Let's consider the current estimate that only 1 in 4 people (US) and 1 in 3 people (UK) who need hearing aids actually have them. That means there are more people who don't have hearing aids (but may benefit from them), than do. And despite the considerable efforts of hearing aid manufacturers, hearing care practitioners and charities to increase the adoption rate over the years, this statistic has remained fairly consistent.

We're obviously still missing a vital ingredient. But what is it?

Perhaps you have some ideas of your own. So before we go any further, how would you complete the following sentence:

"We can increase the rate of hearing aid adoption by..."

The most commonly suggested solutions:

Did you find yourself agreeing with any of the solutions proposed above?

Whilst each of these may be important, unfortunately none of them is our missing vital ingredient. They may each have their role to play, but even taken together these solutions are not going to make any significant impact on increasing the adoption rate for hearing aids, because they're all based on the assumption that the people who need the hearing aids actually recognise that they need them.

And this is where our problem lies. 

The need for need

​It’s not that people don't want hearing aids; it's that they don't think they need them in the first place (See "It's not denial; it's observation"). So they never even reach that point of deciding whether or not they actually want them.

And if they don't think they need them, they really don't care how invisible, how cheap, how comfortable modern hearing aids might be. In fact, they don't even notice any of these factors, because they're not even looking!

So it really doesn't matter how many opportunities we give that person to discover hearing aids, or how clever or appealing our marketing or design concepts are, or how many times they walk past a high street presence, or how simple it is for them to obtain hearing aids... because no matter how much we invest, whether time or resources, we STILL haven't changed the simple fact that they don't think they need hearing aids. We waste a considerable amount of our effort.

In other words, the majority of the 67-75% of people we are trying to reach do not consider hearing aids to be relevant.

And that's our missing ingredient: relevance.

Making hearing aids relevant

If we're serious as a profession or industry about increasing hearing aid adoption rates we need to tackle this issue of relevance head on by addressing the underlying drivers:

1. Most people don't think about their hearing until it becomes a (significant enough) problem; they take it for granted because they can't "switch it off' to find out what it's like to be without.
2. Most changes in hearing happen so gradually that those changes are very easily overlooked or compensated for (which decreases recognition of the need).
3. By the time the problem has crossed their Threshold of Noticeability, other (uncontrolled) factors are likely to have had enough time to come into play, such as opportunities for negative attitude formation.

The 4 steps to relevance

Therefore the steps we need to take someone along if we are going to persuade those 3 out 4 people are as follows:

It is only at Step 4 that hearing aids become relevant to someone, and only then do the suggested solutions we looked at at the very beginning of this article (cosmetics, cost, opportunities to try etc.) play a role in their decision-making process. Of course if those solutions aren't right for them when they reach Step 4, then we will still fail to reach our audience. But we have to get them to Step 4 in the first place by making hearing aids relevant to them. And to do that, we have to take them through Steps 1 to 3.

That may seem like a tall order. But actually it's very simple.

Because to increase relevance, we simply need to detach the hearing test from the need for hearing aids. 

Why the traditional view of the hearing test is wrong

The hearing test has been traditionally viewed by many as a tool to demonstrate the need for hearing aids.

This thinking is still inherent in much of our current approach to hearing care. So much so, in fact, that many hearing aid providers are specifically paid by the number of hearing aids they fit, which means that if they test someone who has turns out to have “clinically normal hearing” it can be seen as "a waste of time".

Similarly, many doctors will not refer onto an audiologist or hearing care professional for a hearing test unless they are convinced their patient will not only need hearing aids, but is likely to use them.

So the traditional recommendation to the public about when to have their hearing tested is if they notice a problem with their hearing, or if they’ve reached a certain age, or if they’re “hearing impaired”.

It is therefore no surprise that the general public has traditionally seen the idea of having their hearing tested as an admission that their hearing has "got bad enough in their own estimation to need hearing aids". And who wants to admit that? Especially if the majority have been told (by implication) that they don’t need their hearing tested.

But as we already know, 67-75% of people have not reached the stage of thinking they need hearing aids. It's all very subjective.

Time for a new message about hearing checks

The general public need to view the hearing test as a way of monitoring their hearing and detecting changes (i.e. not detecting impairment) in their hearing. We need to detach the idea of having your hearing tested as being synonymous with the need for hearing aids and give the hearing test a new purpose so that the it becomes a way to "keep your hearing working at its best throughout life", just as we consider eye tests.

Using the hearing test to avoid loss

If individuals were to have their hearing checked when their hearing is good, they have a baseline to compare against in the future. Humans instinctively avoid loss, so if they see that they have good hearing they are more inclined to protect their hearing because they don't want to risk losing what they already have. The hearing test brings their hearing (and what it does for them) to their attention.

Using routine hearing tests to shape attitude

Furthermore, one of the ways that attitudes are formed is by looking at the evidence of our own actions (provided they are not forced to do it!): "I am the sort of person who cares for the environment because I recycle my carrier bags" versus "I'm not really bothered about the environment because I drop litter."

So if someone has their hearing checked routinely throughout life their own conclusion based on their own actions is "I must be the sort of person who cares about my hearing because I get it checked regularly. I wouldn't do that unless I cared." 

Routine hearing checks: the vehicle to relevance

Providing the right social context for approaching hearing care

Establishing routine hearing checks as the norm provides the right social context for people to do something about their hearing without feeling as though they're standing out as being 'different'. It's the norm…

If people younger than you have had their hearing checked, then it's obviously not an 'age thing'. If your friends have had their hearing checked and their hearing's "speech ready", then it's obviously not for 'deaf' people (so it's 'safe' for me to have my hearing tested). Putting it simply: we've changed the meaning of having a hearing test.

And it's a meaning far more palatable to most people: "I love my hearing. Therefore I keep it working at its best throughout life by regular monitoring." 

​​​​​​​​​​​​​​​​​​​In the diagram, each circle provides the social context for the circle(s) within it. If hearing tests are linked to needing hearing aids then you exclude everyone in the orange circle who do not recognise the need or relevance of hearing aids. If hearing tests are about hearing, then they capture part of the purple circle and every circle within it, including the 67-75% who are potential candidates but don't take action when the action (and context) is linked to the need for hearing aids.​​​​​​​​​​​​​​​​​​

Summary

 Let's finish this article with a practical summary. What do we need to do?

Firstly, if you are involved in running a hearing care practice or service, or you're involved in policy making, you need to ask yourself if there's any reason why you can't begin to offer people routine hearing checks throughout life.

The usual obstacle is the amount of time it will take away from other services (e.g. fittings), available resources (what qualification does someone need to do perform a hearing test), and the absence of remuneration (e.g. if you do the hearing test as a loss leader 'sales tool'). Remember that you'll be testing a lot of people that don't need to be fitted with hearing aids, because 5 out of 6 adults won't need hearing aids.

Can your current service model support this? If not, what do you need to change to make it work?

Because we won't reach the 67-75% people by trying to convince them they need hearing aids; hearing aids just aren't relevant to them. But hearing is. And by detaching the hearing test from the need for hearing aids we suddenly find ourselves with a powerful tool for changing attitudes.

Therefore:

1. Talk about detecting "changes in hearing" (neutral language), rather than "detecting any hearing loss" (negative/avoid language).
2. Explain that the hearing test is for monitoring hearing, to keep it working at its optimum throughout life.
3. Talk about "baselining your hearing" for those individuals who have never had their hearing checked. It makes sense to them. And it's never too early to get a baseline.
4. Until we reach a tipping point where 10% or more of the population are having their hearing tested routinely, we'll need to "borrow a crowd" by piggybacking on people's existing attitudes to having their eyes and teeth checked regularly: "Eyes checked. Teeth checked. Hearing checked."
5. Start promoting the service to everyone without any mention hearing loss or hearing aids. Make it a separate service.
6. If we want to increase relevance, automated screening tests do not count (e.g. telephone hearing tests, web-based tests, screeners) - they play their role in awareness but they miss the vital ingredient of regular exposure to a hearing care professional. Brushing our teeth on a daily basis is not the same as regular visits to the dentist. It needs that personal input.

If we follow these six simple rules we are going to greatly increase our relevance to the very people who up until now have remained unreached, and we are likely to see a change in less than 5 years. As a result we'll increase the rate of hearing aid adoption and to decrease the time it takes for them to do something about their hearing.

But if we do not make hearing checks routine, then no matter how much effort or resources we put into our advocacy or marketing, hearing aid adoption will continue at much the rate it always has.