Barriers and Facilitators to Adult Cochlear Implant Uptake Across Socioeconomic Status

Objective: The study objective was to identify barriers and facilitators to cochlear implant (CI) uptake across socioeconomic status (SES) in adult CI recipients. Study Design: This was a prospective cross-sectional study. We examined SES group differences (low vs high, using Kuppuswamy questionnaire scores ≤15 vs ≥16) using χ 2 /Fisher exact tests for categorical variables and t tests for continuous variables (α = 0.05). Setting: Tertiary medical center. Patients: Fifty-five CI recipients who received their first CI were ≥18 years of age. Intervention: Assessments of CI barriers and facilitators. Main Outcome Measure: 20-question questionnaire on barriers and facilitators to CI uptake, CI Quality of Life Questionnaire (CIQOL-35), and Kuppuswamy SES scale. Results: Common barriers were insurance coverage, cost of surgery, concern that CI would not significantly improve communication, and surgical risk. Frequent facilitators included further hearing decline, impact on job performance, and relevant counseling. By SES, low-SES participants reported concerns of costs of surgery more than high-SES participants ( P < 0.05). Low-SES also reported family encouragement and knowing someone with CI that had a good outcome as facilitators ( P < 0.05). AzBio in quiet was lower in low-SES (11.43 percentage points; P < 0.05), while CIQOL did not differ by SES. Conclusions: Barriers to CI uptake cluster around cost, uncertainty of benefit, and surgical risk, with ubiquitous insurance concerns. Low-SES recipients appear to rely more on family and social networks. Counseling that addresses cost logistics and leverages social support may improve equitable CI access and utilization.