Beyond Speech: Designing Hearing Aids for Real Life, Not Just the Lab

I have been venting on LinkedIn recently about the struggle to adjust to my third set of digital hearing aids. Besides getting used to a new soundscape, I got frustrated with things I didn’t want to hear: music only in one ear in the car and the inconsistency.

I’ve asked, “Shouldn’t user experience feature more in hearing aids research?” Although I received comments from people who agreed, some didn’t. So, I’ve decided to investigate, because from my lived experience, it didn’t.

1. What Is User Experience (UX)?

User experience (UX) is any interaction with a product or service.

It includes the product’s look, how people interact with it, and how it makes them feel.

Intuitive, Efficient. Relevant.

That is the purpose of UX design.

Understanding users’ needs, values, abilities, and limitations is crucial for effective UX design. User research tries to identify these needs, pain points, goals, and behaviours. It also looks at the wider industry and how competitors meet these needs.

Besides research to establish users’ needs, user feedback on prototypes help to refine products by identifying problems, complications, and hesitancy in using features.

2. What Is Effective UX Design?

Effective UX design relies on seven principles. Let’s look at how each applies to UX design in hearing aid development.

2.1 Useful

Knowing why a product is needed and what users will gain from it is essential to determining usefulness.

Why do you need hearing aids?

Many people will say to hear speech for better communication. And although that is the primary focus, hearing is about so much more.

It is hearing low and high notes, and silences in music.

It is hearing your children’s laughter while they’re swimming.

It is hearing a car approaching from behind when walking.

It is hearing notifications from your phone and appliances.

Is hearing speech enough when your hearing aids dull music, amplify unwanted sounds, and increase some sounds to uncomfortable levels?

Hearing is also about enjoyment, optimal functioning, and safety.

2.2 Usable

Usability aims to make using the product as intuitive and efficient as possible.

I would rate analogue hearing aids higher for usability. It only requires putting them in and adjusting the volume with a scrolling wheel.

With older digital models, you could use a remote control. It means you have to remember to take it with you, and I was the victim of a smash-and-grab when I hung it around my neck.

With my newest digital set, I control them with my phone. We all take our phones wherever we go, which is a benefit. These aids are not set it and forget it. You constantly switch between noise filtering at the shop, music profile in the car, and restaurant settings while dining out. If a traffic officer pulls you over, you must scramble to switch back to the general setting to ensure you can hear adequately. And when you get a call and need to adjust volume, you may kill the call in the scramble to get to your settings app!

2.3 Findable

Findability in the traditional sense means that a product must be easy to navigate, like finding information on a website or a video on streaming services.

In the context of hearing aids, it is about finding an audiologist or information about specific hearing aid brands and models. It means audiologists must be visible on Google and medical listing providers. Hearing aid brands must master SEO since not all users will search for specific makes or models.

2.4 Credible

Users expect durability and that the product will deliver the desired result.

Not many people research hearing aids. I did before I got my first digital hearing aids, and again with my most recent set. Did I gain anything by it?

My audiologist discarded all my suggestions the first time without even a discussion. The last time, my new audiologist told me the ones I’m considering are outdated technology and unavailable.

I had Oticon and now Interton hearing aids.

Do I find these brands credible?

I never knew about them until I got that brand’s hearing aids.

I don’t think hearing aid suppliers get high marks for credibility.

2.5 Desirable

Desirability relies on brand perception, image identity, and emotional design.

People don’t desire hearing aids; they want the value and experience they give them. Every time I get new hearing aids, I hope to hear better. Unfortunately, this never happens due to the inherent limitations of hearing aids and the gradual degeneration of your hearing. Ultimately, you are grateful that your hearing aids help you to function and live a good life.

Stigma around hearing loss doesn’t help. Who would desire hearing aids if it means ridicule and exclusion?

2.6 Accessible

Accessibility considers factors like colours and font size to ensure ease of use for all.

Availability and cost limit access to hearing aids. Research and development are costly, and they transfer the cost to the user. Financial help and subsidies are not available in all countries.

Availability of hearing aids differs in various countries. But even more is their availability at the consumer level. Every audiology practice supplies only a few or one brand, limiting users’ choices.

2.7 Valuable

All the previous steps combine to determine the value of the products for users.

How valuable are your hearing aids?

It is here where the gap between research and lived experience shows itself. But what causes this discrepancy?

Let’s explore.

3. How is information regarding user experience with hearing aids collected?

There are three primary research methods to gather data: data-driven methods, self-reported methods, and mixed approaches. Before we explore each of them and their purpose, we need to define data.

Data is facts, figures, objects, symbols, and events from various sources. Researchers use it to provide insight into users’ experiences with hearing aids.

3.1 How Is Information Regarding User Experience With Hearing Aids Collected?

When my audiologist connects my hearing aids to her software, it collects valuable data. She can see which programs I use, how often I make adjustments, and even if I wear them regularly. However, this doesn’t explain the why.

• It can tell her that I used the noise filter, but she doesn’t know that it helped with the noise in the shop, which makes hearing speech impossible.
• She can see that I had my volume low for a long time, but she won’t know that workers were felling a tree close to us that day.
• She may wonder why I have been using my music settings for so long, but she won’t know I forgot to change back to the default.
• When she compliments me for wearing aids most of the day, she doesn’t see the frustration and tears from noise fatigue and cognitive overload.

This data gives her valuable feedback to fine-tune the hearing aids, but misses crucial human feedback.

Although this data can be anonymously shared with hearing aid manufacturers, it is seldom used in development and won’t stand out in the bigger data set to make a difference.

3.2 Self-Reported Methods

Self-reported methods are qualitative and associated with the human experience.

a) Surveys & Questionnaires

Surveys and questionnaires collect data about user experiences through open-ended questions and surveys (online or in print).

b) Interviews

Interviews use pre-prepared questions, individually or in small groups.

c) Focus groups

A small group of up to ten people discusses common issues from a research study. A moderator regulates and records the discussion.

How does this apply to people like you and me, living with hearing loss?

I never participated in a research study about my experience using hearing aids. I’ve built good relationships with my audiologists and like to have a chat when I pop in to buy batteries. Then I will talk about challenges and issues with my hearing aids. These casual conversations likely didn’t even make it into my file, let alone reach any remote hearing aid developers. It was valuable for me, but not part of the bigger picture.

Finding a way to collect this information can provide valuable insights into user experience.

3.3 Observational Studies

Researchers gain insights about human behaviour by watching people in their natural environment. In reality, researchers only observe hearing aid use in a clinical environment.

This quiet and controlled environment doesn’t show where hearing aids fail in reality.

Missed words. Cognitive overload. Lost moments.

3.4 Mixed-Methods

Quantitative data consists of facts, while qualitative data focuses on human experience.

Researchers benefit from both the statistics (quantitative) and the human element (qualitative data) when using quantitative data logging and qualitative interviews. It provides them with a broader picture for research and development.

4. The Importance of Reliable Data Collection Methods

Data collection forms the foundation for decision-making and research. Appropriate collection methods ensure accurate and relevant data, prevent bias, and ensure representativeness.

Since quantitative methods focus on facts and statistics, and qualitative approaches on the human experience, it is best to combine them to ensure you get the whole picture.

5. The Gap Between UX in Hearing Aid Research & Design and Lived Experience

No research or data collection is perfect. Even when combining quantitative and qualitative methods, researchers can still have inaccurate or incomplete data to work with.

Various reasons can explain this:

• The study uses a small group that doesn’t represent all hearing aid users. People from specific locations and income groups don’t have access to the internet and online studies.
• The studies focus on first-time hearing aid users and ignore the needs of long-term or lifetime users.
• The study’s premise and criteria don’t align with the lived experiences of people with hearing loss.
• Hearing loss is complex, and there is no one-size-fits-all approach. It makes it challenging to design for all possible users.
• Lack of collaboration and standardisation between manufacturers. Each manufacturer has a different sound and tuning profile, adding additional difficulty when changing brands.
• Data logs from hearing aids are shared with your audiologist, but may never reach researchers and developers.

User feedback is crucial for hearing aid research and development. Getting user input wrong or not covering all segments of hearing aid users creates a disparity between UX in hearing aids and the lived experience with hearing aids. People may avoid getting hearing aids because they know people who have had bad experiences with them. Or, for many, the expensive hearing aids end up unused in the drawer because of this gap.

In my 45+ years of wearing hearing aids, I never struggled to adjust. It has always been putting them in and going on with my life. Even when my audiologist doubted me changing from the volume of analogue to the softer but clearer digital sound, I loved it. I never missed the volume.

But what about my recent upgrade to my third digital set? It transported me back to wearing analogue: so much volume and little comprehension.

I don’t want my car’s engine noise to drown out my music.

I don’t want the kettle boiling to drown out my husband’s speech.

I don’t want to choose a profile for every listening situation.

I don’t necessarily want to hear everything hearing people can, especially if I couldn’t hear it before.

I want simple hearing aids that let me get on with life. At most, I want to increase or decrease the volume on occasion. But now my hearing aids have become another thing to manage.

Researchers put a lot of time and effort into data collection, design, and development. Only, I don’t see myself or my lived experience anywhere.

I am a woman with hearing loss who wears hearing aids and gets on with my life. I hate that I now feel like the woman struggling to adjust to (my most expensive hearing aids ever) and struggling daily!

---

---

References

Workshopper. (n.d.). What is UX, and why is it important? Workshopper. https://www.workshopper.com/post/what-is-ux-and-why-is-it-important

QuestionPro. (2023, August 3). Data collection methods: Definition, examples, types, and how to choose. QuestionPro. https://www.questionpro.com/blog/data-collection-methods/

QuestionPro. (2022, June 23). Observational data: Definition, types, collection methods, and examples. QuestionPro. https://www.questionpro.com/blog/observational-data/