Help-seeking and hearing aid uptake in adults: a qualitative analysis of enablers and barriers

Abstract

Hearing aid help-seeking and uptake have remained consistently low over the past decades despite technological advancements and increased accessibility. Understanding the enablers and barriers that influence these behaviours from the user’s perspective is essential for improving strategies to promote hearing-health care use and to ensure timely intervention for adults with hearing loss. This study, therefore, aimed to provide an in-depth analysis of user perspectives on help-seeking and hearing aid uptake in the United States (U.S.), with particular attention to the experiences of both prescription hearing aid and over-the-counter (OTC) device users.

A qualitative design using an inductive thematic analysis framework was employed. Participants (n=41) were purposively selected using maximum variation sampling from the Hearing Tracker (n=37) and Lexie Hearing (n=4) databases, following an initial survey and consent for virtual interviews. The study's participants had an average age of 69 years (11 SD), ranging from 36 to 88, and 68% were male. Semi-structured interviews were conducted virtually, transcribed verbatim, and analysed using Braun and Clarke’s six-phase thematic analysis approach with ATLAS.ti software. Coding was conducted by the primary researcher and independently verified by co-supervisors, with discrepancies resolved by consensus. Emerging themes and sub-themes were identified and systematically mapped onto the Capability, Opportunity, Motivation: Behaviour (COM-B) model, which provided a structured framework for examining the behavioural drivers influencing help-seeking and hearing aid uptake. Trustworthiness was enhanced through adherence to COREQ guidelines, independent coding, and an audit trail.

The analysis, framed within the COM-B model, identified 20 themes and 55 sub-themes across two domains of (a) enablers and (b) barriers to help-seeking and hearing aid uptake. The study identified Capability factors that highlighted the importance of adjustable features, such as app-based volume control, while negative beliefs about hearing aids deterred engagement, emphasizing the need for targeted counselling. Opportunity factors underscored the role of external support and technological innovations, such as AI integration and Bluetooth connectivity, in increasing hearing aid adoption. Motivation factors, including improved communication and reduced social isolation, supported uptake, but stigma and fear of dependence acted as barriers. OTC users, while prioritising autonomy and affordability, often still sought professional input, indicating a hybrid approach combining self-management with expert guidance.

These findings demonstrate that help-seeking and hearing aid uptake are shaped by a complex interplay of individual capabilities, environmental opportunities, and intrinsic motivations. Targeted counselling, policy reform to reduce financial barriers, and flexible service models that integrate user-led management with professional guidance are needed to improve adoption rates and ensure more adults with hearing loss receive timely and effective intervention.