The decision to tell or not to tell is associated with experiences of stigma and hearing aid use among adults with hearing loss.

Objectives: To explore the extent to which an international sample of adults with hearing loss experience and respond to stigma-induced identity threat; and the associations between experiences of hearing loss stigma, responses to hearing loss stigma (concealment of hearing loss), and hearing aid use.

Design: Cross-sectional online survey comprising published questionnaires and multiple response questions designed to capture five of seven constructs of the Major and O'Brien model of stigma-induced identity threat. Multivariate modelling examined factors associated with hearing aid use and concealment of hearing loss.

Study sample: 331 adults (50+ years) with self-reported hearing loss, living in Australia, United Kingdom, or United States, participated.

Results: Individuals with hearing loss associated hearing loss and hearing aids with negative stereotypes associated with ageing and disability; although, perceptions of modern hearing aids were positive overall. About 25% of participants did not disclose their hearing loss to anyone or in any situation; and hearing loss disclosure, in addition to attitudes towards hearing aids, stereotypical beliefs, and personal characteristics were associated with hearing aid use in multivariate modelling.

Conclusions: One way in which we may be able to increase use of hearing aids is by explicitly asking about and addressing individuals' experiences of hearing loss stigma.