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Wednesday, 09 November 2011 20:35

Increasing hearing aid adoption: The Missing Ingredient

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Bald man with hair gelLet's take 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 need 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...”

Here is a list of some of the most commonly suggested solutions:

  • "…making hearing aids more cosmetically appealing."
  • "…making hearing aids more affordable."
  • "…making hearing aids more comfortable."
  • "…giving people more/better opportunities to discover hearing aids."
  • "…making hearing aids easier to obtain."
  • "…increasing their visibility on the high street."
  • "…improving how hearing aids are marketed."
  • "…it's pointless trying. People just don't want hearing aids."

Did you find yourself agreeing with any of these answers?

Unfortunately none of these 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 (a commonly held misconception); it's that they don't think they need them in the first place. 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 2 out of 3 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 Steps to Relevance

Therefore the steps we need to take someone along if we are going to persuade those 2 out of 3 people are as follows:

Step 1:

Convince someone their hearing is important enough to be worth bothering about (as many people don't actually realise what their hearing does for them).

Step 2:

Convince them that it is their hearing that is missing things (when they are fully convinced that the problem is due to “everyone else”, e.g. mumbling).

Step 3:

Convince them that they actually need those sounds they are missing (when they often believe they are coping fine or can get by without them: “it's only a few consonants”).

Step 4:

Convince them that there is a solution to give them back those sounds without bringing in unwanted side effects (e.g. "it will be uncomfortable", "it will whistle", "it will make me look like my grandparents").

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

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

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

The traditional view of the hearing test

The hearing test originated as a way to find out who qualified for being fitted with hearing aids, particularly amongst war veterans. Even now it is still viewed by many as a “sales tool”: you demonstrate the need; you fit the solution.

This thinking is still inherent in much of our current approach to hearing care, so much so that many hearing aid dispensers are paid commission for prescribing hearing aids, so if they test someone who has good hearing that can be seen as “a waste of time”.

Similarly, many doctors do not refer to Audiology for a hearing test unless they themselves are convinced in their own mind that their patient will not only need hearing aids but is likely to use them. Even on the NHS Choices website it states that the purpose of the hearing test is:

“to check the hearing of someone who is experiencing hearing problems or has a hearing impairment”.

Compare this to how the NHS website explains the sight test:

"Why are regular eye tests (sight tests) so important?

It's easy to neglect your eyes because they rarely hurt when there's a problem.

Having an eye test won’t only tell you if you need new glasses or a change of prescription, it’s also an important eye health check. It can spot many general health problems and early signs of eye conditions before you're aware of any symptoms – many of which can be treated if found early enough.

It's recommended that you have a sight test every two years (or more frequently if advised)." (underlining added for emphasis)

Presenting the wrong message to the public


Notice on the NHS website how the hearing test is for "someone who is experiencing" (i.e. it happens to someone else, not you) whereas the sight test is addressed to "you"?

Notice also that the hearing test is for someone who is experiencing (i.e. they've noticed it and it's become a problem for them), whereas the sight test is to spot problems and conditions "before you're aware of any symptoms."

Something is seriously wrong here in our messages...

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?

But as we already know, 2 out of 3 people have not reached that stage of thinking they need hearing aids. It's all very subjective.

Time for a new message

The general public need to view the hearing test as a way of monitoring their hearing and detecting changes (notice not detecting hearing loss!) in their hearing. We need to detach that link from 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.

Avoiding 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.

Our behaviour shapes our attitudes

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 journey to relevance

Step 1

So we see that simply 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. This gets them past Step 1 on the journey to relevance.

Step 2

If they are 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.

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. This takes them to Step 2 (above).

Step 3

Step 3 occurs partly 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.

Step 4

Finally we get to Step 4. 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 it.

This will 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 when visiting their hearing care professional, this will spring to mind far more easily. 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).

Changing the environment

Finally 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."

Putting this into effect

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 2 out 3 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.


  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.

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Curtis Alcock

Curtis J. Alcock is Founder of Audira » Think Tank for Hearing.

He was involved in design and marketing for 12 years before making the transition into hearing care nearly 12 years ago. He now runs an independent family-run hearing care practice in the United Kingdom and has spoken internationally on shaping the future of hearing care.

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