Over-the-counter hearing aids challenge the core values of traditional audiology

Abstract

Purpose: Regulatory changes in the United States introduced over-the-counter (OTC) hearing aids with the goal of increasing the accessibility and affordability of hearing healthcare. These changes represent a shift away from the provision of hearing aids by licensed providers. In this study, we evaluated the relative importance of values across service delivery models, and the extent to which OTC hearing aids represents a values shift.Method: We performed a qualitative content analysis of two document categories: critique documents that motivated the creation of OTC hearing aids, and regulatory documents that defined OTC hearing aids. Team members coded portions of text for the values they expressed. In total, 29,235 words were coded across 72 pages in four documents. Rank-order analyses were performed to determine the prioritization of values within each category of documents and subsequently compare values between OTC and traditional audiology documents. Results: The rank order of values was not significantly correlated, but critique and regulatory documents both prioritized values related to reducing barriers to hearing aid access and use. Differences in the rank order of values in the OTC documents compared to traditional audiology were consistent with a values shift.Conclusions: Relative to traditional audiology, the OTC documents highly prioritized access to care and cost, and deprioritized subjective and objective benefit. This research demonstrates a need to establish the values of hearing healthcare service delivery through a consensus of stakeholders, including individuals from diverse backgrounds who were underserved by the traditional model.