Development and preliminary evaluation of a German questionnaire assessing attitudes toward hearing aids and behavioral intention.

BACKGROUND

Hearing aid uptake remains suboptimal despite well-established clinical benefits, suggesting that psychosocial factors influence hearing rehabilitation decisions. This study aimed to develop and perform a preliminary psychometric evaluation of a German-language questionnaire assessing attitudes toward hearing aids and behavioral intention toward hearing aid use.

METHODS

A cross-sectional survey was conducted among German-speaking adults with and without self-reported hearing loss. An existing English-language questionnaire was substantially adapted for the German healthcare system through expert review, psychometric evaluation, and pilot revision before final administration. Preliminary psychometric evaluation included assessment of internal consistency and exploratory factor analysis. Associations between attitudes, behavioral intention, and hearing aid use were examined using correlation and regression analyses.

RESULTS

The overall attitude scale demonstrated acceptable internal consistency (Cronbach's α = 0.77), whereas the behavioral intention scale demonstrated good internal consistency (α = 0.86). Exploratory factor analysis supported a four-factor structure, although several items demonstrated cross-loadings, suggesting that further refinement of the questionnaire is warranted. The study included 159 adults (18-96 years), of whom 48.4% reported hearing loss. General attitude was strongly associated with behavioral intention (r = 0.63, p < 0.001) and explained approximately 40% of its variance (R² = 0.40). Among attitudinal domains, expected benefit and effort (r = 0.66) and stigma (r = 0.65) showed the strongest associations with behavioral intention. Participants with hearing loss who used hearing aids demonstrated significantly more favorable attitudes and stronger behavioral intention than non-users (both p < 0.001).

CONCLUSIONS

This study describes the development and preliminary psychometric evaluation of a German-language questionnaire assessing attitudes toward hearing aids and behavioral intention. The findings provide preliminary evidence supporting the questionnaire's reliability and structural validity while highlighting the need for further psychometric validation in independent populations. Stigma-related beliefs and expectations regarding hearing aid benefit emerged as the attitudinal domains most strongly associated with behavioral intention and may represent important targets for interventions to improve hearing aid uptake.