Introduction: The stigma associated with wearing hearing aids, known as the “hearing aid effect,” remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting. Therefore, the objective of the study is to determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely, area of residence and level of education across African communities. Methods: The study used a cross-sectional design with 322 participants (161 rural, 161 urban), mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices (standard behind-the-ear hearing aid [BTE HA] with an ear mould, mini BTE HA with a slim tube [ST], in-the-canal [ITC] HA, AirPod, receiver in canal [RIC], completely-in-canal HA, and Personal Sound Amplification Product [PSAP]) worn by a peer model using a validated scale of eight attributes (attractiveness, age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with ear mould were used as a benchmark for comparison. Results: No hearing aid effect was observed across all participants (n = 322) with device ratings ranging between neutral and positive. Significant differences between device ratings were evident for attractiveness for ST and PSAP and trustworthiness for ITC. In terms of residence, urban participants provided more favourable ratings compared to rural participants, with significant differences across three attribute ratings: hardworking for ST; attractiveness, hardworking for ITC; age for RIC and AirPod; and hardworking for PSAP. For level of education, significant differences were found for attributes of attractiveness (H = 13.5; p = 0.001) for ITC; attractiveness (H = 14.7; p = 0.001) for PSAP; age (H = 9.5; p = 0.009) for RIC; age (H = 14.3; p < 0.001) and intelligence (H = 15.1; p < 0.001) for AirPod; and hardworking (H = 11.9; p = 0.003) for ST. Conclusion: Overall, participants had a neutral to positive view of hearing devices with preferences for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices.

This study aimed to investigate the “hearing aid effect” and its association with socioeconomic factors in African communities. The study used a cross-sectional design with 322 participants from rural and urban areas, who rated photographs of seven different hearing devices worn by a peer model. The devices included standard behind-the-ear hearing aid (BTE HA) with an ear mould, mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, AirPod, receiver in canal (RIC), completely-in-canal (CIC) HA, and Personal Sound Amplification Product (PSAP). The participants rated the devices on eight attributes, including attractiveness, age, success, hardworking, trustworthiness, intelligence, friendliness, and education. No hearing aid effect was observed across all participants with device ratings ranging between neutral and positive. There was a preference for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices.

1.
Bisgaard N, Zimmer S, Laureyns M, Groth J. Growth: a model for estimating hearing aid coverage world-wide using historical data on hearing aid sales. Int J Audiol. 2022;61(10):841–9.
2.
Chien W, Lin FR. Prevalence of hearing-aid use among older adults in the United States. Arch Intern Med. 2012;172(3):292–3.
3.
World Health Organization. Deafness and Hearing Loss; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss.
4.
Hartley D, Rochtchina E, Newall P, Golding M, Mitchell P. Use of hearing aids and assistive listening devices in an older Australian population. J Am Acad Audiol. 2010;21(10):642–53.
5.
Humes LE. Differences between older adults who do and do not try hearing aids and between those who keep and return the devices. Trends Hearing. 2021:23312165211014329.
6.
Kochkin S. MarkeTrak VII: obstacles to adult non-user adoption of hearing aids. Hear J. 2007;60(4):24–51.
7.
McCormack A, Fortnum H. Why do people fitted with hearing aids do not wear them?Int J Audiol. 2013;52(5):360–8.
8.
David D, Werner P. Stigma regarding hearing loss and hearing aids: a scoping review. Stigma and Health. 2016;1(2):59–71.
9.
Rauterkus EP, Palmer CV. The hearing aid effect in 2013. J Am Acad Audiol. 2014;25(9):893–903.
10.
Blood GW, Blood IM, Danhauer JL. Listener’s impressions of normal-hearing and hearing-impaired children. J Commun Disord. 1978;11(6):513–8.
11.
Dogett S, Stein RL, Gans D. Hearing aid effect in older females. J Am Acad Audiol. 1988;9(5):361–6.
12.
Cienkowski KM, Pimentel V. The hearing aid “effect” revisited in young adults. Br J Audiol. 2001;35(5):289–95.
13.
Andersson G, Hagnebo C. Hearing impairment, coping strategies and anxiety sensitivity. J Clin Psychol Med Settings. 2003;10(1):35–9.
14.
Wallhagen MI. The stigma of hearing loss. Gerontol. 2010;50(1):66–75.
15.
Southall K, Jennings MB, Gagné JP. Factors that influence disclosure of hearing loss in the workplace. Int J Audiol. 2011;50(10):699–707.
16.
Foss KA. (De)stigmatizing the silent epidemic: representations of hearing loss in entertainment television. Health Commun. 2014;29(9):888–900.
17.
Zaitzew CM. Understanding the stigma of hearing loss and how if affects the patient and treatment process. Honors Res Projects. 2016.
18.
Iler KL, Danhauer JL, Mulac A. Peer perceptions of geriatrics wearing hearing aids. J Speech Hear Disord. 1982;47(4):433–8.
19.
Strange A, Johnson A, Ryan B-J, Yonovitz A. The stigma of wearing hearing aids in an adolescent aboriginal population. Aust N Z J Audiol. 2008;30(1):19–37. https://search.informit.org/doi/10.3316/informit.232570468267883.
20.
Archana G, Krishna Y, Shiny R. Reasons for nonacceptance of hearing aid in older adults. Indian J Otol. 2016;22(1):19–2.
21.
Waseem H, Basheer HMU, Rehman AU, Asmat A, Zafar F, Zulfiqar A, et al. Effect of social and self stigma on hearing aid rejection. AJAHS. 2019;3(3).
22.
Chundu S, Allen PM, Han W, Ratinaud P, Krishna R, Manchaiah V. Social representation of hearing aids among people with hearing loss: an exploratory study. Int J Audiol. 2021;60(12):964–78.
23.
Manchaiah V, Danermark B, Vinay, Ahmadi T, Tomé D, Krishna R, et al. Social representation of hearing aids: cross-cultural study in India, Iran, Portugal, and the United Kingdom. Clin Interv Aging. 2015;10:1601–15.
24.
Baker EH. Socioeconomic Status, Definition. The Wiley Blackwell Encyclopedia of Health,Illness, Behavior, and Society; 2014. p. 2210–4.
25.
Koukouli S, Vlachonikolis I, Philalithis A. Socio-demographic factors and self-reported functional status: the significance of social support. BMC Health Serv Res. 2002;2(1):20.
26.
Brimacombe JA, Danhauer JL, Mulac A. Teachers’ perceptions of students who wear hearing aids. Lang Speech Hear Serv Sch. 1983;14(2):128–35.
27.
Mulac A, Danhauer JL, Johnson CE. Young adults’ and peers’ attitudes towards elderly hearing aid wearers. Aust J Audiol. 1983;5(2):57–62.
28.
Dysart J. Smart earbuds: a looming threat to the hearing aid market?Hear J. 2017;70(3):303134.
29.
Ntawanga FF. A roadmap for rural area ict solution deployment: a case of Kgautswane community in South Africa. Afr J Inf Syst. 2013;5(2).
30.
Africa S. Local municipality | statistics South Africa. Statssa.gov.za; 2021. Available from: http://www.statssa.gov.za/?page_id=993&amp;id=city-of-tshwane-municipality.
31.
Winkler A, Latzel M, Holube I. Open versus closed hearing-aid fittings: a literature review of both fitting approaches. Trends Hear. 2016;20:2331216516631741.
32.
Gilmore JN. Design for everyone: Apple AirPods and the mediation of accessibility. Critical Studies in Media Communication; 2019.
33.
Muñoz K, Ong C, Butcher G, Nelson L, Twohig M, Coleman C. Opportunities for audiologists to use patient-centered communication during hearing device monitoring encounters. Semin Hear. 2018;39(01):032–43.
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