Why do greater hearing difficulties not always lead to hearing aid adoption?

One of the longstanding challenges in hearing healthcare is understanding why some individuals adopt hearing aids while others do not.

At first glance, the answer seems straightforward. People experiencing greater hearing difficulties should be more motivated to seek help. After all, hearing aids are designed to address the very challenges they are experiencing.

Yet hearing aid adoption has never been fully explained by hearing loss alone. In fact, when we think about how much the field understands about hearing aid adoption, there is more that we don’t know (so-called unexplained variance) than what we do know.

There is growing recognition that factors beyond the audiogram may influence rehabilitation decisions. How people perceive their hearing difficulties, including how motivated they feel to address them, may shape whether they choose to pursue intervention.

In a recent study, my colleagues and I explored whether cognitive and affective factors might help explain some of the variability in hearing aid adoption. What we found was unexpected.

An unexpected paradox

The study examined the relationship between hearing aid adoption, self-reported hearing difficulties, attentional difficulties, and boredom proneness.¹

The results revealed an intriguing pattern.

Individuals who reported greater attentional difficulties and higher levels of boredom proneness², a tendency to experience boredom more frequently across situations, also reported greater hearing difficulties. Yet despite reporting more hearing-related challenges, these same individuals were less likely to adopt hearing aids.

At first glance, the findings seem contradictory.

If someone is experiencing greater hearing difficulties, why would they be less likely to pursue intervention? This observation led us to describe the phenomenon as the cognitive-affective hearing aid paradox.

Looking beyond hearing loss

The findings suggest that understanding hearing aid adoption may require us to look beyond hearing-related factors alone. Cognitive and affective characteristics may also influence how people perceive challenges and ultimately make decisions about rehabilitation.

For many years, hearing healthcare research has focused on identifying factors associated with hearing aid adoption. Hearing loss severity and self-reported hearing difficulties continue to provide valuable insights. However, they do not fully explain why some people take action while others do not.

Our findings suggest that cognitive and affective characteristics may help explain some of the variability in hearing aid adoption that hearing-related measures alone cannot account for.

Understanding the paradox

Several explanations are possible.

Individuals who experience attentional difficulties or higher levels of boredom proneness may engage differently with health-related decisions. These characteristics may influence motivation, persistence, or how rehabilitation options are evaluated. It is also possible that other factors not measured in the study contribute to the observed relationships.

At this stage, the study does not allow us to determine which explanation, if any, is responsible for the observed relationships. As an observational study, it cannot establish causation. The mechanisms underlying these findings remain uncertain and warrant further investigation.

What the study does provide is a new perspective on hearing aid adoption and important questions for future research.

Implications for understanding individual differences

Individuals are much more than a collection of clinical measurements. Two individuals with similar hearing thresholds may experience their hearing difficulties dissimilarly, approach rehabilitation decisions uniquely, and respond differently to recommendations and support.

Understanding these differences may help us develop a more complete picture of the factors that shape hearing healthcare decisions.

Questions for future research

The cognitive-affective hearing aid paradox raises several important questions.

How do cognitive and affective characteristics influence hearing healthcare decisions? What mechanisms explain the relationship between boredom proneness, attentional difficulties, and hearing aid adoption? Could a better understanding of these factors help support individuals who may be less likely to pursue rehabilitation despite experiencing significant hearing-related challenges?

These questions remain unanswered, but they highlight important directions for future research.

What this study demonstrates is that hearing aid adoption is more complex than we often assume. Hearing thresholds and self-reported hearing difficulties matter, but they may not tell the whole story.

As researchers continue to explore the human factors that influence hearing healthcare decisions, studies such as this remind us that understanding why people adopt hearing aids may require us to look beyond hearing loss itself.

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Reference

1. Smith, A. C., Crawford, C. M. L., Singh, G., & Fenske, M. J. (2026). The cognitive-affective hearing aid paradox: Boredom proneness and attentional difficulties predict worse age-related subjective hearing but lower rates of hearing aid adoption. Ear & Hearing. https://doi.org/10.1097/AUD.0000000000001840
2. Crawford, C. M. L., Ramlackhan, K., Singh, G., & Fenske, M. J. (2023). Subjective Impact of Age-Related Hearing Loss Is Worse for Those Who Routinely Experience Boredom and Failures of Attention. Ear and Hearing, 44(1), 199–208. https://doi.org/10.1097/AUD.0000000000001271