Objectives: The World Health Organization estimates that 25% of older adults worldwide have disabling hearing loss. Although hearing aids are the conventional management strategy for this condition, the rate of abandonment of these devices is high. Complete abandonment of the device can expose individuals to the negative consequences of untreated hearing loss. Although previous studies have examined the effect of attitudes on hearing aid abandonment, they have not investigated the time over which abandonment occurs. Consequently, previous evidence has not explored whether attitudes toward hearing loss and hearing aids are associated with the speed (i.e., hazard) at which individuals abandon their hearing aids over time. Our primary objective was to determine the effect of attitudes toward hearing loss and hearing aids on both the risk and timing of hearing aid abandonment. A secondary objective was to assess the potential effect of attitudes toward hearing loss and hearing aids on changes in social participation and withdrawal from social activities.
Design: We conducted a retrospective cohort study involving 355 patients who received hearing aids from a Chilean public hospital. Device abandonment over time was assessed by asking the patients about the specific month of hearing aid abandonment. Attitudes toward hearing loss and hearing aids were measured using the Spanish version of the Attitudes towards Loss of Hearing Questionnaire (S-ALHQ), while changes in participation and withdrawal from social activities were assessed using the Glasgow Benefit Inventory questionnaire. Univariate and multivariate flexible parametric models were developed to estimate the hazard ratio of hearing aid abandonment over time, with attitudes toward hearing loss and hearing aids as the primary predictors. Furthermore, multivariate multinomial regression models were constructed to evaluate the relationship between attitudes and changes or withdrawal from social activities.
Results: The cumulative incidence of hearing aid abandonment was approximately 21%. The median score on the S-ALHQ was 2.45 points (25th to 75th percentile: 2.05 to 2.77). In the flexible parametric survival models, for each average point increase on the S-ALHQ questionnaire, there was a twofold increase in the risk of hearing aid abandonment over time (Hazard Ratio = 2.09; 95% Confidence Interval = 1.30 to 3.40). In addition, an association was found between attitudes and withdrawal from social activities, with a 5.5-fold increase in the risk ratio for withdrawal from social activities (Relative-Risk Ratio = 5.53; 95% Confidence Interval = 1.49 to 20.56).
Conclusions: More negative attitudes toward hearing loss and hearing aids were associated with an increased risk of hearing aid abandonment over time, and an increased risk of withdrawal from social activities. Thus, attitudes toward hearing loss and hearing aid use should be considered when implementing hearing rehabilitation programs that include the dispensing of hearing aids.
Keywords: Attitudes; Hearing aid abandonment; Hearing aids; Social activities; Social participation.
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