Real-World Hearing Aid Challenges: A Qualitative Analysis of Self-Initiated Ecological Momentary Assessments

Background: Accurate and timely postfitting outcome measures are essential for individualized care and to prevent hearing aid nonuse. Ecological momentary assessment (EMA) can aid in measuring outcomes and enhance ecological validity by reducing recall bias through the collection of near-real-time data on experiences, providing insights into user challenges, preferences, and activities. Purpose: This study aimed to qualitatively explore the everyday listening challenges that hearing aid users report in real time, using a large dataset of self-initiated EMA responses. Research Design: This is a retrospective manual qualitative content analysis of open-text responses, which were collected from hearing aid users through smartphone-based self-initiated EMAs. Study Sample: 3,696 open-text responses describing hearing aid challenges were considered for analysis. The data were a subset of a larger dataset, obtained from 2,301 predominantly English-speaking hearing aid users. Data Collection and Analysis: Deidentified data were collected through a smartphone app compatible with commercially available hearing aids. Clinicians enabled an EMA feature in the fitting software, allowing participants to self-initiate real-time feedback on notable listening experiences as part of their ongoing hearing-health care journey. Results: The categories identified were sound quality, connectivity, speech understanding, discomfort, battery life and charging, performance and practicality, and other user perceptions. Individuals in this study reported challenges with their hearing aids related to distorted or unnatural sound quality, intermittent Bluetooth connectivity, difficulty understanding speech in noisy environments, and challenging auditory acclimatization. The most frequently reported challenges (43.5 percent) related to sound quality. Conclusions: Using smartphones to collect EMA data offers an effective means for hearing aid users to provide real-life feedback to clinicians about their auditory experiences. EMA data from hearing aid users provide an ecologically valid view of their experiences, which could aid clinicians in performing needs assessments, personalized hearing aid adjustments, and clinical counseling. Clinical Relevance Statement: Insights from this studys EMA data accentuate the importance of capturing real-world listening experiences, to guide needs assessments, personalized hearing aid adjustments, and clinical counseling as part of person-centered hearing-health care.