Smartphone-connected hearing aids enable and empower self-management of hearing loss: a qualitative interview study underpinned by the behavior change wheel

Objectives: To identify patient-reported barriers and facilitators to using smartphone connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed. Design: A single-center, prospective, observational study. Eight hearing aid users (new=1, existing=7; mean age= 71.75 years, SD= 5.23, range= 65-81 years) were identified through convenience sampling from 44 participants who took part in a seven-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, pre-set and customized programmes. Participants were assigned to one of two focus groups following trial of the app. Results: Focus group transcripts were thematically analysed and underpinned by the COM-B (Capability, Opportunity, Motivation – Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators. Capability: The app increased participants’ knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use. Opportunity: Perceived smartphone norms (i.e. acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers. Motivation: The ability to control hearing aid settings in any listening situation (e.g. to reduce noise), empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The ...