Facilitators and Barriers to Audiologic Follow-Up in Malawi

Purpose: Routine follow-up care for hearing aid users is crucial to ensure hearing aid satisfaction. This pilot study aimed to explore the facilitators and barriers that affect follow-up appointments among adult hearing aid users at African Bible College Hearing Clinic and Training Centre (ABC HCTC) in Malawi, Africa. Proposed barriers include lack of financial resources, lack of appointment reminders, and poor hearing aid use experience, which were hypothesized to contribute to a lower rate for face-to-face follow-up appointments. Method: To improve hearing aid follow-up care, a new clinic protocol was implemented at ABC HCTC including scheduling and emphasizing the importance of a 1-month fitting follow-up appointment, covering transportation costs (as needed), providing additional educational materials, collecting backup contact phone numbers, initiating a 2-week follow-up phone call and an appointment reminder call, and providing a limited supply of hearing aid batteries to encourage return. At the follow-up appointment, a survey was completed to assess the barriers to follow-up care and hearing aid satisfaction. Results: The fitting follow-up rate at ABC HCTC increased significantly to 62.3%, as compared to an average of 11.5% from 2019 to 2021 with the interventions undertaken in the study. Barriers to follow-up care included financial, travel, and medical concerns; notably, distance traveled for the appointment correlated negatively with follow-up. Additionally, the participants' sense of importance of hearing, the impact of hearing aids, and their satisfaction with their hearing aids correlated with follow-up. Conclusions: Barriers to follow-up care are evident, even with an improved clinic protocol, and it is important to consider these barriers when determining hearing aid candidacy. Routine follow-up and hearing aid success depends on the protocols set in place by each respective practice. Our pilot study identified that both targeted interventions and education can improve follow-up rates, and further research should be done to explore barriers to care.