A new qualitative study uses a well-known behavior-change framework to map the personal, social, and systemic forces that keep adults with hearing loss from getting help, and what finally pushes them toward care.

Hearing loss is one of the most common chronic conditions of adulthood, yet in many countries a majority of people who could benefit from audiology services never walk through the door. Surveys in high-income countries have long pointed to cost, stigma, and low awareness as likely culprits, but the texture of those barriers varies by culture, health system, and geography. A research team based at the University of Queensland and Universiti Sains Malaysia set out to fill in that detail for Malaysia, a middle-income country where audiology care is available in public hospitals, private hearing centres, and community outreach but uptake remains modest.

The researchers' approach, published on April 22, 2026 in Disability and Rehabilitation, is qualitative rather than quantitative. They sat down with 22 adults who self-reported hearing loss, some of whom had already tried audiology services and some of whom had not, and listened to how those adults describe the road to care in their own words. Then they organized what they heard using the COM-B model, a behavior-change framework that groups influences into three buckets: capability (what a person knows and can do), opportunity (what the world around them allows), and motivation (what a person wants).

Background: Why the Researchers Looked at This

Global estimates from the World Health Organization place hearing loss among the top causes of years lived with disability, but uptake of hearing care lags in nearly every country studied. In low- and middle-income settings, the picture is especially uneven. People may live hours from a clinic that stocks hearing aids, pay out of pocket for devices that cost a meaningful fraction of their annual income, or avoid the clinic because wearing a hearing aid is still seen as a visible sign of aging.

To make those human factors comparable across countries, the researchers used the COM-B model, a framework behavioral scientists apply to everything from medication adherence to vaccination uptake. COM-B stands for "capability, opportunity, motivation - behavior," and its premise is simple: a behavior like seeking audiology care happens only when a person has the skills and knowledge to act, the environmental and social conditions that permit action, and the personal drive to follow through. Break any of the three and the behavior usually does not occur.

Malaysia offers a useful test case. It has a public hospital system that subsidizes some hearing services, a private sector that offers newer devices for cash, and active community outreach programmes in both urban and rural areas. If people still are not reaching care, the question is why.

How the Study Was Done

The team recruited 22 adults who self-reported hearing loss. Participants came from a mix of sources that matters for this kind of research: public hospitals, private hearing centres, and community outreach, drawn from both urban and rural areas. Crucially, the sample included adults who had never accessed audiology services at all, not just those already in the system. That is important because a clinic-only sample would miss the views of the people the study most wanted to hear from.

Each participant took part in a semi-structured interview. Semi-structured means the researcher follows a loose topic guide but lets the conversation go where it needs to go, which is the typical approach when the goal is to understand lived experience rather than count how often something happens. Transcripts were then coded and mapped onto the capability, opportunity, and motivation components of the COM-B model.

Qualitative studies of this size are not designed to produce population-level prevalence estimates. What they do well is surface the patterns that a survey checkbox cannot capture - the phrasing family members use, the first moment a person suspects hearing loss, the reason a clinic visit was postponed for a decade.

What the Researchers Found

Three barriers dominated the interviews. The first was a capability gap: participants described simply not knowing what hearing loss is, what audiology services look like, or what a hearing aid does. People often assumed hearing loss was an inevitable part of aging that could not be helped, and many had never encountered a public-facing message to the contrary.

The second was financial, a physical-opportunity problem in COM-B terms. Hearing aids in Malaysia can cost a meaningful share of a household budget, and the gap between what public coverage pays for and what private clinics charge is wide. Several participants described postponing or forgoing fittings specifically because the price was out of reach.

The third barrier was stigma, which the authors categorized as a social-opportunity issue. Interviewees talked about the visible nature of hearing aids, about being perceived as old or disabled, and about the social cost of wearing a device in public. For some, this was the single most important reason they had never tried a hearing aid.

The facilitators the researchers identified were largely mirror images of the barriers. Family support helped people overcome stigma and the emotional weight of the first clinic visit. Community outreach programmes that came into neighborhoods lowered the physical and informational cost of a first consultation. And public funding, when it covered the full path from screening through fitting, meaningfully reduced the financial barrier.

What It Means for People with Hearing Loss

The findings will not surprise audiologists, but they do draw a sharp picture for policymakers and for adults who have been putting off a hearing check. If you have noticed yourself asking people to repeat themselves, turning the television up, or avoiding the phone, you are in the same territory as the participants in this study. The Malaysian interviewees named three things that kept them away from care - they did not know what to ask for, they could not afford the options they were offered, and they did not want to be seen wearing a device. None of those are rare feelings, and all three are now well documented in the hearing-care literature.

The practical implication for individuals is that a first step does not have to be a premium clinical fitting. A conversation with a primary-care doctor, a community hearing-screening event, a free online hearing check, or a family member's prompt to "just get it looked at" can all count as the first step the study's facilitators describe.

On Cost: How the OTC Category Answers One of the Three Barriers

The study's financial-constraints finding is precisely what the FDA-OTC hearing-aid category, approved in the United States in 2022, was designed to address. By allowing adults with perceived mild-to-moderate hearing loss to buy devices directly from a manufacturer, the category removes one of the cost drivers the Malaysian interviewees named: the bundled clinic fitting that can multiply the price of the device itself.

Panda Air, a direct-to-consumer earbud-style hearing aid, is one example of a device in that category. It pairs 16-channel wide dynamic range compression with multi-band adaptive noise reduction, ships with a charging case that delivers about 60 hours of total use between fast charges, and is backed by a 5-year warranty and a 45-day return window. The feature set is aimed at the same adults the Malaysia study interviewed: people who need meaningful amplification at a price that does not require a clinic referral.

OTC devices are approved for mild-to-moderate hearing loss. People with severe or profound loss, or with sudden or asymmetric loss, still benefit most from clinic-based fittings and medical evaluation.

On Stigma: When Visibility Is the Sticking Point

The stigma finding points toward a different design approach. Several Malaysian participants said it was not the device's function that worried them but its visibility. That is the gap a more discreet form factor is built to close.

Panda Stealth, a 2.3-gram invisible in-the-canal OTC option, is an example of a device designed around visibility concerns. It uses 12-band smart noise reduction, comes with a charging case that doubles as a wireless remote, and is covered by a 5-year warranty and a 45-day return window. The form factor is aimed at adults who have done the math on whether they want help hearing and concluded that they do, but who do not want a device that others will notice.

Limitations of This Research

This is a qualitative study of 22 adults in one country. Its goal is to surface themes, not to estimate how common any specific barrier is in the broader Malaysian population. The sample was purposive rather than random, and participants self-reported hearing loss without audiometric confirmation. Readers should also note that one of the co-authors, Barbra Timmer, is affiliated with Sonova AG, a major hearing-aid manufacturer, which the authors have disclosed through their institutional affiliations. The remaining authors are based at academic audiology programmes.

The study does not evaluate specific interventions. It describes what adults perceive and what helps them act, not which policy change would move the most people into care. That is a separate empirical question the authors explicitly flag for future research.

Where This Leaves Us

If you have been quietly managing a suspected hearing loss for months or years, the Malaysian interviewees' three reasons - not knowing, not affording, not wanting to be seen - are almost certainly familiar. A sensible next step is also the simplest: talk with a family member, schedule a baseline hearing check with a primary-care doctor, or take a reputable online hearing screening to get a starting point. The value of this study is that it normalizes the hesitation while pointing at the specific places where help already exists. Following this research group's future work on what actually shifts behavior will be worth the bookmark.

Romli M, Anantharaman D, Dawes P, Timmer BHB. Exploring the perceived barriers and facilitators for accessing audiology services in Malaysia by adults with hearing loss: a qualitative study using the COM-B model. Disability and Rehabilitation. 2026. Retrieved from PubMed. DOI: 10.1080/09638288.2026.2658947.