Investigating Supply and Demand-Side Barriers to Hearing Aid and Audiology Service Access for Older Adults in Rwanda: A Mixed-Methods Research Protocol

Hearing loss is a prevalent yet neglected public health issue among older adults in sub-Saharan Africa, significantly impacting quality of life. In Rwanda, where the ageing population is growing, access to hearing aids and audiology services remains a critical evidence gap. This research protocol outlines a mixed-methods study to investigate comprehensively the barriers to accessing these services for adults aged 60 and above. A concurrent triangulation design will be employed. Quantitatively, a cross-sectional survey of approximately 400 older adults across four districts will assess hearing loss prevalence, service awareness, and perceived barriers. Qualitatively, in-depth interviews with 30–40 survey participants and key informant interviews with 15–20 policymakers, healthcare providers, and service managers will explore systemic and contextual challenges. Integrated analysis will identify convergent and divergent themes. The study aims to delineate specific barriers such as cost, geographical access, stigma, and workforce shortages. This protocol provides a rigorous framework to generate the first comprehensive evidence on this issue in Rwanda. The findings are intended to inform the Rwandan Ministry of Health and regional stakeholders in developing targeted policies to integrate ear and hearing care into primary health systems and healthy ageing strategies, aligning with global priorities.