title: Factors involved in access and utilization of adult hearing healthcare: A systematic review.
abstract: Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare.
  
  
  
  Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015.
  
  
  
  Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study.
  
  
  
  Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process.
  
  
  
  Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017.
authors.affiliation: Division of Audiology and Communication Disorders, Department of Otolaryngology-Head and Neck Surgery, University of Louisville College of Medicine, Louisville, Kentucky, U.S.A.
authors.forename: Margaret
authors.initials: M
authors.lastname: Barnett
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Brian
authors.initials: B
authors.lastname: Hixon
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya.
authors.forename: Neville
authors.initials: N
authors.lastname: Okwiri
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya.
authors.forename: Catherine
authors.initials: C
authors.lastname: Irungu
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Ayugi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Robin
authors.initials: R
authors.lastname: Thompson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
mesh_terms: D000328:Adult; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D034381:Hearing Loss / Q000534:rehabilitation*; D006801:Humans
keywords: Hearing healthcare; access to care; systematic review