Older adults worldwide still trust doctors over stores for hearing care

Age-related hearing loss is the fourth-leading contributor to years lived with disability worldwide, yet hearing health care remains stubbornly underutilized. Only about one in five adults who might benefit from hearing aids actually uses them, a figure that has barely budged despite sweeping policy changes designed to make devices cheaper and easier to buy. Now, a landmark cross-national survey published in BMC Geriatrics offers a striking explanation for why: older adults simply do not want to buy hearing care the way they buy headphones. They want it from doctors.

The study, led by F. Alnafjan of Macquarie University together with an international team including A. C. Davis, C. M. McMahon, M. K. Pichora-Fuller, and K. L. Tremblay, surveyed 9,510 English-speaking adults aged 60 and older in Australia, Canada, England, and the United States between 2016 and 2018. That timing matters enormously. The data were collected after the United States Congress passed the Over-the-Counter Hearing Aid Act in 2017 but before the pandemic and before the Food and Drug Administration’s 2022 ruling that authorized OTC hearing aids to be sold directly to consumers without a medical exam, prescription, or professional fitting. In other words, the survey captured the attitudes of a generation at the exact moment policymakers were betting they would embrace retail channels.

What makes the survey unusual is its methodology. Rather than imposing researchers’ assumptions about what options consumers might want, the team held focus groups in London, Seattle, Sydney, and Toronto and co-created the survey questions and response options with older adults themselves. Participants vetted every item through cognitive interviewing, deciding what content belonged, what wording was clear, and what alternatives deserved inclusion. This participatory design means the response options reflect what older consumers actually consider when thinking about hearing care, not what a market analyst imagines they might. If self-testing, mobile apps, or technology stores appeared as options, it was because focus group participants chose to include them.

The survey asked three questions. First, where would you prefer to get information about hearing health care, with 14 response options and 8,151 respondents? Second, where would you most like to get your hearing tested, with 8 options and 8,035 respondents? Third, from which places would you most like to get hearing aids if you needed them, with 11 options and 8,151 respondents? Participants could select multiple answers for the first and third questions. The results were remarkably consistent. Across all three questions, respondents overwhelmingly preferred traditional medical over nonmedical locations. Radio and internet advertisements ranked as the least preferred sources of information, while doctors and medical or government sources ranked highest. For testing, medical settings such as hospitals, family doctors’ offices, and audiologists’ offices beat supermarkets, pharmacies, community centers, homes, and technology retail stores. For devices, audiologist offices, doctors’ offices, and hospitals were the most favored choices, while technology stores and mail order ranked last.

Crucially, these preferences did not vary by degree of hearing loss, prior help-seeking experience, survey mode, age band, or country. The team measured hearing thresholds in person using the validated Home Hearing Test, an automated computer-based pure-tone audiometry tool that yields better-ear pure-tone averages comparable to gold-standard clinical audiometry. For online respondents who could not be tested, hearing categories were imputed using ordinal regression modeling. Whether someone had normal hearing, mild loss, moderate loss, or worse, whether they had never sought help or already wore hearing aids, whether they completed the survey online or in person, the pattern held. Respondents in England showed a somewhat stronger preference for family doctor and hospital settings, while participants elsewhere leaned toward audiologists’ offices, but the medical-versus-nonmedical divide was universal.

The findings land hard against the central assumption of the OTC policy experiment. The 2022 FDA ruling was designed to expand hearing care delivery beyond traditional medical settings, reduce clinical barriers, attract new technology companies to the market, increase competition, and lower prices. Policymakers assumed consumers would prefer these channels. Consumers told researchers otherwise. And the market data since then confirm the disconnect. In 2024, only about 2 percent of American adults aged 40 and older with hearing difficulties had purchased an OTC device, and only 4 percent planned to do so within the next year. The 2025 MarkeTrak survey found OTC devices accounted for just 1 to 2 percent of total hearing aids sold. Meanwhile, hearing aid adoption rates remain modest even in countries where costs are heavily subsidized. Australia’s government-funded Hearing Services Program covers many older adults, yet adoption among people with self-reported hearing loss was only 45 percent in 2021 and 2025. England’s National Health Service often covers devices fully, yet adoption reached just 50.5 percent in 2025. The United States, where consumers incur significant out-of-pocket expenses, reached 39 percent in 2025 including OTC options. Canada, with partial public and private coverage, sat at roughly 33 percent in 2019. If cost were the only barrier, adoption should be dramatically higher in subsidized systems. It is not.

Why do older adults cling to medical settings? The researchers point to trust and familiarity. Clinical locations signal diagnostic rigor and professional oversight in ways that retail outlets and online channels do not. A 2023 survey of Americans older than 50 found 84 percent would choose an in-person pathway with direct professional interaction. In the 2022 MarkeTrak survey, 78 percent of respondents preferred obtaining future hearing aids through traditional in-person medical channels rather than remote or self-fitting options. By 2025, 85 percent of hearing aid owners said they would prefer to repurchase in person with professional assistance. Even among OTC owners planning to repurchase, over half said they would buy in person from a hearing care provider. In EuroTrak UK and AustraliaTrak studies, doctors and hearing care professionals were the most important sources of information, with print ads and magazine sources least preferred. When Australians were asked where they would prefer to get hearing aids, 93 percent identified hearing aid clinics, ENT offices, and hospitals, with only 2 percent selecting online. These recent findings align almost perfectly with the 2016 to 2018 survey data, suggesting preferences have not shifted in the intervening years despite the pandemic’s acceleration of telehealth.

There is a deeper psychological dimension. Older participants have experienced decades of health communication and services in traditional medical settings, where trust and perceived quality of care are closely tied to long-standing relationships and shared decision-making. Disrupting this continuity generates uncertainty and reduces confidence in care. Unfamiliar systems and technologies increase anxiety and reduce willingness to adopt new care models, especially for older adults. The researchers also note that focus group participants used the term doctor loosely, often not knowing the job titles of the people who treat them. They focused more on where they would prefer to receive services than who would serve them, perhaps assuming that medical-type clinics deliver professional, trustworthy care by a doctor or under a doctor’s direction. This suggests one viable strategy: offer both in-person and OTC services within medical-type settings that older adults perceive as trustworthy, delivered by audiologists alongside trained, supervised hearing care personnel, with follow-up remote services introduced once trust and basic competencies are established.

The researchers caution that relying solely on medical channels poses its own problems. Age-related hearing loss is not routinely addressed in primary care. Fewer than 40 percent of doctors surveyed in the United States reported screening for hearing loss during initial visits, and similar findings emerge from Australia and England. Even when hearing loss is identified, only about half of doctors suggest a comprehensive hearing evaluation, and fewer counsel patients on causes or treatment options. Doctors have themselves been described as a barrier to help-seeking. Yet now that hearing loss has been identified as a potentially modifiable risk factor for dementia, some countries such as Canada have introduced geriatric guidelines recommending primary care hearing screenings. The World Health Organization’s ICOPE handbook includes hearing screening and training tools for primary care and community settings, and there is growing support for task-shifting hearing screening to trained community health workers, volunteers, and retail staff as a scalable strategy for early detection. The study’s authors encourage future researchers to use the same questions to track changes in consumer preferences over time, particularly as telecare adoption increases and generational differences may emerge. The convenience sample was primarily white respondents, limiting generalizability, and preferences may partly reflect the hearing care structures participants were accustomed to at the time of data collection. Still, the message is unambiguous: older consumers prefer to seek hearing care information, testing, and treatment in medical-type settings, and this preference held regardless of hearing loss severity, prior experience, survey mode, or country. As other countries contemplate adopting OTC policies, including parts of Canada and the United Kingdom, which recently granted certain hearing devices the ability to be sold directly to consumers, the lesson from four nations and nearly ten thousand older adults is clear. Access to a trusted hearing care professional continues to be the key factor influencing consumer preferences, and any new hearing care system that ignores this demand risks building services nobody uses.

Subject of Research: Health Policy

Article Title: Consumer preferences for hearing health care information and services as described by older adults surveyed in Australia, Canada, England, and the United States

Article References: Alnafjan, F., Davis, A. C., Lee, M. L., McMahon, C. M., Mokdad, A. H., Mosley, C. L., Pichora-Fuller, M. K., & Tremblay, K. L. (2026). Consumer preferences for hearing health care information and services as described by older adults surveyed in Australia, Canada, England, and the United States. BMC Geriatrics, 26(1), Article 1285. https://doi.org/10.1186/s12877-026-07819-7

Image Credits: AI Generated

DOI: 10.1186/s12877-026-07819-7

Keywords: Consumer, preferences, hearing, health, care, information, services, described, older, adults, surveyed, Australia