectively with their patients. Empathy and communication trainings to transform the empathetic tendency of audiologists into empathic skills will contribute to the success of audiologists in their fields of work.

Keywords: Audiologist; Empathic tendency; Empathetic skill and Self-esteem.

The word meaning of empathy, which originates from the Greek word “empathia”, is the ability to understand [1,2]. Webster's Dictionary defines empathy as "the ability to project one's own personality onto another's personality in order to better understand the person; the ability to share another's feelings, thoughts, and feelings" [3]. According to Rogers, empathy is the process of understanding and conveying one's feelings and thoughts to the other by putting himself in the place of the other person [4]. 

People are in contact with other living things at every stage of their life. It is possible for people to understand each other and communicate successfully if they accept themselves and other people [3].

One of the most important components of quality health services is health personnel equipped with effective communication skills [5,6] Ward et al., Empathy was first included in the doctor-patient relationship by Southard in 1918 as a resource to facilitate diagnosis and treatment [1]. While the correct and effective use of empathy increases patient satisfaction, it also positively affects the general health status of the patient [7-11]. Effective use of empathy also increases the quality of service [1]. Empathy is complex; multidimensional phenomenon [12,13] Understanding empathy can facilitate the relationship building phase in initiating the therapeutic process, maximizing personal interactions with others, and developing diagnostic and treatment materials. Further research on empathy could further help define and measure verbal and no n-verbal language and facilitate the development of more effective assessment tools [3]. In this context, it is inevitable that it will have positive effects on the patient and health worker. Ensuring patient satisfaction improves trust, adherence to treatment, and physician-patient relationship [12]. All these reasons are important for healthcare professionals to develop their empathic skill levels.

Communication with the patient is an integral part of audio logical services [8]. Understanding the communicative partner as an individual is a necessary step in communicating with the patient and gaining the knowledge necessary to give the patient effective assessment and advice for their hearing and balance problems. This information should be used in the context of the patient's personal experience as the audiologist intervenes in the process along with hearing and balance information. Factors such as language and culture affect the communication process. In addition, the previous experience of the audiologists or other factors such as hearing loss, maladaptive communication strategies and cognitive difficulties that affect the patient/client's ability to communicate effectively with the practitioner will also affect the communication process. It is necessary for the audiologist to understand these factors in order to communicate effectively with the patient [7].

When the literature was examined, studies in which empathy was measured and evaluated were mostly carried out with nurses and various student groups, and no study examining empathic tendency in audiologists was found. For this reason, the research was carried out to determine the empathic skill levels of audiologists who provide health services in many different fields, who are in constant communication with patients or healthy individuals, and who have an important role in the improvement and development of public health. It is aimed that the data obtained as a result of the study will guide the audiologists, strengthen the trust of the patient/client, and in this context, contribute to the successful management of the communication of the audiologists with the patient's relatives and other employees.

This study was carried out in connection with KTO Karatay University Institute of Educational Sciences. The study was approved by the Non-Pharmaceutical and Medical Device Research Ethics Committee with the decision dated 14/01/2022 and numbered 2022/003. A consent form was signed by the participants who agreed to participate in the study.

Participants

Participants were evaluated within the scope of the study on a voluntary basis from audiologists working in different titles and different fields of the profession throughout Turkey. Only individuals who have graduated from the audiology undergraduate department and are practicing their profession were included in the study. Individuals with a bachelor's degree in audiology who did not fulfill their profession were excluded from the study. A total of 130 audiologists between the ages of 25-45 were included in the study.

>Data Collection

The form used in this study consists of four parts. The data obtained are filled in by the participants in the study, their level of education, the "Personal Information Form" consisting of questions about the fields they have worked or are working in, "Empathetic Tendency Scale", "Empathetic Skills Scale" and "Rosenberg Self-Esteem Inventory". The forms were sent to the participants in the study via Google Forms and the questionnaires were collected at the end of the time given to the participants.

Analysis of Data

The demographic information distribution of the participants was analyzed by frequency analysis. Compliance of the scores obtained for the Empathic Skill Scale, Rosenberg Self-Esteem Scale and Empathic Tendency Scales and their sub-dimensions with normal distribution was examined by Kolmogrov Smirnov and Shapiro Wilks test. The averages of the scores of the scale and its sub-dimensions according to the demographic information and whether the difference between these averages is significant or not was examined by t-test and one-way analysis of variance in independent groups. If there is a significant difference between the groups as a result of the one-way analysis of variance, the TUKEY test was used to determine which group the difference originated from. Correlation analysis was performed to determine the relationship between the scales and the Pearson correlation coefficient was obtained. Analyzes were performed with SPSS 20.0 software at 95% confidence level.

Personal Information Form

The "Personal Information Form", which consists of questions about the education levels of the audiologists participating in the study, and the fields they have worked or worked in before, was filled in by the participants.

Empathic Tendency Scale

The scale developed by Dokmen to measure empathic tendency has 20 questions with 5 answer options. Some of the questions are for cognitive and some are for emotional empathy. The number marked for each item determines the participant's score for that item. The scores that can be obtained from the scale range from 20 to 100. It is thought that if the participants get a high score from the scale, they have a high level of empathic disposition, and if they get a low score from the scale, they have a low level of empathic disposition.

Empathic Skill Scale

The Empathic Skills Scale form was developed by Dokmen and consists of short paragraphs containing 6 different situations related to daily life. Under each situation, there are 12 response sentences that can be answered against the person who encounters this situation. A total of 72 empathic responses are presented to the participant in writing, with 12 responses for each situation related to daily life. Participants are asked to find 4 responses out of 12 response sentences as the most important ones. There are 6 distracting responses in the scale, and these responses are included in the scale to evaluate the attention of the participants. The 4 responses chosen by the participants are scored, and the total score they get as a result of a total of 24 responses is calculated. If even one of the irrelevant responses is chosen by the participant, the form is excluded from the evaluation on the grounds that the participant did not read the scale sufficiently [13].

Rosemberg Self-Esteem

Inventory In this study, the Rosenberg Self-Esteem Scale was used to measure the self-esteem of audiologists. RSI Rosenberg is a widely used questionnaire to measure self-esteem in English-speaking countries. Internationally, it has also been used in persuasive research among nursing staff [15-17]. The Turkish validity and reliability study of the scale was performed by Cuhadaroglu (1986). The lowest score that can be obtained from the scale is 10 and the highest score that can be obtained is 40. The highest possible score, 40, indicates a high level of self-esteem [15].

Results Variation of Scales by Gender According to the t-test results in independent groups, while there was a significant difference according to gender in the empathic skill scale and the Rosenberg self-esteem scale (p<0.05), no significant difference was observed between male and female participants in the empathic tendency scale. While women's empathic skill level was significantly higher than men's empathic skill level, men's Rosenberg self-esteem levels were significantly higher than women's self-esteem levels.

Table 1: Means of Empathic Skills Scale, Rosenberg Self-Esteem Scale and Empathic Tendency Scales by gender, *p<0,05.

Variation of Scales by Educational Status

According to the results of one-way analysis of variance, there was a significant difference according to educational status in the empathic skill scale and the Rosenberg self-esteem scale (p<0.05), while no significant difference was observed in the empathic tendency scale according to the education level. In the Empathic Skill Scale, the empathic skill level of college/faculty graduates is significantly higher than undergraduate and doctoral graduates. In the Rosenberg self-esteem inventory, the self-esteem levels of people with Doctorate education is significantly higher than those with college/faculty and undergraduate degrees.  

Table 2:Averages of Empathic Skills Scale, Rosenberg Self-Esteem Scale, and Empathic Tendency Scales by education level, *p<0,05.

Variation of Scales by Field Worked in the Institution According to the results of one-way analysis of variance; while the empathic skill scale and the Rosenburg self-esteem inventory differed significantly according to the field of study in the institution (p<0.05), it was seen that the empathic tendency scale did not differ significantly. For the Empathic Skill Scale, the empathic skill level of the hearing aid company and rehabilitation center employees is significantly higher than the hospital/clinic, implant center and academicians. For the Rosenberg self-esteem inventory, the self-esteem level of implant center employees and academics is significantly higher than that of rehabilitation center and hospital/clinic employees.

Table 3: Averages of Empathic Skills Scale, Rosenberg Self-Esteem Scale and Empathic Tendency Scales according to the field of study in the institution, *p<0,05.

Inter scale Relations

Correlation analysis was performed in order to determine the relationships between the scales and analyzed with Pearson correlation analysis. According to this; there is a negative correlation between the empathic skill scale and self-esteem at the level of 28.3%, and a negative correlation at the level of 28.3% with the empathic tendency. There is a positive and significant relationship at the level of 48.4% between self-esteem and empathic tendency.

Table 4: Correlation analysis to determine the relationships between the scales, *p<0,05.

The importance of the physician-patient relationship has been recognized throughout the history of medicine. In a systematic review of the literature, Di Blasi found that doctors who adopt a warm, friendly, and reassuring demeanor are perceived as more effective than those who keep consultations official. Empathy has been found to facilitate better outcomes for both patients and doctors [19-21]. Empathy has also been stated to be an important trait for other healthcare professionals, including pharmacists, nurses [22,23].

Mete and Gercek stated in their study that when nurses approach patients with an empathetic attitude, they can determine the needs of patients more accurately and achieve more positive results in this direction [24]. The individual who feels understood by the healthcare provider thinks that he or she is taken care of. In the case of a mixed trust environment, the patient will also have a positive approach to the treatment that will be applied to him. It has been observed that when the individual feels that he is in a safe environment, the rate of recovery increases and the negative consequences of treatment and care decrease [25,26]. It has been stated that when healthcare professionals respond to patient problems with empathy, patients are more motivated to set and develop their own goals [27].

In studies conducted in Turkey, it has been observed that there are differences between genders in the mean of ETS. In the results of the studies, it has been reported that the mean of ETS of women is significantly higher than the mean of men [28to30]. This situation is thought to be related to the fact that women are more emotional than men [31]. On the other hand, in our study, the ETS scores of male individuals were found to be higher than female individuals. But the difference is not significantly high. The reason for this was thought to be the unequal number of male and female participants in the study.

Empathic skill is the ability to understand the cognitive and emotional reactions, perceptions, thoughts and behaviors of individuals and to give appropriate feedback. When we examine the studies in the literature on this subject; in the study that Arifo?lu conducted with the participation of first-year nursing students, examining the relationship between empathy and communication skills and academic achievement scores, the Empathic Skills Scale (ESS) average score was found as 131.05 ± 14.82 [32]. Again, in the study of Mete and Gercek in which they examined the empathic disposition and empathic skills of problem-based nursing students, it was observed that the students' mean ESS score was 130.78 ± 18.66 [24]. As a result of our study, the empathic skill means score of audiologists was found to be 125.8. The reason for this difference can be considered as the fact that the sample studies were carried out among students and our study was carried out between undergraduate graduates and people with work experience. It can be thought that a certain work experience negatively affects the development of empathic skill.

It was observed in parallel with the empathic skill scale that the mean scores of the empathic tendency scale were higher in females than males. In Sen's study, in which he examined the empathic skill levels of health workers, he observed that women's empathic skill scores were higher than men's [33]. In parallel, in our study, it was observed that while the EES scores of the female participants were 132.5, the EES scores of the male participants were 115.4, which was lower than that of the female participants. Again, this situation can be based on the fact that the emotional aspects of female individuals are heavier than male individuals.

When examining the relationship between ESS scores according to education levels, it was observed in the studies in the literature that as the education level increases, empathic skills increase. Akgun examined communication skills and empathic skill levels in nurses, found that the empathic skill scores increased as the education level increased [34]. Similarly, Pek examined the empathic skills of nurses and observed that the level of empathic skills increased as the education level increased [35]. Van Eckert et al., in their study on 212 German nurses, found that as academic education increases, their self-esteem levels increase significantly, and they concluded that academic success leads to higher self-esteem [36]. According to the results of our study, while the empathic skill scale and the Rosenberg self-esteem scale differed significantly according to education level (p<0.05), it was seen that the empathic tendency scale did not differ significantly according to education level. For the empathic skill scale, the empathic skill level of college/faculty graduates is significantly higher than undergraduate and doctoral graduates. For the Rosenberg self-esteem inventory, the self-esteem levels of people with doctoral education were found to be significantly higher than those with college/faculty and undergraduate degrees, which is consistent with the studies in the literature.

In Celik's study, in which he examined the results of empathic tendency in preschool teachers according to education level, no significant relationship was found between the two premises [37]. In our study, unlike the studies in the literature, it was observed that the empathic tendency scores increased as the education level increased. Empathic disposition requires attitude and personality change rather than a skill or cognitive development. Therefore, it is not easy to change the empathetic disposition. A longer-term education is needed to change the empathic tendency [24]. It is thought that the social, cultural, educational and characteristic differences between the individuals participating in both studies may cause the difference in ETS scores.

No significant results could be found in the literature regarding the relationship between self-esteem and education level [38]. In our study, it was observed that the level of education made a significant difference on the level of self-esteem, and it was concluded that the higher the education level, the higher the Rosenberg Self Esteem Inventory scores.

he limited number of participants, the unequal number of male and female participants, and the unequal distribution of the number of participants in the groups are the limitations of the study. It is recommended that this subject be studied with a larger number of participants in future studies.

In this study, in order to evaluate the empathic disposition levels of audiologists, the Empathic Tendency Scale (ETS), Empathic Skills Scale (ESS) and Rosenberg Self-Esteem Inventory (RSI) were filled in by the audiologists. As a result of the study, it was determined that audiologists have a high empathic tendency, but they are less successful in their empathic skills. The empathic skills of audiologists affect their relationship with the patient. Theoretical and practical skills given in audiology undergraduate education form the basis of these relationships and play a role in healthy communication. For these reasons, it is important that it takes place in the courses given since undergraduate education in terms of the development of empathic skills. Although empathic tendency is one of the emotional qualities of individuals, it has been proven by studies that it can be developed with education. For this reason, communication skills and empathic skills of audiologists should be investigated and necessary training should be included in their education life and/or service. The fact that audiologists are so together with patients/clients and are in constant communication plays an important role in the diagnosis, treatment and rehabilitation process, as also included in this study.

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Corresponding Author: Seyma AL, Department of Audiology, KTO Karatay University, Turkey. E-mail: alseymaa@gmail.com

Copyright: © 2022 All copyrights are reserved by Seyma AL, published by Coalesce Research Group. This work is licensed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.