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What are the factors that affect the use [adoption] of hearing aids?

Updated: Aug 5, 2023

This was a question from my Quora postbag. Here's my response:

MarkeTrack data looks at this issue regularly, although it’s skewed to the US market where factors such as health insurance are apparent. Here’s a quote from Hearing Review on the data for non-owners (those who have not adopted hearing aids despite the fact they would benefit):

“Non-owners don’t move to the next stage of hearing assistance for a variety of reasons: they believe that they can hear well enough in most situations; they feel that hearing aids are too expensive; they have other priorities; or they have no coverage/insurance that will assist with acquiring hearing aids. For others, the old stigma about hearing aids still prevails; hearing aids can be perceived as being large and bulky, and/or not provide enough benefit in challenging listening environments to warrant the time and money to obtain them.”

People who do adopt hearing aids do so because they’re having problems hearing, they are the type of people who seek help, they have been told they would benefit from them (hearing test stage), and they don’t have the barriers noted above.

Between eager adopters and total refusers, we have a group of people who have tried aids but been put off by them. This is a tough group to tackle, and in my experience it can put them off trying again for 5–10 years.

With the NHS, we have very accessible hearing aids, albeit relatively basic and not particularly attractive. The service is the issue though, as it quickly fits you with these aids then doesn’t follow up, you have to go back to them with your problems if you need rehab and this is a huge modifiable factor that’s not captured well in research. Therefore people with quite common initial issues, such as difficulty inserting, aids falling off or sound issues (too much background noise, the intrusive sound of your own chewing), fall off the wagon here. They put their aids in a drawer and struggle on for a number of years until they simply can’t cope any more, then they have to return for another go.

There are a lot of these people in the UK, and their factors are really very fixable, they just need more support with the rehab side. Sadly this is almost totally missing in the NHS. There is no “rehab clinic”, only a repair clinic. Rehab is not present at all in internet aid sales or in sufficient quantities with some of the high volume private dispensers who want you in and out of the chair as quickly as possible.

To my mind, if we took more care with NHS rehab, that message of “aids are not good enough to bother with” would not be as widespread, there would be fewer refusers and more positive role models (NHS users who are clearly getting a benefit).


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