Preferences for Hearing Aid Attributes Among People with Moderate or Greater Hearing Loss in Rural China: A Discrete Choice Experiment

Dawei Zhu,1 Xuefeng Shi,2,3 Stephen Nicholas,4– 7 Xin Ye,1,8 Siyuan Chen,1,8 Ping He1 1China Center for Health Development Studies, Peking University, Beijing 100191, People’s Republic of China; 2School of Management, Beijing University of Chinese Medicine, Beijing 100029, People’s Republic of China; 3National Institute of Chinese Medicine Development and Strategy, University of Chinese Medicine, Beijing 100029, People’s Republic of China; 4School of Economics and School of Management, Tianjin Normal University, Tianjin 300074, People’s Republic of China; 5Australian National Institute of Management and Commerce, Sydney, NSW 2015, Australia; 6Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou 510420, People’s Republic of China; 7Newcastle Business School, University of Newcastle, Newcastle, NSW 2308, Australia; 8School of Public Health, Peking University, Beijing 100191, People’s Republic of ChinaCorrespondence: Ping HeChina Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, People’s Republic of ChinaTel/Fax +861082805709Email phe@pku.edu.cnPurpose: Hearing loss has not received sufficient attention, especially in low- and middle-income countries where more than 80% of the people with hearing loss reside. Little is known about the preference for hearing aids among people with hearing loss in developing countries. The aim of this study is to elicit the preferences for hearing aid attributes among rural Chinese adults with moderate or greater hearing loss and examine how preferences vary across different individual socioeconomic characteristics.Patients and Methods: We interviewed 125 adults in two rural counties in Shandong province in China. A discrete choice experiment (DCE) with eight attributes, comprising out-of-pocket (OOP) costs, hearing aid style, effective in quiet settings and noisy settings, feedback (whistling), connectivity, water/sweat resistance and battery life, were employed to examine participants’ preference for hearing aids. Mixed logit models were used for the statistical analyses.Results: While OOP costs, effectiveness in quiet settings, water/sweat resistance and battery life were significantly associated with choosing a hearing aid, rural Chinese adults with moderate or greater hearing loss valued effectiveness in noisy settings above other attributes of hearing aids, followed closely by lack of feedback. The preference of the attributes of OOP costs, in the canal hearing aids, effectiveness in noisy settings, connectivity and battery life varied across individual socioeconomic characteristics including sex, marriage, employment, income and education level.Conclusion: Our study supported the view that the development of noise suppression and feedback cancellation systems remained the main challenge for the hearing aid industry. Since OOP costs were also associated with choosing a hearing aid, the policy advice is to improve reimbursements from insurance schemes and/or reduce the costs of hearing aids.Keywords: hearing aids, discrete choice experiment, hearing loss, rural China