Identification of the motivators and barriers to cochlear implantation in adults over 60 years at an auditory implant centre in the UK: a mixed-methods study

Abstract

Objectives: cochlear implants are an effective intervention for people with severe to profound hearing loss. However, only a small percentage of those who could benefit from cochlear implants have one. We aimed to understand the barriers to access and receipt of cochlear implants in the UK.

Design: mixed-methods study.

Setting: the University of Southampton Auditory Implant Service.

Participants: data on referral route and personal characteristics of 456 patients over the age of 60 at the time of cochlear implantation, who received a cochlear implant before 2020 were included. Semi-structured interviews were held with six people who hear with an implant.

Primary outcome measures: demographic factors and routes of referral for cochlear implantation for older adults who went on to receive an implant. Semi-structured interviews were designed to identify key motivators and barriers to receiving a cochlear implant.

Results: sex and ethnicity did not affect cochlear implant uptake, whereas socioeconomic status and differences in referral pathways were associated with differences in uptake. People from lower socioeconomic groups were underrepresented in the implanted population at USAIS. Certain health providers across the cohort catchment area were more likely to refer patients than others which in turn affected cochlear implant uptake. Barriers to uptake were poor knowledge about implants by patients and clinicians, and fear of surgery. A willingness by patients to explore a way to reduce the daily challenges associated with hearing loss and the support and encouragement of clinicians, family and friends and other people with implants were motivators to implant uptake.

Conclusion: these findings will inform future research to address the key factors preventing eligible individuals from receiving cochlear implants. This will support the development of strategies to improve access to, and uptake of, cochlear implants for older adults.

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Identifiers

ORCID for Kate Hough: orcid.org/0000-0002-5160-2517

ORCID for Callum Andrew Findlay: orcid.org/0000-0003-0104-3435

ORCID for Tracey Newman: orcid.org/0000-0002-3727-9258

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