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Attitudes toward Hearing Aids and Cochlear Implants for Older Adults
among Ear, Nose and Throat (ENT) Physicians
Patthida Maroongroge, D.D.S.*, Rose L. Allen, Ph.D.*, and Todd Daniel,
*Department of Communication Sciences & Disorders,
The Health Belief Model (HBM)3 has been demonstrated to be a useful
framework for assessing the attitudes of primary care physicians (PCPs)
toward hearing rehabilitation for older patients.4
This study aimed to use the HBM to examine attitudinal factors that might
influence ENT physicians’ recommendations and decisions to refer older
patients for hearing aids and cochlear implants. Furthermore, the attitudes of
ENT physicians in this study were compared to the attitudes of PCPs in the
Gilliver and Hickson study.4
Susceptibility
ENT physicians expressed neutral
attitudes about their older patients’
susceptibility to hearing loss (M =
3.06).
Participants
• 147 ENT physicians were recruited from one local hospital and four
physician conferences held in Missouri, Illinois, and Georgia.
• A total of 46 surveys were returned; 39 were usable (31.3% response rate).
Procedure
• The survey was distributed by two methods: (a) paper survey distributed at
the conferences and at the local hospital, (b) online survey distributed to
ENT physicians’ email addresses after attending the conference.
• Independent samples t-test was used for comparison between groups.
There were no significant differences in their attitudes in perceived susceptibility,
severity, and barriers.
39
40
24
PCP
29
20
8
Disagree
Neutral
Agree
Strongly
agree
ENT
Susceptibility
80
67
40
20
Disagree
Neutral
Agree
60
46
36
20
3
5
Strongly
disagree
Disagree
10
0
Neutral
Agree
Strongly
agree
Figure 5. Responses to “Cost is a significant
barrier for older patients when considering
hearing aids/ CIs.”
80
67
60
40
31
20
3
0
Strongly
disagree
Disagree
Neutral
Agree
Strongly
agree
Figure 6. Responses to “I find it easy to discuss
hearing aids/ CIs and assessment with older
patients.”
Self-Efficacy
4
5
CONCLUSIONS
• Generally, ENT physicians were aware of the high susceptibility and
the severity of hearing loss in older patients, and had positive attitudes
toward the benefits of hearing aids and cochlear implants for this
population.
• However, ENT physicians expressed a high level of concern about their
older patients’ ability to afford and adjust to these devices.
• When compared with PCPs, ENT physicians had more positive
attitudes toward the benefits of hearing aids and cochlear implants, and
had higher levels of self-efficacy for referral (p < .001).
• ENT physicians and audiologists should collaborate to develop
outreach educational programs for PCPs on current intervention
options, especially cochlear implants, and their potential benefits to the
hearing impaired elderly.
• Both ENT physicians and PCPs believed that older patients have
difficulty in affording and adjusting to hearing aids and cochlear
implants. These beliefs may affect their decisions to refer patients for
audiological services.
REFERENCES
80
% of responses
ENT physicians reported high
confidence in their ability to counsel
and refer patients for hearing aids and
cochlear implants (M = 3.97).
3
Mean scores
Strongly
agree
80
40
2
Note. Figure shows mean attitude scores on each HBM construct. Higher scores indicate more
positive attitudes. *p <.001
Figure 4. Responses to “For older people, the
benefits of hearing aids/ CIs often outweigh the
potential disadvantages.”
Barriers
ENT physicians had negative
perceptions about the ability of older
patients to use hearing aids and
cochlear implants (M = 2.49).
*
1
31
Strongly
disagree
• Comparison between groups revealed
that ENT physicians whose offices
provide cochlear implant services had
more positive attitudes toward the
benefits of cochlear implants than
those whose do not (p=.022).
Self-efficacy
60
0
ENT physicians reported positive
attitudes towards the benefits of
hearing aids and cochlear implants for
older patients (M = 4.15).
*
Barriers
3
Benefits
Severity
Benefits
Figure 3. Responses to “Hearing loss often
causes difficulties for older patients’
relationships with their spouse and/or family.”
% of responses
ENT physicians believed that hearing
loss has serious consequences on
their older patients’ lives (M = 3.95).
• They believed that patients would have
difficulties with cost, stigma, and
adaptation to the use of devices.
54
60
41
40
20
5
0
Figure 1. Components of the HBM proposed by Gilliver and Hickson (2011)
•
Figure 7. Mean attitude scores in ENT and PCP groups
60
Strongly
disagree
% of responses
• Each HBM item required participants to respond on a 5-point scale,
ranging from strongly disagree (1) to strongly agree (5).
• Mean scores for each HBM construct were calculated from items in
that construct.
ENT physicians had more positive attitudes in the areas of perceived benefits,
t(38) = 7.43, p < .001; and self-efficacy, t(38) = 5.92, p < .001.
0
• The survey was adapted from a previously published questionnaire, which
was developed based on the HBM constructs.4
• 22 statements measured attitudes toward hearing aids and cochlear
implants for older adults via five HBM constructs (see Figure 1).
•
80
% of responses
Survey
Comparison between ENT physicians and PCPs
Figure 2. Responses to the statement “Almost
all of my older patients have hearing
difficulties.”
Severity
METHODS
RESULTS
Figures 2-6 show responses to sample statements that reflect attitudes in each
HBM construct (CIs = cochlear implants).
% of responses
Ear, Nose and Throat (ENT) physicians play an important role in referring
older patients with hearing loss for hearing aid and cochlear implant services.
Institute, Missouri State University
RESULTS
INTRODUCTION
Hearing aids and cochlear implants are an effective intervention for older
people with hearing impairment.1 However, adoption of these devices among
the older population has remained low.2
†RStats
†
Ph.D.
Strongly
disagree
Disagree
Neutral
Agree
Strongly
agree
1. Sprinzl, G., & Riechelmann, H. (2010). Current trends in treating hearing loss in elderly people: a review
of the technology and treatment options - a mini-review. Gerontology, 56(3), 351-358.
2. Chia, E., Wang, J., Rochtchina, E., Cumming, R., Newall, P., & Mitchell, P. (2007). Hearing impairment
and health-related quality of life: the Blue Mountains Hearing Study. Ear & Hearing, 28(2), 187-195.
3. Rosenstock, I. (1966). Why people use health services. The Milbank Memorial Fund Quarterly, 44(3), 94127.
4. Gilliver, M., & Hickson, L. (2011). Medical practitioners' attitudes to hearing
rehabilitation for older adults. International Journal of Audiology, 50(12), 850-856.