Why do so many people delay or avoid getting help for hearing loss, and what can we do about it?

We all know that unmanaged hearing can greatly impact a person’s emotional and social well-being. We also know that hearing aids improve listening ability in addition to quality of life.

Subsidies are available to many people, and many alternative and adjunct alternatives to hearing aids exist. Despite this, many people don’t seek help, delay it for several years, or walk away from an assessment empty handed.

So, why the disconnect?

Exploring help-seeking behavior with the COM-B Model

This question was at the heart of a program of research that has culminated in the development of an online, individualized patient decision support tool that aims to improve help-seeking and decision-making in hearing care in Australia: HearChoice.

In our recent paper, we explored what factors shape the experiences of help-seeking and decision-making through the lens of the COM-B model. According to the model, three key elements drive behavior:

• Capability (do they know what to do?),
• Opportunity (can they access the help?), and
• Motivation (do they believe it matters?).

It was important to us that HearChoice reflected the wants and needs of people living with hearing loss. We invited 16 people with hearing difficulties to semi-structured interviews where we guided them to share the story of their hearing journey through the lens of the COM-B model.

Capability

A key factor here was knowledge – participants told us about how understanding (or lack thereof) had shaped the early stages of their journey. Many individuals delay help because they lack a clear understanding of hearing loss, or the means to seek support.

Barriers identified:

• Low awareness of hearing loss and early symptoms
• Limited understanding of management options
• Poor digital or health literacy

Some told us they didn’t even realise they had a problem to begin with.

“And I thought, oh my goodness, do I not listen? Is it me?”

“And then it only became highlighted when I was thinking, oh, well this is actually a problem. It’s not something everybody else has all the time.”

Opportunity

So what about those factors outside of an individual’s control? Unsurprisingly, the cost of hearing care featured heavily. But more subtle factors were discussed too, like how convenient it was to access services – some participants described putting off getting help for years, only to get a hearing test when they came across a bus or pop-up clinic.

Even when someone wants to act, external barriers can derail progress.

Having a social circle or health practitioner who was supportive of hearing was a determining factor in whether several participants had, or had not, sought help. Whether or not the participant felt they could make informed decisions about their hearing depended in part on the availability of information. Where this information was not available, some told us that, feeling discouraged, their efforts to improve their hearing had stalled.

“I just want a basic information about what it might cost me, what I might be able to get from the government, what I might be able to do, those types of things. And it’s not there.”

Motivation

Having the capability and opportunity for help-seeking and decision-making in hearing care is no use if people don’t feel they have a reason to do so.

So what motivates people to move forward with hearing care, and what holds them back? An often-discussed topic here is stigma and acceptance of hearing loss, but this was only one factor among many discussed.

Some simply told us that the use of hearing interventions would interfere with their lifestyle. A whole host of limiting and enabling beliefs were discussed, like whether hearing care professionals can be trusted, whether hearing aids are effective, and whether hearing loss is worth addressing in the first place.

“It’s just another bloody job you’ve got to do… It’s a bit like dentures. You’ve got to soak them every night, so you don’t get dentures until you have to.”

Compounding and interacting effects

Many of these factors will be unsurprising to those who care for people with hearing difficulties. Organising them through the lens of the COM-B model provides the ideal starting point for translating these insights into action.

A key take home from our study is that interventions must target all three domains of capability, opportunity, and motivation in order to overcome barriers in any one domain. This is because the factors we identified in these three domains interact with one another, as illustrated below.

Findings serve as a reminder that clients who are unsure about whether to take the next step are best served by a holistic approach, considering how their decision-making processes may be impacted by knowledge and skills, their external environment, and their intrinsic and extrinsic motivations.

The HearChoice app was developed to directly address the real-world barriers uncovered in our research, targeting the three key domains of capability, opportunity, and motivation.

Co-designed with individuals living with hearing loss, this holistic decision support tool provides personalized guidance at critical moments in the help-seeking journey.

HearChoice is designed to:

• Increase knowledge through the provision of easily navigable information
• Empower users and their loved ones to self-advocate to make the most of the opportunity available to them
• Enhance motivation by countering unhelpful beliefs through education and fostering a sense of trust

We have been encouraged by very positive feedback about the value of HearChoice for people with hearing loss and their loved ones.

Those interested to know more can read about it in last month’s blog by my colleague, Mel Ferguson. In our view, if HearChoice can nudge people along the pathway to take any positive action for their hearing sooner than they would have done, this is a huge success. Our ultimate goal is to help people more quickly achieve better outcomes for their hearing.

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Reference:

Bothe, E., Bennett, R. J., Sherman, K. A., Timmer, B. H., Myers, B., & Ferguson, M. A. (2025). “I feel a little bit clueless” perceived barriers and enablers to help-seeking and informed decision-making in hearing care: a qualitative study. International Journal of Audiology, 1-10. https://doi.org/10.1080/14992027.2025.2493918