Perceptions of Over-the-Counter Hearing Aids: A Qualitative Study Informed by the Technology Acceptance Model.

Background: Hearing loss is prevalent among older adults, yet hearing aid uptake remains low. The recent introduction of over-the-counter (OTC) hearing aids by the U.S. Food and Drug Administration aims to improve accessibility by removing the requirement for professional involvement. However, the usability and perceived value of these devices by consumers remain insufficiently understood. Purpose: This study aimed to explore adults' perceptions of OTC hearing aids following direct and structured use and identify factors that influence perceived ease of use, usefulness, and usability-related barriers as framed by the technology acceptance model. Research Design: A qualitative descriptive design that incorporated semi-structured interviews conducted immediately after a hands-on device use task was completed. Study Sample: Seventy-eight adults 55 years of age and older with self-identified mild to moderate hearing loss were recruited through community outreach. Eligibility was based on age and self-reported hearing status. Intervention: Participants used commercially available OTC hearing aids to complete a standardized 10-step device management task prior to being interviewed. Data Collection and Analysis: Data were collected through audio-recorded, semi-structured interviews conducted immediately after the device use task. Transcripts were analyzed thematically using a hybrid inductive-deductive approach informed by the technology acceptance model. Results: The following six major themes emerged: setup and operational barriers; support preferences; usability expectations and confidence; perceived device performance; shifts in knowledge and understanding; and user-centered design suggestions. Participants frequently reported difficulties with device setup and handling, uncertainty about performance, and a desire for support. User expectations, confidence, and information gaps significantly influenced their intention to use OTC devices. Conclusions: Although OTC hearing aids offer greater accessibility, successful adoption requires more than cost reduction. Users' perceived support needs, self-efficacy, and alignment between expectations and device performance play a critical role. Facilitating confident use through improved instructions and accessible support may enhance uptake. These findings emphasize the role of expectation-outcome alignment (i.e., disconfirmation) in shaping satisfaction. Clinical Relevance: Clinicians should anticipate increased patient interest in OTC hearing aids, and they should be prepared to address usability concerns. Supporting patient education and expectation management may improve satisfaction and long-term outcomes outside traditional service delivery models.