Identification of the motivators and barriers to cochlear implantation in adults over 60 years at an auditory implant centre in the UK: a mixed-methods study

ObjectivesCochlear implants are an effective intervention for people with severe to profound hearing loss. However, only a small percentage of those who could benefit from cochlear implants have one. We aimed to understand the barriers to access and receipt of cochlear implants in the UK. DesignMixed-methods study. SettingThe University of Southampton Auditory Implant Service. ParticipantsData on referral route and personal characteristics of 456 patients over the age of 60 at the time of cochlear implantation, who received a cochlear implant before 2020 were included. Semi-structured interviews were held with six people who hear with an implant. Primary Outcome MeasuresDemographic factors and routes of referral for cochlear implantation for older adults who went on to receive an implant. Semi-structured interviews were designed to identify key motivators and barriers to receiving a cochlear implant. ResultsSex and ethnicity did not affect cochlear implant uptake, whereas socioeconomic status and differences in referral pathways were associated with differences in uptake. People from lower socioeconomic groups were underrepresented in the implanted population at USAIS. Certain health providers across the cohort catchment area were more likely to refer patients than others which in turn affected cochlear implant uptake. Barriers to uptake were poor knowledge about implants by patients and clinicians, and fear of surgery. A willingness by patients to explore a way to reduce the daily challenges associated with hearing loss and the support and encouragement of clinicians, family and friends and other people with implants were motivators to implant uptake. ConclusionThese findings will inform future research to address the key factors preventing eligible individuals from receiving cochlear implants. This will support the development of strategies to improve access to, and uptake of, cochlear implants for older adults. ARTICLE SUMMARYO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIStrength: Mixed-methods approach was used: O_LIA service evaluation where we analysed retrospective data from 456 patients from a UK cochlear implant centre. C_LIO_LISemi-structured interviews were used to gather rich qualitative data for a deeper insight into the barriers and motivators of cochlear implant uptake. C_LI C_LIO_LILimitation: Data from patients that were referred to USAIS but did not receive cochlear implants was not included. C_LIO_LILimitation: Sample size for interviews was small (six participants) due to time constrains of the (student) project. C_LI