Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2007.00952.

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volume 51 part 11 pp 913–922 november 2007

Hearing aids: expectations and satisfaction of people

with an intellectual disability, a descriptive pilot study
A. Meuwese-Jongejeugd,1 H. Verschuure2 & H. M. Evenhuis1
1 Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam,
The Netherlands
2 Department of E.N.T., Audiological Center, Erasmus University Medical Center, Rotterdam, The Netherlands

Abstract hearing aids. All satisfaction domains as described

for the general population could be recognized.
Background In spite of an increased risk of hearing
Most participants were partially or totally depen-
impairment in persons with an intellectual disability
dent on carers in use and maintenance of hearing
(ID), rehabilitation with hearing aids often fails. We
aids.
performed a descriptive pilot study with the follow-
Conclusions Adults with ID may have explicit ideas
ing study questions:
and wishes about hearing aids and, if specifically
1 Do comparable elements as in the general popu-
asked, are capable of expressing these. Given infor-
lation contribute to expectations of and satisfaction
mation should be checked and repeated. In satisfac-
with hearing aids in adults with mild or moderate
tion with hearing aids, comparable elements may
IDs?
play a role as in the general population: benefit, cos-
2 To what extent do adults with an ID depend on
metics, sound quality/acoustics, comfort/ease of use,
carers in use and maintenance of hearing aids?
and service delivery. These findings, however, are
Method Study population: 16 adults with a mild or
from a small-scale study. Additional research is nec-
moderate ID and a recent diagnosis of hearing
essary to find out whether they are applicable more
impairment. Method: information by means of spe-
generally.
cially designed booklets; semi-structured interviews
prior to hearing aid fitting and 6 months afterwards. Keywords dependency, hearing aids, intellectual
Analysis: descriptive. disability, satisfaction
Results In total, 14/16 participants were able to
give reliable answers. Most were aware of their
hearing loss and familiar with reasons for hearing Introduction
aids. A minority expressed positive expectations.
Some expressed explicit wishes on the looks of In the past decades, researchers have reported that
adults with an intellectual disability (ID) may have
an increased risk of hearing impairment. This
Correspondence: Professor Heleen M. Evenhuis, Chair of Intellec-
tual Disability Medicine, Department of General Practice,
applies not only to children and adults with Down
Erasmus University Medical Center, PO Box 2040, 3000 CA syndrome (Buchanan 1990; Marcel & Cohen 1992;
Rotterdam, The Netherlands (e-mail: h.evenhuis@erasmusmc.nl). Evenhuis et al. 1992; Roizen et al. 1993), but also to

© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd

 Journal of Intellectual Disability Research
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A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction
people with other causes of ID ( Wilson & Haire
1990; Yeates 1992, 1995; Beange et al. 1995; Mul
et al. 1997; Schrojenstein Lantman-de Valk et al.
1997; Evenhuis et al. 2001; Janicki et al. 2002; Lif-
shitz & Merrick 2004). However, reported preva-
lence figures vary considerably as a result of small
or selected study populations, different diagnostic
criteria and methods of data collection. We have
recently completed a large-scale population-based
epidemiological study among adults with ID in the
Netherlands, applying World Health Organization
criteria, which enabled us to estimate population
prevalences and to quantify risks in subgroups
(Meuwese-Jongejeugd et al. submitted). With a
population prevalence of 30.3%, the risk of hearing
impairment is indeed significantly increased, as
compared with prevalences of 16–17% in general
adult populations in high-income countries (Davis
1989; Quaranta et al. 1996; Wilson et al. 1999). So,
especially in the perspective of the current transi-
tion to community-based living in many countries,
timely detection and audiological rehabilitation
seem of paramount importance for communication
and independent functioning.
In the general population, many persons with a
hearing loss that would warrant use of hearing aids
do not own such devices (van den Brink et al. 1996;
Smeeth et al. 2002). It was demonstrated during the
early 1990s that acceptance of hearing aids was
positively influenced by experienced functional
problems, which were not always related to the
severity of hearing impairment (Mulrow et al. 1990;
Stephens et al. 1990). In the past decades, major
improvements in quality of sound and cosmetic
appearance of hearing aids have been achieved.
Nevertheless, usage of hearing aids still appears to
be strongly related to perceived benefit (Smeeth
et al. 2002). But perceived benefit is not the only
issue that determines satisfaction with hearing aids.
Based on a review and synthesis of published work,
followed by an additional survey (structured inter-
views), Cox & Alexander (1999) categorized the
important elements in satisfaction with hearing aids
in six domains: benefit, cosmetics and self-image,
sound quality/acoustics, comfort and ease of use,
costs, and service.
In adults with an ID, rehabilitation with hearing
aids often fails or is not even started. It is often
assumed that people with an ID do not easily
© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd
volume 51 part 11 november 2007
accept hearing aids. We have shown that insufficient
involvement of providers of ID services and
unfavourable acoustics may play a negative role in
this process (Meuwese-Jongejeugd et al. 2005).
McMillan et al. (2000) have shown that a deaf
awareness training for staff has a positive effect on
carers’ knowledge of hearing impairment and
hearing aid management, and on the use of strate-
gies to facilitate communication. In a pilot study,
we explored whether in adults with a mild or mod-
erate ID, comparable elements as in the general
population may contribute to expectations of
hearing aids and to satisfaction with the application,
and to what extent they are dependent on carers for
the use and maintenance of the devices.
Methods
Study design
A descriptive pilot study was established.
Study group
We assumed that adults with a mild (IQ 55–70) or
moderate (IQ 35–55) ID would have sufficient com-
munication skills to participate in the study, under
the condition that the researcher was an ID physi-
cian with many years of experience in communicat-
ing with persons with an ID. Sixteen adults with a
recent diagnosis of hearing impairment, defined as
a loss of more than 25 dB at the best ear, averaged
over 1, 2 and 4 kHz (Evenhuis & Nagtzaam 1998),
were recruited from an implementation study of
audiological rehabilitation in ID services, which was
in progress in 2002. The degree of hearing impair-
ment was classified as mild (losses of 26–40 dB),
moderate (41–60 dB), severe (61–80 dB), or pro-
found (over 80 dB) ( World Health Organization
1997). Written informed consent was obtained from
the participants and/or their legal representatives.
Methods
The audiological rehabilitation programme included
dissemination of specifically designed information
booklets (Meuwese et al. 2002), hearing aid pre-
scription and training, training of staff, and advice
on optimization of acoustic circumstances
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A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction
(Meuwese-Jongejeugd et al. 2005). All participants
were interviewed individually by the researcher
before, and 6 months after, the introduction of
hearing aids. Topics of the semi-structured inter-
views were related to the research question (Appen-
dix 1). The interviewer used an open interview
technique, posing short simple questions, and asked
the clients to illustrate their answers whenever this
was relevant. During the interview, it was regularly
checked with the interviewee whether the informa-
tion was correctly understood. In case of answers
regarding colours, it was checked whether the par-
ticipant could correctly point out the specific
colour. Each client was first tested on ‘acquiescent
responding’: the tendency of providing the inter-
viewer with desirable answers (Appendix 2)
(Cummins 1997). The interviews lasted around
10 min each, and were recorded on tape after
consent of the interviewee. The taped interviews
were transcribed literally by an independent
coworker. The analysis was performed in a qualita-
tive, descriptive way. Reported positive and negative
experiences were compared with the domains of
satisfaction, as identified for the general adult popu-
lation (Cox & Alexander 1999): benefit, cosmetics
and self-image, sound quality/acoustics, comfort
and ease of use, and service. The domain of costs
was not included, because in the Netherlands,
hearing aids are reimbursed by health insurances.
Results
Study group and characteristics of rehabilitation
Characteristics of the 16 participants are presented
in Table 1. Acquiescent responding testing identified
two participants ( J and L), who were not able to
give reliable answers. Hearing aids turned out to be
a success in J, and a failure in L. The remaining 14
participants were six females and eight males in the
age range of 30–67 years. Nine participants lived in
community-based homes, and five in larger residen-
tial settings. Nine had a mild, and five a moderate
hearing impairment. Ten participants were pre-
scribed binaural hearing aids, whereas four got uni-
lateral hearing aids because of asymmetrical hearing
loss or untreatable loss in one ear. Prescribed
hearing aids were analogue (6), digital (6) or hybrid
(2) (Table 1). All clients were primarily prescribed
© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd
volume 51 part 11 november 2007
‘behind the ear’ hearing aids. However, client F
received ‘in the ear’ hearing aids, because he
insisted on having these owing to his glasses. A
speech and language therapist to provide hearing
aid habituation and training was not available to
four participants. Acoustical circumstances had not
been assessed in the living rooms of four partici-
pants, and were found unfavourable in the living
rooms of five participants, but this had not been
corrected during the time span of the pilot study.
Discussion of findings
Knowledge and expectancies before hearing aid fitting
Interviews before hearing aids were adjusted, were
obtained from 12 participants. Two participants (I
and K) were not interviewed prior to hearing aid
fitting, for psychological or logistical reasons. Ten
interviewees were aware of their hearing loss,
whereas A denied it, and M was unclear about it.
M, however, indicated her preference for sitting at
the ‘table for deaf people’, because ‘that is with ges-
tures, and there I can express myself better’. Only
four interviewees appeared familiar with the infor-
mation booklet. After the first interview, booklets
were again handed to the carers. This resulted in 10
out of 14 participants being familiar with the book-
lets during the second interview. Although one of
them thought the booklet to be worthless and child-
ish (C), and another found it difficult, the other
eight said they appreciated it, which was expressed
as: nice, good or interesting. Three of them could
illustrate this: due to the booklet, they understood
things better (N and P) and it gave practical infor-
mation (H).
All 12 clients knew why they would receive
hearing aids: ‘my ear doesn’t work’, ‘not hearing
well’, or ‘to hear better’. The number of hearing
aids was mentioned correctly by five and incorrect
by four, and three persons did not know. Based on
experience with hearing aids in parents or house-
mates, six persons knew what hearing aids looked
like. E assumed that the hearing aid would be put
under his skin (he pointed at his chest) and from
there linked to the ear with a wire. Five clients
knew what hearing aids would do for them: the
sound would be louder (C and M), or they would
hear better (B, D and F). D added: ‘A little wire
 916

Table 1 Characteristics of participants, their hearing function and hearing aids

Speech and
Age Interval start Type HI in HI in Classification Number language
Sex (years) HA– interview of care Level of ID dB right dB left of HI HA of HA therapist Acoustics
Journal of Intellectual Disability Research

A 씸 48 6 months Inst Moderate 38 43 Mild Analogue 2 + Favourable

B 씹 54 6 months Inst Moderate 75 42 Moderate (R > L) Analogue 1 on L + Favourable
C 씹 45 6 months Inst/cb Mild – moderate 27 40 Mild Analogue 1 on L + Unfavourable
D 씸 36 6 months Inst Moderate 27 28 Mild Analogue 1 on L + Favourable
E 씹 60 6 months Inst Moderate 35 82 Mild (L > R) Analogue 1 on R + Favourable
F 씹 54 6 months Inst/cb Mild 38 42 Mild In-the-ear-canal 2 + Unfavourable
G 씹 55 6 months Inst/cb Moderate 38 37 Mild Digital 2 +→– Unfavourable
H 씸 54 6 months Inst/cb Mild – moderate 37 48 Mild Digital 2 + Unfavourable
I 씸 43 4 months Inst Moderate 60 55 Moderate Hybride 2 + Favourable
K 씹 30 6 months Inst/cb Mild 38 48 Mild Hybride 2 – Unfavourable
M 씸 47 1 month cb Mild 50 50 Moderate Digital 2 – ?

© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd

N 씸 66 6 months cb Moderate 62 47 Moderate Digital 2 – ?
O 씹 67 6 months cb Moderate 52 58 Moderate Digital 2 – ?
P 씹 38 6 months cb Mild 37 43 Mild Digital 2 – ?
Excluded participants because no relevant answers were given:
J 씹 57 Inst Moderate – severe 43 50 Moderate Hybride 2
L 씸 60 cb Moderate 45 45 Moderate Digital 2
A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction

Inst, institutional based; cb, community based; Inst/cb, living in the community but using the facilities of the nearby institution; HI, hearing impairment; HA, hearing aids; ID, intellectual
disability; R, right ear; L, left ear; ?, not assessed.
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 Journal of Intellectual Disability Research
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A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction
Table 2 Attitude towards hearing aids before application
A ‘Don’t like it that I will get hearing aids’ (could not specify
this further)
C ‘If they trouble me, I won’t wear them, I won’t wear
them’
D ‘I am afraid that I will have to live with them all my life’
F ‘I like it, because I know that when I will have a little thing
like that, I will hear somewhat better’
G ‘Give it a try; old age I think’
M ‘I want that it cannot be seen, but that there is one in it
alright’
N ‘On the 11th I will have to go to the ear doctor and then
they can check if I need a hearing aid, or maybe not’
P ‘Honestly I am glad that I will receive it, because then I
will be able to hear a lot better’
that will move your ear’. F had heard he would
have the hearing aids on trial first and was worried
that he would be used as a guinea pig.
Three participants expressed (moderately) posi-
tive expectations (F, G and P) and three others had
a more negative response, which had to do with
comfort (C) and fear of the lifelong aspect of the
fitting (D), whereas A could not specify her attitude
any further (Table 2).
For client M, invisibility was important. Four
participants preferred brightly coloured hearing aids
(blue and red), one a grey one, two were satisfied
with brown, two had no colour preference and two
did not know.
As a conclusion, most participants were aware of
their hearing loss and familiar with the reasons for
hearing aids prescription. Given information was
remembered incompletely or incorrectly. Therefore,
information before and during hearing aid fitting
should be checked and repeated. Effective informa-
tion might add to positive expectations of hearing
rehabilitation. About half of the group communi-
cated specific preferences for cosmetic aspects
(bright colours, invisibility).
Acceptance and satisfaction after hearing aid fitting
Hearing aids were a success in 11/14 participants
(Table 3). With the exception of one, they received
hearing aids on both sides. As reasons for success
were mentioned: hearing (other persons) better (A,
F, H, I and O), understanding other persons better
(D, K and N), understanding better what is said on
© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd
volume 51 part 11 november 2007
television and radio (B), and improved detection of
sounds (F: traffic and cat). In addition to under-
standing other persons better, P described a
decrease in fatigue, which enabled him to work
whole instead of half days.
A special case is G, in whom hearing aids were
an initial success after introduction under the guid-
ance of a speech and language therapist. During a
check-up of the hearing aids, the audiologist had
increased the volume of the hearing aids, which was
too loud for G, so his devices disappeared in a
drawer. Until the second interview (2.5 months
later), no action had taken place to solve this
problem. Fitting with hearing aids failed in three
participants (C, E and M). E and M did not experi-
ence any benefit, whereas for C, irritation of the
device in his ear and whistling dominated his expe-
rience; benefit was neither reported nor denied.
Twelve participants were content with the looks
of the hearing aids (‘nice’, ‘good’, or satisfaction
with small size). E and M, in whom hearing aids
failed, were not content with the visibility of the
hearing aids. All participants received skin-coloured
hearing aids. Ten were content with this colour,
although three of them had preferred red ones prior
to the fitting, whereas two (B and O) would now
prefer brightly coloured ones (blue and red).
Eleven participants reported problems with envi-
ronmental sounds (Table 4). In five of these cases,
acoustics in the living rooms had been established
as unacceptable. Eight persons were troubled by the
loudness of sounds, caused by other people’s voices
(A, D, K and P), the television set or radio (F and
M), the wind (F), or by everything (H and G),
which resulted in nonacceptance in one case (G).
Two persons were troubled by persons talking at
the same time: D did not understand what was
said, and K found it very tiring. Three participants
(A, C and N) were disturbed by humming or whis-
tling sounds when other people were talking or
when the television was switched on. Indeed, envi-
ronmental sound is included in the adversiveness
score in the Abbreviated Profile of Hearing Aid
Benefit (Cox & Alexander 1995) and has been
described by Kramer et al. (1995) as intolerance of
noise.
Five participants reported trouble with the
hearing aids, caused by pain (B, N and P) or dis-
comfort (C and M), whereas D removed her
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A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction

Table 3 Reasons for success or failure of hearing aid fitting

Success or
failure Reason for success or failure

A + ‘I can hear better now. Sound of people. If they talk I can understand them’
B + ‘I can hear better what they say, on television and on the radio. If the hearing aid is out of
my ear, then I cannot hear so loud, very soft. I want a hearing aid just like this for the
other ear’
C – ‘The hearing aid wasn’t comfortable, it just irritated me. So I said: I take it off and will not
put it in for the time being’
D + ‘I can understand staff better, that’s important’
E – He could not tell the difference with or without. ‘I think it is a waste of money.’ Apart
from this, he thought the hearing aid to be too big. ‘People were staring at me’
F + ‘I think they are perfect. I had asked for these (‘in the ear’ hearing aids) you know’. One
hears better, I can hear the oncoming traffic better. And if my cat is miaowing a few
houses down the block, then I know exactly: that’s my cat’
G +→– Hearing aids did help him at the start but: ‘Some bloke messed with them. I am not going
to mess with your (interviewer) things either, put things loud. It drives me crazy’
H + ‘I can hear better’
I + ‘Without hearing aids I can not hear it, hearing aids make you hear other people better’
K + ‘Can hear better what we are talking about’
M – She found it a nuisance when hearing aids were inserted in the ears and were taken out
again. Apart from this, she thought she would receive one hearing aid only. ‘They are in
an envelop in the hearing aid shop, but I won’t wear them, I’m not going there anymore
for these aids, if I can communicate well like now’. ‘It was louder with the hearing aids.
But I can talk more easily without them’. ‘I didn’t like these things behind my ears. I want
to have something that you cannot see. I would like to give that a try’
N + ‘Carers had to say things a few times, and I said: I don’t understand it. Now I understand
everything’
O + ‘If they are in my ear, I can hear more easily, if somebody starts to talk to you I can hear it
more easily’
P + ‘If somebody says something to me, I can hear things better’. ‘I work on a school as a
caretaker. Before, I had to copy something, say two or three times, and then I came back
with five or six. And then they said: no, we’ve ordered two or three. And then I said: I
didn’t hear it’ From January I worked half days, April 1st I received my hearing
aids, . . . and since 14 days I am back to working all day’

hearing aids during meals, because of fear that her
ears would start itching afterwards. Four persons
reported persistent humming or whistling sounds
after hearing aid fitting (A, C, E and I). Three par-
ticipants with such complaints attended their
hearing aid dispenser, who had his shop next door
and successfully ‘did something about it’. In one
participant with pain, the problem still existed at
the time of the interview, 6 months after hearing aid
fitting.
We conclude that, like in the general population,
perceived benefit appears to play a central role in
acceptance of hearing aids by adults with ID.
Reported benefit related primarily to the five factors
that Kramer et al. (1995) described as fundamental
in auditory disability: distinction of sounds, auditory
localization, intelligibility in quiet as well as in noise,
and detection of sounds. Fatigue has been described
as adding to disability, because of the constant effort
to hear and respond appropriately (Hétu et al. 1988;
Kramer et al. 1997; Grimby & Ringdahl 2000). Cos-
metic aspects, especially the visibility of hearing aids,
demonstrably influenced acceptation and satisfaction
in some cases. Although a wish for beautification of
hearing aids by bright colours was regularly
expressed in this group, this did not seem to be
crucial for acceptance. Disturbing environmental
sounds were reported in a majority of cases and may

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A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction

Table 4 Hearing aids and environmental sounds

A ‘When you are talking to somebody, then it’s really loud and it hums’. ‘If the radio is turned on, if there’s music, it hums’
B He is troubled by the sound of the wind when he is wearing his aid: ‘When I have to do some shopping (on his bicycle),
then the wind goes hoeoeoe, but the wind doesn’t bite’
C It started to whistle and to hum in the living room when he was with others. Then he removed it from his ears.
D ‘If I go to my work and put it in, then I hear people talk very loud. I rather have soft language. Sometimes I hear my
neighbour talk very loud, then I have these fears, but then I just look for staff’. ‘If people are talking with each other, I
can’t hear anything’
E No trouble with sound
F They make a lot of noise in the bus; however, in a touring bus they do not. He explains that the engine in a touring bus
is at the back instead of in the middle, as in an ordinary bus. He does not wear the hearing aids in the kitchen where
he works because of the noise. He is troubled by loud music in the living room and then asks if the volume can be
turned down
G The fitting with hearing aids failed in spite of an initial success. The volume which was increased by the audiologist
appeared to be too loud for G. No action was taken by carers to solve this problem.
H ‘If I wear them, everything sounds so loud’. ‘At my work during coffee break and with sowing and hammering I turn
them off ’. ‘If there is a little noise, like (coffee) cups and so on, then I take them out of my ears’
I No trouble with sound
K ‘At the fair it usually hurts a lot, because of the very big music boxes’. ‘When people are talking at the same time, it is
very tiring’. ‘I like to simply listen at people, but they shouldn’t have loud voices. Then I say: take it easy’
M She does not like thunderstorm and ambulances with wailing sirens or television sounds that are too loud
N ‘When the television is too loud I hear cracking, cracking noises’
O No trouble with sound
P ‘If somebody talks loudly, they are used to do that of course, then I say: not too loud’

lead to nonacceptance. Uncorrected poor acoustics
in part of these cases have most likely contributed to
the problems. A majority complained of pain and
other discomfort. Discomfort may disturb accep-
tance, and should be addressed immediately.
However, six participants appeared totally depen-
dent on carers, six partially, and only two with a mild
ID were totally independent. Especially for problems
with environmental sounds and with comfort of
hearing aids, dependency on carers may be
unfavourable. This was shown in the fact that, in
spite of given staff trainings, such problems had
mostly remained unattended until the second inter-
view, 6 months after hearing aid fitting. Effective
help for loudness of noise or discomfort was only
given to three participants who had a hearing aids
dispenser next door, which illustrates the importance
of easily accessible service.
Discussion
This small pilot study demonstrates that adults with
a mild or moderate ID are capable of expressing
their opinions on, and experiences with, hearing
aids, provided that simple, concrete questions are
asked. Elements that define satisfaction with
hearing aids in the general population (Cox &
Alexander 1999) can all be recognized in positive
and negative experiences, reported by this group.
Benefits, as described by most participants, were
completely comparable to fundamental aspects of
auditory disability (Hétu et al. 1988; Kramer et al.
1997; Grimby & Ringdahl 2000). Although the
interviews usually did not last longer than 10 min
and answers might be short and simple, problems
with cosmetic aspects, sound quality and acoustics,
comfort and ease of use, and service provision
were all clearly articulated and illustrated. Total
or partial dependence on carers and hearing aid
dispensers, even among those with mild IDs, may
hinder timely solving of problems as background
noise or pain and discomfort caused by the
hearing aids.
Although this was just a descriptive pilot study,
not providing any quantitative information, it gives
some clear indications for improvement of service
provision to this group and for research.
1 Although in this pilot, benefits of audiological
rehabilitation were articulated by a majority, this is
not scientific evidence. Well-designed studies of

© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd

 Journal of Intellectual Disability Research
920
A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction
acceptance and effects of intervention are urgently
needed, as a basis for improvement of rehabilitation
in this group.
2 Giving ID clients a choice in the looks of hearing
aids may positively influence acceptance. Although
we do realize that ‘in the ear’ hearing aids may not
be an option to every person with an ID, because of
the more complicated handling and vulnerability, it
certainly may be an option in selected clients. Prac-
tical barriers to obtain coloured devices, e.g. after a
prolongued hearing aids training, should not auto-
matically preclude a choice of coloured devices in
all cases.
3 Attention to quality of sound and acoustics are of
paramount importance in ID services (Egli et al.
1999). In general, the sound-absorbing quality of
furniture, curtains and floor covering is low because
of cleaning reasons and wheelchair use, leading to
long reverberation times. As a result of group life,
different activities may occur simultaneously, of
which many (talking, watching TV, listening to a
radio, and cooking food) produce sound. This may
severely complicate comfort and acceptance of
hearing aids. It can be solved by adjusting Wide
Dynamic Range Compression in hearing aids and
by environmental noise reduction. Audiologists and
hearing aids dispensers, as well as carers, all should
be made aware of this important aspect. So far, no
research has been published into architectural solu-
tions for homes and day activity centres, and their
effects on acceptance of audiologic rehabilitation
and on well-being.
4 Improved detection and solution of problems
with hearing aids requires educated professional
carers, next to careful instruction of clients. In
many countries, professional carers in ID services
have a social-educational background and lack
knowledge of sensory impairments. The same
applies to supporting psychologists and behavioural
therapists. The high risk of hearing (as well as
visual) impairments in the ID population justifies
training programmes, in both basic and postgradu-
ate education.
5 Easily accessible professional help (hearing
aids dispenser, speech and hearing therapist)
appears to be of great help in case of problems
with hearing aids and is relatively easy to realize.
Here is a task for the management of ID service
providers.
© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd
volume 51 part 11 november 2007
Acknowledgements
This research was financed by grants of the Nether-
lands Organization for Health Research and Devel-
opment (ZonMw 97-06-012), the Amantia
Foundation and De Bruggen Intellectual Disability
Centre, Zwammerdam, the Netherlands. We are
grateful to all persons who participated in the inter-
views. Alireza Ghandi typed the interviews.
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Accepted 14 December 2006
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A. Meuwese-Jongejeugd et al. • Hearing aids in persons with an ID: attitude and satisfaction

Appendix 1: Topics of the interview before booklet? Did the booklet help you with your
and after the start with hearing aids hearing aids?
(translated from Dutch) 7 What do other people think of your hearing
aids?
Interview before the start with hearing aids
8 How does it feel to have the hearing aids in
1 I am told that you will receive hearing aids. Why
your ears?
will you receive hearing aids?
9 Do the hearing aids hurt you every now and
2 Did you notice yourself that you can’t hear
then?
properly?
10 Are there sounds that bother you?
3 How will those hearing aids help you?
11 Who puts the hearing aids in your ears?
4 What do hearing aids look like?
12 Who takes the hearing aids out of your ears?
5 Would you like to receive coloured hearing aids?
6 Will you have one or two hearing aids?
7 What do you think about the hearing aids that
you will receive? Appendix 2: Client testing for acquiescent
8 Who told you that you will receive hearing aids? responding (Cummins 1997)
What did he/she tell you?
Procedure:
9 Did your carer show you a booklet on hearing
The primary carer may be present for the adminis-
aids? Can you remember what is in the booklet?
tration of the test. However, if they are present, it is
Can you describe a picture in the booklet? What
essential that:
do you think of the booklet?
1 They be instructed to make no response whatso-
10 Do you know other people with hearing aids?
ever to the questions as they are read to the
11 What do you think about those hearing aids
client.
12 Do you have any questions about the hearing
2 They must be located outside the client’s visual
aids?
field.
13 Do you have anything to add about the
hearing aids? Administration:
After checking that the carer is informed as above,
Interview after the introduction of hearing
and the client is comfortable and ready to respond,
aids
carefully and slowly read each question:
1 What do you think of your hearing aids?
1 Point to the client’s watch or some item of
2 Do the hearing aids help you?
clothing.
3 Do you wear the hearing aids all day?
‘Does that (watch) belong to you?’
4 What do you think of the way the hearing aids
2 Do you make all your own clothes and shoes?
look like?
3 Have you seen the people who live next door?
5 What do you think of the colour of the hearing
4 Did you choose who lives next door?
aids?
6 Are you familiar with this booklet (booklet is Scoring:
shown)? Can you remember what is in the If a positive response is provided to items 2 and 4,
booklet? Can you describe a picture in the no further testing should take place.

© 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd