Behavioral Determinants of Adult Hearing Health Care Engagement Across the Care Pathway: A Scoping Review Using the Capability, Opportunity, Motivation–Behavior Framework

PURPOSE: The aim of this study was to identify behavioral determinants influencing adult hearing health care engagement across the hearing health care pathway and to map these determinants to the Capability, Opportunity, Motivation-Behavior (COM-B) framework. METHOD: A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Electronic searches of PubMed/MEDLINE, Scopus, CINAHL, and Web of Science identified 767 records. Fourteen studies involving adults with hearing loss or hearing difficulties met inclusion criteria. RESULTS: Determinants were identified across multiple stages of the hearing health care pathway, revealing stage-specific behavioral influences and evidence gaps across the engagement continuum. Determinants were mapped to the six domains of the COM-B framework. Reflective motivation was represented in all included studies, while social opportunity, physical opportunity, and psychological capability were also frequently reported. Evidence was concentrated at the treatment adoption stage, with comparatively limited research addressing earlier pathway stages or longitudinal behavioral transitions. CONCLUSIONS: Adult hearing health care engagement is shaped by interacting motivational, social, capability-related, and structural determinants across the care pathway. A COM-B-informed synthesis provides a behavioral framework for understanding where engagement may break down and for guiding stage-specific interventions to improve help-seeking, treatment uptake, and sustained engagement with hearing technologies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.34930449.