Factors influencing making a choice and accessing a hearing aid among elders with hearing disability: mixed methods

• Date: 08 July 2022
• Pages: 454-472
• DOI: https://doi.org/10.1108/IJHRH-04-2022-0028
• Published date: 08 July 2022
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations
• Author: Ramida Dindamrongkul,Wachara Riewpaiboon,Kwanchanok Yimtae,Warin Krityakiarana,Wiraman Niyomphol

Factors inf‌luencing making a choice and

accessing a hearing aid among elders

with hearing disability: mixed methods

Ramida Dindamrongkul, Wachara Riewpaiboon, Kwanchanok Yimtae,

Warin Krityakiarana and Wiraman Niyomphol

Abstract

Purpose –Hearing aid (HA) using is an option for enhancing the sound transmission. It effectively

improves hearingability during communication. In Thailand, two-thirdof hearing impaired persons were

elders, while the utilizationof an HA was low. This study aims to explore how the decision wasmade on

the use of HA among the hearingimpaired elderly.

Design/methodology/approach –Mixed-methodssequential explanatory design was used by starting

with a retrospective study to identify the prevalence of HA use and influencing factors including

demographic and clinical data. Total, 199 elders with moderate to severe hearing impairment were

enrolled. Qualitativedata collection for thematic analysis was conducted by interviewing28 participants

to revealelders’ subjective reasoning.

Findings –It was found that 25.63%of elders used an HA, whereas age, types of health insuranceand

disability registration were significant influencing factors. Six themes of subjective reasoning emerged

including social activities, disability perspective, social support, medical and personnel, rights and

accessibilityand benefit of HA, which determined the elders’ decisionson HA use.

Originality/value –This study broadened insights of the elders’ decision process on HA use, which was

mutually made by both health-care professional and care recipients. The elders themselves would make the

final decision. Not only objective indications but also subjective reasoning of users played significant roles

on HA acquisition. To enhance HA use among hearing impaired elders, patient engagement in decision-

making was crucial while hearing counselling and eliminationof reimbursement barriers became essential.

Keywords Elders’ decision-making, Access, Hearing impairment, Inf‌luencing factor, Hearing aid,

Mixed methods

Paper type Research paper

Introduction

Approximately 466 million people around the world had hearing disability, whereas one-

third of elders were suffering from hearing difficulties (World Health Organization, 2021).

Hearing impairment commonly occurred from natural hearing organ degeneration, and

approximately, a half of people older than 75 years had severe hearing disability (National

Institute on Deafness and Other Communication Disorders [NIDCD], 2016). It led a negative

impact on social relationships andpsychological effects such as anxiety, social withdrawal,

loneliness, depression and possible early dementia (Hyams et al., 2018;Said, 2017).

Additionally, it has been reported that the deterioration of cognitive and psycho-social

functioning, which were the major constructs of quality of life, had significant association to

hearing deficiency (Ciorba et al.,2012;Davis et al.,2016;Hyams et al.,2018;Punch et al.,

2019;Said, 2017;World Health Organization, 2021). Hearing impaired persons have been

suffering from inaudible sound and unclear speech comprehension. To improve

Ramida Dindamrongkul is

based at the Ratchasuda

College, Mahidol University,

Nakhon Pathom, Thailand

and Department of

Otolaryngology, Faculty of

Medicine, Prince of Songkla

University, Songkla, Thailand.

Wachara Riewpaiboon is

based at the Ratchasuda

College, Mahidol University,

Nakhon Pathom, Thailand.

Kwanchanok Yimtae is based

at the Department of

Otorhinolaryngology, Faculty

of Medicine and Khon Kaen

Ear Hearing and Balance

Research Group, Khon Kaen

University, Khon Kaen,

Thailand. Warin Krityakiarana

is based at the Faculty of

Physical Therapy, Mahidol

University, Nakhon Pathom,

Thailand. Wiraman Niyomphol

is based at the Ratchasuda

College, Mahidol University,

Nakhon Pathom, Thailand.

Received 12 April 2022

Revised 20 May 2022

Accepted 10 June 2022

The authors would like to

acknowledge the support from

family members and those

elders who participated in this

study. The authors gratefully

thank the Faculty of Graduate

Studies and Ratchasuda

College, Mahidol University, for

a partial funding.

PAGE 454 jINTERNATIONAL JOURNAL OF HUMAN RIGHTSIN HEALTHCARE jVOL. 16 NO. 5 2023, pp. 454 -472, ©Eme rald Publishing Limited, ISSN 2056-4902 DOI 10.1108/IJHRH-04-2022-0028

communication performance, hearing aid (HA) is an assistive device offering proper

audible sound, which would reduce cognitive load of listening (Choi et al.,2011;Dawes

et al.,2015

;Kalluri and Humes, 2012;Sarampalis et al., 2009) and increase the quality of

life (Hyams et al., 2018;Said, 2017).As global aging was alarmed, a timely HA fitting should

be considered to sustain an optimal communication functions of the elders. However, a low

prevalence of HA use among hearing impaired elders was challenging (Bainbridge and

Ramachandran, 2014;Bul

gurcu et al.,2020;Chien and Lin,2012;Lo

¨hler et al.,2019;Mukari

and Wan Hashim, 2018;Sawyeret al.,2019;Wells et al.,2020).

As of June 2021, Thailand reported 208,000 persons living with hearing proble ms aged over

60 years (Department of Empowerment of Persons with Disabilities, 2021).TheaccesstoHA

services was reported only 29% in Songkhla province, which is located in the South, wher eas

80% was reported in Bangkok Metropolitan, the capital city of Thailand (Yimtae et a l.,2014).

This illustrated a risk of delayed HA fitting, which is associated with uneven distribution of both

manpower and financial resources (Chan et al., 2017). In term of health security, there are

three major national health insurance schemes; Civil Servant Medical Benefit Scheme

(CSMBS), Universal Health Coverage Scheme (UHCS) and Social Security Scheme (SSS) . All

schemes use the same health services infrastructure but with different criteria of HA

acquisition and cost reimbursement. The member of UHCS and SSS have to access through

their pre-registered primary care units where there might not be a hearing specialist, as a

result they would be referred to a higher level of health care unit. C onversely, CSMBS’

members are allowed to directly get health-care services from any government hospitals

without referral document.

Even laws and regulations were supportive for universally access to health care as needed

including an HA. The low prevalence of HA acquisition in some particular area needs to be

explored. This study focused on the factors contributing to both access and an individual’s

decision to use an HA. The different types of health insurance schemes, clinical and

demographic data were examined. Furthermore, subjective reasoning underpinned a

decision on HA use was also explored. The results were expected to support the policy

implementation adjustment and improvement of practice guidelines for audiological

rehabilitation, especiallyin HA counselling section.

Methods

Mixed-methods sequential explanatory design was used for this study. First, a retrospective

quantitative study was conducted by reviewing medical records of hearing-impaired patients

who attended audiological clinic at Songklanagarind (SKN) hospital during January to

December 2018 with the inclusion criteria of age 60years and over, diagnosis as having bilateral

or unilateral sensorineural hearing loss (as classified by ICD 10 code of H903 or H904). The

hearing threshold was determined by audiogram using an average pure-tone hearing

thresholds at 0.5, 1, 2 and 4 kHz, while those who had no or mild impairment on better ear were

excluded. The quantitative data collection included age, gender, marital status, occupational

characteristic, type of health insurance, legal disability registration and geographical distance

from home to hospital. PASW statistics version 18 software (Chicago: SPSS Inc, 2009) was used

for data analysis. The prevalence of HA use was determined. Additionally, Pearson’s chi-square

test was used to comprehend the relationships between categorical variables. Independent

sample t-test was used to test the difference of mean age between two groups of HA users and

non-HA users. The statistical significance at P<0.05 was considered.

Second, qualitative study was done to explore elders’ subjective reasoning toward the

decision on HA use. Way of living, reasons of using or not using an HA and perspectives on

hearing disability were asked. Fourteen HA users and fourteen non-HA users were

purposively selected from participants of a retrospective study at SKN hospital, and

30–40min in-depth interviews were conducted during December 2019-January 2020 with

semi-structured questionsas shown on Table 1.

VOL. 16 NO. 5 2023 jINTERNATIONALJOURNAL OF HUMAN RIGHTS IN HEALTHCARE jPAGE 455