Enhancing Screening Systems to Facilitate Hearing-Healthcare Access: A Qualitative Study

Barriers to hearing aid adoption among older adults in mainland China

OBJECTIVE

This study aimed to explore barriers to hearing aid adoption amongst older adults in mainland China.

DESIGN

Semi-structured interviews were audio-recorded and analysed using qualitative thematic analysis.

STUDY SAMPLE

The study included 12 older adults who had seen ENTs and had not adopted hearing aids.

RESULTS

Three overarching themes and ten subthemes were generated to explain why older adults in mainland China do not adopt hearing aids: (1) Desire a cure for hearing loss, (2) Lack of a perceived need for hearing aids, and (3) Negative impressions of, and misconceptions about, hearing aids.

CONCLUSION

Although barriers are similar to those reported in Western societies, the under-developed hearing healthcare infrastructure, Chinese health beliefs, Chinese culture, and low health literacy play important roles in preventing older adults to adopt hearing aids in mainland China. To identify barriers to hearing aid adoption and address them, hearing health practitioners should learn what older adults know about their hearing loss, how they perceive the effects of hearing loss, and how they feel about hearing aids.

[Mobile solutions in hearing assessment]

PURPOSE OF THE STUDY

To evaluate the effectiveness of the application of the web application "Automated system of primary hearing assessment" created by us for the diagnosis of hearing impairment in different age groups.

MATERIAL AND METHODS

With the help of this web application, 712 patients were examined in 3 age groups: group 1 - patients aged 18 to 44 years, 196 people (average age 25.6±2.7 years), group 2 - patients aged 45 to 59 years, 265 people (mean age 46.3±3.6 years), 3rd group - patients 60 years old and older, 251 people (mean age 75.4±1.1 years).

RESULTS

It was revealed that 61.8% of patients had risk factors for the development of hearing loss. In the 1st age group, one risk factor for hearing loss prevailed, in the 2nd and 3rd groups, up to 5-9 factors were simultaneously combined. Clinically significant hearing loss was found in 24.3% of patients. Hearing studies at frequencies of 10 and 12 kHz revealed latent hearing loss in 31.3% of patients, 57% of them had risk factors for the development of hearing loss. Comparative analysis in the groups showed that hearing impairment at high frequencies was found in 47.4% of patients in older age groups and in 15.8% of young people. The possibility of performing otoscopy images made it possible to identify changes in the tympanic membrane in 17.1% of patients, to give a correct conclusion about the state of their hearing and to propose an algorithm for further examination. It was found that the sensitivity of the study in the web application was 98%, the specificity - 99.9%.

FINDINGS

The use of the web application allows assessing the risk factors for the development of hearing loss, identifying patients with latent hearing loss, objectifying the study with otoscopy images, and remotely obtaining a conclusion about the state of hearing from a specialist doctor.

Interpretability of the audiogram by audiologists and physician non-specialists

OBJECTIVE

The audiogram is frequently used by hearing specialists communicate test results to non-specialists, such as physicians. However, it relies on uncommon terminology and interpreting unusual graphical elements to extract information. In this study, we examine whether the audiogram can be accurately interpreted by specialists and non-specialists.

DESIGN

We used an online questionnaire to assess the interpretability of an audiogram by audiologists and primary-care physicians. Participants viewed a sample audiogram and submitted their answers via an online survey system.

STUDY SAMPLE

We recruited actively practicing primary care physicians (n = 100) and actively practicing audiologists (n = 67). We only accepted respondents from the United States.

RESULTS

The audiogram was not easily interpreted by physicians, with a median score of 4/9. Fewer than 25% could accurately report a threshold correctly. Audiologists were more accurate than physicians (median score 7/9, Wilcoxon two-sample p < 0.001, r = 0.648).

CONCLUSIONS

The audiogram is difficult for non-specialists to interpret. Clinicians are advised to supplement or supplant the audiogram in interprofessional communication. The development of tools to facilitate interprofessional communication between audiologists and physicians could have positive effects on physician awareness of hearing loss, and even downstream influences on patient behaviour and outcomes.