Narrative Identities of Adult Hearing Aid Users

iStock/Lazy_Bear, hearing loss, health care, mental health.Human beings are constantly telling stories about their experiences and the world around them. Whether it's recapping their latest TV binge with a colleague or sharing a recent surprise encounter at a coffee shop with a friend, people construct and share stories about their experiences and the details of their lives.1 Over time these stories are internalized and evolve into one's life story. In the field of psychology, this is called narrative identity.2 One way that audiologists can better understand patients and improve the quality of their hearing health care services is by discovering and understanding the patients’ identities.3-5 In our recent qualitative study,6 we uncovered the identities that adults with hearing loss (HL) construct when telling stories about their experiences with HL and hearing aids (HAs). Our goal was to describe the nuances of these identities in a way that can ultimately help audiologists better understand their patients, improve their provision of person-centered hearing health care,6 and ensure better overall health for more adults with HL via consistent adherence to an HA treatment plan.7,8 STUDY HIGHLIGHTS In our study, 30 adults diagnosed with HL who reported using their HAs during all waking hours shared stories about their experiences surrounding their HL and HAs. We gathered the narratives via a guide based on narrative and semi-structured interviewing principles,9,10 then used thematic narrative analysis11 to categorize and understand the HA users’ identities. Our analysis revealed five narrative identities that emerged from the participants’ stories: (1) the satisfied user, (2) the overcomer, (3) the dispassionate user, (4) the resigned user, and (5) the griever. The satisfied user identity emerged from narratives in which the individual seemed to easily accept their HL and adapt to their HAs. They perceived their HAs to be beneficial and worthwhile. For example, one user named Jasper described his experience as: “I was shocked [LAUGHTER] when I left the [audiologist's] office! Woah! The high frequencies are coming in big—and I'm a commuter cyclist, so I'm on my bike quite a bit. All of a sudden, I'm hearing cars and the buzz. You know, the grinding on the street… I was really shocked at how much I'd missed and was missing.” The overcomer narrative identity was revealed in stories that underscored the obstacles individuals faced throughout their journeys. Nonetheless, these HA users were able to overcome their hardships and construct a new normal for their lives.12 This finding echoes existing research that documented people's ability to tell stories where they were able to overcome their challenges and thrive13,14—a type of resilience often linked to better health outcomes.15,16 One such user Bill shared: “…I really realized I had a deficiency in hearing because [SIGH] my communication with potential customers was… I started writing down incorrect phone numbers and incorrect addresses. I guess that's when I really realized that I had a problem. I started leaving them [HAs] on longer at that time—almost till I went to bed. And I put them on in the morning when I got up, but (to me) in a sales position that I had, it was a must. Some of the most embarrassing things with the hearing aids—I [would be in] the middle of a discussion and all of a sudden I hear “BEEP, BEEP, BEEP”—the battery would give me an indication [that it was dying]. I used to hold out as long as possible, and I would say, ‘Excuse me, Mother Nature is calling me’. I was embarrassed to, you know, change the batteries. So, I went to the bathroom and changed the batteries… The HAs were actually a key to my success in the position I had. I had a very good career with [the store], and I attribute that a lot to the HAs.” Narratives of the dispassionate users conveyed little affect regarding their HL diagnoses or experiences with HAs. Instead of describing their experiences with emotion, they focused more on describing the factual details of their experiences. For example, one such user Estelle's narrative reads relatively emotionless: “Realizing HL was a problem in the family, I decided I just needed to have hearing tests and get a hearing aid so that I would be able to at least hear as well as I thought that I might be able to.” People reflecting the resigned user narrative identity described feelings of resignation surrounding their HAs. Interestingly, they recognized the benefit of HAs while also recounting their irritation toward their HL diagnoses as well as their difficulties in adopting consistent HA use habits. They presented their HA use as an obligation rather than a choice. For example, one resigned user Leslie shared: “And I was like, ‘Oh, crap.’ I missed that entire quiz question, and I was really, really fed up with that. So, I was like, ‘Dang it. Like I am going to like at least try and do something.’ I'm really, really tired of missing important stuff in class. I had a friend at the time who was doing audiology, and she really tried to push me to come here [university clinic]. And so, yeah. Then I got fit with HAs, and it's been very interesting.” Lastly, the griever narrative identity emerged from stories where individuals were in a state of mourning surrounding their HL diagnosis and yearned for their lives to be different. As with other grievers, Janice's story suggests that she has not fully accepted her HL and wishes life was different. “It was always disappointing to me as I learned later that—you know—I could have been given some medication that I would not have had to deal with this [HL] my whole life, which hasn't always been easy [CRYING]. I don't think people realize how emotional it is to have your hearing not be where everybody else's is at.” CLINICAL IMPLICATIONS Understanding how a patient identifies is important for health care providers because the relationship that exists between who people believe they are and how they behave has significant implications for their treatment adherence.17 For example, patients with an overcomer identity (the most prevalent identity in our study6) likely face an array of experiences and emotions while adjusting to their HL diagnosis and HA adoption. During this time, these patients can either work to reduce any negative feelings and conquer existing barriers to HL acceptance and HA uptake (thus becoming an overcomer), or they can succumb to those barriers and ultimately cease HA use altogether. Audiologists should be ready to execute different counseling techniques (e.g., motivational interviewing) to facilitate how these patients work through their barriers to become overcomers instead of non-users. Similarly, when patients identify themselves as dispassionate users, audiologists must work with them to set a consistent follow-up schedule, during which the audiologists should employ robust person-centered care and effective counseling to ensure that the patients do not allow their impartiality to their HL diagnosis and HA uptake become reason enough to reduce their consistent use of HAs. In conclusion, our study begins to shed light on the narrative identities of individuals with HL who use HAs. From a clinical perspective, the findings are particularly helpful when considering how these identities are important to audiologists’ holistic understanding of individuals who are diagnosed with HL and adhere to HA recommendations.

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