Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran)
Abstract
:1. Introduction
2. Theoretical Background and Research Framework
2.1. Expectation-Confirmation Theory (ECT)
2.2. Post-Acceptance Model (PAM)
2.3. Extended Post-Acceptance Model (PAM)
2.4. Confirmation
2.5. Perceived Benefits
2.6. Satisfaction
2.7. Hearing Aid Self-Efficacy
2.8. Extraverted Personality Trait
2.9. Perceived Social Support
2.10. Self-Perceived Hearing Handicap
2.11. Actual Use and Continuance Intention to Use
3. Materials and Methods
3.1. Participants
3.2. Measurement Scales
3.2.1. Continuance Intention and Confirmation Scales
3.2.2. Hearing Aid Self-Efficacy Questionnaire
Construct | Instruments | Description/Scale | Cronbach’s α |
---|---|---|---|
Satisfaction | Persian version of Satisfaction with Amplification in Daily Life (SADL) [65]. | A 15-item questionnaire that evaluates the satisfaction that people feel with their current hearing aids. It quantifies satisfaction using a global score and four subscales: Positive Effect, Service and Cost, Negative Features, and Personal Image. The SADL response scale: 7-point Likert (not at all; a little; somewhat; medium; considerably; greatly; tremendously) | 0.91 |
Perceived benefit | Persian version of Abbreviated Profile of Hearing Aid Performance (APHAP) [66]. | A 24-item self-assessment inventory that is divided into four subscales that assess communication, including situations in favorable environments (EC scale) and experiences in the presence of noise (BN scale), reverberating rooms (RV scale), and loud sounds (AV scale). The APHAP response scale: A. Always (99%), B. Almost Always (87%), C. Generally, (75%), D. Half the time (50%), E. Occasionally (25%), F. Seldom (12%), G. Never (1%) | 0.92 |
Actual use | Persian version of the International Outcome Inventory for Hearing Aids (IOI-HA) [67]. | In this study, we defined the actual use of hearing aids based on each participant’s self-report responses to question 1 (average hours of hearing aid use per day) and question 2 (the benefit from hearing aids in the situations where the individual most wanted to hear better) on the IOI-HA. Response scale: 5-point Likert; question 1 (none = 1 … to more than 8 h a day = 5), question 2 (helped not at all = 1 … helped very much = 5) | 0.85 |
Self-perceived hearing handicap | Persian version of the Hearing Handicap Inventory Screening Version for the Elderly (HHIE-S) [68]. | A 10-item questionnaire that evaluates how an individual perceives the social and emotional effects of hearing impairment. Response scale: 3-point Likert (No = 0; Sometimes = 2; Yes = 4) | 0.85 |
Perceived social support | The Iranian version of the Multidimensional Scale of Perceived Social Support (MSPSS) [69]. | A 12-item measure of the perceived adequacy of social support from three sources: family, friends, and significant other Response scale: 5-point Likert (strongly disagree = 0, strongly agree = 5) | 0.93 |
Extraverted personality trait | Persian version of the Ten-Item Personality Inventory (TIPI) [70]. | In this study, we used questions 1 and 6 of the Ten-Item Personality Inventory that evaluates the personality trait of extraversion. Response scale: a 7-point scale ranging from 1 = strongly disagree to 7 = strongly agree | 0.64 |
3.3. Data Analysis
4. Results
4.1. Findings from Multiple Linear Regression
4.2. Results from SEM
5. Discussion
5.1. Demographic and Audiological Characteristics
5.2. Extended PAM-Related Constructs
6. Limitations and Further Research
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | n (%) | Variable | n (%) |
---|---|---|---|
Age (mean) | 71.38 (8.05) | Hearing aid usage | |
60–74 years | 194 (64.7%) | 6–12 months | 90 (30%) |
74–85 years | 81 (27%) | 12–18 months | 75 (25%) |
+85 years | 25 (8.3%) | ˃18 months | 135 (45%) |
Gender | Hearing aid fitting | ||
Female | 152 (50.7%) | Monaural | 98 (32.7%) |
Male | 148 (49.3%) | Binaural | 202 (67.3%) |
Education status | Degree of hearing impairment (BEA) | ||
Illiterate | 45 (15%) | ˂26 dB HL | 12 (4%) |
Primary | 66 (22%) | 26–40 dB HL | 60 (20%) |
Secondary | 65 (21.7%) | 41–55 dB HL | 97 (32.3%) |
Diploma | 77 (25.7%) | 56–70 dB HL | 104 (34.7%) |
Higher education | 47 (15.6%) | ≥71 dB HL | 27 (9%) |
Marital status | Hearing aid style | ||
Married | 211 (70.3%) | ||
Widow/single | 71 (23.7%) | Behind the ear (BTE) | 203 (67.7%) |
Divorced | 18 (6%) | In the ear (ITE) | 97 (32.3%) |
Employment status | Hearing aid type | ||
Employed | 57 (19%) | ||
Retired | 99 (33%) | Digital | 243 (81%) |
Unemployed | 59 (19.7%) | Programmable | 37 (12.3%) |
Housewife | 85 (28.3%) | Analog | 20 (6.7%) |
Variable | Actual Use | df | CI to Use HA | ||
---|---|---|---|---|---|
Mean Square | Value | Mean Square | Value | ||
Age | r = −0.16 *** | r = 0.07 * | |||
Gender | t = 1.36 * | t = 1.53 * | |||
Education status | 51.28 | F = 12.29 *** | 4 | 16.89 | F = 2.002 * |
Marital status | 18.67 | F = 2.96 * | 2 | 13.87 | F = 1.63 * |
Employment status | 20.08 | F = 4.32 *** | 3 | 7.13 | F = 0.83 |
Degree of hearing impairment (BEA) | 1.70 | F = 0.35 | 4 | 1.13 | F = 0.13 |
Hearing aid fitting | t = 0.24 | t = 1.22 | |||
Style of hearing aid | t = −1.16 | t = −0.08 | |||
Types of hearing aids | 32.72 | F = 7.09 *** | 2 | 56.41 | F = 6.87 *** |
Hearing aid use | 0.52 | F = 0.1 | 2 | 13.04 | F = 1.53 |
Variable | Mean (SD) | Possible Range | CI to Use HA | Actual Use HA | Sa | P-B |
---|---|---|---|---|---|---|
1. CI to use HA | 10.14 (2.91) | 3–15 | 1 | |||
2. Actual use HA | 6.12 (2.19) | 2–10 | 0.67 ** | 1 | ||
5. SP hearing handicap | 17.31 (9.13) | 0–40 | 0.34 ** | 0.41 ** | ||
6. HA self-efficacy | 64.58 (16.10) | 0–100 | 0.30 ** | 0.47 ** | ||
7. P social support | 45.59 (9.36) | 12–60 | 0.40 ** | 0.41 ** | ||
3. Satisfaction | 65.41 (14.78) | 15–105 | 0.50 ** | 0.62 ** | 1 | |
4. Perceived benefit | 71.87 (14.40) | 1–99 | 0.49 ** | 0.65 ** | 0.56 ** | 1 |
8. Extraversion Pt | 7.83 (2.71) | 2–14 | 0.37 ** | 0.48 ** | 0.39 ** | 0.50 ** |
9. Confirmation | 11.67 (2.33) | 3–15 | 0.59 ** | 0.60 ** | 0.46 ** | 0.47 ** |
Model | F | Sig | R2 | R2adj | SE | Durbin–Watson |
---|---|---|---|---|---|---|
CI to use HA | 22.91 | 0.001 | 0.60 | 0.57 | 1.91 | 1.93 |
Actual use HA | 63.43 | 0.001 | 0.69 | 0.67 | 1.25 | 2.10 |
Indicators | Cut Point | Results | Conclusion |
---|---|---|---|
CMIN/DF | ≤4 | 2.52 | good fit |
RMSEA | ≤0.08 | 0.07 | good fit |
GFI | ≥0.90 | 0.87 | Not fit |
CFI | ≥0.90 | 0.92 | good fit |
TLI | ≥0.90 | 0.90 | good fit |
IFI | ≥0.90 | 0.92 | good fit |
RFI | ≥0.60 | 0.84 | good fit |
PNFI | ≥0.60 | 0.72 | good fit |
PCFI | ≥0.60 | 0.76 | good fit |
AGFI | ≥0.90 | 0.82 | Not fit |
Path | Total | Direct | Indirect | SE | CR | Sig | Support |
---|---|---|---|---|---|---|---|
Confirmation → Perceived Benefit | 0.35 | 0.35 | 0 | 7.35 | 5.34 | 0.001 | yes |
Confirmation → Satisfaction | 0.41 | 0.29 | 0.12 | 0.22 | 4.23 | 0.002 | yes |
Perceived Benefit → Satisfaction | 0.35 | 0.35 | 0 | 0.003 | 4.02 | 0.001 | yes |
Perceived Benefit → Actual Use | 0.40 | 0.30 | 0.10 | 0.004 | 3.96 | 0.001 | yes |
Perceived Benefit → Actual Use | 0.28 | 0.28 | 0 | 0.03 | 3.54 | 0.001 | yes |
HA Self-efficacy → Perceived Benefit | 0.24 | 0.24 | 0 | 0.02 | 4.31 | 0.001 | yes |
HA Self-efficacy → Satisfaction | 0.41 | 0.32 | 0.09 | 0.001 | 4.61 | 0.001 | yes |
HA Self-efficacy → Actual Use | 0.26 | 0.08 | 0.19 | 0.001 | 1.67 | 0.09 | no |
Extraversion Pt → Actual Use | 0.41 | 0.20 | 0.21 | 0.06 | 2.69 | 0.007 | yes |
Extraversion Pt → Perceived Benefit | 0.46 | 0.46 | 0 | 5.51 | 5.96 | 0.001 | yes |
Extraversion Pt → Satisfaction | 0.26 | 0.10 | 0.16 | 0.16 | 2.24 | 0.04 | yes |
P Social Support → Actual Use | 0.14 | 0.14 | 0 | 0.01 | 3.19 | 0.001 | yes |
SP Hearing Handicap → Actual Use | 0.24 | 0.24 | 0 | 0.01 | 4.97 | 0.001 | yes |
Actual Use → Continuance Intention | 0.81 | 0.81 | 0 | 0.05 | 10.94 | 0.001 | yes |
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Jorbonyan, A.; Abolfathi Momtaz, Y.; Foroughan, M.; Mehrkian, S. Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran). Healthcare 2024, 12, 487. https://doi.org/10.3390/healthcare12040487
Jorbonyan A, Abolfathi Momtaz Y, Foroughan M, Mehrkian S. Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran). Healthcare. 2024; 12(4):487. https://doi.org/10.3390/healthcare12040487
Chicago/Turabian StyleJorbonyan, Abdolhakim, Yadollah Abolfathi Momtaz, Mahshid Foroughan, and Saeideh Mehrkian. 2024. "Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran)" Healthcare 12, no. 4: 487. https://doi.org/10.3390/healthcare12040487
APA StyleJorbonyan, A., Abolfathi Momtaz, Y., Foroughan, M., & Mehrkian, S. (2024). Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran). Healthcare, 12(4), 487. https://doi.org/10.3390/healthcare12040487