The Role of Trust in Treatment Uptake for Hearing Loss in Older Adults

Thesis (Ph.D.)--University of Washington, 2018Untreated hearing loss in older adults is a growing public health problem. Many of the barriers contributing to the low uptake of hearing healthcare (e.g., stigma, accessibility, affordability) have been cited in the audiology/hearing healthcare literature. Policymakers are working to improve accessibility and affordability of hearing healthcare, but other barriers (i.e., trust) require further examination to effectively reduce this gap in need. While trust is a less-documented barrier, qualitative findings suggest that a lack of trust in hearing healthcare providers contributes to the low uptake of hearing aids and hearing healthcare services. However, there is little evidence to support a measurable relationship between trust and treatment uptake for hearing loss. Therefore, the purpose of the proposed study was to quantitatively explore the role of trust in older adults’ decisions to treat their hearing loss. American adults ages 60 years and older (n= 300, 50.3% Female) completed a 30-45 minute survey which examined their experiences with hearing healthcare, hearing healthcare-seeking behaviors, and trust levels in various aspects of the healthcare and hearing healthcare systems. Many of the survey items that measured trust were unique to this study. All participants had subjective hearing loss; 118 (39.4%) participants had never sought help for hearing problems while 182 (60.7%) participants were hearing aid and/or cochlear implant users. Factor analysis, reliability analysis, and multiple regression analyses were employed to examine the relationship between trust and treatment uptake. Factor analysis and reliability analysis confirmed that the items used to measure trust were internally consistent. Regression analyses revealed that hearing sensitivity (as measured by pure-tone average) and having insurance coverage for hearing aids consistently and significantly predicted treatment uptake. Results also suggest that trust moderates the effect of stigma. However, we found no evidence that trust significantly predicted treatment uptake. Limitations and generalizations of these results are discussed, as well as future directions for research