MarkeTrak VII: Obstacles to Hearing Aid Adoption Among Adult Non-users in the U.S.

1. MarkeTrak VII: Obstacles to Hearing Aid AdoptionAmong Adult Non-users in the U.S. Hearing Journal (4/2007)

2. Introduction • Hearing aid adoption rate stubborn at about 20%. • Growth to 23% penetration due to Internet and VA. • Known serious consequences of untreated hearing loss. • Why do so many people delay or avoid amplification? • 23 million adults • 1.5 million children/dependents <age 23

3. Method • 3,000 adult non-adopters from MarkeTrak VII database • 2,300 responded to 7 page survey • 64 reasons why they don’t use hearing aids. • Reasons for return if tried HA • Factors that might entice them • Focus on top 50% of people with hearing loss.

4. HA owners versus non-owners • Not terribly dissimilar. • Hearing aid owners greater hearing loss and younger. • Bilateral loss (61% versus 83%) • Perceived mild hearing loss (39% versus 7%) • Ability to hear whisper across a room without visual cues (16% versus 5%) • Modal unaided APHAB (40-49% versus 50-59%)

5. Aided versus unaided populations by hearing loss decile.

6. Hearing aid adoption rates by hearing loss decile. 83% hearing aid owners 39% non-adopters

7. Non-adopters • New hearing aid user is age 70. • Non-adopter ages vary from a low of age 56 (decile 1) to 61 (deciles 6+). • Why such a large age difference? • Let’s control for hearing loss & then look at adoption rates.

8. Hearing aid adoption by HL decile controlling for age; evidence for the effects of age stigma.

9. Percent of hearing-impaired evaluated for hearing loss and recommendations received.

10. Number of positive recommendations for hearing aids compared to negative recommendations by professional (1984-2004).

11. Hearing Screening • Problem resolution begins with problem identification. • 50% of 23 million adult non-adopters never had their hearing professionally tested. • Huge progress when comparing positive to negative recommendations from professionals.

12. Hearing solution adoption model Specific drivers: Internal stigma External stigma Influencers Product perception Service perception Physicians attitude Fear Medical care Surgery Aural rehab Cochlear Impl. Hearing Aids ALDs Behavior Modif. Stages of denial Predisposition BHI Mission Perceived loss of Physical Behavior intent/ communication Attitude toward impairment Hearing health solutions performance & getting hearing need solutions Price & hearing health solution delivery model Drivers: Perceived age Communication situations Change & emotional reaction Social comparison Alternative solutions General moderators: Socio economic status Health Personality Lifestyle Social network Emotional state

13. Reasons for non-adoption of hearing aids: Top 5 deciles of hearing loss

14. Reasons for not-adoption of hearing aidsFactor = Hearing Loss

15. Reasons for not-adoption of hearing aidsFactor = financial

16. Median income comparing people who state they can and cannot afford hearing aids controlling for age.

17. Reasons for not-adoption of hearing aidsFactor = Minimization or lack of need

18. Reasons for not-adoption of hearing aidsFactor = Attitudes towards hearing aids

19. Reasons for not-adoption of hearing aidsFactor = Attitudes towards hearing aids (Cont.)

20. Reasons for not-adoption of hearing aidsFactor= Knowledge & experience

21. Reasons for hearing aid return (n=237)

22. Reasons for not-adoption of hearing aidsFactor = Stigma

23. Reasons for not-adoption of hearing aidsFactor = Professional recommendations

24. Reasons for not-adoption of hearing aidsFactor= Social network recommendations

25. Reasons for not-adoption of hearing aidsFactor = Trust

26. Hearing aid adoption intent by hearing loss decile.

27. Positive impact of hearing aid enhancements on the total hearing loss population currently not using hearing aids.

28. Reasons for intent to purchase hearing aids

29. Opportunities

30. Motivation • Key reason for purchasing is recognition that hearing loss has gotten worse. • 50% need testing • Concerted effort to test either objectively or subjectively (e.g. BHI Quick Hearing Check). • Physician offices • Free hearing checks by HHP in and outside of office. • Problem recognition is a critical precursor to problem resolution.

31. Professional Recommendations • Significant improvement over last 20 years. • Continued physician education needed: • Efficacy of hearing aids • Improved customer satisfaction • Evidence based critical • Need hearing testing as part of best practice protocol for family doctor.

32. Surgery and HA Trial • 12% of population may not be candidates for hearing aids. • That’s 2.75 million people • Close to 1 out of 10 tried and rejected hearing aids and found: • Insufficient benefit • Problems in noise • 40% of most serious hearing loss group (decile 10) found that HA did not help their hearing loss.

33. Attitudes towards hearing loss • People with serious hearing loss still believe: • Hearing loss too mild for HA • Many believe their life style precludes need for better hearing. • Continued PR on impact of untreated hearing loss especially for younger segments critical to move them toward a solution.

34. Misinformation about candidacy • Opportunity to correct misinformation on who can be helped with hearing aids. • High frequency hearing loss • Low frequency hearing loss • “Nerve damage” – probably sensorineural • Unilateral hearing loss

35. Tinnitus • 4 out of 10 also have tinnitus • May be contraindicative of candidacy or may be an opportunity. • For PR purposes need greater understanding of impact of hearing aid usage when a person has tinnitus.

36. Attitudes towards hearing aids • Need to demonstrate to this population: • Improved ability to communicate in noise • Reduction in aversiveness of sounds when using hearing aids • Reduction in hassle factor (maybe now with open fit HA) • 4.4 million potential users were influenced by other hearing aid owner experiences. • 17% have hearing aids in drawer – needs to be reduced because of impact on negative word of mouth advertising. • Benefit has to be increased. • 28% absolute benefit • Translates into 44% problem resolution • Need greater utility in various listening situations especially phone, cellphone, and group situations.

37. Finances • Significant barrier to two out of three (64%) • Evidence that finances NOT a convenient excuse. • Initiatives to mitigate this problem critical: • Tax credit bill • Insurance • Education on available help (e.g. charities, VA, union, flex dollar programs in corporations, etc) • 40% indicate greater likelihood of HA trial with tax credit of $500.

38. Conclusions • Model of hearing aid adoption is complex. • No one initiative will be enough. • First – person must recognize their loss. • Second – must recognize loss causes them problems. • Third – must believe there is a reasonable probability that visiting a HHP will sufficiently solve their problem. • Some obstacles are perceptual and some are real. • HIA research on improving consumer’s journey is a critical step in introducing more people to the world of better hearing.

39. Opportunities • Demography – demonstrates extent of problem. • Challenging common myths about hearing loss (e.g. only an issue of aging). • Positive customer satisfaction ratings can elevate image of hearing aids and HHP . • Impact of untreated hearing loss on quality of life (e.g. Income) can motivate younger hearing-impaired. • Greater awareness of impact of untreated hearing loss on children. • Lack of involvement of MDs – still an important gatekeeper.