Supplementary Material for: The hearing aid effect across diverse African populations and various hearing device modalities

Introduction: The stigma associated with wearing hearing aids, known as the "hearing aid effect," remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting. Objective: To determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely area of residence and level of education across African communities. Method: The study used a cross-sectional design with 322 participants (161 rural, 161 urban); mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices [standard behind-the-ear hearing aid (BTE HA) with an earmould, mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, Airpod, receiver-in-canal (RIC), completely-in-canal (CIC) HA, and Personal Sound Amplification Product (PSAP)] worn by a peer model using a validated scale of eight attributes (attractiveness , age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with earmould were used as a benchmark for comparison. Results: No hearing aid effect was observed across all participants (n=322) with device ratings ranging between neutral and positive. Significant differences between device ratings were evident for attractiveness for ST and PSAP and trustworthiness for ITC. In terms of residence, urban participants provided more favorable ratings compared to rural participants, with significant differences across three attribute ratings: hardworking for ST; attractiveness, hardworking for ITC; age for RIC and Airpod and hardworking for PSAP. For level of education, significant differences were found for attributes of attractiveness (H = 13.5; p = 0.001) for ITC; attractiveness (H = 14.7, p = 0.001) for PSAP; age (H = 9.5; p = 0.009) for RIC; age (H = 14.3; p<0.001) and intelligence (H = 15.1; p< 0.001) for Airpod and; hardworking (H =11.9, p = 0.003) for ST. Conclusion: Overall, participants had a neutral to positive view of hearing devices with preferences for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices.

引言：与佩戴助听器相关的污名化现象，即所谓的“助听器效应（hearing aid effect）”，仍是听力保健领域的突出问题。尽管过去十年间助听器的外观与佩戴体验已发生显著改进，但在社会经济背景多元的环境中，关于社会经济因素对不同听力设备认知的影响，目前仍知之甚少。
研究目的：明确多种听力设备的助听器效应，及其与非洲社区内的社会经济因素——即居住区域与受教育水平——的关联。
研究方法：本研究采用横断面研究设计，共纳入322名受试者（农村、城市各161名），平均年龄31.9岁（标准差14.7）。受试者参照经过验证的8项属性量表，对一名同龄模特佩戴的7种不同款式设备的照片进行评分，7种设备分别为：带耳模的标准耳背式助听器（standard behind-the-ear hearing aid, BTE HA）、细管型迷你耳背式助听器（mini BTE HA with a slim tube, ST）、耳道内式助听器（in-the-canal, ITC HA）、Airpod、耳道接收器式助听器（receiver-in-canal, RIC）、全耳道内式助听器（completely-in-canal, CIC HA）以及个人声音放大产品（Personal Sound Amplification Product, PSAP）。8项评分属性包括：吸引力、年龄、成功度、勤奋度、可信度、智力水平、友善度与受教育程度。本研究以带耳模的BTE HA的评分作为参照基准进行对比。
研究结果：所有受试者（n=322）均未表现出明显的助听器效应，各类设备的评分介于中性至正向之间。不同设备的评分存在显著统计学差异：细管型迷你BTE HA（ST）与个人声音放大产品（PSAP）的吸引力评分、耳道内式助听器（ITC HA）的可信度评分均存在显著差异。按居住区域分层分析显示，城市受试者的评分较农村受试者更为积极，且在3项属性评分中存在显著差异：ST的勤奋度评分、ITC HA的吸引力与勤奋度评分、RIC与Airpod的年龄评分，以及PSAP的勤奋度评分。按受教育水平分层分析则显示，ITC HA的吸引力评分（H = 13.5; p = 0.001）、PSAP的吸引力评分（H = 14.7, p = 0.001）、RIC的年龄评分（H = 9.5; p = 0.009）、Airpod的年龄评分（H = 14.3; p<0.001）与智力水平评分（H = 15.1; p< 0.001），以及ST的勤奋度评分（H =11.9, p = 0.003）均存在显著统计学差异。
研究结论：总体而言，受试者对各类听力设备的态度介于中性至正向，且更偏好隐蔽性更强、造型更常规的设备。社会经济变量如受教育程度与地理位置会影响人们对听力设备的认知，这提示在选配听力设备时，需将上述因素纳入考量范畴。