Enablers and Barriers to Hearing Aid Help-Seeking and Uptake: A Qualitative Analysis Using the COM-B Model

Background: Hearing aid help-seeking and uptake remain low despite technological advancements and increased accessibility. Understanding the enablers and barriers influencing these behaviors is essential for improving strategies to promote hearing-health care use. Purpose: This study explores user perspectives on hearing aid help-seeking and uptake in the United States, using the Capability, Opportunity, Motivation–Behavior (COM-B) model to analyze behavioral enablers and barriers among prescription and over-the-counter (OTC) device users. Research Design: This was a qualitative study using an inductive thematic analysis framework. Study Sample: Participants (n = 41) included adult hearing aid users from the Hearing Tracker (n = 37) website community and the Lexie Hearing database (n = 4). Participants had a mean age of 69 years (11 standard deviations; range 36–88 years), and 68 percent were male. Data Collection and Analysis: Semistructured interviews were conducted virtually, transcribed verbatim, and analyzed using thematic analysis. Themes and subthemes were mapped onto the COM-B model to explore the behavioral drivers of hearing aid help-seeking and uptake. Results: The analysis, framed within the COM-B model, identified 20 themes and 55 subthemes across two overarching categories of enablers and barriers to help-seeking and hearing aid uptake. For hearing aid help-seeking, opportunity factors (e.g., support from hearing care professionals [HCPs] and social networks and trial periods) and motivation factors (e.g., job performance and self-perceived need) were primary enablers, and preconceived beliefs (capability), fear of dependence (motivation), stigma, and cost (opportunity) acted as key barriers. For hearing aid uptake, capability factors (e.g., ability to make adjustments on an app and technology advancements levels), opportunity factors (e.g., support and guidance from HCP, device trials, and affordability), and motivation factors (e.g., social interaction) promoted adoption, whereas lack of informational counseling (capability), device functionality, limited insurance coverage, negative HCP experiences (opportunity), and stigma (motivation) discouraged uptake. Conclusions: Hearing aid help-seeking and uptake are influenced by a complex interplay of capability, opportunity, and motivation factors. Targeted interventions addressing stigma, affordability, and user expectations, especially for the growing OTC population, may improve adoption. Clinical Relevance Statement: Understanding enablers and barriers to hearing aid help-seeking and uptake may guide audiologists in developing more personalized, motivation-based counseling strategies. The findings highlight practical approaches for addressing stigma and affordability concerns, enhancing user autonomy, and personalizing support for both prescription and OTC hearing aid users, ultimately improving patient engagement and hearing-health care outcomes.