Consistent hearing aid use in babies (CHerUB): a systematic review and mixed methods synthesis of barriers and facilitators using the theoretical domains framework.

Abstract

Consistent hearing aid use protects against spoken language delays in 0-3-year-olds with hearing loss; however, use is at its lowest and most variable during this critical period for language development. The few intervention efforts to increase infant hearing aid use demonstrate limited effectiveness and lack a theoretically driven understanding of the factors influencing use, potentially inhibiting progress in increasing infant hearing aid use. We aimed to address this gap in understanding by conducting a systematic review and mixed methods synthesis of research reporting parent- and professional-reported barriers and facilitators to hearing aid use in 0-3-year-olds, using framework analysis guided by the Theoretical Domains Framework (TDF). Twenty-seven studies were included, which reported 203 unique barriers and 196 unique facilitators, representing all 14 TDF domains. The most prevalent domains identified were environmental context and resources, knowledge, skills, social influences, and emotion. The determinants of hearing aid use in children aged 0-3 years therefore appear to extend beyond the narrow subset targeted by current interventions (e.g., predominantly knowledge and skills). Interventions would benefit from: (i) targeting a wider range of determinants than existing interventions address; and (ii) applying a theoretically informed framework to guide intervention design.