Barriers and facilitators for older adults in mainland China to purchase hearing aids

Abstract

Timely adoption of hearing aids can effectively mitigate the negative impacts of age-related hearing loss and enhance the overall well-being and quality of life of older adults. Despite these benefits, the global hearing aid adoption rate remains low, even in Western societies where free hearing aids and third-party funding are available. Approximately 66.8 million older adults in mainland China are affected by moderate or greater hearing loss yet the hearing aid adoption rate remains lower than 10%. The current study aimed to investigate the barriers and facilitators for older adults in mainland China to purchase hearing aids, taking into account older adults’ perceptions, attitudes, preferences, and experiences as well as contextual factors such as infrastructure and culture. This thesis contains two qualitative studies (i.e., Study One and Study Two) and one quantitative study (i.e., Study Three). Study One explored barriers to hearing aid adoption among 12 older adults who had consulted ENTs but had not adopted hearing aids. Through semi-structured interviews that were audio-recorded and thematically analyzed, this study identified key themes including: (1) desiring a cure for hearing loss, (2) lack of a perceived need for hearing aids, and (3) negativeimpressions of, and misconceptions about, hearing aids. Study Two focused on facilitators for hearing aid purchase by interviewing 19 older adults who had purchased hearing aids. Key facilitators included: (1) an “active self” who can recognize the need for hearing aids, seek relevant information, and pay for hearing aids; (2) having ENTs who can confirm the need for hearing aids and dispensers who can provide information and hearing aid demonstrations; and (3) having supportive families that can advocate for hearing aids, seek information on hearing aids, assist in visiting hearing aid shops, and provide financial support. Building on these results, a nationwide online survey was conducted for Study Three, which explored the importance of various factors influencing older adults’ hearing aid purchases from the perspective of dispensers. Responses were from 1,537 subjects across 285 cities of 30 provinces, municipalities, and autonomous regions. Friedman test showed that Cost received the highest importance rating for barriers, while Dispenser and shop characteristics, along with ENTs’ suggestions, were rated highest among facilitators. Additionally, the most frequently mentioned barrier in the open-response section was Their family does not support purchasing hearing aids. Overall, the current studies identified a variety of individual and contextual barriers and facilitators affecting hearing aid purchases among older adults in mainland China, from both patient and dispenser perspectives. The research revealed that, beyond the perceptions and attitudes of older adults towards hearing loss and hearing aids, other stakeholders such as families, ENTs, dispensers, and hearing aidusers also play crucial roles at different stages of the purchasing process. Additionally, the under-developed hearing healthcare infrastructure in mainland China, along with the cultural tendencies towards collectivism and filial piety, inevitably influence older adults’ decisions and actions regarding hearing aid purchases. These findings highlight the importance of improving clinician interactions and fostering family involvement to encourage hearing aid adoption among older adults in mainland China.