Does educational level predict hearing aid self-efficacy in experienced older adult hearing aid users from Latin America? Validation process of the Spanish version of the MARS-HA questionnaire

Hearing aids are the most common rehabilitation strategy for age-related hearing loss. However, 25% to 50% of older adults fitted with hearing aids do not wear them post-fitting. Hearing aid self-efficacy has been suggested as one of the key factors that may explain adherence to hearing aids in older adults. The primary aim of this study was to determine a possible association between educational level and hearing aid self-efficacy in older adult hearing aid users from a Latin American country (i.e., Chile). The secondary aim was to determine if in this sample of older adults, hearing aid self-efficacy predicted hearing aid adherence as previously suggested by other studies. The MARS-HA (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids) questionnaire was used to measure hearing aid self-efficacy. This questionnaire was initially adapted into Spanish (S-MARS-HA) using forward and backward translations by bilingual English-Spanish speakers. A sample of 252 older adults fitted with hearing aids at a public hospital in Santiago, Chile, was investigated. Educational level was measured as the number of years of formal education. Participants responded to the S-MARS-HA along with questions exploring social support, attitudes in using hearing aids, participation in social events, and vision and joint problems. Hearing aid adherence was investigated with the use of a question from the International Outcome Inventory for Hearing Aids. All these procedures were conducted at the participants’ homes. Pure-tone average (PTA; 500–4000 Hz) in the fitted ear was obtained from the participants’ medical records. Univariate and multivariate regression models were constructed to investigate the association between educational level and hearing aid self-efficacy controlling for the covariates of interest (e.g., social support, attitudes in using hearing aids, PTA). The S-MARS-HA showed an adequate construct validity along with a good reliability. Results of the multivariate regression analyses showed that educational level significantly predicted hearing aid self-efficacy. Covariates significantly associated with this outcome included attitudes in using hearing aids and PTA in the fitted ear. Finally, a significant association between hearing aid self-efficacy and adherence to hearing aid use was observed. In conclusion, this study showed a significant association between educational level and hearing aid self-efficacy in older adults from a developing Latin American country. Thus, this variable should be considered when designing and delivering aural rehabilitation programs such as hearing aids to older adults, especially those from developing countries.助听器是年龄相关性听力损失（age-related hearing loss）最常用的康复干预手段。然而，适配助听器的老年群体中，有25%至50%的人在适配后并未佩戴助听器。助听器自我效能感被认为是解释老年群体助听器佩戴依从性的关键因素之一。本研究的首要目标是探究某拉美国家（即智利）老年助听器使用者的受教育水平与助听器自我效能感之间的潜在关联。次要目标则是验证在本次老年受试者样本中，助听器自我效能感是否如此前其他研究所提出的那样，能够预测助听器佩戴依从性。本研究采用MARS-HA（助听器听力学康复自我效能量表，Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids）问卷评估助听器自我效能感。该问卷最初由英西双语使用者通过正向与反向翻译流程适配为西班牙语版本（S-MARS-HA）。研究共纳入智利圣地亚哥某公立医院收治的252名老年助听器适配者作为受试对象。受教育水平以受正规教育的年限进行量化。受试者需填写S-MARS-HA问卷，并完成关于社会支持、助听器使用态度、社交活动参与度以及视力与关节问题相关问题的调查。助听器佩戴依从性则通过国际助听器结局问卷（International Outcome Inventory for Hearing Aids）中的相关问题进行评估。所有调研流程均在受试者家中完成。受试耳的纯音平均值（Pure-tone average, PTA；500–4000 Hz）取自受试者的医疗记录。研究构建了单因素与多因素回归模型，在控制感兴趣的协变量（如社会支持、助听器使用态度、受试耳纯音平均值）的前提下，探究受教育水平与助听器自我效能感之间的关联。S-MARS-HA量表展现出良好的结构效度与信度。多因素回归分析结果显示，受教育水平可显著预测助听器自我效能感。与该结果显著相关的协变量包括助听器使用态度与受试耳纯音平均值。最终，本研究观察到助听器自我效能感与助听器佩戴依从性之间存在显著关联。综上，本研究证实了某拉美发展中国家老年群体的受教育水平与助听器自我效能感之间存在显著关联。因此，在为老年群体设计并实施听觉康复项目（如助听器适配服务）时，应将该变量纳入考量，尤其针对来自发展中国家的老年群体。