This study examined the social representation of hearing loss and hearing aids in
people with hearing loss (PHL) in India, Republic of Korea, United Kingdom and the
United States using Social Representation Theory. The study helps to understand
collective view of PHL about hearing loss and hearing aids. The results will aid to
develop culutrally appropriate public education campaigns, marketing material and
appropriate rehabilitation for PHL with the aim to reduce delay in seeking help and
improve hearing aid adoption.
Background and Objective: Despite the negative consequences of hearing loss,
people with hearing loss (PHL) wait about 10 years before seeking professional help
and adopt hearing aid. Much of the knowledge in hearing help-seeking and hearing
aid adoption have used attitude theories and stigma theory. However, the strategies
developed based on these theories have not resulted in any substantial improvements
to help-seeking behavior. Thus, it is essential to consider alternative theories (e.g.,
Theory of Social Representations) which have been successfully used in disability
research to better understand how PHL perceives hearing loss and hearing aids to
improve help seeking ad hearing aid adoption. The aim of the current study was to
examine the social representation of hearing loss and hearing aids in PHL in India,
Republic of Korea (ROK), United Kingdom (UK), and the United States (US). Social
representation refers to values, practices, customs, ideas, and beliefs that are shared
between individuals in a society or group.
Design: The study used a cross-sectional survey design. 424 participants were
recruited using a consecutive sampling method in four countries (India, ROK, UK and
US). Data was collected using a free association task self-reported questionnaire and
analyzed using qualitative (i.e., content analysis) and quantitative (similarities analysis,
prototypical analysis, and Chi-square analysis) techniques.
Results: The free associations of the PHL relating to hearing loss were grouped into
37 categories. The most commonly reported categories were ‘communication
difficulties,’ ‘negative mental state,’ ‘ageing,’ ‘assessment and management,’ ‘causes
of hearing loss,’ ‘hearing ability or disability,’ ‘hearing instruments,’ and ‘symptoms of
hearing loss.’ Similarities analysis and prototypical analysis highlighted two main
negative categories ‘negative mental state’ and ‘communication difficulties’ which form
the central elements of social representation of hearing loss. PHL associated hearing
loss mainly as a negative phenomenon but with some positive and neutral aspects.
ROK respondents reported a greater number of neutral associations compared to
In terms of the hearing aids, the free associations were grouped into 45 categories.
The frequently reported categories across all countries were ‘beneficial,’ ‘cost and
time’ and ‘appearance and design.’ Approximately 50% of the associations reported
were negative. There were variations in terms of the categories that were predominant
in the social representation of each country. ‘Others' actions and attitude’ category
was predominantly reported by PHL in India. ‘Disturbance’ and ‘dissatisfaction’ of
hearing aids and the ‘repairs and maintenance of hearing aids’ categories were mainly
reported from the ROK and the US, respectively.
Overall, there were cross cultural similarities and differences in PHL’s social
representation of hearing loss and hearing aids, although more similarities than
differences were noted.
Conclusions: The study provides an insight into how PHL collectively view hearing
loss and hearing aids. We believe that these findings will help to develop our
understanding of the influence of culture on the social representation of hearing loss
and hearing aids. The results will aid the development of culturally appropriate public
education campaigns, marketing material and appropriate rehabilitation for PHL with
the aim to improve help-seeking and hearing aid adoption.