J Am Acad Audiol 2019; 30(04): 250-263
DOI: 10.3766/jaaa.15087
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Enhancing Screening Systems to Facilitate Hearing-Healthcare Access: A Qualitative Study

Kathleen F. Carlson
*   National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
†   Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
‡   Oregon Health and Science University, Portland, OR
Sara Sell
*   National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
Jay Vachhani
*   National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
Robert L. Folmer
*   National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
‡   Oregon Health and Science University, Portland, OR
Gabrielle Saunders
*   National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
‡   Oregon Health and Science University, Portland, OR
M. Patrick Feeney
*   National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
‡   Oregon Health and Science University, Portland, OR
› Author Affiliations
Further Information

Publication History

Publication Date:
26 May 2020 (online)



Although hearing loss is a common health issue, hearing healthcare (HHC) is poorly accessed. Screening to identify hearing loss is an important part of HHC access, specifically for those who screen positive for hearing loss and would benefit from seeing a HHC provider. New technologies can be automated to provide information and recommendations that are tailored to the needs of individual users, potentially enhancing rates of HHC access after positive screens. A greater understanding of the facilitators of postscreening HHC access that could be leveraged in such systems is needed.


The purpose of this project was to identify facilitators of postscreening HHC access that can be used in automated screening systems.

Research Design:

This qualitative study used focus groups (FGs) to understand perceived barriers, perceived benefits, and potential cues to action, as informed by the Health Belief Model, for accessing HHC after use of automated hearing screening systems.

Study Sample:

Fifty individuals participated in one of seven FGs. FGs were conducted separately with three types of stakeholders: four FGs included adults who reported some degree of perceived hearing loss and had recently completed a hearing screening; two FGs included adults who had recently sought HHC for the first time because of hearing loss; and one FG involved significant others/family members of individuals with hearing loss.

Data Collection and Analysis:

FGs were 60–90 minutes in length and were led by a trained facilitator following a discussion guide. A research audiologist was present at each FG and served as a notetaker. FGs were recorded and transcribed by research team members, and transcripts were then coded in an iterative process by multiple team members. Qualitative content analysis was used to reduce data and to identify salient themes and subthemes, following an inductive approach. We focused on identifying themes that were related to facilitators of HHC access after positive screens for hearing loss and, separately, potential enhancements to automated hearing screening systems that would leverage these facilitators to improve HHC access.


We identified five key themes related to HHC access after a positive screen for hearing loss, along with ideas for enhancing automated hearing screening systems based on these themes. The themes included knowledge, trust, access, quality of life, and interpersonal influence.


The results of our work help inform the development of innovative hearing screening systems that can be automated to leverage individual facilitators of HHC access.


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