German hearing-aid survey links stigma and expected benefits to intentions

A German-language questionnaire developed to assess attitudes toward hearing aids found that expectations of benefit and effort, together with stigma-related beliefs, were most strongly associated with participants’ behavioral intention to use hearing aids. In a cross-sectional study of 159 German-speaking adults with and without self-reported hearing loss, general attitudes correlated strongly with behavioral intention, while attitude scores accounted for about 40% of the variation in that intention. The findings provide preliminary evidence that the questionnaire may help identify psychosocial factors relevant to hearing rehabilitation, but the instrument requires refinement and validation in independent populations before it can guide interventions.

The researchers described the results as preliminary rather than definitive, and the study did not establish that changing particular beliefs would cause more people to obtain hearing aids. The researchers adapted an existing English-language questionnaire for the German healthcare system through expert review, psychometric evaluation and pilot revision. They then surveyed adults aged 18 to 96, of whom 48.4% reported hearing loss.

The instrument measured general attitudes toward hearing aids, behavioral intention and attitudes organized into domains. Its overall attitude scale showed acceptable internal consistency, with Cronbach’s alpha of 0.77, while the behavioral intention scale showed good internal consistency, with an alpha of 0.86. Exploratory factor analysis supported a four-factor structure, providing preliminary evidence for the questionnaire’s structural validity.

The authors therefore said that further refinement and independent psychometric validation were warranted. The results support a four-factor model in the studied sample, but they do not show that the structure will remain the same in other populations. General attitude was strongly associated with behavioral intention, with a correlation coefficient of 0.63 and a p-value below 0.001.

Regression analysis showed that general attitude explained approximately 40% of the variance in behavioral intention, represented by an R² of 0.40. Among the attitudinal domains, expected benefit and effort had the strongest association with intention, at r = 0.66, followed by stigma at r = 0.65. These are statistical associations in a cross-sectional survey, not evidence that the measured attitudes predict future behavior or that changing them would increase hearing-aid uptake.

Participants with self-reported hearing loss who used hearing aids also showed significantly more favorable attitudes and stronger behavioral intention than non-users, with both comparisons reporting p-values below 0.001. The survey cannot determine what produced that difference or estimate how many people would begin using hearing aids after an intervention. Nevertheless, the results identify stigma-related beliefs and expectations of benefit and effort as prominent correlates of intention and as topics that could be examined in future research on approaches to hearing-aid uptake.

It was conducted among German-speaking adults, included people with and without self-reported hearing loss, and assessed preliminary psychometric properties of a newly adapted questionnaire. It was not a trial of a hearing-aid intervention, and it did not measure whether intentions translated into actual device acquisition or use. The strongest conclusions supported by the evidence concern the questionnaire’s preliminary reliability, the four-factor structure observed in the sample, and the associations between attitudes and stated behavioral intention.

The research was published in BMC Health Services Research as an early-access, peer-reviewed article and is presented by the authors as early evidence supporting the questionnaire’s reliability and structural validity while highlighting the need for further validation in independent populations. In practical terms, the study points toward stigma and expectations of benefit and effort as measurable areas for future investigation. It does not, on its own, demonstrate a successful strategy for improving hearing-aid uptake or justify clinical recommendations based on the questionnaire alone.

Subject of Research: Psychometric development of a German questionnaire on hearing-aid attitudes and behavioral intention

Article Title: Development and preliminary evaluation of a German questionnaire assessing attitudes toward hearing aids and behavioral intention

Article References: Mathern, C., Reimann, K., Weiß, R. M., Rusche, J. R., Stuck, B. A., & Thangavelu, K. (2026). Development and preliminary evaluation of a German questionnaire assessing attitudes toward hearing aids and behavioral intention. BMC Health Services Research, 26(1), Article 1274. https://doi.org/10.1186/s12913-026-15549-0

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DOI: 10.1186/s12913-026-15549-0

Keywords: hearing aids, behavioral intention, German questionnaire, hearing loss, health services research, stigma, psychometrics, factor analysis, hearing rehabilitation, attitudes, Development, preliminary