Usability of Over-the-Counter Hearing Aids in Older Adults

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Abstract
Purpose: This study aimed to identify individual factors associated with older adults' ability to manage commercially available over-the-counter (OTC) hearing aids (HAs). Method: Participants completed an OTC HA skills assessment, scored on a 4-point Likert scale (3 = independent with no difficulty , 0 = unable to complete ). Steps included downloading the application (app), inserting the HAs, and cleaning them with a brush. Scores were averaged to calculate an overall mean; higher scores indicated better OTC HA skills. Each independent variable was analyzed in separate linear regression models, and geometric mean ratios (GMRs) were calculated for significant factors. OTC HA skills were also examined dichotomously, with unsuccessful performance defined as any unresolved error. Results: Eighty-two adults participated in the study, 66% ( n = 54) of whom were new HA users. After adjusting for covariates, education remained a strong predictor of OTC HA skills: Individuals with less than a college degree demonstrated 45% lower performance compared to those with a master's degree or higher (GMR = 0.55, 95% confidence interval [0.34, 0.89]). Overall, 68% ( n = 56) of participants were unsuccessful in completing the OTC HA assessment. The most challenging tasks across all participants were manually adjusting the volume, pairing the HAs with a smartphone, and replacing the wax guard. New HA users performed significantly worse than experienced users on the task of putting the HAs on, t (52) = −2.58, p = .013, with a moderate effect size (Cohen's d = −0.44). Conclusions: Education emerged as a strong predictor of OTC HA skills, underscoring the need to address disparities in device usability. These findings highlight the importance of developing tailored devices and educational materials to support users with lower educational attainment. Such efforts may help promote more equitable access and prevent the exacerbation of existing hearing health disparities in the era of OTC HAs. Supplemental Material: https://doi.org/10.23641/asha.29847827

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