Comparing hearing aid settings with ecological momentary assessment using direct and indirect approaches

Ecological momentary assessment (EMA) is frequently utilized to evaluate hearing programs (HPs) in real life, either by indirect comparison (i.e., rating one program in each study period) or by direct comparison (i.e., switching between HPs in a survey and rating the difference). To compare these methods, a randomized crossover design was implemented with 30 participants and three hearing programs differing in gain and noise reduction features. Data collection spanned 15 days, capturing participants' ratings of sound quality, hearing aid satisfaction, and speech understanding. For programs differing in gain, the direct method showed the highest contrast across the three evaluated attributes. For programs differing in noise reduction features, only the direct method showed a difference in speech understanding. The direct comparison method sampled fewer situations in which using the phone might be inconvenient (e.g., conversations and driving) and was also perceived as more burdensome. Overall, representativeness detected differences between HPs, and participant burden varied between methods, suggesting that the choice of approach is highly context dependent (i.e., whether the focus is immediate perceptual differences, long-term effects, or sampling specific real-life environments). The findings of this study are converted into a set of recommendations for designing an EMA study.