Why Is It That a Person Cannot Go Back to Wearing a Hearing Aid Again in That Ear?
Int J Audiol. 2013 May; 52(5): 360–368.
Why do people fitted with hearing aids not wear them?
Abby McCormack
NIHR Nottingham Hearing Biomedical Enquiry Unit of measurement, School of Clinical Sciences, University of Nottingham, Great britain
Heather Fortnum
NIHR Nottingham Hearing Biomedical Enquiry Unit of measurement, School of Clinical Sciences, University of Nottingham, Britain
Received 2012 Aug thirty; Accepted 2013 Jan 12.
Abstruse
Objective:
Historic period-related hearing loss is an increasingly of import public wellness problem affecting approximately 40% of 55–74 yr olds. The chief clinical management intervention for people with hearing loss is hearing aids, withal, the majority (fourscore%) of adults aged 55–74 years who would benefit from a hearing aid, do non utilise them. Furthermore, many people given a hearing assist do not wearable information technology. The aim was to collate the available testify as to the potential reasons for not-use of hearing aids among people who have been fitted with at least 1.
Design:
Data were gathered via the utilize of a scoping study.
Written report sample:
A comprehensive search strategy identified x articles reporting reasons for non-use of hearing aids.
Results:
A number of reasons were given, including hearing help value, fit and comfort and maintenance of the hearing aid, attitude, device factors, financial reasons, psycho-social/situational factors, healthcare professionals attitudes, ear problems, and appearance.
Conclusions:
The virtually important issues were around hearing assistance value, i.due east. the hearing help not providing plenty do good, and comfort related to wearing the hearing aid. Identifying factors that affect hearing aid usage are necessary for devising advisable rehabilitation strategies to ensure greater use of hearing aids.
Keywords: Aging, hearing assistance
Age-related hearing loss is the most common form of sensorineural hearing loss (Gratton & Vazquez, 2003). A review of the prevalence of historic period-related hearing loss in Europe (Roth et al, 2011) found that by age seventy years approximately thirty% of men and twenty% of women have a pure-tone average (PTA) hearing loss of xxx dB or more than in the better ear, and 55% of men and 45% of women by age 80 years. Issues with hearing and communicating are frustrating, and touch on on the affected individuals besides every bit other people in their environment (Arlinger, 2003). Information technology has been firmly established that hearing loss is associated with poor quality of life amid older people (Chia et al, 2007; Heine & Browning, 2004), and may even lead to poor general health and mood disorders such as depression and anxiety (Gopinath et al, 2009), equally well every bit increased mortality risk (Karpa et al, 2010).
The primary clinical management intervention for people with hearing loss is hearing aids but not all people with some measurable form of hearing loss are candidates for hearing aids (Kochkin, 2009). At that place are a number of interventions for people with hearing loss, such as auditory rehabilitation, counselling, instruction, and assistive listening devices. For those who are candidates, the average age of a first time hearing aid user is 74 years old, with many having suffered a significant hearing loss for an average of ten years before receiving a hearing aid (Davis et al, 2007). Despite the negative consequences associated with hearing loss, only one out of v people who could do good from a hearing assist actually wears ane (World Health Organization, 2006). Based on information from the 1999–2006 cycles of the National Health and Nutritional Examination Surveys (NHANES) in the U.s.a., Chien and Lin (2012) written report that one in seven individuals anile 50 years or older with a hearing loss uses a hearing aid. Overall, the prevalence of hearing aid use increases with every age decade from 4.3% for adults aged 50–59 years, to 22.1% for adults aged 80 years and older. Chien and Lin (2012) approximate that nearly 23 million adults in the United States have a hearing loss (PTA 25 dB hearing level or greater in both ears) but do not use hearing aids.
Numerous studies have examined hearing aid usage, including a contempo systematic review of studies measuring and reporting hearing aid usage in older adults since 1999 (Perez & Edmonds, 2012). They found there was a lack of consistency and robustness in the way that usage of hearing aids was assessed and categorized. Fifteen different methods were identified for assessing the usage of hearing aids, then it is articulate that there is no standard tool for evaluating hearing help usage. Furthermore, historically, hearing aid buying and regular employ of hearing aids has been found to exist low (Popelka et al, 1998; Upfold & Wilson, 1980; Weiss, 1973) and the numbers of people given a hearing aid who do non wearable it/them ranges from 4.7% (Hougaard & Ruf, 2011) to 24% (Hartley et al, 2010).
In the 1980s, (pre-digital hearing aid era) in a follow up study of 150 people fitted with a hearing assist in Finland, 23% reported never wearing their hearing assistance two years later on they had been fitted (Sorri et al, 1984). The reasons given included problem treatment the aid and footling opportunity to converse with others. Brooks (1985) too constitute that reasons given for non-use of hearing aids included difficulty inserting the ear mould, difficulty coping with signals in noise, lack of recognition of hearing loss, advanced age and poor health, and less than ideal matching of the aid to the loss of hearing. It might be expected that virtually three decades later, reasons for non-use of hearing aids might be quite dissimilar, peculiarly given the improvements in hearing aids typically available. Digital hearing aids now offer a number of advantages over analogue hearing aids including increased condolement; digital feedback reduction; digital noise reduction; digital speech enhancement, automatically switching listening programmes, directional microphones, and remote controls, as well as smaller size and open fit design. Benefits of digital hearing aids also include improved sound quality, multiple listening programs for unlike listening environments, compatibility with remote command options, and flexibility in manipulation of the frequency, compression, and gain (Davis, 2001). Equally such, audiologists at present take greater flexibility in choosing advisable technology for the needs of older adults.
Despite the improvements in hearing aids, usage is still low and the underuse of hearing aids among older adults is notwithstanding of significant concern. Hearing aid usage has been plant to improve quality of life issues, specifically improving communication in relationships; intimacy and warmth in family relationships; emotional stability; sense of control over life events; perception of mental functioning and physical health (Kochkin, 2012). If a patient does not wear their hearing assist so it could impact on their quality of life as well equally others around them, and may besides increase their risk of depression and feet (Gopinath et al, 2009). In countries where in that location is access to quality audiological services, it is imperative to resolve why people fail to utilize their hearing aids (Goulios & Patuzzi, 2008). Identifying factors that affect hearing aid usage is necessary for devising advisable rehabilitation strategies to ensure greater use of hearing aids.
The majority of literature on the reasons for non-use of hearing aids was published earlier the introduction of digital hearing aids in the NHS in the United kingdom of great britain and northern ireland. Given that digital hearing aids were designed to offer practical and clinical advantages over analogue hearing aids information technology might therefore be reasonable to wait an increase in the numbers of people wearing their hearing aids over this period. However this has not happened. The reasons are not clear as to why some people who demand hearing aids and possess them do not utilize them. Therefore in that location is a need to wait at the literature over the by decade examining the reasons for non-utilise of hearing aids. We might also look a deviation in reasons for non-employ between gender and age, considering that women written report a higher prevalence of daily and regular use of hearing aids (Staehelin et al, 2011), and Kochkin (1993) institute that adults aged 35 to 44 were twice as likely to cite stigma as a reason to reject a hearing help, compared to adults anile 75 to 84 years old. This review attempts to collate the bachelor testify equally to the potential reasons for non-use of hearing aids amid people who take been fitted with them and suggests priority areas for hereafter research based on these findings.
Method
Design
Information were gathered via the apply of a scoping report. Scoping studies are condign an increasingly popular mode of reviewing health enquiry evidence (Davis et al, 2009), particularly where an surface area has not been reviewed comprehensively earlier (Arksey & O'Malley, 2005). The purpose is to both map a wide range of literature and to envisage where gaps and innovative approaches may lie (Ehrich et al, 2002). Arksey and O'Malley (2005) contend that scoping studies tin exist undertaken as stand up-lonely projects in their own correct. They differ from a systematic review in that they tend to address broader topics where many different study designs might be applicable, rather than focusing on a well-divers research question. A scoping report besides does not attempt to address the quality of the research reviewed (Arksey & O'Malley, 2005). However, these features practice not mean that scoping studies should exist seen as 'second' or '3rd best' to systematic and narrative reviews. They offer the advantage of wider coverage and must notwithstanding be methodologically rigorous and transparent (Stalker et al, 2006). Compared to systematic reviews and meta-analysis, the scoping method is different considering the studies included in the review may involve more than than one intervention, dissimilar types of people, and/or a range of issue measures. This is especially of import for the aims of our written report every bit it was likely that many studies reporting reasons for non-use of hearing aids may have included this every bit a secondary or tertiary aim of the newspaper. Scoping reviews aim to point where knowledge has been established and where findings are suggestive just not definitive (Rushton, 2004). Furthermore, Arksey & O'Malley (2005) suggest that aims of scoping studies include 'to summarize and disseminate inquiry findings', and 'identifying gaps in the existing research literature'. A scoping report was deemed the almost appropriate method for this review as the objective was to list and describe all the possible reasons for non-use of hearing aids among individuals with hearing loss who have been fitted with a hearing aid. The primary aim was to present a summarized overview of all the reasons identified in the literature to inform future research.
Process
A comprehensive strategy was adopted that involved searching for evidence, both quantitative and qualitative, from various sources. A systematic search of PubMed was conducted using the following search terms in the title:
– Hearing AND aid AND usage
– Hearing AND help AND use
– Hearing AND aid AND non AND use
– Hearing AND aid AND non-employ
This arroyo was accounted suitable to identify the relevant reasons for non-use of hearing aids that have been reported in studies looking at hearing aid usage. Only studies published since the yr 2000 were included. An additional search of Web of Science was carried out which resulted in no farther articles. Figure 1 shows the manufactures identified in the review process. The systematic search of the electronic database PubMed produced 155 articles, of which 74 were deemed potentially suitable later on reading the title. An additional six studies were obtained from reference lists and later reading the fourscore abstracts, 23 articles were considered for review. Of these 23 articles, just 10 actually reported any reasons for non-use of hearing aids; (the other papers only looked at usage rates, benefit, or reasons for non-acquisition of hearing aids). These were not identified before because after reading the abstracts it was still unclear whether the papers reported any information on reasons for non-use of hearing aids, therefore it was considered worthwhile to read the full commodity. Nine out of the final ten papers were also institute in Spider web of Science. The one that was not found in Spider web of Science (Kochkin, 2000) was also not found in the PubMed search (it was obtained from a reference listing). The researchers feel confident that they covered the majority of recent academic journals of involvement by searching PubMed and Web of Science.
Flow diagram to illustrate the review process.
Results
The final x articles are considered hither. Table 1 lists all the papers reviewed and the reasons they identified for non-use of hearing aids. The number of each article besides corresponds with the articles listed in Table ii.
Table 1.
Key characteristics of included manufactures (in engagement order).
| Authors | Land | Total sample size | Age (years) | Gender | Reasons for not using the hearing aid | Number/percentage of people |
|---|---|---|---|---|---|---|
| 1. Kochkin (2000) | USA | 348 non-users | Unknown | Unknown | Poor do good from HA Background dissonance Fit and comfort Negative side furnishings Price of repairs Don't need help HA broken Sound quality is poor Unspecified – do non wear Volume command adjustment Whistling and feedback Nuisance/hassle/annoying Poor service from dispenser High frequency loss non helped Stigma of wearing hearing aids Work in limited situations Profound hearing loss not helped Too loud Battery life too brusque Forget to use Does not piece of work on phone Monaural aids inadequate Oversold expectations Have tinnitus Family pressure led to purchase Manual dexterity Rare social user Experience like ear plugs Poor directivity Proceeds is also low Cannot find them Ear wax problem | 103 (29.6%) 88 (25.iii%) 65 (18.7%) 38 (10.nine%) 36 (x.3%) 28 (eight%) 27 (7.viii%) 22 (6.3%) 21 (6%) 17 (four.9%) fifteen (4.3%) 14 (4%) 11 (three.ii%) 10 (2.ix%) 10 (2.9%) 9 (2.six%) 9 (ii.vi%) 8 (two.3%) seven (2%) iv (1.1%) four (1.1%) iii (0.ix%) 3 (0.9%) iii (0.nine%) 3 (0.9%) ii (0.6%) 2 (0.vi%) 1 (0.3%) 1 (0.3%) 1 (0.three%) i (0.3%) 1 (0.3%) |
| ii. Tomita et al (2001) | USA | 227 with hearing impairment (59 of those had a hearing aid) 1 | Hateful 76 (SD = viii.7) | 71.iv% Female person | Does non help Makes a whistling or buzzing sound Picks up too much background noise Bothersome/nuisance Makes vocalism sound funny Uncomfortable Batteries too expensive Hard to replace batteries/not certain when to replace Volume control adjustment difficult Hard putting it in Do non like appearance Device lost Device needs repair Devise requires adjustment Devise is broken Can hear adequately without Embarrassed to use it | 8 (13.6%) four (6.8%) 13 (22%) 3 (5.1%) i (i.7%) v (8.5%) 1 (1.vii%) 4 (half dozen.8%) 4 (vi.viii%) 5 (8.5%) i (one.7%) 2 (3.4%) 3 (five.1%) three (5.i%) 1 (1.7%) 3 (v.i%) 1 (one.vii%) |
| iii. Gianopoulos et al (2002) | UK | 116 fitted with HA (66 not using HA at follow upwards, 47 gave reasons) | fifty–65 (hateful unknown) | Unknown | HA did non ameliorate their hearing Other (corrective concerns; handling difficulties; irritation in the ear; and feedback) | 8 (17%) 39 (83%) |
| four. Cohen-Mansfield & Taylor (2004) | The states | 279 (33 vesture HA) two | Unknown | Unknown | HA not working properly/ broken Device does not fit well Besides difficult to put in/ inconvenient to use Device requiring service Too expensive to fix/ replace Need help putting device on Need assistance taking device off Need help changing batteries | 12 (36%) seven (21%) 14 (42%) 2 (half dozen%) one (3%) xiv (43%) four (thirteen%) xx (62%) |
| 5. Lupsakko et al (2005) | Finland | 601 (100 people had been fitted with HA; 24 (25%) were non-users). | Mean 81.iii | 74.1% Female person | No demand/or no do good for a HA Also hard to use HA cleaved Costs too much to replace batteries HA lost Cannot utilise due to external otitis media No reasons documented | x (42%) 5 (21%) iv (17%) 1 (four%) 1 (4%) i (4%) ii (8%) |
| 6. Vuorialho et al (2006) | Finland | 76 (all fitted with a HA half-dozen months prior; 32 were rare / occasional use of which four were non-users). | Mean 73.8 | 51.3% Female | No opportunity for chat Background noise amplified by HA Difficulties inserting ear mould Ear mould unsuitable Difficult to supersede battery Acoustic feedback Difficulties in hearing despite the HA | twenty (62.five%) 15 (46.nine%) ix (28.1%) 9 (28.ane%) 3 (four.1%) 2 (9.4%) 5 (15.6%) |
| seven. Bertoli et al (2009) | Switzerland | 8707; (1086 occasional use or never) | 18+ | Unknown | Noisy/disturbing situations No perceived need No/poor perceived benefit Unpleasant side effects (e.yard. rashes, itching, hurting) Poor sound quality But used for specific situations, e.g. concerts, church, family Difficulties with management Poor fit/comfort Other reasons | 565 (52%) 257 (23.7%) 254 (23.4%) 201 (xviii.5%) 138 (12.7%) 126 (11.6%) 102 (ix.iv%) 97 (eight.9%) 195 (xviii.0%) |
| viii. Hartley et al (2010) | Australia | 2956 (322 were HA owners; 78 (24%) were not-users) | 49–99 Hateful 67.4 | Unknown | Does not help Also noisy Uncomfortable HA whistles Unable to put it in Batteries also expensive Not working | 23 (xxx%) 22 (28%) 22 (28%) 7 (8.4%) ii (2.8%) one (1.4%) i (1.4%) |
| 9. Gopinath et al (2011) | Commonwealth of australia | 2015 (no. of HA non-users unknown) | 55+ (mean unknown) | Unknown | Information technology does not help It was likewise uncomfortable They were unable to put it in | v.4% three five.ane% 1.4% |
| 10. Oberg et al (2012) | Sweden | 346 responded to items relating to hearing difficulties. 124 had a HA; thirteen (12%) were non-users. | 85+ | 57% Female | Handling issues It is uncomfortable Disappointed with HA Hearing is non bad enough Hear well without HA | 4 (30.8%) 2 (xv.4%) 4 (xxx.8%) 1 (7.7%) 2 (xv.4%) |
Table 2.
Reasons for non-use of hearing aids every bit identified in all studies.
| Reasons for non-employ of hearing aids | Total number of studies, and percentage of participants reporting yes | References |
| Hearing assist value/voice communication clarity | seven | |
| • Noisy situations/background noise | 5 (52%; 46.9%; 28%; 25.iii%; 22%) | 7; 6; 8; 1; 2 |
| • Does not assist/poor benefit | 7 (thirty%; 29.6%; 23.four%; 17%; xv.6%) | 8; 1; 7; 3; half dozen; 2; 9 |
| • Poor audio quality | ii (12.7%; 6.3%) | 7;i |
| • Not suitable for type of hearing loss | i (v.5%) | one |
| Fit and comfort of the hearing aid | 9 papers | |
| • Need assistance putting HA in | v (42%; 28.ane%; viii.five%; 2.8%; 1.4%) | 4; 6; 2; 8; 9 |
| • Demand help taking HA off | one (xiii%) | four |
| • Uncomfortable | eight (28.1%; 28%; 21%; eighteen.7%; 15.4%; 8.ix%; eight.5%; v.ane%) | 6; 8; 4; ane; 10; 7; 2; 9 |
| • Side effects (rashes, itching) | iii (xviii.5%; x.9%; unknown) | 7; one; three |
| Care and maintenance of hearing aid | viii | |
| • Need help changing batteries | 3 (62%; 6.8%; 4.ane%) | 4; two; 6 |
| • Handling problems/ manual dexterity | 5 (30.viii%; 21%; 9.4%; 0.vi%; unknown) | 10; 5; 7; i; 3 |
| • Book command aligning | 2 (6.eight%; iv.9%) | two; 1. |
| Attitude | 4 | |
| • No need/hear well enough without HA | 4 (42%; 23.7%; 23.i%; 8%) | 5; seven; 10; i |
| Device factors | 8 | |
| • Non working properly/broken | 4 (36%; 17%; 7.8%; 1.4%) | 4; 5; 1; 8 |
| • Disappointed with HA | one (thirty.viii%) | 10 |
| • Feedback/whistling | 5 (9.4%; viii.4%; vi.8%; 4.3%; unknown) | 6; 8; 2; 1; 3 |
| • Device requires service | 1 (6%) | 4 |
| • Battery life also brusk | ane (ii%) | 1 |
| • Makes voice sound funny | 1 (ane.7%) | 2 |
| • Poor directivity | 1 (0.3%) | one |
| Situational factors | 3 | |
| • No opportunity/lack of situations necessary for HA | 1 (62.5%) | 6 |
| • But used for specific situations | 1 (eleven.6%) | seven |
| • Only works in limited situations | one (ii.6%) | i |
| • Does not work on the phone | 1 (one.1%) | 1 |
| • Rare social user | 1 (0.vi%) | ane |
| Financial factors | 5 | |
| • Cost of repairs | ii (10.3%; 3%) | one; 4 |
| • Cost of batteries | 3 (ane.seven%; 1.4%; 0.iv%) | 2 ; 8 ; v |
| Psycho-social factors | iii | |
| • Nuisance/hassle | ii (5.one%; 4%) | 2;ane |
| • Forget to employ it | 1 (1.ane%) | i |
| • Lost it | two (0.4%; 0.iii%) | 5; one |
| Health care professionals | 1 | |
| • Poor service from dispenser | 1 (3.two%) | 1 |
| • Oversold expectations | 1 (0.9%) | 1 |
| Appearance | three | |
| • Stigma of wearing HA | 1 (2.9%) | i |
| • Exercise not similar the appearance | 1 (1.7%) | ii |
| • Cosmetic concerns | 1 (unknown) | three |
| Infection/ear problems | 2 | |
| • Have tinnitus | one (0.9%) | 1 |
| • Cannot use due to external otitis | i (0.4%) | five |
| • Ear wax problem | 1 (0.3%) | 1 |
| Recommendations | 1 | |
| • Family pressure to get HA | 1 (0.9%) | ane |
Of the ten studies, one was from the UK, three were from the US, two from Australia, two from Finland, one from Sweden, and one from Switzerland. Of all the studies, just three specifically aimed to address the reasons for non-use of hearing aids (Cohen-Mansfield & Taylor, 2004; Kochkin, 2000; Lupsakko et al, 2005). The other studies had different chief aims but mentioned the reasons for non-use of hearing aids every bit a secondary result. Main aims included prevalence rates of hearing aid use (Hartley et al, 2010; Gopinath et al, 2011; Oberg et al, 2012); usage rates of hearing aids (Hartley et al, 2010; Gianopoulos et al, 2002; Vuorialho et al, 2006); a comparison of elderly people with hearing loss and elderly people without hearing loss on a range of demographic, wellness, and functional factors (Tomita et al, 2001); and an investigation of the efficiency of the Swiss hearing aid dispensing system (Bertoli et al, 2009).
The sample size in the studies ranged from 76 (Vuorialho et al, 2006) to 8707 (Bertoli et al, 2009), and the numbers of HA not-users ranged from four (Vuorialho et al, 2006) to 348 (Kochkin, 2000). Nevertheless, the sample size of hearing assistance users or the numbers of people not using the hearing assistance was not always clear. Not all studies reported the numbers of non-users. Additionally, in near half of the studies (Bertoli et al, 2009; Cohen-Mansfield & Taylor, 2004; Tomita et al, 2001; Vuorialho et al, 2006) non-users were grouped together with depression-apply/occasional-utilize hearing aid users to examine the reasons for not-apply of hearing aids. The studies also differed in whether participants responded to predetermined reasons for non-utilize of hearing aids or whether they gave their own answer. Half-dozen studies (Gianopolous et al, 2002; Hartley et al, 2010; Kochkin, 2000; Lupsakko et al, 2005; Tomita et al, 2001; Vuorialho et al, 2006) had open ended questions relating to reasons for non-apply of hearing aids. The remaining studies (Bertoli et al, 2009; Cohen-Mansfield & Taylor, 2004; Gopinath et al, 2011; Oberg et al, 2012) all had fixed choices and the choice of 'other' to write in their own reason.
The historic period range in the studies varied considerably (from 18 to 99 years). 2 studies did not report the historic period (Cohen-Mansfield & Taylor, 2004; Kochkin, 2000) and i study recruited people aged 18 years and over (Bertoli et al, 2009), with 54.2% over 75 years. The age of the participants in the remaining studies ranged from 49 years and in a higher place. The gender ratio was merely reported in four of the studies. In two of the studies just over one-half of the sample were female person (Oberg et al, 2012; Vuorialho et al, 2006) and in the other two studies virtually three-quarters of the sample were female (74.1%, Lupsakko et al, 2005; 71.4%, Tomita et al, 2001). None of the studies reported whether at that place were differences betwixt gender or age in terms of reasons for non-use of the hearing aids.
Non all studies reported the length of fourth dimension since people were fitted with a hearing aid. Among the studies that did report this, the length of fourth dimension ranged from six months (Vuorialho et al, 2006) to between viii and xvi years (Gianopoulos et al, 2002). Considering that experienced hearing aid users are more probable to exist satisfied with their hearing aid than new hearing assist users (Kochkin et al, 2010), the length of time since fitted with a hearing help may have implications in terms of the reasons for non-use.
In terms of the reasons for non-apply of hearing aids, these tin be separated into dissimilar categories. Table 2 shows the full list of reasons identified in the 10 studies. These have been listed in social club of importance (based on the percentages and numbers given in each of study); however this is not necessarily a definitive order of importance.
A number of different reasons were identified as to why people do not wear their hearing aid(s) when they have been fitted with them. These reasons have been grouped into different categories depending on whether it relates to hearing; the device itself (wearing or handling the aid, and effectiveness of aid); attitudes; personal, situational, and financial factors; appearance; wellness intendance professionals' attitudes; ear bug; or recommendations from others. Although the highest response was for the 'lack of situations necessary for a hearing aid' with 62.5% reporting this equally a reason in Vuorialho et al, (2006) report, this was the simply study to written report this as a reason. The nearly significant reasons announced to be associated with 'hearing aid value/spoken communication clarity', and 'fit and comfort of the hearing aid'. Seven studies reported that participants had issues relating to 'hearing assistance value', the virtually pregnant being that the hearing aid does not help or provides poor benefit (Bertoli et al, 2009; Gianopoulos et al, 2002; Gopinath et al, 2011; Hartley et al, 2010; Kochkin, 2000; Tomita et al, 2001; Vuorialho et al, 2006). The side by side most common reason in this category was 'difficulty in noisy situations/groundwork racket' with v studies mentioning this . Other reasons include 'poor sound quality' (mentioned in two studies) and 'not suitable for the type of hearing loss' (mentioned in 1 study). Eight studies reported that participants institute the device uncomfortable (Vuorialho et al, 2006; Hartley et al, 2010; Cohen-Mansfield & Taylor, 2004; Kochkin, 2000; Oberg et al, 2012; Tomita et al, 2001; Bertoli et al, 2009; Gopinath et al, 2011), and five studies reported that participants indicated needing assistance putting the device in (Cohen-Mansfield & Taylor, 2004; Vuorialho et al, 2006; Tomita et al, 2001; Hartley et al, 2010; Gopinath et al, 2011).
Issues to do with intendance and maintenance of the hearing assist were reported in eight studies, for example, 'handling problems/manual dexterity' (Bertoli et al, 2009; Gianopoulos et al, 2002; Kochkin, 2000; Lupsakko et al, 2005; Oberg et al, 2012); 'need help changing the batteries' (Cohen-Mansfield & Taylor, 2004; Tomita et al, 2001; Vuorialho et al, 2006), and problems with 'volume control aligning' (Kochkin, 2000; Tomita et al, 2001).
Issues relating to the device itself were mentioned in half dozen studies and included 'hearing aid not working properly/cleaved' (Cohen-Mansfield & Taylor, 2004; Hartley et al, 2010; Kochkin, 2000; Lupsakko et al, 2005); 'feedback and whistling' (Gianopoulos et al, 2002; Hartley et al, 2010; Kochkin, 2000; Tomita et al, 2001; Vuorialho et al, 2006); 'disappointment with the hearing assist' (Oberg et al, 2012); 'hearing aid needs servicing' (Cohen-Mansfield & Taylor, 2004); 'battery life is as well short' (Kochkin, 2000); and 'poor directivity' (Kochkin, 2000).
Mental attitude was mentioned in four studies, as participants reported they had no need for a hearing assist or can hear well plenty without a hearing aid (Bertoli et al, 2009; Kochkin, 2000; Lupsakko et al, 2005; Oberg et al, 2012). Financial reasons were reported in 5 studies and related to 'cost of repairs' (Cohen-Mansfield & Taylor, 2004; Kochkin, 2000) or 'cost of batteries' (Hartley et al, 2010; Lupsakko et al, 2005; Tomita et al, 2001).
Other less common reasons reported for the non-utilise of hearing aids related to psychosocial factors (hearing aid is a nuisance/hassle; forget to use it; lost information technology); healthcare professionals attitudes (poor service from dispenser; oversold expectations); appearance; infection/ear issues; and force per unit area from others to get a hearing aid.
Word
The aim of this review was to gather the bachelor show on the potential reasons for non-use of hearing aids among people who have been fitted with at to the lowest degree one. This was accomplished by means of a scoping written report by reviewing previous literature which may have looked at reasons for not-use of hearing aids as either a principal or secondary aim. The results bear witness that at that place were many different reasons given, with factors relating to hearing assist value and/or fit and comfort of the hearing assist the most commonly reported reasons. More specifically these reasons include the hearing assistance not existence effective in noisy situations, providing poor benefit or poor sound quality, and not suitable for the type of hearing loss. Factors relating to fit and comfort of the hearing aid include needing assistance putting the hearing aid in and taking it out, feeling uncomfortable, or experiencing side effects (e.g rashes, itching).
1 important upshot seems to relate to the intendance and maintenance of the hearing aid and manual dexterity. The majority of people with a hearing aid are older adults and consequently may accept problems handling the device due to limitations in manual dexterity (Erber, 2003). Hearing aids are quite modest and fiddly devices (to make the device less noticeable and reduce the concern over the appearance of the assistance), withal this has been to a detriment of the manual dexterity. If the hearing assist user cannot properly insert, remove, and manipulate their hearing aids, they are less likely to clothing them. Many people need help changing the batteries or adjusting the book control considering the dials are so awkward. Even experienced hearing aid users have been found to have a poor understanding of how to utilize their hearing aid (Desjardins & Doherty, 2009). Therefore it is important to assess a patient's ability to use their hearing aids.
A major reason why people do not wear their hearing aids when prescribed them seems to be considering of discomfort or they do not know how to put them in correctly. These reasons should be relatively straightforward for clinicians to deal with by ensuring the hearing assist fitting process is accompanied by counselling and support from the audiologist in case of issues (Bertoli et al, 2009). Some researchers have begun to address this. Ferguson et al (2011), through a participatory approach, found that healthcare professionals and hearing aid users identified practical topics such as hearing aid insertion and removal, hearing aid functions and maintenance as key to aid the new hearing aid users experience. As a consequence they have developed an interactive video tutorial with the aim of enabling patients to assimilate relevant information at their convenience in their own home. This could bear witness invaluable to first-fourth dimension hearing aid users as Gianopoulos et al (2002) found that the majority of non-users rejected their aids for reasons amenable to better training in use of the assist. Further rehabilitation could focus on the bug hearing aid users have to develop private management plans, and it has been suggested that one-year follow up appointments after hearing aid plumbing fixtures are appropriate to cover rehabilitation issues and improve usage rates (Goggins & Solar day, 2009). Information technology would seem that, in terms of increasing hearing aid usage, back up and counselling may be more than important than expensive modern technology (Gianopoulos et al, 2002). Vuorialho et al (2006) found that follow upwardly counselling on hearing assist use can significantly increase the benefit obtained from a hearing aid. What is interesting to notation is that ane study (Kochkin, 2000) reported that people had concerns with healthcare professionals in that they had received poor service from their dispenser or they had been oversold expectations of the hearing assist. The best practices employed by hearing healthcare professionals play a significant role in the success of the patient's hearing aid feel and journey (Kochkin et al, 2010). Therefore information technology is of import that the right support, information, and counselling is given at the fourth dimension of hearing assist fitting.
Financial reasons for not wearing a hearing aid were reported in half of the studies. Only one study was from the UK, where healthcare is free at point of delivery and this report did not study financial reasons. Interestingly, appearance of the hearing aid was only noted in iii studies every bit a reason for not-apply of the hearing help and was reported by a small percentage of participants in each of these 3 studies. This low incidence is noteworthy every bit stigma has oft been idea of as a major reason why people do not wear their hearing aids. Nonetheless in this review 'appearance' was one of the to the lowest degree important reasons. Instead it may be more likely that advent is a meaning barrier to acquisition of a hearing aid because people who are concerned about what it looks like may be less inclined to go their hearing checked and after exist fitted with a hearing help. Stigma has been found to be a predictor of hearing assistance uptake (Meister et al, 2008), however, a recent systematic review (Jenstad & Moon, 2011) reported that stigma is inconsistent in terms of its predictability ability, as some studies report stigma as the highest business organization (Franks & Beckmann, 1985), while others found that stigma merely accounted for a minor amount of the variability (Meister et al, 2008). The age of these studies is likely to have some influence on the findings. Hearing aid designs have changed considerably since 1985 and are much more detached and unnoticeable then it could be that the appearance and stigma of the hearing aids is non as great as it once was.
One possible arroyo could take been a meta-assay, as this is an accepted method of reducing heterogeneous inquiry to an integrated overview (Swanson & Deshler, 2003), involving statistical assay of a big collection of assay results from private studies. However, in the majority of the studies the reasons reported for not wearing a hearing aid was a pocket-sized section and not the primary aim of the paper. Additionally, the fact we were non concentrating on a single outcome variable or intervention made the statistical techniques of meta-analysis inappropriate. The systematic review methodology is too limited in its guidelines for appraising and extracting data from qualitative studies (Dixon Woods & Fitzpatrick, 2001). Since the majority of the studies used a qualitative approach to find out why people practise not wearable their hearing aids, a systematic review was not considered appropriate. The scoping method is appropriate to place gaps and was accounted the near appropriate method for our particular aims. One of the strengths of a scoping study is that it provides a thorough overview of areas of enquiry (Arskey & O'Malley, 2005). However, there are a number of limitations of this study to consider: First of all there was no critical review of the individual studies themselves, and assessment of the quality of the data was not possible. However, scoping studies are exploratory and they differ from systematic and meta-assay reviews in that the criteria for exclusion and inclusion are non based on quality of the studies, simply on relevance. The studies varied considerably in the total sample size, number of hearing help owners, number of hearing aid users and not-users, and length of time owning a hearing assist, also as methodologically in how the information on reasons for non-utilise of hearing aids was acquired. As such this is a descriptive business relationship of the reasons why people do not wear their hearing assistance(s) after they have been fitted with at least ane; it is not to be taken as a critical analysis of the current research. However, such limitations are in the nature of scoping studies. Arskey and O'Malley (2005, p.27) report that 'the scoping study does non seek to assess quality of evidence and consequently cannot determine whether particular studies provide robust or generalizable findings'. Research into the reasons for non-use of hearing aids when fitted with at to the lowest degree one is essential if appropriate intervention programmes are to be designed to increase hearing assistance usage. Because of the wide inclusion criteria compared to a meta-analysis or systematic review, the search strategy can aid researchers place gaps in the existing research.
It is as well worth pointing out that the studies in this review were international, and different countries will vary in their provision of hearing aids. For example, in countries where hearing aids and batteries are gratuitous, the financial reasons identified may non use but may deport more importance in countries where this is non gratuitous.
We also searched the major medical scientific discipline databases and identified no additional articles in Spider web of Scientific discipline after initially searching PubMed. We are confident that all relevant articles were identified and we are confident that this review has highlighted the nigh common reasons equally to why people fitted with hearing aids cull not to wear them.
Interestingly, it is worth noting that none of the studies reported whether there were differences between gender or age in terms of reasons for non-use of the hearing aids. To appointment, there has been very fiddling inquiry examining the differences between men and women in the apply of hearing aids. The underlying reasons for not using hearing aids may differ between males and females, and a consideration of such factors could potentially increment hearing aid use. Furthermore, not all the studies reported the length of fourth dimension since people were fitted with a hearing aid. This may accept implications in terms of the reasons for not-employ, i.e. whether people give up direct away or whether people persevere for a few months/years before giving up with the hearing assist. In that location is some inquiry to suggest that if people are notwithstanding using their hearing aids later ane year, they remain a hearing aid user (Schumacher & Carruth, 1997), however this data does demand updating.
Conclusions
The use of a scoping study allowed the inclusion of a broad range of literature and at the aforementioned fourth dimension identified priority areas to explore further, and possible topics for both meta-analysis and systematic reviews that require a more narrowly defined research question. As a result of this scoping study, we recommend that areas for future research on reasons for non-employ of hearing aids should focus on hearing aid value; fit and comfort of the hearing aid; care and maintenance of the hearing assist; attitudes and device factors. Researchers interested in hearing aid usage should conduct empirical enquiry to examine specifically what it is near each of these five areas that could be improved to increment hearing aid usage rates among patients. Researchers should also expect at how non-utilise of hearing aids and reasons for non-use vary between gender and age. Gender and/or age differences may have important implications for hearing intendance and rehabilitative intervention and, as such, crave further study. The aforementioned can exist applied to differences in the length of time a person was fitted with a hearing assist earlier stopping using it. It is hoped that this study suggests ways frontwards and tin assist researchers prepare agendas for future research looking at the not-utilise of hearing aids.
Acknowledgments
Proclamation of interest: The authors report no confl icts of interest. The authors lonely are responsible for the content and writing of the paper.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665209/
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