Social representation of hearing loss and hearing aids

Background and Objective: Despite the negative consequences of hearing loss, people with hearing loss (PHL) wait about 10 years before seeking professional help and adopt hearing aid. Much of the knowledge in hearing help-seeking and hearing aid adoption have used attitude theories and stigma theory. However, the strategies developed based on these theories have not resulted in any substantial improvements to help-seeking behavior. Thus, it is essential to consider alternative theories (e.g., Theory of Social Representations) which have been successfully used in disability research to better understand how PHL perceives hearing loss and hearing aids to improve help seeking ad hearing aid adoption. The aim of the current study was to examine the social representation of hearing loss and hearing aids in PHL in India, Republic of Korea (ROK), United Kingdom (UK), and the United States (US). Social representation refers to values, practices, customs, ideas, and beliefs that are shared between individuals in a society or group. Design: The study used a cross-sectional survey design. 424 participants were recruited using a consecutive sampling method in four countries (India, ROK, UK and US). Data was collected using a free association task self-reported questionnaire and analyzed using various qualitative (i.e., content analysis) and quantitative (similarities analysis, prototypical analysis, and Chi-square analysis) techniques. Results: The free associations of the PHL relating to hearing loss were grouped into 37 categories. The most commonly reported categories were ‘communication difficulties,’ ‘negative mental state,’ ‘ageing,’ ‘assessment and management,’ ‘causes of hearing loss,’ ‘hearing ability or disability,’ ‘hearing instruments,’ and ‘symptoms of hearing loss.’ Similarities analysis and prototypical analysis highlighted two main negative categories ‘negative mental state’ and ‘communication difficulties’ which form the central elements of social representation of hearing loss. PHL associated hearing loss mainly as a negative phenomenon but with some positive and neutral aspects. ROK respondents reported a greater number of neutral associations compared to other countries. In terms of the hearing aids, the free associations were grouped into 45 categories. The frequently reported categories across all countries were ‘beneficial,’ ‘cost and time’ and ‘appearance and design.’ Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the social representation of each country. ‘Others' actions and attitude’ category was predominantly reported by PHL in India. ‘Disturbance’ and ‘dissatisfaction’ of hearing aids and the ‘repairs and maintenance of hearing aids’ categories were mainly reported from the ROK and the US, respectively. Overall, there were cross cultural similarities and differences in PHL’s social representation of hearing loss and hearing aids, although more similarities than differences were noted. Conclusions: The study provides an insight into how PHL collectively view hearing loss and hearing aids. We believe that these findings will help to develop our understanding of the influence of culture on the social representation of hearing loss and hearing aids. The results will aid the development of culturally appropriate public education campaigns, marketing material and appropriate rehabilitation for PHL with the aim to improve help-seeking and hearing aid adoption