Hearing Healthcare Professionals’ Views about Over-The-Counter (OTC) Hearing Aids: Analysis of Retrospective Survey Data

Over-the-counter hearing aids have been available to consumers in the US since 17 October 2022 following a ruling by the Food and Drug Administration. However, their reception by hearing healthcare professionals (HHP) has been mixed, and concerns have been expressed by many HHPs. The aim of this study was to examine the concerns that HHPs have towards over-the-counter (OTC) hearing aids. The study used a retrospective survey design. The survey data of HHPs (n = 730) was obtained from Hearing Tracker. A 22-item structured questionnaire was administered using a Question Scout platform. Descriptive analyses examined reported areas of concern and a Fisher’s exact test examined the relationship between demographics and responses. A cluster analysis with partitioning around medoids (PAM) was used to identify a sub-group of participants based on responses. Nearly half of HHPs who participated reported that they will support patients with OTC hearing aids purchased elsewhere, whereas a quarter reported that they will sell OTC hearing aids in their clinic or website. HHPs expressed over 70% agreement in ‘concern’ statements in 14 of the 17 items. Issues about safety, counseling, and audiological care were the key concerns expressed by HHPs about OTC hearing aids. Some demographics (i.e., profession, primary position) were associated with responses to some statements. Two groups were identified based on the responses to concern statements. The HHPs in the first cluster ‘OTC averse’ (51%) agreed on all the 17 concern statements, whereas the second cluster ‘OTC apprehensive’ (49%) had some items rated as disagree (i.e., consumers will give up on amplification) and neither agree nor disagree (i.e., do not provide good value, warranties and return periods will be worse), and remaining items were rated as agree. OTC hearing aids were initiated to improve affordability, accessibility, and hearing aid uptake and are currently a rapidly emerging category of hearing devices. Overall, the results of the current study indicate that HHPs have serious concerns about OTC hearing aids. HHP concerns cited in this study provide useful feedback to stakeholders (e.g., HHP professional agencies, FDA, industry, and insurance payers) involved in improving OTC hearing aid implementation.


Introduction
Hearing loss is one of the most frequent chronic conditions in older adults with over 430 million people across the globe requiring rehabilitation [1]. Hearing aids are the most common management options for individuals with hearing loss [2]. However, hearing aid uptake remains low with only one in four people in the U.S. obtaining hearing aids [3]. The reason for this low uptake is multifaceted, although some of the main reasons include low perceived need, stigma, and high cost of the device [4]. In order to address access and affordability issues, the U.S. Congress passed the Over-the-Counter (OTC) Hearing Aid Act in 2017 mandating that the U.S. Food and Drug Administration (FDA) create a new hearing aid category for OTC hearing aids [5]. The FDA's final ruling on 16 August 2022 allows OTC hearing aids to be sold directly to consumers without the consultation of hearing healthcare professionals (HHPs) from 17 October 2022 in the US [6].
OTC hearing aids add to a range of hearing devices in the U.S. market including prescription hearing aids and various direct-to-consumer hearing devices such as personal sound amplification products (PSAPs) and hearables [7,8]. The OTC hearing aid category supersedes the direct-to-consumer (DTC) hearing aid category which was previously available for purchase online [9]. Companies who have legally sold DTC hearing devices prior to 16 October 2022 have until 14 April 2023 to comply with the labeling and packaging requirements set by the new OTC Hearing Aid Regulations.
The availability of OTC hearing aids has already created new service delivery models which can be primarily grouped into three categories [8]. First, OTC hearing aids can be purchased online or in-store without consulting HHPs in which the users self-select, self-fit, and self-manage the devices. Second, several companies that sell OTC hearing aids also provide remote customer service or clinical services to users. Finally, some HHPs are starting to dispense OTC hearing aids in their clinics and/or providing consultation sessions to select, fit, and troubleshoot the devices as required by the user. In the latter model, it is critical that HHPs understand the benefits and limitations of OTC HAs as well as recognize who may be a good candidate for OTC hearing aids in order to ensure users obtain optimal benefits. For this reason, it is important to understand HHPs' current understanding and views towards OTC hearing aids.
Discussion and development of an OTC hearing aid category started over a decade ago following the recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM), President's Council of Advisors on Science and Technology (PCAST), and the 2009 National Institute on Deafness and Other Communication Disorders (NIDCD) working group [10]. HHPs and the hearing device industry as well as professional organizations initially expressed significant concerns that OTC hearing aids will do more harm than good [11]. More recently professional associations such as the American Academy of Audiology (AAA) and the American Speech-Language and Hearing Association (ASHA) have changed their messaging to be more neutral and positive. However, HHPs continue to express concerns about OTC hearing aids in various forums (e.g., social media posts and popular media interviews). Given that HHPs currently fit most users with prescription hearing aids, their view on newly available OTC hearing aids presents an opportunity to better understand their concerns regarding this device category and evaluate their perceptions systematically against the available evidence.
The primary aim of this study was to examine HHP views regarding OTC hearing aids. The secondary aims included understanding how HHP professional positions interacted with their views on OTC hearing aids and identifying sub-group of HHPs based on their views towards OTC hearing aids.

Study Design
The study used a retrospective survey design using an anonymous survey of HHPs on their views towards OTC hearing aids. Institutional review board approval was obtained from the research ethics committee (Reference number 02606623-HUM007/0922) at the University of Pretoria, South Africa prior to data analysis. There was no informed consent as the survey data was not part of a research study, although participants were aware that the data can potentially be used for research purposes.

Data Collection
Data was collected by a cross-sectional online survey administered by Hearing-Tracker.com using the Question Scout platform using convenience sampling. The survey link was posted in several audiology Facebook groups and for those audiologists who are registered for audiologist informer newsletters at HearingTracker.com in August 2022, immediately after the FDA ruling was released. The users of this group were encouraged to complete the survey anonymously and no incentive was given to participants. No strict inclusion/exclusion criteria were used. However, all users of this community who were mainly HHPs were encouraged to complete the survey. The survey included a 22-item structured questionnaire of which 17 items were focused on examining the HHPs' concerns about OTC hearing aids and the remaining 5 questions gathered some basic demographics (i.e., profession, primary practice type, primary position, OTC hearing aid association). The questions on concerns about OTC hearing aids were rated on a 5-point Likert scale (strongly agree with a value of 5 to strongly disagree with a value of (1), with agreement suggesting a more negative view or concern about OTC hearing aids. These 17 items were grouped into 5 domains that included HPP's views regarding (a) safety, (b) concerns about device handling and self-adjustment, (c) concerns about service delivery model, (d) concerns about counseling and audiological care, and (e) concerns about the optimal benefit and adverse events. Seven hundred and thirty HHPs completed the survey.

Data Analyses
Analyses were performed using R software (version 4.2.2). Concerns towards OTC hearing aids for each of the 17 items expressed by HHPs were analyzed using descriptive statistics. Fisher's exact test was used to examine the relationship between demographic variables of HHPs (i.e., profession and position) and their views towards OTC hearing aids. The unadjusted odds ratio was also calculated and reported. A Fisher's exact test was performed on each of the 17 items with the two demographic variables, although only significant associations are reported in the manuscript. Finally, cluster analysis with partitioning around medoids (PAM) was used to identify a sub-group of HHPs based on their views towards OTC hearing aids. Table 1 presents the participants' demographics. HHPs mainly consisted of audiologists (n = 653; 89.5%), followed by business owners, hearing instrument specialist (HIS), and Doctorate of Audiology (AuD) students. The mean years in practice was 16.7 years (SD = 12.4 years). In terms of the primary position, practice employee (n = 359; 49.2%) was the largest group followed by owner and practice manager. A total of 55.5% of the HHPs reported willingness to support patients with OTC hearing aids purchased elsewhere, whereas only 26.7% reported that they will sell OTC hearing aids in their clinic or website. The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.

Participant Demographics
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Hearing Instrument Specialist Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-the- Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Independent private practice PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Ear, Nose, and Throat (ENT) practice PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Manufacturer owned practice PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Big box store (e.g., Costco, Sam's club) PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in fa- Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their prac-Practice employee PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their pa-Owner PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP I currently dispense hearing aids PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for I will support patients with over-the-counter (OTC) hearing aids purchased elsewhere PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will sup-I will offer unbundled prices to compete with OTC hearing aid price PEER REVIEW 8 Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:


Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost I employ best practices or plan to improve my standard.  Table 2 presents HHPs' concerns towards OTC hearing aids in terms of percentage response to each of the 17 items on a 5-point scale, as well as mean values. The mean responses for the 17 items ranged from 3.4 to items in the domain of concerns about the optimal benefit and adverse events (i.e., do not provide good value and consumers will give up amplification) to 4.5 to a few items in the domain of concerns about device handling and self-management (i.e., consumers will struggle to identify and address common problems) and the domain on concerns about counseling and audiological care (i.e., best practice audiological care is more important). Figure 1 presents the agreement (i.e., strongly agree and agree) or disagreement (i.e., disagree, strongly disagree) about concerns by combining the positive and negative items together. The proportion (%) of participants agreeing with the items of concern ranged from 44% for the item do not provide good value to 93.4% for the item on will not be educated on effective communication strategies. Moreover, for 14 of the 17 items, HHPs expressed over 70% agreement to concern statements. Issues about safety as well as about counseling and audiological care were the key concerns expressed by HHPs about OTC hearing aids. Overall, these results suggest that HHPs have serious concerns about OTC hearing aids.  Table 3 presents the results of the Fisher's exact test showing the relationship between the HHPs' professional position and views towards OTC hearing aids. There was a significant association for the items related to consumers having problems to identify and address common problems, lead to greater confusion, ripped off by bad actors, warranties and return period will be worse, and that consumers will give up on hearing aids. Among audiologists, the odds of believing the following facts: consumers having problems to identify and address common problems, lead to greater confusion, ripped off by bad actors, and warranties and return period will be worse is significantly higher compared to the other HHP professions (i.e., business owners, HIS, student). Nevertheless, the odds of believing consumers will give up on amplification is significantly higher among business owners. Audiol. Res. 2023, 13, FOR PEER REVIEW 6 Figure 1. Hearing healthcare professionals' (HHPs) concerns towards over-the-counter (OTC) hearing aids. Table 3 presents the results of the Fisher's exact test showing the relationship between the HHPs' professional position and views towards OTC hearing aids. There was a significant association for the items related to consumers having problems to identify and address common problems, lead to greater confusion, ripped off by bad actors, warranties and return period will be worse, and that consumers will give up on hearing aids. Among audiologists, the odds of believing the following facts: consumers having problems to identify and address common problems, lead to greater confusion, ripped off by bad actors, and warranties and return period will be worse is significantly higher compared to the other HHP professions (i.e., business owners, HIS, student). Nevertheless, the odds of believing consumers will give up on amplification is significantly higher among business owners.    Table 4 presents the results of the Fisher's exact test showing the relationship between professional position and the responses to the survey items about OTC hearing aids. There was a significant association for items related to significant safety risk, lead to greater confusion, not benefit as professionally fit hearing aids, do not provide value, and that consumers will give up on hearing aids for practice employees. In comparison with practice employees, the odds of believing significant safety risk is significantly higher in owner category, whereas the odds of believing consumers will give up on amplification is significantly higher in other positions.  Table 5 presents cluster analysis results showing the sub-group of HHPs based on their view towards OTC hearing aids on the 17-item questionnaire. This table includes the most likely responses of participants who belong to this group on the preference questionnaire. Based on the Silhouette value, a two-cluster solution was identified. Cluster 1 included 374 (i.e., 51.2%) HHPs who mainly had concerns about all the items rated as strongly agree (14 items) or agree (3 items). We named this group 'OTC-Averse.' On the other hand, cluster two included the remaining 356 (i.e., 48.8%) had some items rated as disagree (i.e., consumers will give up on amplification) and neither agree nor disagree (i.e., do not provide good value, warranties and return periods will be worse), whereas the remaining items were rated as either agree (13 items) or strongly agree (1 item). Based on its characteristics, we named this group as 'OTC-Apprehensive'.  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in Not able to accurately predict hearing loss hearing healthcare professionals (HHPs) based on their views on over-theaids. Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in Not benefit as professionally fitted hearing aids 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in Consumers will struggle to program 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in Warranties and return periods will be worse 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in Best practice audiological care is more important 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in faof OTC hearing aid users. A recent survey of pharmacists showed ited understanding of OTC hearing aids and were interested in Consumers will struggle to identify and address common problems  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pahearing aid consultations and/or include OTC devices in their practher healthcare professionals may also have some role to play in fa-Consumers will not have access to adequate servicing Agree: 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pa-Struggle to insert hearing aids 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards d service delivery models may impact how HHPs advise their pa-Do not provide good value 8 hearing healthcare professionals (HHPs) based on their views on over-theaids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification dy examined views of HHPs regarding OTC hearing aids by asking ents relating to several potential areas of concern. In addition, the relationship between responses and key demographics (i.e., profeson) as well as identifying sub-groups of HHPs based on their OTC ncerns. The key results are discussed below. key hearing health stakeholders such as HHPs are important for the tation of new and emerging service delivery models for OTC hearing study, the majority of the participants expressed concerns in almost d but particularly in terms of safety, counseling, and audiological care. light of the fact that nearly half of HHPs reported that they will sup-C hearing aids purchased elsewhere and a quarter reported that they g aids in their clinic or website. Many HHPs have been preparing for y moving from bundled pricing (i.e., which bundles together HHP of the hearing aid) to unbundled pricing (which differentiates prices ng aids) [12]. Nevertheless, having a high level of concerns towards Consumers will give up on amplification Strongly agree: Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Best practice audiological care is more important Agree: Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Not able to accurately predict hearing loss Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Significant safety risk Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Not benefit as professionally fitted hearing aids Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids.

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Struggle to insert hearing aids Audiol. Res. 2023, 13, FOR PEER REVIEW 8

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Consumers will struggle to program, Audiol. Res. 2023, 13, FOR PEER REVIEW 8

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in  Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in Consumers will struggle to identify and address common problems Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in fa-Consumers will not have access to adequate servicing Neither agree nor disagree: Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their pa-Do not provide good value Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their pa-Warranties and return periods will be worse Disagree: Audiol. Res. 2023, 13, FOR PEER REVIEW 8 Table 5. Sub-group of hearing healthcare professionals (HHPs) based on their views on over-thecounter (OTC) hearing aids. Consumers will struggle to identify and address common problems  Consumers will not have access to adequate servicing Neither agree nor disagree:  Do not provide good value  Warranties and return periods will be worse Disagree:  Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices Consumers will give up on amplification

Discussion
The current study examined views of HHPs regarding OTC hearing aids by asking them to rate statements relating to several potential areas of concern. In addition, the study examined the relationship between responses and key demographics (i.e., profession, primary position) as well as identifying sub-groups of HHPs based on their OTC hearing aid-rated concerns. The key results are discussed below.
Perspectives of key hearing health stakeholders such as HHPs are important for the successful implementation of new and emerging service delivery models for OTC hearing aids. In the current study, the majority of the participants expressed concerns in almost all domains examined but particularly in terms of safety, counseling, and audiological care. This is interesting in light of the fact that nearly half of HHPs reported that they will support patients with OTC hearing aids purchased elsewhere and a quarter reported that they will sell OTC hearing aids in their clinic or website. Many HHPs have been preparing for OTC hearing aids by moving from bundled pricing (i.e., which bundles together HHP services and the cost of the hearing aid) to unbundled pricing (which differentiates prices for services vs. hearing aids) [12]. Nevertheless, having a high level of concerns towards OTC hearing aids and service delivery models may impact how HHPs advise their patients on OTC during hearing aid consultations and/or include OTC devices in their practice. It is likely that other healthcare professionals may also have some role to play in facilitating the journey of OTC hearing aid users. A recent survey of pharmacists showed that they had a limited understanding of OTC hearing aids and were interested in increasing their knowledge on this topic [13]. Future research should examine the validity of these concerns given that research on early generation DTC hearing devices (for review see [14,15], selffitting algorithms [16], outcomes of OTC hearing aids and service delivery models [17][18][19][20][21] suggest generally positive outcomes for individuals with mild-to-moderate hearing loss. This study showed associations between demographic variables such as profession (i.e., audiologists, HIS, business owner, student) as well as primary position (i.e., practice employee, practice manager, owner, other) with some survey items. In particular, practice employees are likely to believe that OTC hearing aids cause safety risks, audiologists are likely