Factors Influencing Hearing Healthcare and Hearing Aid Access in Southern Appalachia

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Although hearing loss is among the most common chronic conditions in the U.S., many individuals never speak to a healthcare provider about it. Thus, evaluation and rehabilitation services remain underutilized. Even mild hearing loss may result in decreased quality of life, social isolation, and decreased selfsufficiency. The purpose of this study was to assess factors that influence hearing healthcare access and hearing aid acquisition by individuals in Southern Appalachia. The identification of barriers to hearing healthcare access may help audiologists tailor care to this group‘s specific needs. The Hearing Handicap Inventory for Adults (HHIA), a questionnaire assessing self-perceived hearing handicap (a major determinant in help-seeking behaviors in people with hearing loss), was administered along with a researcher-designed survey. The researcher-designed survey was comprised of two forms. Form A asked questions specific to unaided individuals, with half pertaining to individuals with normal hearing, and the other half pertaining to individuals with unaided hearing loss. Form B asked questions specific to hearing aid users. Both forms collected demographic information. Survey participants were recruited from the Remote Area Medical (RAM) clinic held in Bristol, TN on May 1-3, 2015. HHIAs and surveys were obtained from 127 individuals. Two major barriers to hearing healthcare were identified: financial barriers and transportation-related barriers. 62% of respondents reported a household income of $20,000 or less, with an average household size of 2.6 members. Because hearing aids must often be purchased out of pocket, individuals in this income bracket may not be able to afford assistive devices. Some individuals in Southern Appalachia live far from the urban centers where audiologists tend to be located. Although the unaided individuals surveyed indicated they could travel some distance for hearing healthcare services, more than half indicated that they would be unable to travel more than an hour. In contrast, more than half of the aided group indicated that they were required to travel more than an hour for services. Since rural areas often lack public transportation, costs associated with traveling a long distance using personal transportation may present a barrier to hearing healthcare access. These barriers may be at least partially remediated by financial aid programs, telehealth services, and self-help/support group initiatives. The Bristol RAM clinic, in partnership with ETSU‘s audiology department, attempts to overcome these barriers by providing free hearing screenings and low-cost amplification options to individuals with hearing loss living in rural areas.


Johnson City, TN

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