Download MarkeTrak V Hearing Aid Industry Market Tracking Survey

MarkeTrak VI:
Measurement Drives Success –
Consumer Feedback on Needs, Benefit,
Satisfaction & Value
Sergei Kochkin, Ph.D.
Better Hearing Institute
Agenda
•
•
•
•
•
Factors impacting choice of dispenser
Factors impacting choice of brand
Improvements in H.I. sought by consumers
The impact of VC on satisfaction
The issue of value (price, benefit &
satisfaction)
• Toward a best practices protocol
Factors Impacting Choice of
Dispenser & Brand
Factors Impacting Choice of
Dispensing Practice (n=2,251)
(Importance scores =4-5 on 5 point scale)
Professional staff
77
Convenient location
64
Convenient hours
63
Price
63
Free hrg screening
59
Range of hearing aids
52
Physician referral
51
Live demonstration
50
Insurance coverage
46
Previous purchase
41
Friend recommended
31
0
10
20
30
40
50
60
% highly important
70
80
90
100
Example of Professional Office
Dr. Gyl Kasewurm – St. Joseph MI
Number of hearing health providers visited
prior to deciding on current hearing instrument
purchase.
One
61.1%
None
1.4%
Three or more
9.0%
Two
28.5%
Amount of Counseling Time Spent with Hearing Aid
Users During Last Hearing Instrument Purchase
(H.I. < 6 years compared to H.I. < 1 year).
35
Modal time is half hour
Percent of users
H. I. User
New < 6 years
Experienced < 6 years
All <1 year
30
25
None
0.25
0.5
0.75
4.3
3.4
4.3
0
3.3
2.2
2.2
5
4.4
4.6
5.7
13
14.4
12.8
10
18.3
19.8
20.7
15
25.1
24.3
25.2
31.7
31.4
29.2
20
2
3+
1
Counseling time spent (hours) with users
Percent of Consumers Receiving Followup Customer Satisfaction Survey
(H.I. < 6 years compared to H.I. <1 year in age).
Post-survey method
58.9
57.2
None
21.1
21.5
Verbal office
9
8.7
Mail
5.3
7.1
Written office
4.1
2.6
Phone
1.7
3
Computer office
0
5
Age of H.I.
H.I.< 6 years
H.I.< 1 year
10 15 20 25 30 35 40 45 50 55 60 65 70
Percent hearing instrument owners
Overall Customer Satisfaction Ratings as a
Function of Counseling Time Spent with Users
During Last Hearing Instrument Purchase
(H.I. < 6 years compared to H.I. < 1 year).
80
60
50
60
68
65
65
68
67
0.75
1
2
65
59
59
64
62
0.5
53
54
63
59
20
42
30
52
48
40
39
45
42
Percent of users
70
H. I. User
New < 6 years
Experienced < 6 years
All <1 year
10
0
None
0.25
Counseling time spent (hours)
3+
Overall Satisfaction with Hearing Instruments as a
Function of Post-fitting Survey Follow-up
(H.I. < 6 years compared to HI < 2 years).
Post-survey method
Age of H.I.
< 6 years
< 2 years
54
None
57
62
Verbal office
60
68
Mail
71
69
Written office
72
64
Phone
69
62
61
Computer office
30
40
50
60
70
Percent overall customer satisfaction
80
Key Conclusions
• Top factors in choosing dispenser:
– Professionalism
– Convenient location
– Convenient hours
– Price
• Minority of dispensers conduct formal post-purchase
survey with consumers.
• Post-purchase survey + related to satisfaction.
• Customers shop around for dispenser (4 in 10).
• Modal counseling time spent by dispenser is one-half
hour.
• Amount of counseling + related to satisfaction.
Factors Impacting Choice of
Brand
Factors Considered Helpful When Choosing
Brand of Hearing Aid (n=2,273)
(Helpfulness scores =4-5 on 5 point scale)
Audiologist recommendation
H.I.S. recommendation
Medical doctor recommendation
Other hearing aid owner recommendation
Consumer reports
Family members recommendation
Manufacturer brochures
Scientific papers
Magazine articles
Books on hearing aids
Newpaper articles
AARP recommendation
Direct mail ad
TV ads
Newspaper ads
HHP websites
Manufacturer websites
Radio ad
Internet chat sites
76
61
60
55
49
46
37
36
26
25
24
22
20
16
15
12
11
10
5
0 10 20 30 40 50 60 70 80 90 100
% helpful
Number of Hearing Instrument Brands Taken
Home at Last Fitting Prior to Final Purchase
(n=1,387 instruments < 5 years of age )
One
87.0%
Three or more
3.0%
Two
10.0%
Greater likelihood of receiving multiple brands if the
customer is an experienced user with a severe loss.
Prior Knowledge
• 60% of consumers had “some” to “good”
knowledge of technology prior to purchase.
• 40% of consumers knew the brand of
hearing instrument purchased.
Conclusions
• Top factors considered to be helpful and reliable
when choosing a hearing aid brand:
–
–
–
–
Audiologist recommendations
Hearing instrument specialist recommendation
Medical doctor recommendation
Hearing aid user recommendations
• Less than 20% consider marketing material or
websites as helpful in their purchase decision.
• 13% customers receive multiple brands at first
fitting.
– Equates to the 16% return rate in our industry
Conclusions
• Brand awareness is low (40%); technology
knowledge is higher (60%).
• Limited usage of Internet by our key
customer (elderly).
• ALD usage is low – highest is phone
amplifier (27%).
The Impact of the VC on
Consumer Satisfaction
Issues
• Consumer accessible VC (ease of regulating
volume) is diminishing with CIC and digital
hearing instrument growth.
• Previous MarkeTrak research:
– Use of VC rated desirable (77.5% consumers in US
market).
– Easier regulation of volume is on wish list of 72% US
and 65% German consumers.
– Customer satisfaction with volume regulation declined
by 11% points in last 10 years.
• Is removal of VC negatively impacting overall
satisfaction with hearing aids?
Percent of in-the-ear Hearing Instruments with
Volume Controls by Year of Purchase
Percent with VC
(MarkeTrak VI – n=2352)
100
90
80
70
60
50
40
30
20
10
0
98
<1994
91
94-95
88
1996
85
1997
81
78
75
1998
1999
20002001
Year of purchase
Customer Satisfaction with Hearing Instruments
as a Function of Desire for Volume Control
(MarkeTrak VI - H.I.< 6 years)
% Satisfied
No
90
80
70
60
50
40
30
20
10
0
Not Sure
Yes
79
66
60
60
73
66
63
48
39
New User
Experienced User
Total Users
Straight Comparisons of Hearing
Instruments With and Without VC
• In general ITE hearing instruments without VC
receive higher ratings (>10%):
–
–
–
–
–
Visibility
Comfort with loud sounds
Whistling/feedback
Use in noise
Telephone and cell phone usage
• The individual who wants a VC but does not have
one rates 35 MarkeTrak factors lower by at least
10% points – clearly dissatisfied with the total
experience.
Isolating VC effect
• Analysis of covariance
– Control for H.I. style, experience, technology
• On average , presence of VC shown to have
negative impact on:
– Comfort with loud sounds
– Use in noise
– Cell phone usage
• Presence of VC shown to have positive impact on:
– Battery life
• However, there are significant interactions due to
experience in favor of the VC.
Frequency of Desired Volume Adjustment –
Consumers without a VC
Source: Surr, Cord, Walden (HJ 2001 n=79 users)
Generally
6%
Half the time
10%
Occasionally
36%
Almost
always
5%
Always
0%
Never
23%
Currently the VC is
removed for a
minority segment
Seldom
20%
Conclusions
• Consumers do not like to fiddle with their hearing
instruments every 10 minutes.
• Automatic hearing instruments for all consumers
should be our goal.
• Until hearing instruments are PERFECT the
categorical removal of the VC will be problematic
for some consumers.
Conclusions
• Most likely problem areas are:
– Automatic hearing aids are not perfect and cannot
predict consumer needs in 100% of listening situations.
– Some consumers psychologically need some control
over their hearing instruments.
– Experienced users are unwilling to part with the VC
through habit.
• The dispenser needs to be especially vigilant to the
consumer’s need to control the volume of their
hearing instrument---especially experienced users.
– Even an “occasional” or “seldom” need is indicative of
the need for a VC.
Hearing Instrument
Improvements Sought by
Consumers
Hearing Aid Improvements Sought by Current
Hearing Aid Owners (n=2,428)
(Highly desirable scores =4-5 on 5 point scale)
Speech in noise
Better sound quality
Less whistle/buzzing
Lower price
More soft sounds
Longer lasting batteries
Work better on telephone
Loud sounds less painful
Speech in quiet
Better fit & comfort
Should have VC
Longer money back guarantee
Less costly to repair
95
88
85
84
83
82
82
81
81
79
77
74
73
0
10
20
30
40
50
60
70
% highly desirable
80
90 100
Hearing Aid Improvements Sought by
Current Hearing Aid Owners (n=2,428)
(Desirable scores =4-5 on 5 point scale)
Easier to regulate volume
Mask tinnitus
Easier to clean
Work better on cell phone
Better sound to music
Should not break down as much
Less visibility
Easier battery change
2-5 year payment plan
Should have remote
More fashionable
Color
Lease hearing aid
72
71
66
63
62
56
52
48
34
32
28
21
15
0
10 20 30 40 50 60 70 80 90 100
% highly desirable
Summary of Consumer Needs –
Four Methods
• Factors </= 40% satisfaction.
• Factors most related to overall customer
satisfaction.
• Reasons why hearing instruments are in the
drawer.
• Improvements sought in hearing
instruments.
Factors < / = 40% Satisfaction
• Hearing in noise
• Hearing instrument usage in large groups
• Hearing instrument usage on telephones &
cell phones
• Hearing instrument usage at concerts and
movies
• Whistling, feedback and buzzing
• Comfort with loud sounds
Factors Most Related to Overall
Customer Satisfaction
• Improved benefit at a good value
• Better sound quality
• Better Reliability
• Multiple Environmental Listening Utility
(MELU)
Reasons Why Hearing
Instruments are in the Drawer
• Poor benefit
• Inability to hear in noise/background
noise
• Poor fit and comfort
• Negative side effect of hearing
instrument
• Price & cost of repairs
Improvements Sought in Hearing
Instruments
•
•
•
•
•
Speech intelligibility in noise
Better sound quality
Less whistling & buzzing (feedback)
Lower price
More soft sounds audible
What does it take to turn the hearing
instrument market around? (Rihs
1997)
• The underdeveloped hearing instrument
market can only reach its potential if the
hearing instrument becomes a true
personal communication device.
• The stigma of hearing instruments will
decrease parallel to the increase in
hearing performance.
What does it take to turn the hearing
instrument market around? (Rihs
1997)
• The degree of user satisfaction is
directly related to hearing performance
and not the cosmetics.
• The negative image of the hearing
instrument will only disappear when
hearing comfort and communication in
all environments are guaranteed.
The Issue of Price & Value
Is This a Common Societal Perception?
Issues & Agenda
• Customer satisfaction with benefit and value are
key drivers of customer satisfaction.
• Without major improvements in these two areas
market growth is unlikely.
• Agenda:
– Explore the relationship between price, benefit and
satisfaction.
– Position our industry relative to other industries on
customer satisfaction.
– Explore possibilities of “best practices”
selection/fitting/verification/validation protocol
Customer Satisfaction with Value, Benefit in Noise,
Overall Benefit and Likelihood of Repurchasing
Percent Satisfaction
(H. I <3 years of age; source MarkeTrak III (1991) – MarkeTrak VI (2000)
100
90
80
70
60
50
40
30
20
10
0
Noise
Value
Repurchase Likelihood
77
31
32
1994
76
55 54
53 52
27
1991
80
75
54
Benefit
55 54
31
1997
2000
Method
• 36 MarkeTrak customer satisfaction studies
combined (n=16,519).
• Conducted between 1990-2002.
• More than half also administered
Abbreviated Profile of Hearing Aid Benefit
(APHAB).
• 26 of the studies have been published.
• Price of hearing system adjusted for
consumer price index in CY2002 terms.
Basic Descriptive Data
•
•
•
•
•
•
•
•
•
36 studies
Average age of consumer = 69
Median household income = $35,000.
82% bilateral loss/66% binaural user.
Half programmable
5% directional
5% DSP
28% BTE (higher than US average)
Mean CPI adjusted out of pocket cost of hearing
system was $2,308.
Measurement of Benefit
• Combined scales from APHAB
– Ease of communication
– Background noise
– Reverberation
• Absolute Benefit = Unaided – aided
• Percent Disability Improvement =
(Benefit/Unaided) x 100
• Consumer value = $$$/Percent disability
improvement.
Histogram of Hearing Disability Improvement as
Measured by the APHAB (n=8,654).
Hearing disability improvement =(APHAB Benefit/Unaided APHAB).
Sample size
Median=44%
600
550
500
450
400
350
300
250
200
150
100
50
0
0
10
20
30
40
50
60
70
Hearing disability improvement (%)
80
90
100
Validity of APHAB
• Related to market penetration (unaided).
• Correlated with customer satisfaction and hearing
aid usage.
• Unaided APHAB correlated (.45 - .68) with:
– Pure tone threshold
– NU-6 word recognition
– Speech in noise test
• Indirect validity:
– Absolute benefit of my studies is 28%
– Absolute benefit of the JAMA hearing aid efficacy
study (n=360):
• 29% on NU-6
• 26% on Connected Speech Test (CST)
Hearing Instrument Market Penetration is Highly
Related to Recognition of Hearing Disability
Percent Hearing Aid
Ownership
Source MarkeTrak IV (n=5,954 individuals with self-admitted hearing loss)
100
90
80
70
60
50
40
30
20
10
0
1-4 5-9 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- 90- 9514 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89 94 99
APHAB Unaided (Hearing Disability)
Relationship Between Price and Customer
Satisfaction for Hearing Instruments
Price
6000+
5000
4500
4000
3750
3500
3250
3000
2750
2500
2250
2000
1750
1500
1250
1000
750
500
250
Overall
Benefit
Value
Poly. (Overall)
Poly. (Benefit)
Poly. (Value)
<250
100
95
90
85
80
75
70
65
60
55
50
45
40
0
Satisfaction
< 3 years of age (n=13,451)
The correlation between price and overall satisfaction is low (+.02)
Relationship Between Improvement in Hearing
Disability and Customer Satisfaction (n=8,654)
Satisfaction
Powerful relationship between disability improvement and satisfaction
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
Overall
Benefit
Value
Poly. (Overall)
Poly. (Benefit)
Poly. (Value)
0
10
20
30
40
50
60
70
80
% Change in Hearing Disability
90
Satisfaction
Customer Satisfaction is Highly Related to $$$
Spent per 1% Improvement in Hearing Disability
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
Overall
Benefit
Value
Poly. (Overall)
Poly. (Benefit)
Poly. (Value)
5
15
25
35
45
55
65
75
85
95
125
Price ($$) spent per 1% disability improvement
200
500
Development of Underlying Models
• Aggregate consumers into narrow cohorts:
– $250 ranges for hearing system (free - $6000+)
– %10 hearing improvement range (10% - 100%)
• 110 aggregates
• Average consumer per cohort 78 people.
• Model weighted based on subjects per cohort after
calculating within each cohort:
– Satisfaction
– Hearing disability improvement (benefit)
– Average price paid (CPI adjusted)
% Satisfaction/repurchase
Satisfaction with Benefit and Likelihood of Repurchasing
Current Brand of Hearing Aid as a Function of Hearing
Disability Improvement.Price is not related to these two
variables. (Statistical model)
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
Benefit R2=87
Brand repurchase R2 =66
Benefit-Satisfaction
Brand repurchase
likelihood
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
Percent Improvement in Hearing Disability
90
95 100
Overall Customer Satisfaction as a Function of
Price and Hearing Disability Improvement
(Statistical Model)
Overall
Customer
Satisfaction (%)
Price
Hearing disability
improvement (%)
R2=.86
Customer Satisfaction with Value as a Function of
Price and Hearing Disability Improvement
(Statistical Model)
Customer
Satisfaction (%)
with Value
Price
Hearing disability
improvement (%)
R2=.87
General Conclusions
• Benefit more powerful predictor of customer
satisfaction then price.
• Customers are rational and will attempt to
maximize their benefit.
– Less than perfect benefit will result in significant brand
shifting
– Using the models a 50% improvement in hearing
disability=
•
•
•
•
86% satisfaction with benefit
59% repurchase rate
56% satisfaction with value at $3,000 (binaural)
75% overall satisfaction at $3,000 (binaural)
Toward a Best Practices Protocol
Benefit is Critical to Market Growth
• High benefit is related to:
– High customer satisfaction
– High brand retention
• High customer satisfaction :
– Leads to positive-word-of-mouth advertising
– And therefore market growth
• Important to focus on the dispenser’s role in
optimizing consumer benefit.
• Development of equivalent of a ISO9002 program
to optimize individual benefit at the point of sale.
Selection/verification/validation
Some Considerations
• Convene committee of industry’s brightest to
develop/recommend “best practices” hearing
instrument selection/verification/validation
protocol
– Medwetsky found wide variability in protocols in 60
practices.
– “might be a great need for a best practices standard
that is widely accepted and used by all hearing care
professionals”.
– Standards may be available but not utilized (e.g. ASHA
guidelines for hearing aid fitting for adults)
– Washington University School of Medicine Protocol
(attached for your review and consideration)
Selection/verification/validation
Some Considerations
• Fitting formula have become more sophisticated but they
are still a starting point. How many dispensers use the
default settings versus attempt to optimize individual
benefit at the point of sale?
• There will be significant differences in outcome measures
both in terms of speech intelligibility and subjective
consumer preference depending on which prescriptive
formula is used. (See January 2003 Hearing Review)
• May be significant interactions between prescriptive
formula, individual hearing loss characteristics,
style/circuit of hearing instrument, and perhaps even the
personality of the end-user .
Selection/verification/validation
Some Considerations
• Advanced multivariate research (e.g. use of artificial
intelligence software) could lead to the development of a
prescriptive decision tree which would assist the hearing
care professional in optimizing benefit for the end-user.
• Does the lack of wide scale adoption and/or usage of real
ear measurement impact benefit?
– 50% of HIS own
– 75% of audiologists own
• Does the lack of wide scale adoption and/or usage of
hearing aid analyzers impact benefit (e.g. measurements on
the functionality of the hearing instrument). Is a listening
test enough?
– 59% of HIS own
– 85% of audiologists own
Selection/verification/validation
Some Considerations
• Assure audibility of important sounds
(especially speech) and loud sounds should be
comfortable:
– 44% satisfaction with loud sounds comfortable in a custom
industry is unacceptable.
• Measurement of unaided and aided speech
intelligibility in quiet and noise. The difference is
benefit (see January 2003 Hearing Journal):
– Minority of dispensers and audiologists measure benefit routinely.
– Subjective (APHAB), or objective (HINT, QuickSIN) tests widely
available.
• Share benefit scores with consumers helping to
shape realistic expectations.
Selection/verification/validation
Some Considerations
• Should we establish contracts with consumers
promising certain levels of benefit in quiet and
noise based on our knowledge of the consumer’s
hearing loss characteristics?
• Does the use of patient focused 360 sound field
aided testing (e.g. Beltone Avenue) have a positive
impact on maximizing individual benefit?
– Preliminary research shows < fitting time
– No impact on APHAB benefit scores
• Should consumers be made to pay for hearing
instruments with little or no measurable benefit?
(e.g. speech intelligibility improvement).
Selection/verification/validation
Some Considerations
• Measurement of longer term customer
satisfaction (3+ months after fitting).
– Minority- 18% do any form of formal
follow-up.
• Issue of value assures that the
consumer expenditure of energy (time,
money) is exceeded by the dispensers
energy expenditure (time, service,
Dispenser
product).
Consumer
Selection/verification/validation
Some Considerations
• Industry associations should validate the best practices in
order to gain wide scale acceptance of a “golden” or “best
practice” protocol:
– Customer satisfaction
– Consumer benefit
– Profitability
– Dispenser morale
– Practice growth
– Referrals
– Return rates
• Turn best practices protocol into equivalent “Good
Housekeeping Seal of Approval”. Implicit in such a seal is
a “benefit guarantee” to the consumer.
Some Methods for Improving
Satisfaction 10%-20%
• More counseling time with consumer.
• Creating realistic expectations especially given
very high consumer expectations of DSP.
• Any form of outcome measure (benefit).
• Use of VC especially for experienced user.
• Directional hearing aids as standard technique for
improved communication in noisy situations.
• More patient focused techniques for optimizing
benefit.
• Creating more perceived value for the consumer.
Some Final Considerations
• Measuring performance helps drive success.
• Without effective measurement how can we assure
we have optimized the customer’s hearing
experience?
• Without effective measurement how can
dispenser’s grow in their wisdom on behalf of the
consumer?
Sample Protocol
Washington University School of Medicine
• Established appropriate prescriptive REIG (corrected for
mixed HL (>20% of A-B gap) and/or binaural summation
(<3-5 dB))
• REM for nonlinear hearing aids with input levels of 50, 65
and 80 dB with speech-weighted composite noise (analog)
or modulated ANSI noise (DSP) provides appropriate gain
and smooth frequency response. Printout placed in chart.
• REM for linear hearing aid with input level of 65 dB with
speech-weighted composite noise (analog) or modulated
ANSI noise (DSP) provides appropriate gain and smooth
frequency response. Printout placed in chart.
Sample Protocol
Washington University School of Medicine
• Assessed performance of directional microphone by
looking @ differences in REAR @ 00 and at azimuth of
greatest null. Printout placed in chart.
• Assess functionality of DSP NR circuitry using appropriate
bias signals.
• RESR90 using a pure-tone sweep corresponds to
appropriate frequency-specific SPL level for loudness
judgment of “loud, but OK.” Printout placed in chart.
• Loudness judgment of 50 dB composite noise is “very
soft” or “soft”
Sample Protocol
Washington University School of Medicine
• Loudness judgment of 65 dB composite noise is
“Comfortable, but slightly soft,” “comfortable,” or
“Comfortable, but slightly loud.”
• Loudness judgment of 85 dB composite noise is “loud, but
OK.”
• Measure aided thresholds @ 500, 1000, 2000 and 4000 Hz
using FM signals @ 00*
• Measure unaided and aided HINT (dBA) in Quiet with
sentences @ 00*
* Currently under consideration
Sample Protocol
Washington University School of Medicine
• Measure unaided and aided HINT RTS in Noise with
Sentences and Noise @ 00*
• ANSI-96 reveals <10% THD; ANSI-92 reveals smooth
coupler response @ 50-80 dB SPL. Printout placed in
chart.
• Potentiometer or programmed settings are in the chart.
• Discuss and/or recommended Aural Rehabilitation and/or
ALDs.
* Currently under consideration
Sample Protocol
Washington University School of Medicine
• APHAB, COSI or Wash U Questionnaire (unaided, aided
and benefit) and placed in chart.
• Called patient 2-3 days post-initial fit.
• Customer satisfaction survey (3-6 months after fitting) –
Kochkin recommendation.