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The missing ingredient for increasing hearing aid adoption

What's wrong with this picture? What's the missing ingredient (and don't say hair).

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:

  • "We need to make hearing aids more cosmetically appealing."
  • "We need to make hearing aids more affordable."
  • "We need to make hearing aids more comfortable."
  • "We need to give people more/better opportunities to discover hearing aids."
  • "We need to make hearing aids easier to obtain."
  • "We need to increase their visibility on the high street."
  • "We need to improve how hearing aids are marketed."
  • "It's pointless trying. People just don't want hearing aids."

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:

Our 1st goal…

Convince someone their hearing is important enough to be worth bothering about.

Our challenge…

 Many people don't actually realise what their hearing does for them.

Our 2nd goal…

Convince them their hearing is missing things​.

Our challenge…

They may be fully convinced that the problem is due to everyone else (e.g. mumbling) or the situation (e.g. background noise).

Our 3rd goal…

Convince them they need those missing sounds.

Our challenge…

They may believe they are coping fine or can get by without those missing sounds: "It's only a few of the consonants" or "I hear everything I want to hear". 

Our 4th goal…

Convince them that there is a solution to give them back those sounds.

Our challenge…

They may have beliefs about unwanted side effects: "it will be uncomfortable", "it will whistle", "it will make me look like my grandparents". 

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

Our 1st goal…

Convince someone their hearing is important enough to be worth bothering about. 

The behaviour of having routine hearing checks demonstrates the importance of hearing

By promoting routine hearing checks, we begin to instil in people a new respect for their hearing. We help convince them that hearing is worth bothering with, just as routine dental checks and routine servicing on our vehicles convince us they're important.

Our 2nd goal…

Convince them their hearing is missing things​. 

Routine hearing checks provide early detection of otherwise unnoticeable changes

If someone is having their hearing checked regularly, then any changes are picked up in the earlier stages. The individual can then apply that knowledge against their everyday experience, and are more likely to see those times when they miss things as being due to their own hearing (because they now have the relevant evidence) rather than due to the situation or another person.

But it's also been a gradual awakening for them, so they are likely to have several years to get used to the idea of "doing something about their hearing"; this removes that sudden shock (and the accompanying grieving process) that many experience today when they go for their first test only to discover that not only is their hearing not as good as they believed it was, it's so bad they actually need hearing aids!! Double whammy!

So by 'monitoring the hearing' and detecting changes, they convince themselves that they are missing things, which gets them past Step 2.

Our 3rd goal…

Convince them they need those missing sounds. 

Routine hearing checks bring self-knowledge

Getting someone to recognise they need the sounds they are missing comes mainly as a consequence of the education provided through repeated exposure to the hearing care practitioner and partly by their own desire to be "socially liked and socially right", a universally powerful motivator of human behaviour.

Because they now know the problem is due to them, they are likely to feel "less settled" on those occasions when their hearing lets them down ("what will others think of me?").This will generate the necessary self-motivation to overcome that unsettled feeling. And motivation is always better if it comes from the individual rather than a third party (e.g. "my family sent me.") because they're in "problem solving mode", rather than on the defensive looking for ways out.

Our 4th goal…

Convince them that there is a solution to give them back those sounds. 

Routine hearing checks provide early positive exposure to potential solutions

By now they will have had plenty of opportunity over the years of regular visits to the hearing care practitioner to see and discuss what's available before there's any real need for a solution.

This is going to form a very important foundation for positive attitude formation for when the time eventually comes to treat their reduction in hearing. Before deciding to wear hearing aids, they will need to form an attitude towards them: do they approach or avoid?

In doing so, they will draw on “what comes most easily to mind”. If they have had repeated exposure to the latest designs and technology during their visits to their hearing care professional, this will spring to mind far more easily than outdated memories or negative anecdotes.

In other words, the repeated (passive) exposure guides their attitude formation towards the modern rather than the outdated (with all their intrinsic shortcomings and unwanted side-effects). 

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.

How to resonate with how people see themselves and...
Why we must never use the ‘S’ word in hearing care

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