Attitudes toward smartphone-based self-hearing screening among mild cognitive impairment: A mixed method study

Hearing loss is the largest modifiable risk factor for dementia with high prevalence in memory clinics. Early identification and intervention are crucial to prevent cognitive decline. Pure-tone audiometry is often lacking in many settings. Smartphone-based hearing screening tests present an innovative solution; however, cognitive impairment poses a barrier to their use. This study aims to explore the perceptions, acceptability, and attitudes of older adults with cognitive impairment toward this tool. Seventeen cognitively impaired patients participated in this cross-sectional study, using a mixed-method approach. Participants used a self-administered smartphone application, including the Hearing Handicap Inventory for the Elderly, pure-tone hearing screening test, and digit-in-noise test. They completed a System Usability Scale (SUS) questionnaire for quantitative analysis, and qualitative data were collected through three focus group interviews. Participants averaged 71.8 years old, with a mean MoCA score of 25.8. The SUS score was 61 ± 24, indicating marginal acceptability. Thematic analysis revealed five main themes: hearing status, past hearing test experiences, experiences with the smartphone test, test performance and engagement, and attitudes toward the smartphone test. User experience was shaped by several interrelated factors, including ease of use, guidance support, aging, and trust in the technology. Smartphone-based hearing tests are a possible workable option for people with mild cognitive impairment, though their usability remains modest and practical challenges persist. The valuable findings of this study will help refine these tools to better meet their specific needs.