Hearing Aids Use Preferences Among Older Adults with Hearing Loss: A Discrete Choice Experiment

Hearing loss is highly prevalent among older adults in China, yet hearing aid uptake remains substantially low. Understanding preferences for updated hearing aid attributes is essential for improving accessibility and promoting adoption, particularly amid rapid technological advancement such as over-the-counter (OTC) devices. This study aimed to elicit preferences for hearing aid attributes and examine preference heterogeneity across demographic and socioeconomic subgroups among older adults with hearing loss living in six cities in China.

A discrete choice experiment (DCE) was conducted among 346 community-dwelling adults aged over 60 years with hearing loss in six cities of China. Twenty-one choice sets were generated and divided into three versions. An opt-out option was included in each choice set. Six attributes were included: out-of-pocket (OOP) cost, accessibility (OTC vs audiologist-fitted), effectiveness in noisy settings, style, battery type, and connectivity. Mixed logit and conditional logit models were estimated, with model fit compared using log likelihood, AIC, and BIC. Preference heterogeneity was examined through interaction terms between participant characteristics and attributes with significant random parameters.

Effectiveness in noisy settings was the most influential attribute (Coefficient=3.01, 95% CI: 2.41, 3.62), followed by accessibility. Participants preferred OTC hearing aids (Coefficient=0.89, 95% CI: 0.60, 1.18), receiver-in-canal style (Coefficient=0.40, 95% CI: 0.05, 0.76), and rechargeable batteries (Coefficient=0.38, 95% CI: 0.17, 0.59), and showed significant aversion to higher OOP costs (Coefficient=-0.03, 95% CI: -0.04, -0.02). Significant heterogeneity was observed. Cost sensitivity was lower among individuals with higher education, married status, and prior hearing aids use, but greater among those with dementia risk. OTC preference was stronger in the higher education group and weaker among participants with dementia risk.

Older adults from six cities in China prioritize performance in noisy environments and improved accessibility when selecting hearing aids. OTC accessibility appears to be valued by respondents and may warrant further evaluation as part of broader hearing-care strategies.