MarkeTrak VII: New Opportunities for Promoting Hearing Solutions Sergei Kochkin, Ph.D.
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MarkeTrak VII: MarkeTrak VII: New Opportunities for New Opportunities for Promoting Hearing Promoting Hearing Solutions Solutions Sergei Kochkin, Ph.D. Sergei Kochkin, Ph.D.
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Transcript of MarkeTrak VII: New Opportunities for Promoting Hearing Solutions Sergei Kochkin, Ph.D.
MarkeTrak VII: MarkeTrak VII: New Opportunities forNew Opportunities for
Promoting Hearing Solutions Promoting Hearing Solutions
Sergei Kochkin, Ph.D.Sergei Kochkin, Ph.D.
IntroductionIntroduction
• Altruistic goal of the BHI is to Altruistic goal of the BHI is to Bring the gift of Bring the gift of better hearing to millions of Americans.better hearing to millions of Americans.
• To do this we need to:To do this we need to:– Elevate the importance of hearing health in Elevate the importance of hearing health in
AmericaAmerica (general public, medical profession, (general public, medical profession, media).media).
– Increase the number of people seeking a hearing Increase the number of people seeking a hearing solution EARLIER in their life.solution EARLIER in their life.
– Partner with the hearing health industry to Partner with the hearing health industry to translate National initiatives into local initiatives.translate National initiatives into local initiatives.
Overall AgendaOverall Agenda• Part I : Review MarkeTrak VII findings in detail:Part I : Review MarkeTrak VII findings in detail:
– Impact of hearing loss on incomeImpact of hearing loss on income– 21 year trends21 year trends– Customer satisfaction with hearing aids in the digital ageCustomer satisfaction with hearing aids in the digital age– Why adults with hearing loss choose not to adopt hearing Why adults with hearing loss choose not to adopt hearing
aidsaids– Including why adults return hearing aidsIncluding why adults return hearing aids– Why children with hearing loss choose not to use hearing Why children with hearing loss choose not to use hearing
aidsaids
• As we review this data: ask how can I turn this As we review this data: ask how can I turn this problem, obstacle, misinformation, consumer problem, obstacle, misinformation, consumer disappointment, etc into an opportunity?disappointment, etc into an opportunity?
Overall AgendaOverall Agenda
• Part II – Integrating national and local Part II – Integrating national and local promotion of hearing solutions.promotion of hearing solutions.
• Review the current BHI : mission, strategies, Review the current BHI : mission, strategies, tactics for promoting hearing solutionstactics for promoting hearing solutions
• Explore ways of promoting hearing solutions Explore ways of promoting hearing solutions based on:based on:– MarkeTrak researchMarkeTrak research– Knowledge of impact of hearing loss on quality of Knowledge of impact of hearing loss on quality of
lifelife– Integrate National with local initiativesIntegrate National with local initiatives
www.betterhearing.orgwww.betterhearing.org
Redesigned HHP websiteRedesigned HHP website
www.betterhearing.org/professionals
Redesigned HHP websiteRedesigned HHP website
MarkeTrak MethodologyMarkeTrak Methodology
MethodMethod• National family opinion panelNational family opinion panel
– 80,000 households 80,000 households – Balanced to 9 key census variablesBalanced to 9 key census variables– Used since 1984 starting with HIA survey.Used since 1984 starting with HIA survey.– MarkeTrak I – Knowles 1988-2003MarkeTrak I – Knowles 1988-2003– MarkeTrak VII - Sponsored by Knowles Electronics at BHI MarkeTrak VII - Sponsored by Knowles Electronics at BHI
2004.2004.– Does not include institutional settings.Does not include institutional settings.
• Screening Question – Phase I (11/2004)Screening Question – Phase I (11/2004)– ““Does anyone in your household have a hearing difficulty in Does anyone in your household have a hearing difficulty in
one or both ears without the use of a hearing aid?”one or both ears without the use of a hearing aid?”
MethodMethod
• Screening Questions Screening Questions – Physician screening for hearing loss during Physician screening for hearing loss during
last physical within last six months.last physical within last six months.– Self, Spouse, Other, Child (Under age 18), Self, Spouse, Other, Child (Under age 18),
Dependent 18-22.Dependent 18-22.• Hearing aid ownerHearing aid owner• Non-ownerNon-owner
– 15,947 hearing-impaired individuals15,947 hearing-impaired individuals– 66% response rate66% response rate
MethodMethod
• Detailed Survey - Phase II (1/2005)Detailed Survey - Phase II (1/2005)– 3,000 hearing aid owners3,000 hearing aid owners– 3,000 adult non-owners3,000 adult non-owners– Response rate 75% & 77% Response rate 75% & 77%
• Detailed Survey – Phase III (5/2005)Detailed Survey – Phase III (5/2005)– 475 parents of children/dependents with untreated 475 parents of children/dependents with untreated
hearing losshearing loss– Included essays from parentsIncluded essays from parents
Impact of Untreated Hearing Loss Impact of Untreated Hearing Loss on Household Income on Household Income
(Oct 2005 HR)(Oct 2005 HR)
ObjectiveObjective
• Research has established link between Research has established link between hearing loss and:hearing loss and: UnemploymentUnemployment Underemployment (salary & position)Underemployment (salary & position) Educational achievementEducational achievement
• Primarily profound hearing loss Primarily profound hearing loss population.population.
ObjectiveObjective
• Need for understanding impact of Need for understanding impact of untreated hearing loss in employment and untreated hearing loss in employment and scholastic situations for “typical” hearing scholastic situations for “typical” hearing loss profile since majority of people with loss profile since majority of people with hearing loss are not deaf.hearing loss are not deaf. Support consumer educational Support consumer educational
objectivesobjectives Secure needed support services for Secure needed support services for
childrenchildren Support tax-credit initiativeSupport tax-credit initiative To get media attentionTo get media attention
MethodMethod
• MarkeTrak VII database from National Family MarkeTrak VII database from National Family Opinion Panel:Opinion Panel: 1,891 households – aided (head of 1,891 households – aided (head of
household or spouse)household or spouse) 1,954 households – unaided (head of 1,954 households – unaided (head of
household or spouse)household or spouse) 39,420 households – no hearing loss 39,420 households – no hearing loss
(head of household and spouse)(head of household and spouse)
MethodMethod• Household income predicted with following variables Household income predicted with following variables
(which were related to hearing aid ownership):(which were related to hearing aid ownership): Hearing loss - factor analysis scoreHearing loss - factor analysis score
Gallaudet Scale,Gallaudet Scale, Number of ears impaired,Number of ears impaired, Subjective hearing loss,Subjective hearing loss, Unaided abbreviated profile of hearing aid benefit). Unaided abbreviated profile of hearing aid benefit).
Hearing loss measure expressed as deciles Hearing loss measure expressed as deciles taking the value 10% (mild) to 100% (profound). taking the value 10% (mild) to 100% (profound). Normal hearing coded as “none”.Normal hearing coded as “none”.
MethodMethod• Household income predicted with following Household income predicted with following
variables (Continued):variables (Continued): Household designation (7 point Household designation (7 point
classification of household composition)classification of household composition) Marital status (2 point classification)Marital status (2 point classification) Age (12 brackets)Age (12 brackets) Geography ( 9 regions)Geography ( 9 regions) Market size (range from < 50k to >2 Market size (range from < 50k to >2
million)million) Group (aided, unaided, normal) Group (aided, unaided, normal)
MethodMethod• Analysis of variance:Analysis of variance:
All variables significant at p<.0001 levelAll variables significant at p<.0001 level Hearing loss by group interaction Hearing loss by group interaction
significant at p<.0001 level indicative of significant at p<.0001 level indicative of different income slopes as a function of different income slopes as a function of hearing loss.hearing loss.
Least square household income means Least square household income means calculated (see next chart)calculated (see next chart)
Hearing Less Means Earning LessHearing Less Means Earning Less
None 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
25
30
35
40
45
50
55
An
nu
al
Ho
us
eh
old
In
co
me
($
00
0)
Severity of Hearing Loss in Deciles
MildModerate
Severe
Unaided
$23,000
But, Use of Hearing Aids But, Use of Hearing Aids Cuts Income Loss in HalfCuts Income Loss in Half
None 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
25
30
35
40
45
50
55
An
nu
al
Ho
us
eh
old
In
co
me
($
00
0)
Severity of Hearing Loss in Deciles
MildModerate
Severe
UnaidedAided
$12,000
Linear (smoothed) relationship between Linear (smoothed) relationship between household income and hearing losshousehold income and hearing loss
• Unaided household income = :Unaided household income = :$53.5k - $2.25k (for every decile of hearing loss).$53.5k - $2.25k (for every decile of hearing loss).
• Aided household income = ;Aided household income = ;$54.1k - $1.13k (for every decile of hearing loss).$54.1k - $1.13k (for every decile of hearing loss).
• While both treated and untreated hearing loss groups While both treated and untreated hearing loss groups show deterioration of income as their hearing loss show deterioration of income as their hearing loss worsens the income decline is cut in half for hearing aid worsens the income decline is cut in half for hearing aid owners. For example, the difference between decile 1 owners. For example, the difference between decile 1 (mild) and decile 10 (profound) incomes is as follows:(mild) and decile 10 (profound) incomes is as follows:Unaided income differential - $20,200Unaided income differential - $20,200Aided income differential - $10,200Aided income differential - $10,200
Use of Hearing aids Increases Income Use of Hearing aids Increases Income Depending on Severity of Hearing LossDepending on Severity of Hearing Loss
0
1
2
3
4
5
6
7
8
9
10
11
12
13
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Severity of Hearing Loss
An
nu
al
Inc
om
e D
iffe
ren
tia
l ($
00
0)
Simulation of income lossSimulation of income loss• Currently 24 million people with admitted hearing Currently 24 million people with admitted hearing
loss, who do not use hearing aids in the U.S.loss, who do not use hearing aids in the U.S.
• Non-owner population segmented into hearing loss Non-owner population segmented into hearing loss decile group:decile group: Non-owner hearing loss significantly lower than Non-owner hearing loss significantly lower than
hearing aid owner population hearing loss.hearing aid owner population hearing loss.
• Cross multiplying population size by income Cross multiplying population size by income differential:differential: Estimated loss in income due to untreated hearing Estimated loss in income due to untreated hearing
loss.loss. Estimated Federal taxes not realized due to Estimated Federal taxes not realized due to
untreated hearing loss assuming 15% tax bracket untreated hearing loss assuming 15% tax bracket (simplified).(simplified).
Simulated household income loss and unrealized Simulated household income loss and unrealized Federal Taxes from non-aided householdsFederal Taxes from non-aided households
Hearing Loss Hearing Loss (Decile)(Decile)
Current HLCurrent HL
DistributionDistribution
PopulationPopulation
Size (Millions)Size (Millions)
Annual Lost Annual Lost Income Income ($Billions)($Billions)
Annual Annual unrealized unrealized Federal Taxes Federal Taxes ($Billions)($Billions)
10%10% 18.1%18.1% 4.364.36 $7.36$7.36 $1.10$1.10
20%20% 17.0%17.0% 4.094.09 $11.46$11.46 $1.72$1.72
30%30% 14.6%14.6% 3.533.53 $13.81$13.81 $2.07$2.07
40%40% 12.0%12.0% 3.903.90 $15.92$15.92 $2.19$2.19
50%50% 10.8%10.8% 2.592.59 $15.92$15.92 $2.39$2.39
60%60% 08.1%08.1% 1.951.95 $14.16$14.16 $2.12$2.12
70%70% 06.8%06.8% 1.631.63 $13.64$13.64 $2.05$2.05
80%80% 05.7%05.7% 1.381.38 $13.11$13.11 $1.97$1.97
90%90% 04.2%04.2% 1.001.00 $10.61$10.61 $1.59$1.59
100%100% 02.8%02.8% 0.670.67 $7.80$7.80 $1.17$1.17
TotalTotal 100%100% 24.0824.08 $122.4$122.4 $18.4$18.4
Conclusions & CommentaryConclusions & Commentary
• The greater the hearing loss the greater the decline in The greater the hearing loss the greater the decline in household income.household income.
• On average, the use of hearing aids would appear to mitigate On average, the use of hearing aids would appear to mitigate income loss by 50%. income loss by 50%.
• For sensitivity analysis one can assume no impact on bottom For sensitivity analysis one can assume no impact on bottom 30% of population with hearing loss. No matter what cut-off is 30% of population with hearing loss. No matter what cut-off is accepted the impact on household income and unrealized accepted the impact on household income and unrealized Federal taxes will be significant.Federal taxes will be significant.
• The diverging income profiles (e.g. interactive slopes) of aided The diverging income profiles (e.g. interactive slopes) of aided and unaided households leads one to conclude that there is a and unaided households leads one to conclude that there is a probable positive causal relationship between hearing loss probable positive causal relationship between hearing loss treatment and household income. treatment and household income.
21 Year Trends21 Year Trends
July 2005 Hearing ReviewJuly 2005 Hearing Review
Hearing Loss Population has doubled since 1984 and will Hearing Loss Population has doubled since 1984 and will reach 41 million by 2025reach 41 million by 2025
24.7 26.128.6
31.533.4
35.838.4
4143.7
46.448.8
50.952.9
15
20
25
30
35
40
45
50
55
60
19
89
19
94
20
00
20
04
20
10
20
15
20
20
20
25
20
30
20
35
20
40
20
45
20
50
Po
pu
latio
n (
Mill
ion
s)
Hearing instrument adoption rates are improvingHearing instrument adoption rates are improving
23.8
22.922.6
21.3
20.4
22.2
23.5
18
19
20
21
22
23
24
25
1984 1989 1991 1994 1997 2000 2004
% H
I A
do
ptio
n
Hearing loss population 1989-2004. Hearing loss population 1989-2004. Active* hearing instrument users and non-owners.Active* hearing instrument users and non-owners.
4.9 5.1 4.6 4.75.6 6.2
1920
21.7 22.324.1
20.6
0
5
10
15
20
25
30
1989 1991 1994 1997 2000 2004
Pop
ulat
ions
(Mill
ions
)
Active users Non-owners
* Note: Active user is defined as a hearing instrument owner who uses their hearing instruments even if only once a year.
Binaural penetration has nearly peakedBinaural penetration has nearly peaked
22
37
51 52
6064
70
25
47
6165 65
74 7470
79
8685
79
0
10
20
30
40
50
60
70
80
90
100
1984 1989 1991 1994 1997 2000 2004
% o
f H
earin
g In
stru
men
t O
wne
rs
Total Owners
Total Owners - Current year
Bilateral HL - Current year
30
Physician screening for hearing loss is Physician screening for hearing loss is still decliningstill declining
15.116.3
18.8 1816.6 16.6
1412.9
20.2
0
5
10
15
20
25
May-89 Nov-89 May-90 Nov-90 Jan-92 Dec-94 Dec-97 Dec-00 'Dec-04
Per
cent
scr
eene
d
Third-party payment trend is flat Third-party payment trend is flat but VA is growingbut VA is growing
22.2
19.4
17.7 20
.8 24.7
24.8
21.9
23.5
21.7 25
.6 30.2 34 37
.3
0
5
10
15
20
25
30
35
40
1984 1989 1991 1994 1997 2000 2004
% o
f sa
les
Without VA With VA
Average out-of-pocket retail price paid by consumer Average out-of-pocket retail price paid by consumer ((includes free, direct mail hearing aids, & all third-party includes free, direct mail hearing aids, & all third-party discounts but excludes VA fittings) --- close to inflation.discounts but excludes VA fittings) --- close to inflation.
1434
109712
15
1276 13
69 1514
1361
1306
0100200300400500600700800900
100011001200130014001500
Total BTE ITC ITE
Dol
lars
1989 1991 1994 1997 2000 2004
Some evidence that HIS fittings are increasing (as Some evidence that HIS fittings are increasing (as perceived by the consumer)perceived by the consumer)
6.9
4.8
66.4
22
4.1
1.9
44.7
49.3
4.1
2.1
28.8
7.1
2
35.9
5565
0 10 20 30 40 50 60 70
Other
Physician
Hearing AidSpecialist
Audiologist
% fittings
1984 19942000 2004
Hearing instrument fittings by source of distribution as Hearing instrument fittings by source of distribution as perceived by the consumer ranked in order of 2004 fittingsperceived by the consumer ranked in order of 2004 fittings
0 5 10 15 20 25 30 35 40 45 50
HA Specialist Office*
Audiology office
VA/military
MD office
Hospital/clinic
Dept store/wholesale club
% purchases
2004200019941989
* Note: In the 2004 MarkeTrak “hearing Aid store” was changed to “hearing aid specialist office”.
U.S. overall customer satisfaction trends for U.S. overall customer satisfaction trends for hearing instruments 1-4 years old. hearing instruments 1-4 years old.
61 58.7 58.9 59.4
73.1
17.5 16.3 15 17.2 18.4
0102030405060708090
100
1991 1994 1997 2000 2004
% S
atis
fact
ion
Positive Negative
Note: In 2004 the MarkeTrak scale was changed to include “somewhat satisfied” and “somewhat dissatisfied”.
U.S. overall customer satisfaction trends for new U.S. overall customer satisfaction trends for new hearing instruments (< 1 year)hearing instruments (< 1 year)
66.471.8
62.9 63.1
77.5
11.86.2 10.1
14.5 14.5
0102030405060708090
100
1991 1994 1997 2000 2004
% S
atis
fact
ion
Positive Negative
Average age of hearing Average age of hearing instruments is increasinginstruments is increasing
05
1015
202530
3540
4550
<2 yr 3-4 yrs 5-6 yrs 7-8 yrs 9+ yrs
Age of hearing instruments
% o
f he
arin
g in
stru
me
nts 1991
1994199720002004
Mean age of instruments:
1991 = 3.1 yrs
1994 = 3.7 yrs
1997 = 3.8 yrs
2000 = 3.8 yrs
2004 = 4.5 yrs
First -time user rate is improvingFirst -time user rate is improving
53.4
40.5
29
39
31.6
39.3
0
10
20
30
40
50
60
1989 1991 1994 1997 2000 2004
Pe
rce
nt
of
sa
les
Average age of new hearing instrument users is Average age of new hearing instrument users is increasingincreasing
66
68.467.8
66.3
68.8
69.7
63
64
65
66
67
68
69
70
71
1989 1991 1994 1997 2000 2004
Ave
rag
e a
ge
And so is household income as digital sales And so is household income as digital sales penetration passes 90%penetration passes 90%
$31$35
$31
$40
$56
$31 $32
$26$31
$33$38
$46
$10
$20
$30
$40
$50
$60
1989 1991 1994 1997 2000 2004
Ho
use
ho
ld I
nco
me
(0
00
)
Income CPI adjusted Linear (CPI adjusted)
The opportunity is still below retirement ageThe opportunity is still below retirement age
1.2
2.2
3.3
5.4
5.2
3.6
2.6
0.5
0.2
0.3
0.3
0.6
1.1
1.8
2.2
0.9
0 1 2 3 4 5 6
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
Millions of People
Owners
Non-owners
Hearing instrument adoption rates highly related to ageHearing instrument adoption rates highly related to ageThis would make sense if hearing loss was perfectly correlated with age.This would make sense if hearing loss was perfectly correlated with age.
12.5
10.9
6.7
9.7
16.7
31.3
44.1
60.6
0 20 40 60 80
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
Age
% Hearing Instrument Adoption
Subject of special Children’s MarkeTrak
Trend SummaryTrend Summary
• Population admitting HL grew to 31.5 million.Population admitting HL grew to 31.5 million.• Hearing aid adoption rate – a stubborn 23%Hearing aid adoption rate – a stubborn 23%• Major increases in “baby boomer” and 75+ Major increases in “baby boomer” and 75+
populations.populations.
• Official Press Indices:Official Press Indices:– Generation Y & Children (0-28) – 2% Generation Y & Children (0-28) – 2% – Children (<18 ) - (1.4 million)Children (<18 ) - (1.4 million)– Generation Xers (ages 29-40) – 7.4%Generation Xers (ages 29-40) – 7.4%– Baby Boomer (ages 41-59) – 14.6%Baby Boomer (ages 41-59) – 14.6%– Silent Generation (60+) – 29%Silent Generation (60+) – 29%
Trend SummaryTrend Summary
• Physician screening 12.9% (declining).Physician screening 12.9% (declining).• New User ProfileNew User Profile
– New user rate still low (39% trending upward)New user rate still low (39% trending upward)– Average age 70 years of age (trend toward older).Average age 70 years of age (trend toward older).– Average income ($56,000 trending upward)Average income ($56,000 trending upward)
• 6/10 people with HL are male – though 6/10 people with HL are male – though female population increased (15%).female population increased (15%).
Trend SummaryTrend Summary• Binaural growth maxed out at 74% Binaural growth maxed out at 74% (86% for (86% for
bilateral loss patients).bilateral loss patients).• 10% perceived reduction in use of audiologist 10% perceived reduction in use of audiologist
for HA fitting.for HA fitting.• Highest growth segments:Highest growth segments:
– Veterans AdministrationVeterans Administration– Internet and mail salesInternet and mail sales
• Out-of-pocket costs of HA to consumer at Out-of-pocket costs of HA to consumer at about the rate of inflation.about the rate of inflation.
• Average age of instrument 4.5 years Average age of instrument 4.5 years (trending upward) – could reduce sales w/o (trending upward) – could reduce sales w/o new user rate improvement.new user rate improvement.
Trend SummaryTrend Summary• 1.23 million people with hearing aids in 1.23 million people with hearing aids in
drawer.drawer.
• Customer satisfaction improving:Customer satisfaction improving: 73% for HI <4 years73% for HI <4 years 78% for HI <1 year78% for HI <1 year Due to 2 factors:Due to 2 factors:
50% digital penetration last 5 years50% digital penetration last 5 yearsChange in satisfaction scale (“somewhat”)Change in satisfaction scale (“somewhat”)
Customer Satisfaction with Customer Satisfaction with Hearing InstrumentsHearing Instruments
in the Digital Age in the Digital AgeSeptember 2005September 2005
Hearing JournalHearing Journal
Overall indices of customer satisfaction with Overall indices of customer satisfaction with hearing instruments (H.I. < 6 years of age).hearing instruments (H.I. < 6 years of age).
11
26
16
13
13
7
19
10
18
89
74
79
73
44
93
71
85
64
Usage
Wear HI
Wear HI 4+ hours
Behavioral
Recommend HI to friend
Recommend dispenser
Would repurchase H.I. brand
Quality of life improvement
Key Satisfaction Indices
Overall satisfaction
Benefit
Value
020406080100
% Dissatisfied
0 20 40 60 80 100
% Satisfied
Customer Satisfaction is Highly Related to $$$ Customer Satisfaction is Highly Related to $$$ Spent per 1% Improvement in Hearing DisabilitySpent per 1% Improvement in Hearing DisabilityWhere % change = (benefit/unaided APHAB)Where % change = (benefit/unaided APHAB)
253035404550556065707580859095
100
5 15 25 35 45 55 65 75 85 95 125 200 500
Price ($$) spent per 1% disability improvement
Sat
isfa
ctio
n
Overall
Benefit
Value
Poly. (Overall)
Poly. (Benefit)
Poly. (Value)
Overall Customer Satisfaction as a Function of Overall Customer Satisfaction as a Function of Price and Hearing Disability ImprovementPrice and Hearing Disability Improvement
(Statistical Model)(Statistical Model)
PriceHearing disability improvement (%)
Overall Customer Satisfaction (%)
R2=.86
Key customer satisfaction ratings by age of Key customer satisfaction ratings by age of hearing instrument.hearing instrument.
90
8486
84
7779
70
78
7270 69
58
66
51
72
61 62 6264
60
56
1 2 3 4 5 6-9 10+
Age of hearing instrument
40
50
60
70
80
90
100
Per
cent
Sa t
isfi e
d
Benefit Overall Satisfaction Value
Percent of current hearing instrument users Percent of current hearing instrument users reporting improved quality of life due to reporting improved quality of life due to
hearing instruments (H.I. < 6 years)hearing instruments (H.I. < 6 years)71
56
56
55
50
50
49
48
45
40
35
24
Effective communications
Social life
Ability to join in groups
Relationships at home
Sense of safety
Confidence in self
Feelings about self
Relationships at work
Sense of independence
Mental/emotional health
Mental ability
Physical health
0 20 40 60 80
% consumers reporting QOL improvements
Better
A lot better
Customer satisfaction with hearing instrument Customer satisfaction with hearing instrument product features (H.I. < 6 years of age).product features (H.I. < 6 years of age).
5
8
8
5
7
4
18
12
13
11
89
86
79
78
74
73
71
69
66
66
Ease/battery change
Fit/comfort
Reliability
Visibility
Frequency of cleaning
Packaging
Battery life
Warranty
Ease/volume adjustment
On-going expense
020406080100
% Dissatisfied
0 20 40 60 80 100
% Satisfied
Customer satisfaction with signal processing and Customer satisfaction with signal processing and sound quality (H.I. < 6 years of age).sound quality (H.I. < 6 years of age).
15
11
15
18
22
16
26
28
23
35
30
74
70
69
66
64
61
60
55
54
51
49
Clearness tone/sound
Sound of voice
Natural sounding
Directionality
Able to hear soft sounds
Richness of sound/fidelity
Comfort with loud sounds
Whistling/feedback/buzzing
Chewing/swallowing sound
Use In noisy situations
Wind noise
020406080100
% Dissatisfied
0 20 40 60 80 100
% Satisfied
Customer satisfaction with hearing instruments in Customer satisfaction with hearing instruments in selected listening situations (H.I. < 6 years of age).selected listening situations (H.I. < 6 years of age).
6
10
10
9
9
9
13
11
15
13
20
11
23
13
21
90
85
81
78
77
76
75
74
74
71
69
66
63
59
59
One-on-oneSmall groups
T.V.Outdoors
Listening to musicLeisure activities
CarPlace of worship
RestaurantConcert/Movie
TelephoneWorkplace
Large groupSchool/classroom
Cell phone
020406080100
% Dissatisfied
0 20 40 60 80 100
% Satisfied
Impact of improving multiple environmental listening Impact of improving multiple environmental listening utility (MELU) on overall satisfaction; Hearing utility (MELU) on overall satisfaction; Hearing
instruments < 6 years (n=1,368)instruments < 6 years (n=1,368)
1723
15
36
53 5563
70
84 82 8491
0% <10% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Listening Situations Satisfied
0
20
40
60
80
100Overall H.I. Satisfaction
Customer satisfaction with hearing instrument Customer satisfaction with hearing instrument hearing healthcare provider (H.I. < 6 years of age)hearing healthcare provider (H.I. < 6 years of age)
2
2
3
3
2
4
6
94
94
94
93
90
91
87
Explained how to care for H.I.
Knowledge of dispenser
Professionalism of dispenser
Quality of service (during fitting)
Front office staff
Explained what to expect from H.I.
Post-purchase service
020406080100
% Dissatisfied
0 20 40 60 80 100
% Satisfied
Satisfaction SummarySatisfaction Summary• Customer satisfaction improving:Customer satisfaction improving:
73% for HI <4 years73% for HI <4 years 78% for HI <1 year78% for HI <1 year Due to 2 factors:Due to 2 factors:
50% digital penetration last 5 years50% digital penetration last 5 yearsChange in satisfaction scale (“somewhat”)Change in satisfaction scale (“somewhat”)
• Only 44% of consumers will repurchase their current Only 44% of consumers will repurchase their current brand of hearing aids when it is time to replace.brand of hearing aids when it is time to replace.
• Satisfaction with HHP is 92%. When something goes Satisfaction with HHP is 92%. When something goes wrong it is not their fault it is the product.wrong it is not their fault it is the product.
1.23 million people with hearing 1.23 million people with hearing aids in drawer; that’s 1/6 owners.aids in drawer; that’s 1/6 owners.
• Defined as 0 hours per Defined as 0 hours per year usage.year usage.
• Huge unused hearing Huge unused hearing aid population.aid population.– 1.23 million people1.23 million people– 1 in 6 users1 in 6 users
• Half of them are new Half of them are new hearing aids (<1-5 hearing aids (<1-5 years old)years old)
• And consider of all HA:And consider of all HA:– 61% use them more than 61% use them more than
4 hours per day.4 hours per day.– 26% < 1 hour per day.26% < 1 hour per day.
6
11
13
11
29
20
10
0 20 40
<1
2
3
4
5
6-10
11+
Age
of
HA
Percent of hearing aids in Drawer
60
HA in The DrawerHA in The Drawer• Half of hearing aids in the drawer represent a Half of hearing aids in the drawer represent a
possible opportunity for upgrade (>5 years).possible opportunity for upgrade (>5 years).• Half of hearing aids in the drawer are < 5 Half of hearing aids in the drawer are < 5
years old:years old:– An Albatross around our neck An Albatross around our neck according to according to U.S. U.S.
World and News Report World and News Report – Most likely due to top 5 reasons measured in Most likely due to top 5 reasons measured in
MarkeTrak V (2000):MarkeTrak V (2000):• Poor benefit or utilityPoor benefit or utility• Poor performance in noisy situationsPoor performance in noisy situations• Poor fit and comfortPoor fit and comfort• Negative side effectsNegative side effects• Cost of repairsCost of repairs
Reasons for Non-UseReasons for Non-Use• #1. Poor benefit (30%) - 268,507#1. Poor benefit (30%) - 268,507
““When ______sold me the H.A., I was When ______sold me the H.A., I was confident it would help me hear better. confident it would help me hear better. When I received it and wore it every day, it When I received it and wore it every day, it did not make my hearing any better. So, I did not make my hearing any better. So, I don’t wear the HA and feel like I wasted don’t wear the HA and feel like I wasted my money. I tried to return it and the my money. I tried to return it and the person did not seem to want to help me. I person did not seem to want to help me. I am quite dissatisfied with the whole am quite dissatisfied with the whole experience.”experience.”
Reasons for Non-UseReasons for Non-Use• #2. Background noise (25%) - 229,383#2. Background noise (25%) - 229,383
““I don’t wear my H.A. because I need it at a dance, restaurants, and large groups. All the H.A. does is increase all sound including background sounds. No help.”I don’t wear my H.A. because I need it at a dance, restaurants, and large groups. All the H.A. does is increase all sound including background sounds. No help.”
Reasons for Non-UseReasons for Non-Use
• #3. Fit & Comfort (19%) - 169,431#3. Fit & Comfort (19%) - 169,431““It’s hard to keep it in my ear. I travel for business It’s hard to keep it in my ear. I travel for business a lot and can’t risk it falling out of my ear.”a lot and can’t risk it falling out of my ear.”
Satisfaction RankingsSatisfaction Rankings
• 45 subjective evaluations ranked by 45 subjective evaluations ranked by average mean score.average mean score.
• Satisfaction segments color coded.Satisfaction segments color coded.• Is Is “somewhat satisfied”“somewhat satisfied” really really
acceptable?acceptable?• Satisfaction ratings actually lower when Satisfaction ratings actually lower when
you add “Very satisfied” and “Satisfied” you add “Very satisfied” and “Satisfied” and then compare to previous and then compare to previous MarkeTrak surveys.MarkeTrak surveys.
Detailed Positive Satisfaction in Detailed Positive Satisfaction in Ascending Order (#1-9) Ascending Order (#1-9)
16
10
13
10
9
10
9
9
7
27
32
24
30
28
26
27
20
21
17
19
26
23
23
19
18
22
21
0 10 20 30 40 50 60 70 80 90 100
Cell phone
Sound quality
Large group
Hear soft sounds
Comfort loud sounds
Feedback whistling
Chew/swallow
Use in noisy situations
Wind noise
Percent
Very Satisfied Satisfied Somewhat satisfied
Detailed Positive Satisfaction in ADetailed Positive Satisfaction in AAscending Order (#10-18)Ascending Order (#10-18)
14
16
14
20
14
18
17
12
15
37
36
36
29
37
32
30
32
30
20
14
19
23
23
18
16
22
14
0 10 20 30 40 50 60 70 80 90 100
Battery life
Ease/volume adjustment
Natural sounding
Overall satisfaction
Clearness tone/sound
Telephone
Value
Directionality
School/classroom
Percent
Very Satisfied Satisfied Somewhat satisfied
Detailed Positive Satisfaction in Detailed Positive Satisfaction in Ascending Order (#19-27)Ascending Order (#19-27)
20
18
12
18
16
18
17
16
13
35
36
43
37
34
37
34
34
39
19
21
18
15
24
12
16
21
18
0 10 20 30 40 50 60 70 80 90 100
Place of worship
Car
Frequency of cleaning
Warranty
Restaurant
On-going expense
Workplace
Concert/Movie
Sound of voice
Percent
Very Satisfied Satisfied Somewhat satisfied
Detailed Positive Satisfaction in ADetailed Positive Satisfaction in AAscending Order (#28-36)Ascending Order (#28-36)
26
19
20
18
21
22
18
16
16
38
48
44
45
41
40
42
40
39
21
11
15
10
22
19
17
19
23
0 10 20 30 40 50 60 70 80 90 100
Benefit
Visibility
Reliability
Packaging
Small groups
T.V.
Listening to music
Leisure activities
Outdoors
Percent
Very Satisfied Satisfied Somewhat satisfied
Detailed Positive Satisfaction in Detailed Positive Satisfaction in Ascending Order (#37-45)Ascending Order (#37-45)
51
51
51
44
43
44
37
30
26
35
35
33
39
37
33
40
47
46
8
8
8
8
11
9
13
12
14
0 10 20 30 40 50 60 70 80 90 100
Professional HHP
Knowledge HHP
Quality service HHP
Front office staff
Create expectations
Post-purchase service
One-on-one
Ease/battery change
Fit/comfort
Percent
Very Satisfied Satisfied Somewhat satisfied
Factors Correlated with DigitalFactors Correlated with Digital• HIA statistics demonstrate 50% digital HIA statistics demonstrate 50% digital
penetration previous 5 years.penetration previous 5 years.• MarkeTrak survey presents consumer MarkeTrak survey presents consumer
with a number of product features for with a number of product features for which consumer responds:which consumer responds:– ““Yes”, “No”, “Not sure”Yes”, “No”, “Not sure”– HA purchased last 5 yearsHA purchased last 5 years– MarkeTrak consumer indicates – 47% digital.MarkeTrak consumer indicates – 47% digital.
• Compare “Yes” with “No”.Compare “Yes” with “No”.
Factors Correlated with DigitalFactors Correlated with Digital• One negativeOne negative
– Ease of volume adjustment (-11%)Ease of volume adjustment (-11%)
• 20% + difference:20% + difference:– Comfort with loud soundsComfort with loud sounds
• 15-19% + difference15-19% + difference– Sound quality (fidelity)Sound quality (fidelity)– Whistling/feedbackWhistling/feedback– WorkplaceWorkplace– Use in noisy situationsUse in noisy situations– Wind noiseWind noise
Factors Correlated with DigitalFactors Correlated with Digital
• 11-14% + difference11-14% + difference– Soft sounds audibleSoft sounds audible– Telephone and cellphoneTelephone and cellphone– Clarity of soundClarity of sound– Sound of voiceSound of voice– Natural soundingNatural sounding– Chewing/swallowingChewing/swallowing– Overall satisfactionOverall satisfaction– Localization of soundLocalization of sound– Leisure activitiesLeisure activities
Satisfaction & HL SeveritySatisfaction & HL Severity
• User population divided into Quintiles based User population divided into Quintiles based on factor scores of:on factor scores of:– # ears impaired# ears impaired– Perception of HLPerception of HL– Unaided APHAB (with exception of AV)Unaided APHAB (with exception of AV)– Gallaudet ScaleGallaudet Scale
• Difference scoresDifference scores– Quintile 1 (bottom 20% on subjective hearing loss)Quintile 1 (bottom 20% on subjective hearing loss)– Quintile 5 (Top 20% on subjective hearing loss) Quintile 5 (Top 20% on subjective hearing loss)
Largest DifferencesLargest Differences
• 25% + difference25% + difference– Cell phoneCell phone
• 15-19% difference15-19% difference– Comfort with loud soundsComfort with loud sounds– Able to hear soft soundsAble to hear soft sounds– School/classroom usageSchool/classroom usage– Wind noiseWind noise– Large GroupLarge Group– TelephoneTelephone– Concert/movieConcert/movie– DirectionalityDirectionality– Listening to MusicListening to Music
• 11-14% difference11-14% difference– TVTV– Place of worshipPlace of worship– Leisure activitiesLeisure activities– Whistling/feedbackWhistling/feedback– WorkplaceWorkplace– Use in noisy situationsUse in noisy situations– Richness soundRichness sound– RestaurantRestaurant– CarCar– OutdoorsOutdoors– Natural soundingNatural sounding
Hearing Instrument Hearing Instrument Improvements Sought by Improvements Sought by
ConsumersConsumersMarkeTrak VIMarkeTrak VI
20022002
Hearing Aid Improvements Sought by Hearing Aid Improvements Sought by Current Hearing Aid Owners (n=2,428)Current Hearing Aid Owners (n=2,428)
(Highly desirable scores =4-5 on 5 point scale)(Highly desirable scores =4-5 on 5 point scale)
9588
858483828281817977
7473
Speech in noiseBetter sound quality
Less whistle/buzzingLower price
More soft soundsLonger lasting batteries
Work better on telephoneLoud sounds less painful
Speech in quietBetter fit & comfort
Should have VCLonger money back guarantee
Less costly to repair
0 10 20 30 40 50 60 70 80 90 100
% highly desirable
Hearing Aid Improvements Sought by Hearing Aid Improvements Sought by Current Hearing Aid Owners (n=2,428)Current Hearing Aid Owners (n=2,428)
(Desirable scores =4-5 on 5 point scale)(Desirable scores =4-5 on 5 point scale)
7271
666362
5652
483432
2821
15
Easier to regulate volumeMask tinnitus
Easier to cleanWork better on cell phone
Better sound to musicShould not break down as much
Less visibilityEasier battery change2-5 year payment plan
Should have remoteMore fashionable
ColorLease hearing aid
0 10 20 30 40 50 60 70 80 90 100
% highly desirable
MarkeTrak VII: MarkeTrak VII: Obstacles to Hearing Aid AdoptionObstacles to Hearing Aid AdoptionAmong Adult Non-users in the U.S.Among Adult Non-users in the U.S.
April 2007April 2007
Hearing JournalHearing Journal
IntroductionIntroduction
• Hearing aid adoption rate stubborn at about Hearing aid adoption rate stubborn at about 20%.20%.
• Growth to 23% penetration due to Internet Growth to 23% penetration due to Internet and VA.and VA.
• Known serious consequences of untreated Known serious consequences of untreated hearing loss.hearing loss.
• Why do so many people delay or avoid Why do so many people delay or avoid amplification?amplification?– 23 million adults23 million adults– 1.5 million children/dependents <age 231.5 million children/dependents <age 23
MethodMethod
• 3,000 adult non-adopters from MarkeTrak VII 3,000 adult non-adopters from MarkeTrak VII databasedatabase
• 2,300 responded to 7 page survey2,300 responded to 7 page survey• 64 reasons why they don’t use hearing aids.64 reasons why they don’t use hearing aids.• Reasons for return if tried HAReasons for return if tried HA• Factors that might entice themFactors that might entice them• Focus on top 50% of people with hearing Focus on top 50% of people with hearing
loss.loss.
HA owners versus non-ownersHA owners versus non-owners
• Not terribly dissimilar.Not terribly dissimilar.• Hearing aid owners greater hearing loss and Hearing aid owners greater hearing loss and
younger.younger.– Bilateral loss (61% versus 83%)Bilateral loss (61% versus 83%)– Perceived mild hearing loss (39% versus 7%)Perceived mild hearing loss (39% versus 7%)– Ability to hear whisper across a room without Ability to hear whisper across a room without
visual cues (16% versus 5%)visual cues (16% versus 5%)– Modal unaided APHAB (40-49% versus 50-59%)Modal unaided APHAB (40-49% versus 50-59%)
Aided versus unaided populations by Aided versus unaided populations by hearing loss decile. hearing loss decile.
0200400600800
100012001400160018002000220024002600280030003200
1 2 3 4 5 6 7 8 9 10
Hearing Loss Decile
Po
pu
lati
on
Siz
e (0
00)
Aided Unaided
Hearing aid adoption rates by hearing Hearing aid adoption rates by hearing loss decile.loss decile.
1.9 4.16.6
11.315.5
23.929.8
48.3
59.9
37.7
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8 9 10
Hearing Loss Decile
HI
Pen
etra
tio
n (
%)
83% hearing aid owners
39% non-adopters
Non-adoptersNon-adopters
• New hearing aid user is age 70.New hearing aid user is age 70.
• Non-adopter ages vary from a low of Non-adopter ages vary from a low of age 56 (decile 1) to 61 (deciles 6+).age 56 (decile 1) to 61 (deciles 6+).
• Why such a large age difference?Why such a large age difference?
• Let’s control for hearing loss & then Let’s control for hearing loss & then look at adoption rates.look at adoption rates.
Hearing aid adoption by HL decile controlling Hearing aid adoption by HL decile controlling for age; evidence for the effects of age stigma.for age; evidence for the effects of age stigma.
0102030405060708090
100
1 2 3 4 5 6 7 8 9 10
Hearing Loss Decile
HI
Pen
etra
tio
n (
%)
21-44 45-54 55-64 65-74 75+
Percent of hearing-impaired evaluated for Percent of hearing-impaired evaluated for hearing loss and recommendations received.hearing loss and recommendations received.
0
10
20
30
40
50
60
Family doctor ENT Audiologist HIS
Discussed hearing Referred/test Get HA
Don’t get HA Wait/retest Surgery
Number of positive recommendations for Number of positive recommendations for hearing aids compared to negative hearing aids compared to negative
recommendations by professional (1984-2004).recommendations by professional (1984-2004).
0.3 0.30.6
2.6
0.30.5
0.9
3.1
0.71
1.3
2.8
0
0.5
1
1.5
2
2.5
3
3.5
Family doctor ENT Audiologist HIS
1984 1994 2004
Hearing ScreeningHearing Screening
• Problem resolution begins with problem Problem resolution begins with problem identification.identification.
• 50% of 23 million adult non-adopters 50% of 23 million adult non-adopters never had their hearing professionally never had their hearing professionally tested.tested.
• Huge progress when comparing Huge progress when comparing positive to negative recommendations positive to negative recommendations from professionals.from professionals.
Hearing solution adoption model Hearing solution adoption model
BHIMission
Specific drivers:Internal stigmaExternal stigmaInfluencersProduct perceptionService perceptionPhysicians attitudeFear
Physicalimpairment
Stages of denial
Perceived loss ofcommunicationperformance & need
Attitude towardgetting hearingsolutions
Behavior intent/Hearing healthsolutions
Predisposition
Price & hearing health solution delivery model
Drivers:Perceived ageCommunication situationsChange & emotional reactionSocial comparisonAlternative solutions
General moderators: Socio economic status Health Personality Lifestyle Social network Emotional state
Medical careSurgeryAural rehabCochlear Impl.Hearing AidsALDsBehavior Modif.
90
Reasons for non-adoption of hearing aids: Reasons for non-adoption of hearing aids: Top 5 deciles of hearing lossTop 5 deciles of hearing loss
9
12
13
24
29
32
33
52
53
60
71
10
8
11
23
17
16
13
16
24
16
19
0 10 20 30 40 50 60 70 80 90 100
Vision or dexterity
Experience with HA
Trust
Social network rec.
Professional rec.
Stigma
Knowledge
Attitude toward HA
Minimization/need
Financial
Type of hearing loss
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = Hearing LossFactor = Hearing Loss
6
7
23
20
18
19
29
22
25
71
3
7
11
16
20
20
14
28
27
19
0 10 20 30 40 50 60 70 80 90 100
Had surgery
Need surgery
Unilateral
Have nerve deafness
Low frequency loss
High frequency loss
Tinnitus
Loss too mild
Loss not severe enough
Total
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = financialFactor = financial
5
25
35
49
60
6
20
17
15
16
0 10 20 30 40 50 60 70 80 90 100
Use less expensivedevice
Not worth expense
Expensive to maintain
Can't afford
Total
Percent
Definite Somewhat
Median income comparing people who state they can and Median income comparing people who state they can and cannot afford hearing aids controlling for age.cannot afford hearing aids controlling for age.
62.567.5
72.5
62.5
41.3
31.323.8
31.323.8
20
0
10
20
30
40
50
60
70
80
21-44 45-54 55-64 65-74 75+
Age Group
Mea
n H
ou
seh
old
In
com
e $(
000)
Can afford Can't afford
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = Minimization or lack of needFactor = Minimization or lack of need
14
12
12
17
32
24
53
16
18
19
24
20
29
24
0 10 20 30 40 50 60 70 80 90 100
Occupation does not require it
Do not socialize with many people
Do not need fine hearing
Loss not disruptive to life
Have more serious priorities
Hear well enough in most situations
Total
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = Attitudes towards hearing aidsFactor = Attitudes towards hearing aids
21
19
20
22
24
26
25
27
32
52
15
18
18
19
18
18
20
20
16
16
0 10 20 30 40 50 60 70 80 90 100
Require frequent battery change
Require too many adjustments
Do not perform as promised
Hassle
Don’t work in crowds
Whistling and feedback
Pick up background noise
Do not restore hearing to normal
Do not work in noise
Total
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = Attitudes towards hearing aids (Cont.)Factor = Attitudes towards hearing aids (Cont.)
10
13
15
14
11
13
16
15
16
52
16
15
15
16
19
18
16
17
19
16
0 10 20 30 40 50 60 70 80 90 100
They break down
Uncomfortable
Do not work in humid climates
Unnatural sound
Limited situational use
Difficult to handle
Do not fit well
Cannot be used on phone
They don't work well
Total
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor= Knowledge & experienceFactor= Knowledge & experience
9
9
8
9
9
11
33
7
7
9
10
10
29
13
0 10 20 30 40 50 60 70 80 90 100
Tried and do not work
Tried and do not like
Do not know where to get hearing aids
Do not know where to get tested
Vision or dexterity problems
Hearing not tested yet
Total knowledge
Percent
Definite Somewhat
Reasons for hearing aid return (n=237)Reasons for hearing aid return (n=237)
6
16
18
19
29
35
36
38
49
51
0 10 20 30 40 50 60
Stigma
Reliability
Difficult to handle
Phone utility
Sound quality
Comfort
Value
Whistling/feedback
Background noise
Benefit
Percent
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = StigmaFactor = Stigma
1112131617181719
1722
32
9
10
13
12
12
13
14
15
18
13
16
0 10 20 30 40 50 60 70 80 90 100
Make you look mentally slow
People make fun of you
Make you look weak and feeble
People treat you differently
Too proud to wear
Make you look old
Make you look disabled
Too embarrassed to wear
Noticeable
Do not admit hearing loss in public
Total stigma
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = Professional recommendationsFactor = Professional recommendations
10
14
20
22
29
10
15
12
13
17
0 10 20 30 40 50 60 70 80 90 100
Hearing instrument specialist
Family doctor
Audiologist
ENT
Total professionals
Percent
Definite Somewhat
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor= Social network recommendationsFactor= Social network recommendations
7
10
11
14
24
11
13
15
14
23
0 10 20 30 40 50 60 70 80 90 100
Child opinion
Friend opinion
Other hearing aid owner opinion
Spouse opinion
Total network
Percent
Definite Somewhat
The Cost of The Cost of Negative Word-of-Mouth Negative Word-of-Mouth
• One out of four people with serious hearing loss don’t One out of four people with serious hearing loss don’t purchase hearing aids due to bad experiences of purchase hearing aids due to bad experiences of their friends with hearing aids.their friends with hearing aids.
• 19% of total 23 million adults don’t purchase because 19% of total 23 million adults don’t purchase because of other hearing aid owners.of other hearing aid owners.
• That’s 4.4 million peopleThat’s 4.4 million people• Assuming 1.75 hearing aids each over 5 purchase Assuming 1.75 hearing aids each over 5 purchase
cycles of 5 years (their average age is now 60)cycles of 5 years (their average age is now 60)• That’s potentially 38,200,000 hearing aids not That’s potentially 38,200,000 hearing aids not
purchased over their lifetime….if we cannot purchased over their lifetime….if we cannot overcome these negative perceptions based on overcome these negative perceptions based on REAL experiences (@$1,800 retail price)REAL experiences (@$1,800 retail price)
• That’s 19 years of lost sales for the whole US!That’s 19 years of lost sales for the whole US!• That’s $69 billion in lost revenue!That’s $69 billion in lost revenue!
Reasons for not-adoption of hearing aidsReasons for not-adoption of hearing aidsFactor = TrustFactor = Trust
7
9
11
13
9
9
11
11
0 10 20 30 40 50 60 70 80 90 100
Do not trust doctors
Do not trustaudiologists
Do not trustdispensers of HA
Total trust
Percent
Definite Somewhat
Hearing aid adoption intent by hearing loss Hearing aid adoption intent by hearing loss decile.decile.
05
10152025303540
Total 1 2 3 4 5 6 7 8 9 10
Hearing Loss Decile
Per
cent
Next 6 months 12 months 2-4 years
Positive impact of hearing aid enhancements Positive impact of hearing aid enhancements on the total hearing loss population currently on the total hearing loss population currently
not using hearing aids.not using hearing aids.
10
11
11
19
19
20
27
40
0 10 20 30 40 50
Language translator
Built in FM radio
MP3 connectivity
Self fit/adjust
Headset functionality to phone
Built into fashionable eyeglass
Able to buy software upgrade
$500 tax credit
Percent
Reasons for intent to purchase hearing aidsReasons for intent to purchase hearing aids
7
8
8
8
10
12
15
15
18
20
22
62
67
0 10 20 30 40 50 60 70 80
Employment
Family doctor
Improved finances
Free hearing aid
HIS
Price
ENT
PR & media
HA owner
Safety concerns
Audiologist
Family member
HL got worse
Unamplified Unamplified Children & DependentsChildren & Dependents
““Are a million dependents in Are a million dependents in America being left behind due to America being left behind due to
hearing loss?” 9/2007 HRhearing loss?” 9/2007 HR
IntroductionIntroduction
• Only 12% of children (ages 0-17) with admitted Only 12% of children (ages 0-17) with admitted hearing loss use hearing aids.hearing loss use hearing aids.– Equates to 1.2 million children Equates to 1.2 million children – And another .3 million dependents ages 18-21And another .3 million dependents ages 18-21– JAMA (1998) quantified that 15% of children 6-19 JAMA (1998) quantified that 15% of children 6-19
had at least a low or high frequency hearing loss had at least a low or high frequency hearing loss of 16 dB or more.of 16 dB or more.
• Do they all have transitory hearing loss due to ear Do they all have transitory hearing loss due to ear infections?infections?
• If not why don’t they use hearing aids especially If not why don’t they use hearing aids especially given the importance of hearing in speech given the importance of hearing in speech development?development?
MethodMethod
• Queried MarkeTrak VII database:Queried MarkeTrak VII database:– Children under age 18Children under age 18– Dependents up to age 21Dependents up to age 21– Sample 475Sample 475– 52% response rate to survey52% response rate to survey
• SurveySurvey– Subjective survey questions with emphasis on Subjective survey questions with emphasis on
reasons why hearing aids not used.reasons why hearing aids not used.– Essay questions from parentsEssay questions from parents
• Nature of hearing lossNature of hearing loss• Quality of life impactQuality of life impact• Interventions for child’s hearing lossInterventions for child’s hearing loss
MethodMethod
• ExclusionsExclusions– Children/dependents with transitory ear Children/dependents with transitory ear
infections (4%)infections (4%)– And with Tinnitus but NO hearing loss And with Tinnitus but NO hearing loss
(5%)(5%)
• Thus 91% of unamplified dependents Thus 91% of unamplified dependents have a hearing loss according to their have a hearing loss according to their parents.parents.
Some ComparisonsSome Comparisons
FactorsFactors HA OwnersHA Owners Non-ownersNon-owners
Median ageMedian age 1313 1212
Bilateral %Bilateral % 7878 4444
Subjective HL Subjective HL – Moderate >– Moderate >
79%79% 50%50%
GallaudetGallaudet
““whisper”whisper”
73%73% 83%83%
HH incomeHH income $31.3$31.3 $$43.8$$43.8
Hearing loss testing & diagnosisHearing loss testing & diagnosis
• First hearing test (Mode 4-6 years old)First hearing test (Mode 4-6 years old)• HL first identifiedHL first identified
– ENT office (21%)ENT office (21%)– Pediatricians office (19%)Pediatricians office (19%)– Audiologist office (17%)Audiologist office (17%)– School 18%School 18%
• Age of first diagnosis (Mode 4-6 years old)Age of first diagnosis (Mode 4-6 years old)• Main prompting for hearing test (Parental Main prompting for hearing test (Parental
concern – 37%; family doctor – 25%)concern – 37%; family doctor – 25%)
Follow-up by ParentsFollow-up by Parents(Multiple response)(Multiple response)
36
34
32
32
6
4
10
0 5 10 15 20 25 30 35 40
Medical treatment
Classroom asst
Surgery
Wait/retest
Detail newborn tests
Tried HA
Did nothing
Impact of hearing loss on quality of lifeImpact of hearing loss on quality of life
0 10 20 30 40 50 60 70 80
Mental acuity
Sense of safety
Group participation
Leisure/play
Ability to communicate
Relationships - home
Self esteem
Relationships - peers
Emotional health
Grades
Speech/language
Social skills
Use of phone
All areas
Major Some Minor
Quality of Life Impact QuotesQuality of Life Impact Quotes
• ““She gets very frustrated and wants to She gets very frustrated and wants to give up because she isn’t like other give up because she isn’t like other people.”people.” (#2494762, parent of a 17- (#2494762, parent of a 17- year old girl with perforated ear drum year old girl with perforated ear drum that required surgery and resulted in that required surgery and resulted in subsequent scarring and “moderate” subsequent scarring and “moderate” hearing loss).hearing loss).
Quality of Life Impact QuotesQuality of Life Impact Quotes
• ““Hearing loss had dramatic negative effects on my Hearing loss had dramatic negative effects on my daughter’s social development, making and keeping daughter’s social development, making and keeping friends and generally feeling good about herself. friends and generally feeling good about herself. Professional at the time said there did not appear to Professional at the time said there did not appear to be any reason for the hearing loss and that she just be any reason for the hearing loss and that she just could not hear and that a hearing aid would not help. could not hear and that a hearing aid would not help. Her hearing loss isolated her almost completely. She Her hearing loss isolated her almost completely. She received classroom adjustment but in the end she received classroom adjustment but in the end she dropped out of school then dropped out of job corps.” dropped out of school then dropped out of job corps.” (#1772639, parent of a dependent age unknown, (#1772639, parent of a dependent age unknown, with profound hearing loss in one ear according to with profound hearing loss in one ear according to parent).parent).
Quality of Life Impact QuotesQuality of Life Impact Quotes
• ““I noticed I had to yell really loud for him to hear me if I noticed I had to yell really loud for him to hear me if I were to ask him a question. A lot of time nobody I were to ask him a question. A lot of time nobody wants to talk to him cause if they don’t talk loud then wants to talk to him cause if they don’t talk loud then when they ask him a question and he can’t hear so when they ask him a question and he can’t hear so he doesn’t answer them and they think he is ignoring he doesn’t answer them and they think he is ignoring them. Have not sought any solution for child’s them. Have not sought any solution for child’s hearing. Doctor said he could adjust. Maybe a wax hearing. Doctor said he could adjust. Maybe a wax build up. He would check it at a later date. I don’t build up. He would check it at a later date. I don’t think my child would be comfortable with a hearing think my child would be comfortable with a hearing aid in his ear. He might lose it.”aid in his ear. He might lose it.” (#2136004, parent of (#2136004, parent of a 4 year old boy who the parent describes with a 4 year old boy who the parent describes with moderate hearing loss; child cannot hear normal moderate hearing loss; child cannot hear normal speech across a room).speech across a room).
Reasons why children with hearing loss do Reasons why children with hearing loss do not use hearing aidsnot use hearing aids
9
10
14
16
28
32
41
76
80
84
0 20 40 60 80 100
Experience w/ HA
Knowledge
Attitudes HA
Physical problems
Financial
Stigma
Social network recommendation
Degree of hearing loss
Professional recommendations
Minimization of hearing loss
Percent
Minimization of HLMinimization of HL
• Many parent essays did not agree with the Many parent essays did not agree with the subjective evaluations of their child’s HL. subjective evaluations of their child’s HL.
• ““The hearing loss was discovered from my The hearing loss was discovered from my daughter’s speech. She doesn’t talk as well daughter’s speech. She doesn’t talk as well as she should. The family doctor has her as she should. The family doctor has her going to Easter Seals for speech. Hearing going to Easter Seals for speech. Hearing testing was mild but not real bad hearing testing was mild but not real bad hearing loss”loss” (#1557570, parent of 4 year old female) (#1557570, parent of 4 year old female)
120
MinimizationMinimization
• ““When you talked to him, he wouldn’t answer When you talked to him, he wouldn’t answer you or he would say huh? You have to repeat you or he would say huh? You have to repeat what you say to him. The teacher sets him what you say to him. The teacher sets him closer up front of the class. He does not have closer up front of the class. He does not have hearing aids because his hearing isn’t that hearing aids because his hearing isn’t that bad yet”.bad yet”. (#1595791, parent of dependent (#1595791, parent of dependent age 8 years, with hearing loss described as age 8 years, with hearing loss described as moderate and inability to hear normal speech moderate and inability to hear normal speech across a room w/o visual cues).across a room w/o visual cues).
MinimizationMinimization
• ““Had some difficulty with phonetic based Had some difficulty with phonetic based hearing program when in kindergarten and hearing program when in kindergarten and first grade. This hindered confidence in first grade. This hindered confidence in performance in language arts and is still 3 performance in language arts and is still 3 years behind peers. The reason for not using years behind peers. The reason for not using hearing aids is hearing loss is very mild at hearing aids is hearing loss is very mild at this time but will be monitored by physicians.”this time but will be monitored by physicians.” (#2339100, parent of 14 year old boy with (#2339100, parent of 14 year old boy with “mild” hearing loss)“mild” hearing loss)
Professional RecommendationsProfessional Recommendations
• Some parents received conflicting Some parents received conflicting information from two or more professionals information from two or more professionals
• Some of the advice would appear to be Some of the advice would appear to be misinformation. Some professional reasons misinformation. Some professional reasons for NOT getting hearing aids are that hearing for NOT getting hearing aids are that hearing aids would not help dependentaids would not help dependent– with high frequency hearing loss (21%), with high frequency hearing loss (21%), – low frequency hearing loss (22%), orlow frequency hearing loss (22%), or– unilateral loss (42%). unilateral loss (42%).
Professional RecommendationsProfessional Recommendations
• ““At approximately 18 months of age I noticed At approximately 18 months of age I noticed my daughter walked like a drunken sailor. my daughter walked like a drunken sailor. She did not respond if I stood behind her and She did not respond if I stood behind her and talked to her. I took her to our pediatrician’s talked to her. I took her to our pediatrician’s office. At first he brushed me off. I persisted office. At first he brushed me off. I persisted until he did a basic audio test. She was flat until he did a basic audio test. She was flat line – the test would have had a bell curve if line – the test would have had a bell curve if she could hear. He referred me to an ENT she could hear. He referred me to an ENT doctor.”doctor.” (#1246561, parent of 9 year old (#1246561, parent of 9 year old female with “mild” hearing loss requiring female with “mild” hearing loss requiring speech therapy).speech therapy).
Professional RecommendationsProfessional Recommendations
• ““I was concerned because Steven wouldn’t I was concerned because Steven wouldn’t turn to look when a loud noise was made. turn to look when a loud noise was made. The pediatrician referred us to have his The pediatrician referred us to have his hearing tested and they say he is hearing hearing tested and they say he is hearing within normal ranges. He still does not seem within normal ranges. He still does not seem to hear well. For awhile he had fluid in his to hear well. For awhile he had fluid in his ears, but now it is gone. He still has a speech ears, but now it is gone. He still has a speech delay.”delay.” (#2220301, parent of 11 year old (#2220301, parent of 11 year old male with “mild“ hearing loss now home male with “mild“ hearing loss now home schooled by parents and described as schooled by parents and described as introverted) .introverted) .
StigmaStigma• One in three indicated that the stigma associated One in three indicated that the stigma associated
with hearing aids impacted their decision not to with hearing aids impacted their decision not to pursue hearing aids.pursue hearing aids.
• Some physicians concurred that the stigma of Some physicians concurred that the stigma of hearing aids out-weighed the benefit.hearing aids out-weighed the benefit.
• Obstacles to hearing aids:Obstacles to hearing aids:– make dependent or parent embarrassed (22%),make dependent or parent embarrassed (22%),– aversion with wearing the devices in front of friends aversion with wearing the devices in front of friends
(20%),(20%),– peers make fun of the dependent with hearing aids peers make fun of the dependent with hearing aids
(19%),(19%),– discriminatory treatment (19%),discriminatory treatment (19%),– too noticeable (18%),too noticeable (18%),– make the dependent look disabled (17%) or mentally make the dependent look disabled (17%) or mentally
slow (14%). slow (14%).
StigmaStigma
• ““As a high school student she doesn’t want As a high school student she doesn’t want that stigma of wearing a hearing aid. Her that stigma of wearing a hearing aid. Her hearing loss has not affected her schooling, hearing loss has not affected her schooling, friendships, etc. that greatly.” friendships, etc. that greatly.” (#1073992, (#1073992, parent of 16 year old female with ear parent of 16 year old female with ear infections as child, adenoid removal, PE infections as child, adenoid removal, PE tubes, ear drum perforations requiring tubes, ear drum perforations requiring surgery that did not heal properly, described surgery that did not heal properly, described as “moderate” hearing loss by parent).as “moderate” hearing loss by parent).
StigmaStigma
• ““His hearing loss is not too severe. He has His hearing loss is not too severe. He has special seating in school which helps him pay special seating in school which helps him pay attention more. It’s difficult with new attention more. It’s difficult with new relationships. We must tell people to speak to relationships. We must tell people to speak to him face-to-face or on left side. Family was him face-to-face or on left side. Family was saddened by many surgeries but we speak saddened by many surgeries but we speak slow and clear, and louder than normal. He slow and clear, and louder than normal. He gets very frustrated often. He doesn’t want gets very frustrated often. He doesn’t want hassle at this time with hearing aids. Maybe hassle at this time with hearing aids. Maybe when young adult he may change mind.”when young adult he may change mind.” (#1888350, parent of 8 year -old described (#1888350, parent of 8 year -old described as “moderate” hearing loss in one ear by as “moderate” hearing loss in one ear by parent).parent).
FinancialFinancial
• 28% indicated financial barriers28% indicated financial barriers• ““Do not buy hearing aids mostly due to the Do not buy hearing aids mostly due to the
high cost and we can’t afford them. I hate to high cost and we can’t afford them. I hate to deny his need of them if we can’t afford them. deny his need of them if we can’t afford them. We have a hard time paying bills, but yet we We have a hard time paying bills, but yet we never seem to qualify for financial assistance never seem to qualify for financial assistance because we make too much money.”because we make too much money.” (#2320407, parent of 8 year- old male with (#2320407, parent of 8 year- old male with “moderate” hearing loss according to parent)“moderate” hearing loss according to parent)
ConclusionsConclusions• Optimum communication access by dependent, Optimum communication access by dependent,
not just in the classroom, is critical for language not just in the classroom, is critical for language competence, cognitive development, social and competence, cognitive development, social and emotional well-being, academic competence and emotional well-being, academic competence and ultimately their development as productive ultimately their development as productive citizens.citizens.
• When communication access is denied through When communication access is denied through misinformation, minimization, neglect, stigma or misinformation, minimization, neglect, stigma or where there are financial barriers to where there are financial barriers to communication access, then it is likely that the communication access, then it is likely that the dependent with untreated HL will eventually join dependent with untreated HL will eventually join the ranks of adults with untreated hearing loss the ranks of adults with untreated hearing loss leading to a life of underperformance. leading to a life of underperformance.
Concluding QuestionsConcluding Questions• This study raises more questions then it answers:This study raises more questions then it answers:
– While newborn screening tests are successful is there While newborn screening tests are successful is there adequate follow-up when the infant fails the test and the adequate follow-up when the infant fails the test and the parent does not return with the child for detailed testing in a parent does not return with the child for detailed testing in a timely fashion? timely fashion? (historically 50% did not follow-up)(historically 50% did not follow-up)
– Are pediatricians adequately trained to identify childhood Are pediatricians adequately trained to identify childhood hearing loss?hearing loss?
– Are too many children with “mild” or “moderate” hearing loss Are too many children with “mild” or “moderate” hearing loss falling through the cracks? falling through the cracks? e.g. they don’t fit existing e.g. they don’t fit existing paradigms of hearing-impairment.paradigms of hearing-impairment.
– Are parents receiving misinformation regarding their child’s Are parents receiving misinformation regarding their child’s hearing loss?hearing loss?
– Is there too much HL minimization and denial on the parts of Is there too much HL minimization and denial on the parts of parents?parents?
– In such a rich nation how can financial need be a barrier to In such a rich nation how can financial need be a barrier to care for children?care for children?
Opportunities Opportunities
MotivationMotivation
• Key reason for purchasing is recognition that Key reason for purchasing is recognition that hearing loss has gotten worse.hearing loss has gotten worse.
• 50% need testing50% need testing• Concerted effort to test either objectively or Concerted effort to test either objectively or
subjectively (e.g. BHI Quick Hearing Check).subjectively (e.g. BHI Quick Hearing Check).– Physician officesPhysician offices– Free hearing checks by HHP in and outside of Free hearing checks by HHP in and outside of
office.office.• Problem recognition is a critical precursor to Problem recognition is a critical precursor to
problem resolution.problem resolution.
Professional RecommendationsProfessional Recommendations
• Significant improvement over last 20 Significant improvement over last 20 years.years.
• Continued physician education needed:Continued physician education needed:– Efficacy of hearing aidsEfficacy of hearing aids– Improved customer satisfactionImproved customer satisfaction– Evidence based criticalEvidence based critical– Need hearing testing as part of best Need hearing testing as part of best
practice protocol for family doctor.practice protocol for family doctor.
Surgery and HA TrialSurgery and HA Trial
• 12% of population may not be candidates for 12% of population may not be candidates for hearing aids.hearing aids.
• That’s 2.75 million peopleThat’s 2.75 million people• Close to 1 out of 10 tried and rejected Close to 1 out of 10 tried and rejected
hearing aids and found:hearing aids and found:– Insufficient benefitInsufficient benefit– Problems in noiseProblems in noise
• 40% of most serious hearing loss group 40% of most serious hearing loss group (decile 10) found that HA did not help their (decile 10) found that HA did not help their hearing loss.hearing loss.
Attitudes towards hearing lossAttitudes towards hearing loss
• People with serious hearing loss still believe:People with serious hearing loss still believe:– Hearing loss too mild for HAHearing loss too mild for HA– Many believe their life style precludes need for Many believe their life style precludes need for
better hearing.better hearing.
• Continued PR on impact of untreated hearing Continued PR on impact of untreated hearing loss especially for younger segments critical loss especially for younger segments critical to move them toward a solution.to move them toward a solution.
Misinformation about candidacyMisinformation about candidacy
• Opportunity to correct misinformation Opportunity to correct misinformation on who can be helped with hearing on who can be helped with hearing aids.aids.– High frequency hearing lossHigh frequency hearing loss– Low frequency hearing lossLow frequency hearing loss– ““Nerve damage” – probably sensorineuralNerve damage” – probably sensorineural– Unilateral hearing lossUnilateral hearing loss
TinnitusTinnitus
• 4 out of 10 also have tinnitus4 out of 10 also have tinnitus
• May be contraindicative of candidacy or May be contraindicative of candidacy or may be an opportunity.may be an opportunity.
• For PR purposes need greater For PR purposes need greater understanding of impact of hearing aid understanding of impact of hearing aid usage when a person has tinnitus.usage when a person has tinnitus.
Attitudes towards hearing aidsAttitudes towards hearing aids
• Need to demonstrate to this population:Need to demonstrate to this population:– Improved ability to communicate in noiseImproved ability to communicate in noise– Reduction in aversiveness of sounds when using hearing Reduction in aversiveness of sounds when using hearing
aidsaids– Reduction in hassle factor (maybe now with open fit HA)Reduction in hassle factor (maybe now with open fit HA)– 4.4 million potential users were influenced by other hearing 4.4 million potential users were influenced by other hearing
aid owner experiences.aid owner experiences.– 17% have hearing aids in drawer – needs to be reduced 17% have hearing aids in drawer – needs to be reduced
because of impact on negative word of mouth advertising.because of impact on negative word of mouth advertising.– Benefit has to be increased.Benefit has to be increased.
• 28% absolute benefit28% absolute benefit• Translates into 44% problem resolutionTranslates into 44% problem resolution
– Need greater utility in various listening situations especially Need greater utility in various listening situations especially phone, cellphone, and group situations.phone, cellphone, and group situations.
FinancesFinances
• Significant barrier to two out of three (64%)Significant barrier to two out of three (64%)• Evidence that finances NOT a convenient Evidence that finances NOT a convenient
excuse.excuse.• Initiatives to mitigate this problem critical:Initiatives to mitigate this problem critical:
– Tax credit billTax credit bill– InsuranceInsurance– Education on available help (e.g. charities, VA, Education on available help (e.g. charities, VA,
union, flex dollar programs in corporations, etc)union, flex dollar programs in corporations, etc)• 40% indicate greater likelihood of HA trial 40% indicate greater likelihood of HA trial
with tax credit of $500.with tax credit of $500.
ConclusionsConclusions
• Model of hearing aid adoption is complex.Model of hearing aid adoption is complex.• No one initiative will be enough.No one initiative will be enough.• First – person must recognize their loss.First – person must recognize their loss.• Second – must recognize loss causes them Second – must recognize loss causes them
problems.problems.• Third – must believe there is a reasonable probability Third – must believe there is a reasonable probability
that visiting a HHP will sufficiently solve their that visiting a HHP will sufficiently solve their problem.problem.
• Some obstacles are perceptual and some are real.Some obstacles are perceptual and some are real.• HIA research on improving consumer’s journey is a HIA research on improving consumer’s journey is a
critical step in introducing more people to the world of critical step in introducing more people to the world of better hearing.better hearing.
OpportunitiesOpportunities• Demography – demonstrates extent of problem.Demography – demonstrates extent of problem.• Challenging common myths about hearing loss Challenging common myths about hearing loss
((e.g. only an issue of aging).e.g. only an issue of aging).• Positive customer satisfaction ratings can elevate Positive customer satisfaction ratings can elevate
image of hearing aids and HHP .image of hearing aids and HHP .• Impact of untreated hearing loss on quality of life Impact of untreated hearing loss on quality of life
(e.g. Income) can motivate younger hearing-(e.g. Income) can motivate younger hearing-impaired.impaired.
• Greater awareness of impact of untreated hearing Greater awareness of impact of untreated hearing loss on children.loss on children.
• Lack of involvement of MDs – still an important Lack of involvement of MDs – still an important gatekeeper.gatekeeper.
Acknowledgment:Acknowledgment:All MarkeTrak research made All MarkeTrak research made
possible through a special grant from possible through a special grant from Knowles ElectronicsKnowles Electronics
