Article
Hearing Loss- and Hearing Aid-Related
Stigma: Perceptions of Women with Age-
Normal Hearing
Susan F. Erler
Dean C. Garstecki
Northwestern University, Evanston, IL
Impaired hearing and the use of hearing aids
are often perceived negatively. Many adults
deny hearing loss and reject amplification, in
part due to such stigma. Women and men
differ in how they age and adjust to impaired
hearing, yet little is known specifically about
women’s perceptions of stigma related to
hearing loss and hearing aid use. The purpose
of this study was to examine the degree of
stigma associated with hearing loss and
hearing aid use among women in three age
groups (35– 45 years, 55– 65 years, and 75– 85
years). Participants were 191 women with
hearing within normal limits based on age-
related norms. Using pairs of descriptors (i.e.,
B oth hearing loss and the use of hearing aids are
widely reported as unacceptably different from
normal, or stigmatizing (Hétu, 1996; Kochkin,
1990, 1993; Noble, 1996). Perceptions of stigmatiza-
tion most often result in denial of hearing problems
(Hallberg, 1999; Hétu, 1996; Kochkin, 1993) and lack
of adherence to professional recommendations to use
hearing aids (Garstecki and Erler, 1998; Surr and
Hawkins, 1988). Hearing impairment is common
among older adults, and hearing aids offer a viable so-
lution to communication problems, yet hearing aids are
used by only 22% of the market (Kochkin, 2001). The
anticipation of negative perceptions is a strong deter-
rent to hearing loss management.
Little is known specifically about women’s perceptions
of hearing loss and hearing aid use. Women experience
aging and disability differently than men (Guralnick,
Fried, Simonsick, Kasper, and Lafferty, 1995), including
how they adjust to hearing loss (Garstecki and Erler,
1999). Although women live longer than men, they are
more likely to experience restrictions of mobility and self-
care as they age (Arber and Cooper, 1999). By age 65,
25% of women report hearing loss with estimated preva-
lence increasing to more than 70% by age 85 (Guralnick
American Journal of Audiology ● Vol. 11 ● 83–91 ● December 2002 ● © American Speech-Language-Hearing Association
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semantic differentials), participants completed
statements related to hearing loss and hearing
aid use. Results suggest that negative
perceptions associated with hearing loss and
hearing aid use are affected by age. Younger
women perceive greater stigma than older
women. Less stigma is associated with
hearing aid use than hearing loss, suggesting
a positive effect of hearing loss management.
Implications for clinical practice and marketing
of hearing instruments are discussed.
Key Words: stigma, women, hearing loss,
hearing aids
et al., 1995). Hanna and Rogovsky (1991) argue that be-
cause of the tendency to devalue women in general,
women with impairments are particularly vulnerable to
the negative effects of stigma. The combination of hear-
ing impairment and physical and social limitations among
aging women underscores the importance of understand-
ing perceptions of stigma in this population.
There have been numerous investigations of stigma
associated with hearing loss and hearing aid use. Method-
ology varies and few studies have differentiated between
the perceptions of men and women. Some studies have
relied on reactions to photographs of individuals wearing
hearing aids (e.g., Blood, Blood, & Danhauer, 1977; Iler,
Danhauer, & Mulac, 1982), whereas others used survey
techniques (Kochkin, 1993). Two studies reported on
women’s perceptions of stigma associated with hearing
loss and hearing aid use. Outcomes of interviews with
employed female hearing aid wearers conducted in 1993
by Waridel revealed a need to conceal their hearing aids
(reported in Hétu, 1996). Waridel’s participants associated
hearing loss with less intelligence, mental health prob-
lems, old age, and disability. Further, they indicated hear-
ing loss made them feel less feminine. Doggett, Stein,
and Gans (1998) gathered judgments after face-to-face
83
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 TABLE 1. Mean (standard deviation) right (RE) and left ear (LE) air conduction thresholds for younger (YW), middle-aged (MW), and
older (OW) groups of women.
Group YW
Frequency
(Hz) RE LE
500 2.3 (5.1) 7.1 (7.4)
1000 2.8 (5.1) 2.0 (5.5)
2000 1.45 (4.9) 1.6 (5.4)
4000 5.0 (7.0) 5.5 (7.3)
6000 12.4 (8.3) 14.8 (10.3)
8000 10.8 (8.6) 13.6 (11.3)
interaction of female peers with and without hearing aids.
None of the participants had owned or used hearing aids
previously. Half of Doggett et al.’s observers were informed
that their peer was wearing a hearing aid and half were not.
Results revealed a hearing aid effect. All observers rated
peers wearing hearing aids more negatively on measures of
confidence, intelligence, and friendliness. Hétu, Jones, and
Getty (1993), in a review of literature related to the impact
of hearing impairment on intimate relationships, suggested
that social competence is particularly important to women.
They conjectured that the negative impact on self-image
might be more pronounced among women than men if tradi-
tionally female skills (i.e., communication and nurturing) are
affected by hearing loss. Results of these investigations and
review suggest that gender influences perceptions of hearing
loss and hearing aid use.
Age might affect perceptions of acceptability and
normalcy related to hearing loss and hearing aid use.
Blood et al. (1977) found that college students rated
school-aged children pictured wearing hearing aids
more negatively on measures of intelligence and ap-
pearance. In contrast, Iler, Danhauer, and Mulac (1982)
found no such hearing aid effect among older adult
observers. Kochkin (1993) found that 60% of adults 35
to 44 years old cited stigma as a reason to reject a
hearing aid, compared with only 30% of adults 75 to
84 years old.
The present investigation examines stigma related to
hearing loss and hearing aid use among three age groups
of women with hearing that is normal for their age. The
purpose of the study was to determine whether women
vary by age in the degree of stigma they attach to hearing
loss and hearing aid use and to identify patterns of nega-
tive and/or positive characteristics associated with hearing
loss and hearing aid use.
Methods
Participants
Participants were recruited from a database of adult
research volunteers and through newspaper advertise-
ments. They were divided into three age groups: Group
YW (younger women) consisted of 62 women aged 35 to
45 years (M ⫽ 40 years), Group MW (middle-aged
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Group MW Group OW
RE LE RE LE
5.8 (7.5) 10.7 (7.7) 14.6 (9.2) 18.1 (7.7)
6.2 (7.2) 5.5 (7.3) 15.3 (11.9) 14.3 (13.6)
8.8 (8.9) 9.3 (10.3) 25.7 (13.1) 22.8 (11.8)
15.7 (11.8) 15.1 (10.8) 38.6 (15.0) 37.7 (15.2)
23.5 (12.0) 26.4 (14.3) 51.5 (18.2) 51.8 (18.7)
29.8 (17.1) 29.0 (17.0) 62.5 (17.1) 60.3 (16.4)
women) consisted of 67 women aged 55 to 65 years
(M ⫽ 60 years), and Group OW (older women) consisted
of 62 women aged 75 to 85 years (M⫽78 years). All re-
ported “normal” hearing (i.e., no unusual problems related
to hearing and no professional recommendations for hear-
ing aid use). These age groups were selected because of
earlier evidence that stigma varies with age. Further, a
number of demographic and social variables typify
women in these groups (e.g., marital status, general
health) and might influence perceptions of hearing loss
and hearing aid use.
Procedures
Participants completed a demographic data form de-
signed for the study, reporting whether or not they were
currently married, providing care to others, or employed.
Participants indicated their current level of income by
selecting one of five $20,000 increments, ranging from
less than $20,000 per year to greater than $80,000 per
year. These five categories were later combined into two
categories (less than or greater than $40,000) for purposes
of analyses. Years of education were reported. Health and
health handicap (i.e., the degree to which one’s health
interferes with daily activities) were measured continu-
ously using seven point scales (where 1 ⫽ poor health
and 7 ⫽ good health, or 1 ⫽ no interference in daily ac-
tivities and 7 ⫽ great interference).
Next, pure-tone air conduction thresholds for each ear
at octave frequencies from 500 through 8000 Hz (re:
ANSI S3.6-R-1996) and bone conduction thresholds from
500 through 4000 Hz were obtained using standard audio-
metric procedures to confirm hearing within age-normal
limits (Table 1). Age-normal hearing was considered
within ⫾5 dB of the estimated thresholds reported by
Pearson et al. (1995).
Results of testing in quiet, using a compact disk pre-
sentation (Auditory Research Laboratory, 1991) of the
NU #6 list (Tillman and Carhart, 1966), revealed average
word recognition scores of 97% (range 90 –100) for
Group YW, 95% (range 84 –100) for Group MW, and
89% (range 62–100) for Group OW. Women with unilat-
eral hearing loss and/or evidence of middle ear disorders
were excused from participation.
 TABLE 2. Demographic data (in percent) for younger (YW), middle-aged (MW), and older (OW) groups of women.

Group YW Group MW Group OW

Variable (Mage⫽40; n⫽62) (Mage⫽60; n⫽67) (Mage⫽78; n⫽62) ␹2 p

Married 65 63 34 14.9 ⬍.01

Caregivers 61 26 10 39.4 ⬍.001
Employed 77 55 16 46.2 ⬍.001
Income ⬍$40,000 25 28 54 10.8 ⬍.05

Semantic Differential Task
After audiometric testing, each participant completed
statements related to perceptions of persons with impaired
hearing (“If someone has a hearing loss, other people
think of them as _____.”) and those who use hearing aids
(“If someone wears a hearing aid, other people think of
them as _____.”) by marking one of seven evenly spaced,
unnumbered boxes printed between each of seven pairs of
semantic differentials (e.g., “Old/Young”). For purposes
of data analysis, numbers 1 to 7 were assigned later to
the boxes (i.e., where 1 ⫽ the box nearest the most nega-
tive adjective and 7 ⫽ the box nearest the most positive
adjective). The selected semantic differentials reflect con-
cepts associated with hearing loss reported previously
(e.g., Hétu, 1996; Iler et al., 1982), including intelligence,
aging, achievement, function, and ability to relate to oth-
ers. A measure of attractiveness was not included as it
has been reported as contributing little to measures of
stigma associated with hearing loss or hearing aid use
(e.g., Doggett et al., 1998).
Data Analysis
Summary statistics (e.g., mean, standard deviation, and
range data) were derived for all variables (Dynamic Mi-
crosystems, 1997). Demographic data were subjected to
chi-square tests of association for categorical variables
and one-way analysis of variance for continuous variables
to determine group differences. Analyses of covariance
(ANCOVA), controlling for the effect of hearing (i.e.,
average of thresholds at 500, 1000, 2000, and 4000 Hz),
were used to determine whether significant overall group
differences exist for each variable. Post hoc Tukey/
Kramer multiple comparisons (Kramer, 1956) were used
to determine whether significant differences exist between
groups. Stepwise multiple regression analyses were con-
ducted using responses to each semantic differential as
the dependent variable and demographic variables (includ-
ing age) as independent variables.
Results
Demographic Data
Using chi-square tests for categorical variables and
one-way ANOVAs for years of education, general health,
and health handicap, results reveal group differences for
all measures except general health (Tables 2 and 3). The
majority of women in Group YW were married, caregiv-
ing, employed, earning more than $40,000 per year, col-
lege-educated, and in good health. Responses were similar
for women in Group MW, although fewer participants
were employed and only one-fourth were caregivers. In
contrast, women in Group OW were unlikely to be mar-
ried, caregiving, or employed. They reported fewer years
of education and less than half reported income greater
than $40,000 per year. Although self-assessments of gen-
eral health did not differ among groups, women in Group
OW were more likely to report health handicap.
Perceptions of Stigma Associated With
Hearing Loss
Perceptions of hearing loss-related stigma were most
negative for Group YW (i.e., lower scores) and most pos-
itive for Group OW (Table 4). Results of ANCOVAs,
with average hearing threshold as the control variable,
revealed significant group differences for all pairs except
“Old/Young” and “Cold/Warm.” Results of post hoc
Tukey/Kramer multiple comparisons revealed significant
differences between groups. Group YW differed from
Group MW on 4 of 7 measures: “Dumb/Smart,” “Handi-
capped/Normal,” “Unfriendly/Friendly,” and “Unsuccess-
ful/Successful,” all at the p ⬍ .01 level. Groups YW and
OW differed on 7 of 7 measures at the p ⬍ .01 level.

TABLE 3. Means (standard deviations) of education and health variables for younger (YW), middle-aged (MW), and older (OW)
groups of women.

Group YW Group MW Group OW

Variable (Mage ⫽ 40; n ⫽ 62) (Mage ⫽ 60; n ⫽ 67) (Mage ⫽ 78; n ⫽ 62) F p

Years of Education 16.2 (5.5) 16.3 (4.6) 15.0 (5.1) 6.2 ⬍.01
Health (1 ⫽ poor; 7 ⫽ good) 5.6 (1.4) 5.7 (1/5) 5.5 (1.3) .053 ns
Health Handicap (1 ⫽ none; 7 ⫽ interferes greatly) 2.8 (1.9) 2.4 (1.6) 3.2 (1.8) 3.2 ⬍.05

ns, not significant.

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 TABLE 4. Mean (standard deviation) and adjusted mean scores, controlling for average hearing threshold, for stigma associated
with hearing loss for younger (YW), middle-aged (MW), and older (OW) groups of women.

Group YW Group MW Group OW

Variable Mean (SD) Adjusted Mean Mean (SD) Adjusted Mean Mean (SD) Adjusted Mean F p

Dumb/Smart 3.50 (1.0) 3.37 3.97 (1.2) 3.94 4.67 (1.1) 4.64 9.53 ⬍.0001
Old/Young 2.27 (1.1) 2.45 2.71 (1.3) 2.76 3.20 (1.4) 2.96 1.25 ns
Insecure/Self-Confident 3.87 (1.9) 3.69 3.98 (1.1) 3.94 4.27 (1.4) 4.49 3.75 .025
Handicapped/Normal 2.44 (1.2) 2.37 3.48 (1.8) 3.46 3.77 (1.7) 3.81 8.03 ⬍.001
Cold/Warm 3.79 (1.0) 3.77 3.92 (1.0) 3.92 4.23 (1.1) 4.46 1.82 ns
Unfriendly/Friendly 3.59 (1.0) 3.56 4.00 (1.4) 3.96 4.23 (1.2) 4.46 5.67 .004
Unsuccessful/Successful 3.77 (1.0) 3.73 4.15 (1.0) 4.15 4.52 (1.1) 4.56 4.38 .014

Note. Scores range from 1 to 7 with lower scores indicative of more negative perceptions, or greater stigma. ns, not significant.

Groups MW and OW differed on 4 of 7 measures: Comparison of Stigma Associated With Hearing

“Dumb/Smart,” “Insecure/Secure,” “Unfriendly/Friendly,” Loss and Hearing Aid Use
and “Unsuccessful/Successful” at the p ⬍ .01 level.
Group mean scores for hearing loss and hearing aid
Distribution of responses for semantic differentials
semantic differentials were compared. Differences were
measuring stigma associated with hearing loss is summa-
rized in Table 5. Regardless of age, neutral responses (a
score of 3, 4, or 5) were most common for five of seven TABLE 5. Distribution of hearing loss stigma scores (in percent).
pairs. Strong negative perceptions (a score of 1 or 2)
were reported by a majority of women in Groups YW Responses
(66%) and MW (52%) for the “Old/Young” differential a
Semantic Differentials Negative Neutralb Positivec
compared with 28% of Group OW. Similarly, responses
to the “Handicapped/Normal” descriptor tended to be neg- Dumb/Smart
ative (61%, 35%, and 28% of Groups YW, MW, and Group YW 16 82 2
OW, respectively). Group MW 10 81 9
Group OW 2 85 13
Perceptions of Stigma Associated With Hearing Old/Young
Aid Use Group YW 66 34 0
Group MW 52 45 3
Perceptions of hearing aid use were most negative for
Group OW 28 70 2
Group YW and most positive for Group OW (Table 6). Insecure/Self-
Results of ANCOVAs, with average hearing threshold as Confident
the control variable, revealed significant differences Group YW 7 90 3
among groups for 6 of 7 semantic differentials. Post hoc Group MW 10 81 9
Tukey/Kramer analyses revealed that Groups YW and Group OW 8 77 15
MW differed significantly at the p ⬍ .01 level for 4 of 7 Handicapped/Normal
measures: “Dumb/Smart,” “Old/Young,” “Handicapped/ Group YW 61 37 2
Normal,” and “Unfriendly/Friendly.” Groups YW and Group MW 35 49 16
OW differed for 7 of 7 measures at the p ⬍ .01 level. Group OW 28 57 15
Groups MW and OW differed for 4 of 7 measures at the Cold/Warm
p ⬍ .01 level: “Dumb/Smart,” “Insecure/Self-Confident,” Group YW 10 87 37
“Cold/Warm,” and “Unfriendly/Friendly.” Group MW 8 88 4
Table 7 summarizes response distribution for stigma Group OW 3 85 12
associated with hearing aid use. Again, neutral responses Unfriendly/Friendly
were most common, with a tendency toward negative as- Group YW 16 81 3
sessment among younger women and positive responses Group MW 14 74 12
among older women evident. Hearing aid use was associ- Group OW 7 76 17
ated negatively with age by 65% of women in Group Unsuccessful/Successful
YW, compared with 38% and 23% of Groups MW and Group YW 10 85 5
OW, respectively. Similarly, persons who wore hearing Group MW 5 84 11
aids were perceived as handicapped by 58% of Group Group OW 2 83 15
YW, compared with 24% and 23% of Groups MW and
OW, respectively. Notably, 53% of Group OW responses Note. 1 is most negative (e.g., ⬘dumb⬘) and 7 is most positive (e.g.,
⬘smart⬘).a responses of 1 or 2 are negative; b responses of 3, 4, or 5 are
to the “Dumb/Smart” and 48% of responses to the “Inse- neutral; c responses of 6 or 7 are positive.
cure/Self-confident” differentials were positive.

86 American Journal of Audiology ● Vol. 11

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 TABLE 6. Mean (standard deviation) and adjusted mean scores, controlling for average hearing threshold, for stigma associated
with hearing aid use for younger (YW), middle-aged (MW), and older (OW) groups of women.

Group YW Group MW Group OW

Variable Mean (SD) Adjusted Mean Mean (SD) Adjusted Mean Mean (SD) Adjusted Mean F p

Dumb/Smart 3.88 (1.1) 4.03 4.71 (1.1) 4.75 5.41 (1.4) 5.22 7.60 ⬍.001
Old/Young 2.34 (1.2) 2.34 3.11 (1.4) 3.11 3.32 (1.4) 3.32 5.45 .005
Insecure/Self-Confident 4.20 (1/1) 4.20 4.64 (1.4) 4.64 5.17 (1.6) 5.17 3.40 .036
Handicapped/Normal 2.58 (1.2) 2.77 3.71 (1.6) 3.52 4.23 (2.0) 3.99 4.18 .017
Cold/Warm 4.05 (.81) 4.01 4.33 (1.1) 4.32 4.73 (1.2) 4.79 3.75 .025
Unfriendly/Friendly 4.02 (.83) 3.98 4.47 (1.1) 4.46 4.84 (1.4) 4.89 4.74 .01
Unsuccessful/Successful 4.17 (1.0) 4.20 4.39 (1.1) 4.40 4.85 (1.4) 4.81 1.92 ns

Note. Scores range from 1–7 with lower scores indicative of more negative perceptions, or greater stigma. ns, not significant

derived by subtracting unadjusted mean stigma associated all groups, responses related to hearing aid use were sig-
with hearing loss from unadjusted mean hearing aid use nificantly more positive than those for two hearing loss
scores (Table 8). Results of paired t-tests revealed that for semantic differentials: “Dumb/Smart” and “Unfriendly/
Friendly.” In addition, for women in Group YW, hearing
aid use responses were significantly more positive for the
TABLE 7. Distribution of hearing aid use stigma scores (in percent).
“Unsuccessful/Successful” pair. Responses of Group MW
and OW women were significantly more positive for “In-
Responses secure/Self-Confident” and “Cold/Warm” pairs.
Semantic
a
Differentials Negative Neutralb Positivec
Stepwise Multiple Regression Analyses
Dumb/Smart
Group YW 10 84 6 Forward stepwise multiple regression analyses were
Group MW 0 71 29 conducted to determine which variables contribute to per-
Group OW 0 48 52
ceptions of hearing loss and hearing aid use. Independent
Old/Young
variables (IV) were all demographic variables including
right ear four frequency pure-tone average. To avoid
Group YW 65 35 0
problems of multicollinearity, left ear four frequency
Group MW 38 57 5
pure-tone average, which has a correlation of 0.93 with
Group OW 23 73 4
right ear four frequency pure-tone average, was not used
Insecure/Self-Confident
as an IV. Only those IVs significant at the ⱕ0.05 were
Group YW 8 79 13 entered into the model.
Group MW 5 66 29 Results of stepwise multiple regression analyses re-
Group OW 5 48 47 vealed that age, years of education, and income con-
Handicapped/Normal tributed most to variance in stigma associated with
Group YW 58 40 2 hearing loss (Table 9). Multiple R’s ranged from 0.14
Group MW 24 62 14 to 0.36. Age, years of education, and right ear four fre-
Group OW 23 48 29 quency pure-tone average contributed most to variance
Cold/Warm
Group YW 2 91 7 TABLE 8. Differences between hearing aid use stigma and
hearing loss stigma mean scores.
Group MW 13 85 12
Group OW 0 72 28
Variable Group YW Group MW Group OW
Unfriendly/Friendly
Group YW 5 90 5 Dumb/Smart .38* .74** .74**
Group MW 2 80 18 Old/Young .07 .40 .12
Group OW 2 64 34 Insecure/Self-Confident .33 .66* .90**
Unsuccessful/Successful Handicapped/Normal .14 .23 .46
Group YW 3 84 13 Cold/Warm .26 .41* .46**
Group MW 2 83 15 Unfriendly/Friendly .43** .47* .61**
Group OW 2 64 34 Unsuccessful/Successful .40* .24 .33

Note. 1 is most negative (e.g., ⬘dumb⬘) and 7 is most positive (e.g., Note. Significance of differences between hearing aid stigma and
⬘smart⬘). a responses of 1 or 2 are negative; b responses of 3, 4, or 5 are hearing loss stigma mean scores within groups: * p ⬍ .01, and ** p ⬍
neutral; c responses of 6 or 7 are positive. .001.

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 TABLE 9. Summary of stepwise multiple regression analysis for demographic variables predicting perceptions of stigma related to
hearing loss.

Semantic Differential R Variable B Coefficient Standard Error t-value p

Dumb/Smart .36
Age .02 .01 3.58 ⬍.001
Years education ⫺.14 .04 ⫺3.35 .001
Income .29 .13 2.24 .03
Old/Young .27
Age .02 .01 3.85 ⬍.001
Insecure/Self-confident .18
Years education ⫺.10 .04 ⫺2.52 .01
Handicapped/Normal .36
Age .03 .01 4.15 ⬍.001
Years education ⫺.13 .05 ⫺2.43 .02
Cold/Warm .14
Age .01 .01 1.97 .05
Unfriendly/Friendly .17
Age .02 .01 2.41 .02
Unsucccesful/Successful .29
Age .02 .01 3.04 .003
Years education ⫺.08 .04 ⫺2.07 .04

in perceptions of stigma associated with hearing aid Discussion

use (Table 10). Multiple R’s ranged from 0.23 to 0.48.
Note that the IV years of education was negatively re-
lated in these models. Rather than suggesting that
higher education levels resulted in more negative per-
ceptions, this finding is more likely attributable to the
relationship between age and years of education among
participants.
Stigma associated with hearing loss and hearing aid use
stands as a barrier to successful management of hearing loss.
Little is known specifically about such perceptions among
women. Three groups of women with age-normal hearing, but
differing demographically, participated in the present study to
determine their perceptions of hearing loss and hearing aid use.

TABLE 10. Summary of stepwise multiple regression analysis for demographic variables predicting perceptions of stigma related
to hearing aid use.

Semantic Differential R Variable B Coefficient Standard Error t-value p

Dumb/Smart .48
Age .04 .01 6.47 ⬍.001
Years education ⫺.10 .04 ⫺2.32 .02
Old/Young .27
Age .03 .01 3.92 ⬍.001
Insecure/Self-confident .26
Age .02 .01 2.69 .01
Years education ⫺.10 .05 ⫺1.98 .05
Handicapped/Normal .41
Age .04 .01 5.27 ⬍.001
Years education ⫺.11 .05 ⫺2.01 .05
Cold/Warm .23
Age .02 .01 3.22 .002
Unfriendly/Friendly .32
Age .02 .01 4.26 ⬍.001
RE-PTAa ⫺.03 .01 ⫺2.08 .04
Unsucccesful/Successful .28
Age .02 .01 3.07 .003
Years education ⫺.08 .04 ⫺2.07 .05

a
RE-PTA, right ear four frequency pure-tone average.

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 Data must be interpreted with caution as participants
represent a generally advantaged population (e.g., they
are well-educated, enjoy good health). Such advantages
might influence views about and access to hearing care.
The oldest participants in this study might represent a
biologic and intellectual elite who perceive chronic
conditions and their treatment differently from other
cohorts of aging adults. Almost all participants were
White; other ethnic and racial groups might demon-
strate different perceptions of stigma related to hearing
loss and hearing aid use. Further, outcomes might be
affected by response bias. Participants might have hesi-
tated to “label” persons with hearing impairment or
those who use hearing aids.
Perceptions of Stigma and Age
Regardless of semantic differential, perceptions of
stigma associated with hearing loss and hearing aid use
were most negative among youngest women and most
positive among oldest participants. Age is the largest con-
tributor to variance in perceptions of stigma related to
hearing loss and hearing aid use. Results are consistent
with previous research that did not differentiate for gen-
der. Gilhome-Herbst (1983) found employment-age adults
reported greater stigma associated with hearing loss than
did elderly adults. Similarly, Kochkin (1993) found twice
as many younger adults cited stigma as a reason for rejec-
tion of hearing aids than older adults. Among adults 57 to
92 years with impaired hearing, van den Brink, Wit,
Kempen, and van Heuvelen (1996) found modest reduc-
tions in stigma with age.
Several factors might contribute to the age effect
revealed in these data. First, the incidence of hearing
loss and use of hearing aids among aging peers in-
creases familiarity and acceptability. The same phe-
nomenon is noted with other disabilities and chronic
conditions. For example, Arikan and Uysal (1999) re-
port that attitudes related to persons with mental disor-
ders were more positive if respondents were personally
familiar with a psychiatric patient. Another factor in-
fluencing responses might be the prevailing atmosphere
of ageism (Palmore, 2000), or the stereotypes of older
persons as frail, incompetent, and dependent. Further,
Hétu (1996) suggests that age-related stigma might add
to the stigma associated with hearing loss. An addi-
tional factor that might affect degree of stigma is the
communication demand experienced by each of the
participant groups. Gordon-Salant, Lantz, and Fitzgib-
bons (1994), comparing younger (less than 40 years
old) and older (65–75 years old) adults with mild-to-
moderate hearing loss, found that younger adults dem-
onstrated significantly more hearing disability. The au-
thors suggested that this age effect might reflect not
only the insidious onset of hearing loss in late life, but
might also relate to the communication needs of each
group. In the present study, women in Group YW were
most likely to be married, raising children, and em-
ployed, situations that place high demands on effective
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communication. Familiarity with hearing loss and hear-
ing aid use, the impact of aging stereotypes, and com-
munication demands likely vary among these groups of
women.
Although age had the greatest influence on percep-
tions of hearing loss and hearing aid use in the present
study, clearly other factors contribute to the variance in
responses of these participants. In their study of older
men with impaired hearing, Saunders and Cienkowski
(1996) found personality variables, such as extrover-
sion, anxiety, neuroticism, self-esteem, and obsessive-
ness, contributed to the variance in responses to the
Attitudes Toward Loss of Hearing Questionnaire. Fu-
ture investigations should examine such personality
variables among women.
Differences between stigma associated with hearing
loss and hearing aid use are of interest. The overall
trend toward more positive assessment of hearing aid
use, regardless of age, suggests that taking action re-
duces negative perceptions. Group YW and MW re-
sponses to several semantic differentials are somewhat
more positive, whereas Group OW responses are sig-
nificantly more so. Compared with either Group YW or
MW, the oldest participants responded positively twice
as often to pairs related to intelligence, self-confidence,
normalcy, warmth, friendliness, and success. Group
OW responses might reflect first-hand knowledge of
the benefits to those who use amplification and frustra-
tions with those who do not. These results are consis-
tent with the findings of others (e.g., Weiner, 1993),
that individuals restricted by mental or physical condi-
tions and making an effort to cope are judged more
positively than those who do not.
Patterns of Responses
The strongest patterns of response revealed are (1) a
preponderance of neutral responses; (2) an age-indepen-
dent relationship between aging and perceptions of hear-
ing loss and hearing aid use; (3) a consistent association
between hearing loss and hearing aid use with handicap
among younger women; and (4) significantly more posi-
tive perceptions of hearing aid use, particularly among the
oldest participants. Among these women, hearing loss was
not associated negatively or positively with intelligence,
self-confidence, warmth, friendliness, or success. For se-
mantic differentials related to hearing loss, only the “Old/
Young” and “Handicapped/Normal” did not follow this
pattern. Response patterns are similar for differentials
related to hearing aid use. Again, the “Old/Young” differ-
ential evoked negative responses from all ages. Simply
put, hearing loss and hearing aid use summon an image
of aging, and for younger women, one of handicap. In
contrast, these women, particularly those in Groups MW
and OW, assign positive traits to people who actively
manage their hearing loss. They associate hearing aid use
with intelligence and self-confidence; and to a lesser de-
gree with normalcy, warmth, friendliness, and success.
Individuals with an impairment might experience
overt discrimination (i.e., enacted stigma), but more
89
 commonly, they anticipate negative treatment and atti-
tudes (Scambler, 1998). Marketers might exacerbate
fears of negative labeling or discrimination by portray-
ing hearing loss and hearing aid use as conditions that
need to be concealed. Based on the findings of the Na-
tional Council on Aging study, Kochkin and Rogin
(2000) state that hearing care must change to empha-
size its impact on sense of well-being, life satisfaction,
confidence, and social function. Responses of the
women in this study indicate a similar awareness of the
positive benefits of hearing care.
Conclusions and Implications
Perceptions that hearing loss and hearing aid use are
stigmatizing are thought to contribute to denial of hearing
impairment and, for many adults, rejection of hearing aid
use. This study provides evidence of the variability of
stigma associated with hearing loss and hearing aid use
among women with age-normal hearing. Perceptions of
impairments are shaped by factors such as one’s stage of
life and belief system (Gitlin, Luborsky, and Schemm,
1998). Younger women, for whom hearing loss and hear-
ing aid use are less familiar, are likely to have life styles
that require communicative competence for effective em-
ployment and parenting. For women in their middle years
who also face professional and personal demands on ef-
fective communication, hearing loss might or might not
be anticipated and accepted. Although women in this age
group recognize the benefits of amplification, they also
admit to concerns about hearing loss and hearing aid use
as a sign of aging. Women in these two age groups might
respond best to counseling and marketing that emphasize
control, competence, and confidence. By the time women
are 75 years and older, hearing impairment and the use of
hearing aids are common and familiar. Although hearing
aid use is closely associated with aging, use of a hearing
aid is perceived as an enhancement to successful function
and personal interaction. Counseling and marketing that
emphasize improved quality of life might be most effec-
tive with older clients.
Acknowledgments
This research was funded by a grant from The Retirement
Research Foundation, Principal Investigator Dean C. Garstecki.
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Received June 14, 2001
Accepted December 10, 2002
First published (online) February 18, 2003
http://professionals.asha.org/resources/journals/aja
DOI: 10.1044/1059 – 0889(2002/020)
Contact author: Address correspondence to Susan F. Erler, North-
western University, 2240 North Campus Drive, Evanston, Illi-
nois 60208-3540. Email: s-erler@northwestern.edu
91