The Hearing Aid Effect across Diverse African Populations and Various Hearing Device Modalities.

Introduction: The stigma associated with wearing hearing aids, known as the "hearing aid effect," remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting. Therefore, the objective of the study is to determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely, area of residence and level of education across African communities.

Methods: The study used a cross-sectional design with 322 participants (161 rural, 161 urban), mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices (standard behind-the-ear hearing aid [BTE HA] with an ear mould, mini BTE HA with a slim tube [ST], in-the-canal [ITC] HA, AirPod, receiver in canal [RIC], completely-in-canal HA, and Personal Sound Amplification Product [PSAP]) worn by a peer model using a validated scale of eight attributes (attractiveness, age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with ear mould were used as a benchmark for comparison.

Results: No hearing aid effect was observed across all participants (n = 322) with device ratings ranging between neutral and positive. Significant differences between device ratings were evident for attractiveness for ST and PSAP and trustworthiness for ITC. In terms of residence, urban participants provided more favourable ratings compared to rural participants, with significant differences across three attribute ratings: hardworking for ST; attractiveness, hardworking for ITC; age for RIC and AirPod; and hardworking for PSAP. For level of education, significant differences were found for attributes of attractiveness (H = 13.5; p = 0.001) for ITC; attractiveness (H = 14.7; p = 0.001) for PSAP; age (H = 9.5; p = 0.009) for RIC; age (H = 14.3; p < 0.001) and intelligence (H = 15.1; p < 0.001) for AirPod; and hardworking (H = 11.9; p = 0.003) for ST.

Conclusion: Overall, participants had a neutral to positive view of hearing devices with preferences for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices.