Dr. Krishnan is a clinical professor at Purdue University in West Lafayette, IN. Dr. Nelson is an audiologist at West Coast Hearing and Balance Center in Camarillo, CA. Dr. Novak is a professor in the department of otolaryngology-head & neck surgery at the University of Texas Health Science Center and a research scientist at Audie Murphy VA Hospital Geriatric Research, Education and Clinical Center and Audiology Service, both in San Antonio.
The authors thank Siemens Hearing Instruments for donating hearing aid shells, Westone for donating ear molds, Wal-Mart for the color photographs of the models, and Aida Muñoz and the Latino Coalition of Tippecanoe County in West Lafayette, IN, for their contribution to this project.
An investigation of Hispanics’ and Caucasians’ attitudes toward individuals wearing hearing devices revealed a negative self-image among Hispanics, according to an unpublished study we conducted. Caucasian models were routinely rated higher by both groups regardless of the type of device worn, and Hispanics rated other Hispanics more adversely, raising the possibility of a negative self-image among this group. Hispanics wearing a Bluetooth, however, were rated as more assertive and more successful by both groups, suggesting a bias for the Hispanic sample when utilizing Bluetooth technology.
Approximately 36 million people in the United States — 17 percent of the population — report some degree of hearing loss, but only about 20 percent of those who might benefit from a hearing aid actually use one. (NIDCD, 2010.) Hispanics, who account for nearly 17 percent of the US population, are expected to make up 30 percent of the population by the year 2050. (Census Bureau, 2011.) The prevalence of hearing loss among the Hispanic population is similar to the general population, ranging from 10 percent to 23 percent, but only up to 11 percent of Hispanics use hearing aids. (Public Health Rep 1991;106:97; Am J Public Health 1991;81:1471.)
In addition to cultural differences in attitudes toward hearing aids, and healthcare in general, our data suggest that negative self-image should be considered in delivering hearing healthcare to the Hispanic population. Other studies have suggested that culture and language-specific interventions are needed to improve hearing aid use among Hispanics and that Hispanic children display a pronounced preference for lighter skin tones and no tendency to favor their own ethnic group because of repeated exposure to negative stereotypes about them. (Early Child Dev Care 2012;182:277; SocCognit 2002;20:198; Am J Public Health 1991;81:1471.)
Understanding how the Hispanic population views hearing devices and the effect current technology has on their perception may allow audiologists to begin meeting their hearing healthcare needs more appropriately. Providers may also take advantage of the positive effects of using new technology to enhance hearing aid acceptance. Our unpublished data suggest that this will help audiologists understand Hispanics’ perceptions of hearing aids and hearing loss, allowing for improved counseling techniques and a possible increase in the use of amplification when needed.
The Hearing Aid Effect
Negative associations with hearing aid use, often called the hearing aid effect, have typically been measured using a semantic differential task. (Hear Instrum 1977;28:12; Lang, Speech Hear Serv Sch 1983;14:128.) Photographs of people with and without hearing aids are rated on appearance, personality, assertiveness, and achievement. College students, teachers, school-age children, and even healthcare professionals express a stigma toward hearing aid wearers. Senior citizens and women have also indicated a negative perception of age-matched peers wearing hearing aids. (Hear Instrum 1977;28:12; J Am Acad Audiol 1998;9:361.)
Few studies have examined the cultural differences in attitudes toward hearing aids in Hispanics, and this may contribute to low hearing aid use among them, but an increase in demand for services will likely occur as the US Hispanic population grows. Programs to educate Hispanics about hearing loss and offer culturally appropriate counseling services must be developed.
Caucasian and Hispanic Perceptions
Our study used a semantic differential task to rate Caucasian and Hispanic models wearing hearing aids or a Bluetooth device. Across and within cultures, when we compared the “no hearing aid” condition with any style of hearing aid, neither Hispanics nor Caucasians rated the models wearing hearing aids lower than those without a device, indicating no negative stigma or hearing aid effect. This appears to be a positive finding suggesting that the hearing aid effect is beginning to diminish and hearing devices are becoming more acceptable. However, advancements in hearing aid and ear mold technology and the angle of the photographs used made it difficult to see the models’ devices, except for the Bluetooth, so further study is required before making such a conclusion.
When comparing ratings of models with hearing aids across and within cultures, Caucasian and Hispanic participants uniformly rated Caucasian models higher than Hispanic models on all four measures— appearance, personality, assertiveness, and achievement— regardless of hearing aid style, suggesting an inherent bias by both groups. (Figure 1.) This may imply a more negative self-image among the Hispanic sample. A significant negative perception of Hispanics toward models from their own cultural group could contribute to low hearing aid use, although hearing aid cost, lack of insurance coverage, and low consumer awareness have been previously cited. (Ear Hear 1985;6:161; Public Health Rep 1991;106:97; Epidemiology 1996;7:443.)
In contrast to the hearing aid conditions, Hispanic models wearing a Bluetooth device were viewed as significantly more assertive and higher achieving by Caucasian and Hispanic participants, but they were rated lower in personality, according to our study. (Figures 2B, 2C.) These data indicate that a person wearing a Bluetooth may be rated as more assertive and successful but also judged to be less personable, perhaps because a Bluetooth eliminates the need for face-to-face communication.
The more positive ratings in assertiveness and achievement can potentially be attributed to new technology or to a technology halo effect. Perhaps the use of the Bluetooth device by the Hispanic model lessens the negative self-image because of this effect. Hearing aids that resemble a device like Bluetooth may eliminate negative attitudes within the Hispanic culture and possibly improve perceptions and attitudes toward hearing aids, allowing more individuals to feel comfortable wearing such a device. Overall, however, Hispanic participants continued to rate the models from their own culture significantly more negatively than the Caucasian models across all measures, while Caucasians consistently rated other Caucasians more positively. More research is needed to determine to what extent this technology halo effect may improve acceptance of hearing aids.