Hearing Aid Services and Satisfaction: The Consumer
Viewpoint
Carren J. Stika*,
Ph.D. & Mark Ross**, Ph.D.
Introduction
In the U.S. today, a
person can purchase hearing aids from two types of dispensers: Audiologists and
Hearing Instrument Specialists (formally known as hearing aid dealers). Both
groups are licensed to dispense hearing aids, but come to this activity based
on significantly different paths of formal education and training. There is no information that indicates that
consumers as a whole favor either group of dispensers. Such decisions are uniquely personal and
appear to have less to do with the dispenser’s professional association (i.e.,
audiologist vs. hearing instrument specialist) than the consumer’s past
experiences with a particular dispenser or facility, the recommendation of a
referring source, the influence of advertising, as well as such factors as
convenience, cost, etc. Once involved
with someone, consumers are likely to continue to patronize the same person or
facility in the future, if they are satisfied with the quality of services
previously obtained.
There are significant
differences in the nature and scope of training between audiologists and
hearing instrument specialists.
Audiologists receive their specialized training in colleges and
universities and currently require a minimum of a master’s degree in order to
be eligible for professional certification (CCC-A) and to meet state licensing
requirements. Before being certified,
audiologists must also pass a standardized, national competency
examination. In 2007, a clinical
doctorate (the Au.D.) will be required of all audiologists entering the
profession. This will add, at a minimum, a full year to their academic training. Audiologists work in a variety of medical,
educational, industrial, clinical and private practice settings with all ages
and types of populations. Much of their training and activities, however, is
concerned with the medical and diagnostic aspects of hearing loss and not with
hearing aids directly.
State licensure
practices for hearing instrument specialists, on the other hand, are less
standardized across the country. The
general requirement typically specifies a high-school diploma or two-year
degree as well as the passage of a written and practical examination. In
addition, approximately 15 states require a training program or apprenticeship
ranging from 6 to 12 months before a hearing aid dispensing license can be
obtained. In order to become a board
certified hearing instrument specialist, two years of additional experience as
a hearing instrument specialist, and the passage of a national competency
examination, is required. Rather than working in a variety of settings, as do
audiologists, hearing instrument dispensers are primarily engaged in private
practice. It is when hearing aids are
dispensed to adults that roles of the hearing instrument specialists and the
audiologists overlap (audiologists are the group that usually selects and fits
children under the age of 18 with hearing aids).
These differences in
training and background between the two groups beg the question whether such
differences are relevant insofar as consumer perceptions of satisfaction are
concerned. In other words, is there indeed
a difference in satisfaction between those who purchased their hearing aids
from audiologists or hearing instrument specialists? In order to answer this question, we constructed a questionnaire
in which we sought to determine, if on average, consumers were generally more
satisfied with the services they received from a member of one or the other
group. While there have been studies
that have compared audiologists and hearing aid dispensers in regards to their
relative demographic make-up, referral sources, financial factors, number of
client visits, binaural/monaural recommendation, etc. (Skafte, 2000; Strom
2001), none have, to our knowledge explicitly reported the relative
satisfaction of consumers to the services provided by these two groups.
In addition to this
basic objective, we also included other questions related to the hearing aid
selection process. These includes such
factors as the cost of the hearing aids, number of visits and hours spent, the
nature of the services received, and the work location of the audiologists (private
practice, ENT office, hospital, University or Speech and Hearing Center). In total, the two-page questionnaire
consisted of 13 questions. In the
analyses below, respondent ratings for all types of audiologists were averaged
when compared to hearing instrument specialists.
Survey
Respondents
A total of 942
hearing aid users completed the questionnaire.
Respondents were drawn from a number of sources, including people who
attended the Self Help for Hard of Hearing People, Inc. (SHHH) national
convention in St. Paul, MN, in 2000, members of several local SHHH chapters,
members of the “SayWhatClub,” plus a large number of hearing aid users who
received the Massachusetts Commission on the Deaf and Hard of Hearing
newsletter. Respondents were mostly
older folks (about 76% were age 60 years or older), with a wide range of
educational levels (although half had either a bachelors or graduate
degree). For the most part, these were
experienced hearing aid users (about half had worn aids for 10 years or more).
Satisfaction
with Services Received
It is important to
emphasize that we did not ask whether people were satisfied with their hearing
aids, but rather whether they were satisfied with the services they received
from the person who dispensed the aids to them. We view this as much broader question than focusing just on the
hearing aids themselves, encompassing as it does the totality of interactions
consumers have with the person who sold them the hearing aids.
The results indicated
that most consumers (76.6%), regardless from which type of dispenser they
purchased their aids (i.e., audiologist or hearing instrument specialist),
indicated that they were “definitely satisfied” or “satisfied” with the
services they received. However, with
regards to the key question comparing satisfaction between the two groups of
hearing aid dispensers, we found that a significantly greater percentage of
people who received hearing aids from audiologists reported higher levels of
satisfaction compared to those who received their aids from hearing instrument
dispensers (81.4% versus 66.8%).
On the flip side of this question, we
wondered whether there would be a difference in the percentage of consumers who
expressed dissatisfaction with the services they received from
audiologists versus hearing instrument specialists. The results of this survey did show such a difference: more folks
who purchased their aids from hearing instrument specialists expressed
dissatisfaction than those people who obtained hearing aids from audiologists
(21.5% versus 9.6%). In a related
question, people were asked if they would recommend their hearing aid dispenser
to friends or relatives. In response,
more people who saw audiologists said, “yes” (8l.3%) compared to those who saw
hearing instrument specialists (62.7%). According to our findings, therefore,
while people are generally satisfied with the services they receive when
purchasing hearing aids, they are generally more satisfied, and less
dissatisfied, with the services provided by audiologists than by hearing
instrument specialists. For both groups, the longer a person wore a hearing aid and the higher
the education level, the more satisfied they tended to be with their hearing
aids.
Referral
Patterns to Hearing Aid Dispenser
We were interested in knowing more
about how people are referred to a particular hearing aid dispenser and whether
there are differences in referral patterns for people who purchase their
hearing aids from audiologists compared to those who purchase their aids from
hearing instrument specialists. The
results of this survey indicated clear differences in referral patterns. We found physicians referring a much higher
percentage of consumers to audiologists (32.5%) than to hearing instrument
specialists (7.8%). On the other hand,
survey results indicated that fewer people who saw audiologists (2.3%) were
influenced by advertisements in the public media compared to those individuals
who purchased their hearing aids from hearing instrument specialists (21.2%). This is the same pattern found in other
studies (Skafte 2000; Strom, 2001).
Apparently, hearing instrument specialists depend more upon advertising
than do audiologists to acquire new clients, while audiologists benefit more
than do hearing instrument specialists from professional networking. For other sources of potential referral
(e.g., family or friends), the percentages were similar for audiologists and
hearing instrument specialists.
Number of
Visits and Hours Spent with the Hearing Aid Dispenser
We wanted to know
whether audiologists spend more or less time with their clients than hearing
instrument specialists. Based on the
results of this study, no significant difference emerged between audiologists
and hearing instrument specialists with respect to number of visits and hours
spent with the consumer. When obtaining
a hearing aid, consumers tended to make slightly more visits to the hearing
instrument specialist (4.3 visits) than to audiologists (4.1 visits), but
actually spent a bit more time with the audiologists (3.2 hours) than with
hearing instrument specialists (2.6 hours).
Evidently, people saw their audiologists for a longer period with each
visit.
Cost of Hearing
Aid
There were no significant differences between the groups in
respect to the prices they charged for hearing aids. We asked respondents to
indicate cost category (e.g. $501-1000, $1001-1500, $1501-2000) rather than the
specific price. While both groups charged people a wide range of prices for
hearing aids, neither group favored either the higher or lower category price
hearing aids. For both groups, however, cost was significantly related to the
number of visits and hours devoted to the selection process, as well as to the
age of the hearing aid. The more a hearing
aid costs, the more visits and hours spent on the selection process and
the more recently it had been purchased. Nothing surprising about this.
Probably, these relationships reflect the fact that the more expensive hearing
aids were purchased more recently, that they contain more programming options
to work through, and that they may require more remakes (in the case in
completely-in-the canal hearing aids).
Interestingly, while for the hearing instrument specialists
there was no significant relationship between the cost of the hearing aids and
subsequent satisfaction, there was such a positive relationship for the
audiologists. In other words, those people who purchased expensive hearing aids
from audiologists tended to be more satisfied than those who purchased similar
hearing aids from hearing instrument specialists. We hasten to point out that
this does not imply that people who purchased expensive aids from hearing
instrument specialists are dissatisfied, only that no significant statistical
relationship existed between satisfaction and cost. At this point in time, the reason for such an asymmetrical
relationship can only be speculative; possibly, it reflects the generally
higher satisfaction ratings received by audiologists.
Services and Information Received
During
the hearing aid dispensing process, prospective users must receive certain
kinds of information and services if they are to be successful hearing aid
users. Certainly information about the
care and maintenance of the hearing aids is essential; however, people with
hearing loss can also benefit from other types of information and services,
such as group hearing aid orientation programs, information about various
assistive listening technologies other than hearing aids, coping strategies for
both the hearing aid wearer and hearing family members, and community and
national resources. Indeed, several
SHHH position papers are explicit on this point, emphasizing the benefits of
consumer education and support services at the time of the hearing aid
purchase. Because we too recognize the
value of providing this type of information and services to hearing aid
consumers, we asked people to indicate whether or not they received various
services and information at the time of purchasing their hearing aid(s). The
results are shown in Table 1.
Table 1
Percentage of Respondents Indicating Information or Services
were Provided by Hearing Aid Dispenser
|
Information/Services |
Audiologists (N = 651) |
Hearing Instrument Specialists (N = 230) |
|
Provided clear
explanation of my current audiogram |
77.7% |
66.8% |
|
Provided reason for
selecting my hearing aid |
78.6% |
71.6% |
|
Discussed care of
the hearing aid |
79.2% |
79.0% |
|
Discussed care of
the battery |
66.6% |
66.2% |
|
Discussed earmold
hygiene |
59.8% |
57.9% |
|
Made certain I
understood the T-switch |
48.2% |
42.4% |
|
Explained use of
directional microphones |
25.7% |
20.5% |
|
Informed me about
other hearing assistive technologies (e.g., for the TV and telephone,
Personal FM system; signaling and warning devices) |
33.7% |
28.4% |
|
Asked to complete a
questionnaire to identify problems my hearing aid causes me |
11.7% |
9.6% |
|
Asked to complete a
follow-up questionnaire after wearing the hearing aid to determine
improvement |
10.1% |
8.7% |
|
Discussed coping
and communication strategies |
16.9% |
9.2% |
|
Discussed with my
spouse and/or other family members the specifics of my hearing loss and
communication strategies |
20.8% |
20.2% |
|
Invited to
participate in group meetings to help orient me to my new hearing aid(s) |
7.7% |
3.1% |
|
Provided
information about Self Help for Hard of Hearing People, Inc. (SHHH),
Association for Late Deafened Adults (ALDA), or other consumer resources |
19.1% |
14.8% |
|
Discussed
communication strategies for dealing with my hearing loss at work |
13.3% |
7.9% |
As
can be seen in Table 1, several patterns emerge with respect to services and
information provided to hearing aid consumers.
First, there is a slight, although not significant, greater frequency of
services and information provided to consumers by audiologists than by hearing
instrument specialists. Second, and
certainly more striking, is the finding that services and information that
directly impact upon the hearing aids themselves are provided more frequently
by both groups than any which may appear to be secondary or ancillary to the hearing
aid device itself. In other words,
although the vast majority of respondents reported receiving information about
the care of their new hearing aids, batteries, and earmold hygiene, fewer than
fifty percent of the respondents noted that they received information about the
use of the “T-switch” (telecoil), directional microphones, or other hearing
assistive technology from either audiologists or hearing instrument
specialists. Moreover, the number of
respondents who reported receiving information about coping and communication
strategies, support groups (e.g., SHHH, ALDA), or invitations to participate in
group hearing aid orientation meetings drops precipitously to less than
20%.
A few points must be
made clear when interpreting the results regarding services and information
received. Respondents had three
choices: “no,” “yes,” and “not needed.”
This latter category was mostly appropriate for long-time hearing aid users,
those who the dispenser “knew for certain” that the specified service or information
was not needed. It is probable,
therefore, that more hearing aid users actually received these services than
these figures indicate.
It
should also be noted that we were asking what people remembered, not what they
actually received. It is probable that some people simply forgot that the
information or services were provided.
None of us can claim an infallible memory. Still, what people rated is
what they recalled. If they did not remember receiving some service/information
then it suggests a need for more extensive follow-up procedures for review and
reinforcement.
Discussion
While the results
indicate that, on the average, consumers expressed a significant preference for
the services provided by audiologists, it is important to note that there was a
large overlap in the ratings between the two groups. These results represent
average data and should not be applied to any individual. We do not recommend
that consumers abandon any hearing instrument specialist whose services they
were content with, just on the basis of the results of this study. On the other hand, however, it is apparent
that consumers as a whole are generally more satisfied with the services they
receive from audiologists than from hearing instrument specialists. This should hardly be a surprising
observation. It conforms to every other
professional activity that we are aware of.
Given a condition of varying complexity, such as is presented by hearing
loss, and “solutions” which likewise embody a range of possibilities, naturally
that group with the most comprehensive training will, on the average, provide
the more appropriate treatment. This is
why schools were invented.
When we began this
study, we were not certain how many people with hearing loss understood the
background and training differences between audiologists and hearing instrument
specialists, or understood that there were indeed two separate groups legally
dispensing hearing aids. We are still
not certain. We did try to get at this in several of our questions. In the very first question in the
questionnaire, we specifically asked people to indicate the source from whom
they purchased their last hearing aid.
Choices included audiologists working in various settings, hearing
instrument specialists and an “I don’t know” category. Only 2% of the respondents checked this
latter option, which suggests that people did understand the differences
between the two groups.
Still, when we tried
to word several question to specifically make this determination, the responses
we received are difficult to interpret.
It was a challenging question to formulate without suggesting a
preferred answer. We asked people to
comment if they distinguished between the two groups when seeking professional
help for their hearing loss needs. The majority of respondents (71%) reported
distinguishing a hearing instrument specialist and an audiologist when
purchasing hearing aids. But this
doesn’t inform us whether a greater percentage actually knew the difference
between the groups, but simply did not take that into consideration when they
purchased hearing aids.
Written responses to
this question suggested that people did sense that there was a “professional”
difference, although they couldn’t specify exactly what that was. There were
frequent comments that audiologists were trained in the medical aspects of
hearing loss while hearing instrument specialists focused on the hearing aids
themselves.
In our judgment,
perhaps the most relevant information we obtained in this study is contained in
Table 1. Frankly, from either group,
the percentage of respondents who reported that they received some particular
service or information was appallingly low.
Perhaps, as we noted above, these items were actually conveyed to the
hearing users; no matter, what they recall is the only information that can
possibly be of assistance to them.
Neither audiologists nor hearing instrument specialists did a very good
job in conveying information about T-coils, directional microphones, and other
types of hearing assistive devices.
Very few conveyed information about coping and communication strategies
generally, or on the job. Few also
administered some sort of standardized self-report scale, either before or
after the hearing aid was dispensed.
Without this kind of information, it is not possible to develop
quantitative accountability information or the content necessary for
individualized counseling of the client and family. In a way, it matters little how many degrees a hearing aid
dispenser has; if he/she does not incorporate the additional information
obtained in routine clinical practice, it might as well be non-existent.
It is likely that
people would express more satisfaction with the services they received from any
hearing aid dispenser had more extensive and intensive services aural
rehabilitation been provided them. For the most part, and for most people, we
believe that this can be provided within a routine group hearing aid
orientation program, as recommended by an SHHH position paper. There is no magic to this; we know that
hearing aid users can benefit from additional counseling and a group A/R
program (Kochkin, 1999; reviewed in Ross, 1999). Current marketing and clinical trends, however, suggest a future
where even less follow-up services and information will be provided rather than
more. Hearing aids purchased via the
internet is one example of how the product and aural rehabilitation services
can be disconnected (as reviewed in another SHHH position paper). Clearly, consumers will have to be both more
knowledgeable and more assertive if they are to ensure that they receive the
kinds of information and services necessary to help them reduce the total
impact of a hearing loss on their lives.
References
Kochkin, S. Paper
delivered at the World of Hearing Conference, Brussels, Belguim, May 29th
l999.
Ross, M. (1999).
Redefining the Hearing Aid Selection Process. Aural Rehabilitation and Its
Instrumentation, ASHA Special Interest Division #7, 7(1), 3-7.
Skafte, M. D. (2000).
The 1999 Hearing Instrument Market – The Dispensers’ Perspective. The Hearing
Review, 7(6), 8-40.
Strom, K. E. (2001).
The HR 2000 Dispenser Survey. The Hearing Review, 8(6), 20-42.
Acknowledgment
This project was a
collaborative effort of the Rehabilitation Research and Training Center RRTC)
for Persons who are Hard of Hearing or Late Deafened, located in San Diego, and
the Rehabilitation Engineering Research Center Center (RERC), located at the
Lexington School for the Deaf in NYC. The RRTC and RERC are funded by the US
Department of Education, National Institute on Disability and Rehabilitation
Research, to learn more about how individuals adjust to their hearing loss,
including their use of assistive listening technology.
*
Director of Research, Rehabilitation Research Training Center, San Diego
** Rehabilitation
Engineering Research Center, Lexington School for the Deaf