We all know non-use of hearing aids occurs, but why, and what can we do about it?
Numerous studies have investigated the challenges surrounding the underutilisation of hearing aids, examining factors such as reluctance to seek assistance, the impact of successful hearing aid use on daily life and the role of family members in hearing care. However, there remains a gap in understanding the interplay among these factors.
A recent study aimed to address this gap by examining the perspectives on hearing aid use among individuals with hearing loss and their family members [1]. A total of 332 adults with hearing loss and 313 family members of adults with hearing loss were recruited across Australia, the UK and the USA. The adults with hearing loss were over 50 years of age and had a self-reported hearing loss. The family members of adults with hearing loss were over 18 years of age, had a family member over the age of 50 with hearing loss and did not have a hearing loss themselves.
"The most common reason for the non‑use of hearing aids by people with hearing loss was that hearing aids had never been suggested to them"
All participants were asked to complete an online survey which contained questions about their (or their family member’s) hearing status, attitudes towards hearing aids and hearing loss, experience with hearing aids and reasons for non-use. Participants’ demographic information was also surveyed.
Of the 332 adults with hearing loss, 218 did not use hearing aids, 85 were current hearing aid users, and 29 had used hearing aids in the past but no longer used them now. Nearly all participants in the two latter groups reported having had their hearing tested, while 59% of participants who had never used hearing aids had had their hearing tested. Two thirds of the family members reported the adult with hearing loss had had their hearing tested.
The table below shows the most common reasons given for the non-use of hearing aids. Multiple response options were possible.
In general, the results showed that hearing aid non-users and family members were more likely to report external factors and attitudinal barriers as the reason for having never used hearing aids.
The most common reason for the non-use of hearing aids by people with hearing loss was that hearing aids had never been suggested to them. Research shows that even when a hearing loss is confirmed, there are still significant numbers of adults who are not recommended hearing aids. For example, of a group of US adults who had their hearing loss confirmed by a hearing health professional, only 53% were recommended hearing aids [2]. Studies from the UK and Australia show similar findings; results suggest that half the adults with self-reported hearing loss were not recommended the use of hearing aids by their audiologists. Many respondents also stated that they were advised to wait until their hearing deteriorated further before taking any action [3,4].
"Many respondents also stated that they were advised to wait until their hearing deteriorated further before taking any action"
This low rate of hearing aid recommendation may also at least partly explain the high rate of family members who reported the adults with hearing loss did not think they needed a hearing aid. Other factors could also be that the adult with hearing loss had not (yet) consulted a hearing care professional or were minimising the impact of their hearing loss. Research shows that it is not unusual for family members to be more aware of a deterioration in hearing of somebody close to them.
In comparison to non-users, the reasons given by past users and family members of past users were more aligned and can generally be described as device related. Past users did not like wearing the hearing aids, found them uncomfortable and did not think hearing aids were of benefit. These results are generally consistent with those in the literature. A review by McCormack and Fortnum reported similar results, with hearing aid benefit or value, and comfort and fit reasons cited as the most important reasons for discontinuing the use of hearing aids [5]. Interestingly, not being able to manage hearing aids was also a common reason for no longer using them.
A common reason for all respondent groups was that they, or their family member, would not like wearing hearing aids. It is unclear what the underlying reason for this might be. This could be related to either device or attitude issues as well as stigma-related issues. Hearing loss and hearing aids are often negatively associated with ageing, and this is also reflected in the number of responses suggesting the person with hearing loss would feel old wearing hearing aids.
The implications from this study for hearing care professionals can be summarised as:
- Explore the client’s perspectives and attitudes towards hearing aids.
- If appropriate, discuss hearing aids as a possible solution.
- Involve family members in the audiological rehabilitation process.
- Ensure that any device-related issues post fitting, such as wearing comfort and management, are addressed in follow-up appointments.
Hearing care professionals play a key role in addressing the low uptake and use of hearing aids by people with hearing loss. These findings help inform clinical practice and how to improve audiological rehabilitation outcomes.
References
1. Franks I, Timmer BHB. Reasons for the non-use of hearing aids: perspectives of non-users, past users, and family members. Int J Audiol 2023:1–8 [ePub ahead of print].
2. Jorgensen L, Novak M. Factors Influencing Hearing Aid Adoption. Semin Hear 2020;41(1):6–20.
3. Anovum. Results: EuroTrak UK 2018.
https://www.ehima.com/wp-content/
uploads/2021/02/EuroTrak_2018_UK.pdf.
4. Anovum. Results: AustraliaTrak 2021.
https://www.ehima.com/wp-content/
uploads/2022/03/AustraliaTrak_2021.pdf.
5. McCormack A, Fortnum H. Why do people fitted with hearing aids not wear them? Int J Audiol 2013;52(5):360–8.
Declaration of competing interests: None declared.
