The Key Word Is Trust: Hearing Healthcare Experiences Among Black Adults Who Meet Audiometric Candidacy Criteria for Cochlear Implantation

Objectives: The objective of this study is to explore the lived experiences and perspectives of Black adults who meet audiometric candidacy criteria for cochlear implantation, as well as their communication partners. While disparities in cochlear implant (CI) uptake among Black adults are well-documented, the reasons for these inequities are less understood. This study examines how Social Determinants of Health shape access and engagement with hearing healthcare, identifying factors that influence CI utilization. Design: This study is the first phase of the Memphis SOUND (Serving Our Underrepresented Neighbors who are Deaf and Hard of Hearing) Project, a community-engaged research initiative to address hearing health disparities among underserved populations. Guided by the PRECEDE-PROCEED Model, we conducted qualitative interviews with Black adults who met audiometric criteria for cochlear implantation and their communication partners. Using iterative inductive and deductive coding, we identified predisposing, reinforcing, and enabling factors across individual, family, and systemic levels that influence hearing healthcare engagement. Results: Semi-structured interviews with 15 participants, including 6 individuals with CIs, 4 without CIs, and 5 communication partners, revealed limited awareness of hearing loss as a health condition and reported no prior knowledge of CIs until suggested by a healthcare professional. Common barriers included delays in care, poor healthcare coordination, and negative provider interactions. Several participants cited medical mistrust as influencing decision-making. Facilitators included trust in the provider and receiving clear, satisfactory information on CIs. Socioeconomic factors also affected some participants’ access. All participants expressed a desire for community-based efforts to improve awareness of hearing healthcare and CIs. Conclusions: Underutilization of CIs among Black adults is driven by systemic barriers. Participants described complex, individual pathways from the onset of hearing loss to their decision on cochlear implantation, with delays linked to late awareness, inadequate provider communication, and limited specialist referrals. Participants who proceeded with cochlear implantation felt well-informed, while non-users cited skepticism and insufficient information as key obstacles. Medical mistrust further shaped participants’ engagement with hearing healthcare. Findings underscore the need for accessible, trustworthy hearing health information within Black communities and highlight the potential of community-level engagement to build trust and improve hearing health outcomes in underserved populations.