The Food and Drug Administration will most likely issue proposed rules for a new category of over-the-counter (OTC) hearing aids within the next three months. These new regulations will create an entirely new category of affordable hearing aids. However, the hearing health industry will still need to focus on boosting adoption by addressing an intransigent challenge: stigma.
Once in place, OTC regulations will specify hearing aids that are self-fit and available without a prescription or professional guidance, to adults with mild to moderate hearing loss.
OTC devices will join recent market introductions of FDA-cleared hearing aids from new players in hearing healthcare. These entries are priced as low as 20% of the $5,000 current average price per pair of hearing aids from audiology and ENT clinics.
Lower prices will play an important role in spurring adoption of hearing aids, with only 15% of people who would benefit from assistance currently wearing hearing aids on a regular basis. Lower prices alone could double adoption up to 30% (the rate of adoption of people who use hearing aids in the U.K., where the National Health Service provides coverage).
Once price recedes as an adoption barrier, device companies will need to address the next frontier in hearing healthcare: stigma. Looking outside of hearing healthcare for inspiration pinpoints an iconic public health initiative as a compelling analog: the U.S. anti-smoking campaigns.
In the mid-20th century, cigarettes symbolized urban elegance, with movie stars acting as cigarette brand ambassadors. In 1954, 45% of adults had smoked a cigarette in the past week, but by 2019, that number had decreased dramatically to 15%, thanks in large part to anti-smoking campaigns.
The intensity with which society stigmatizes hearing loss today parallels the potency with which society once glamorized cigarette smoking. Strategies for combating the intensity and infiltration of a set of beliefs that leads to poor health outcomes is what makes anti-smoking campaigns a powerful analog on the eve of a new OTC hearing aid category.
Price is Currently Top Adoption Barrier in Hearing Healthcare
In a survey conducted in 2018, one-third of respondents with hearing loss complained that hearing aids are “too expensive” or that they lack insurance coverage.
Yet in the last year, lower-priced options have proliferated:
- Private Labeling at Costco. Costco’s fully-featured Kirkland Signature hearing aids are programmable in the clinic and offer streaming for music and calls and rechargeable batteries, for $1,399.99 a pair. Sonova, a leading global hearing aid manufacturer, supplies the devices.
- Consumer Electronics Brands’ Entries. Apple, Bose, and Samsung now compete in hearing healthcare with either FDA-cleared hearing aids or personal sound amplification products (PSAPs). Bose recently launched SoundControl hearing aids for $849 a pair. Although this first iteration lacks streaming and rechargeable batteries, the hearing aids are self-fit, effectively serving as an OTC-category test case.
- Telehealth D2C Companies. Select direct-to-consumer (D2C) companies, such as Listen Lively, provide full-service telehealth. Their current price per pair of $2,000 provides significant savings over hearing aids from the clinic, and Lively audiologists consult over video calls to maximize hearing outcomes.
- Forthcoming OTC Category. In contrast to PSAPs, OTC hearing aids will have the imprimatur of FDA clearance. Once the FDA finalizes OTC rules, consumer electronics brands will most likely deepen their investment in the hearing aid category.
Stigma Will Gain Importance as Adoption Barrier
With an array of lower price points for good hearing outcomes becoming available, the adoption barrier of stigma will gain importance. An analysis of the same MarkeTrak survey noted above demonstrates that 21% of people cited stigma as a barrier to pursuing hearing care. People expressed the concern that hearing aids are “unattractive” or that they are “too young” to wear them.
An additional 30% cited reasons that fall under what we term “Denial,” for example, that people “can hear well enough” without hearing aids, despite a medical diagnosis indicating otherwise. Given that societal stigma usually operates at a subterranean level, people’s reasons for not seeking hearing care classified under “Denial” may also be fueled by stigma.
Societal perceptions that reflect stigma against hearing loss and hearing aids generally fall into three categories: “not whole,” “disabled,” and “cognitively impaired,” according to Margaret Wallhagen. Stigma impacts people along the entire lifecycle of living with hearing loss, from initial acceptance of their hearing loss to the decision on how often to wear hearing aids.
Anti-Smoking Campaigns Provides Strategies for Addressing Stigma
A comprehensive analysis of the anti-smoking campaigns reveals three proven marketing strategies for dislodging entrenched societal beliefs–whether that smoking is glamorous or hearing loss signals infirmity. The three strategies are to deploy a negative shock factor, create empowerment, and advance counter-narratives.
To deploy a negative shock factor, anti-smoking campaigns use visceral images and stories from real-life people to illustrate the toll smoking takes on habitual smokers. To create empowerment, these campaigns equip people with factual information, positive reinforcement, and support programs. Finally, to advance counter-narratives, anti-smoking campaigns seek to rewrite entrenched societal scripts, opposing stereotypes about specific groups in society.
An impressive example of the strategy to create empowerment is FDA’s Every Try Counts campaign, launched in 2018. The campaign targets adult smokers, aged 25-54, who visit convenience stores at least once a month and have tried unsuccessfully to quit smoking within the past year. The campaign seeks to empower smokers by reframing past failures as positive steps, instilling beliefs that they are ready to quit, and celebrating each quit attempt in a non-judgmental manner. Visitors to the website may choose one of three text-message support programs and may contact a coach trained in cessation, reachable through chat or phone.
All three of the anti-smoking strategies could be applied effectively to reducing stigma against hearing loss.
Example of Applying Anti-Smoking Strategies to Create Empowerment
Consider the strategy to create empowerment. One specific campaign example would be to help destigmatize wearing hearing aids in the workplace. Prior to the Covid-19 pandemic, a third of people aged 66 to 69 were in the workforce, in either part-time or full-time roles. With the economy shifting in the distribution of jobs in response to the pandemic, people 65 and older face new challenges in maintaining employment.
Being able to hear on the job is essential. Yet many people with hearing loss will wait until they receive a negative performance review, potentially risking their job, before they seek treatment with hearing aids.
The creating empowerment strategy would target people with either a confirmed or suspected hearing loss who want to continue working. Factual information would underscore that people with hearing loss are more likely to be underemployed and even unemployed. Positive reinforcement would encourage people to experiment with different forms of hearing assistance in the workplace, from video calls captioning, to earbuds with customized amplification, to full-fledged hearing aids. Support programs would structure participants’ goal-setting by connecting them to both text programs and counselors on-demand.
Conclusion: Stigma Remains
With consumer electronics brands introducing reasonably priced hearing devices and with the forthcoming regulation for OTC hearing aids, price will block adoption less often. The challenge of stigma, on the other hand, remains. Hearing healthcare companies would benefit from employing new and creative strategies to dislodge entrenched stigma against hearing loss and hearing aids. The three proven strategies highlighted by the above analysis of the anti-smoking campaigns offer opportunities for the hearing healthcare industry to adopt fresh approaches.
Auditory Insight analyst Morgan Leppla contributed to the research and writing of this article.
Photo: PIKSEL, Getty Images