Hearing aid delivery in older adults: An investigation of older adults’ journey through audiology services and their perceptions towards an alternative hearing aid delivery model

Abstract

Introduction: Age-related hearing loss is a significant public health concern, as it can have adverse effects on the social and psychological functioning of older adults. Despite evidence that hearing aids can improve the quality of life of older adults, hearing aid uptake is shown to be low internationally. Internet hearing aid sales have emerged as an alternative model of hearing aid delivery for those unable to afford or access hearing aids. Aims and Objectives: This thesis aims to explore older hearing aid users’ experiences of utilising audiology services in New Zealand, and their perceptions towards internet-based delivery of hearing aids. The key objectives are to explore positive and negative experiences of older adults, as well as barriers faced, through their journey of utilising the hearing aid delivery system, and to explore their perceptions of the benefits and shortcomings of internet- based delivery of hearing aids. Methods: A qualitative approach was adopted to accomplish the aims of this thesis. Semi structured interviews were conducted with participants in a face-to-face manner. In order to be eligible to participate in this study, individuals needed to be aged 65 years and over, be a hearing aid user, and be residing within the Auckland region. Participants were recruited from various sources, including the University of Auckland Hearing and Tinnitus Clinic, the Hearing Association, via a mass email sent to members of the University of Auckland’s Faculty of Medical and Health Sciences, and via snowball sampling. The interviews were transcribed and analysed thematically for common themes related to the research aims and objectives. Results: Five main aspects of the hearing aid delivery system were discussed. Physical accessibility to the clinic was generally reported to be easy, and the overall journey through the system was mainly described to have progressed seamlessly. Financial troubles were however, reported in meeting the high cost of the hearing aids. The interpersonal and communication skills of the audiologist were commonly discussed. Trust in the audiologist also emerged as a theme, and was influenced by patients’ perception towards the audiologist’s focus on making a sale versus providing hearing aids suited to the individual’s needs, as well as towards the audiologist’s competence in their work. A general lack of awareness regarding internet hearing aid sales was found. Lower cost hearing aids and greater convenience were perceived to be the benefits. Numerous concerns and limitations related to this model were also expressed. Concern regarding whether and how clinical procedures, such as hearing tests and adjusting or fine-tuning of the hearing aids would be conducted in this model were expressed. Participants preferred to be treated by an expert with knowledge of hearing loss, and preferred face-to-face contact. A fear of being ripped off on the internet, and a general lack of familiarity and confidence in using the internet for purchasing were further expressed. Conclusions: The findings of this study have highlighted aspects of the hearing healthcare system in New Zealand, that need greater focus in order to enhance hearing healthcare services for older adults. These include addressing difficulties in meeting the cost of the hearing aids, and providing adequate training and education of audiologists in developing therapeutic relationships and involving patients in their healthcare. Exploration of patients’ perceptions towards internet-based hearing aid delivery has revealed benefits as well as several concerns. These concerns would likely need to be addressed and could be used for future research in this area as well as to guide the development of an internet-based model that is likely to appeal to older adults. This could potentially improve access to hearing aids. Overall, the findings of this research are relevant to policy-makers, audiology providers, and researchers, and have implications for improvements in hearing aid delivery services and access to hearing aids in older adults.