Uwe Andreas Hermann


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The process of recognising the need for hearing help: a grounded theory study

This PhD study used a qualitative approach to illuminate why people often are slow to seek hearing help. The study identified a process of four stages towards recognition, but did not find evidence of stigma.


A large proportion of people who could benefit from hearing-aid fittings either never acquire hearing aids, or do so very late. One approach to this issue is to describe the processes (emotional or psychosocial) which people typically go through to become ‘ready’ for hearing help, and then to devise ways to help people towards true readiness.

To a large extent, these processes go on before the client ever meets a hearing care professional, so the potential for this study to generate innovation in dispensing processes is limited. Nevertheless, this type of work can inspire methods to ensure that the crucial first meeting with a hearing care professional leads to success rather than rejection, plus appropriate ways of addressing the general public. 


With this type of research question, qualitative methods are highly appropriate. The method chosen here was Grounded Theory according to Glaser1, whereby concepts emerging from the collected data form an explanatory model which is not strictly proven, but is ‘grounded’ in the data. Interviews were carried out with fourteen adults with varying degrees of hearing problems. Some had scarcely begun the process of recognising their hearing loss, while others were in process with clinical services, or were hearing-aid users.

The process of recognising the need for hearing help a grounded theory study
The study concluded that it is more fruitful to think of people as being in a process towards recognition, rather than in a state of stigmatisation or denial. Appropriate help to move a person forwards will depend on what stage of recognition they have reached.


The recognition process towards “time for hearing” could be divided into four more-or-less distinct stages:

  1. ‘Attracting attention’; people with an emergent hearing loss begin to draw attention to themselves due to communication breakdowns.
  2. ‘Becoming suspicious’; the person in question starts to notice that their communication is more fallible than it should be. However, confusions and attention-attracting incidents are not so frequent that they cannot be explained away as ‘normal’.
  3. ‘Sensing tribulation’; people recognise the consequences of their hearing problems and have emotional and behavioural reactions. Now there are negative consequences for their self-identity.
  4. ‘Jeopardising fundamental self’; the moments of relational and personal tribulations have intensified so much that the person’s sense of self is threatened. They may feel a risk of alienation from their normal self and from other people. Adaptation is no longer possible. This is where the person decides that it is time to seek help.

The outcome of the whole process – “Time for hearing” – is a decision for action.

Further reading

1 Glaser B (1992). Emergence versus forcing: Basics of Grounded Theory Analysis. Sociology Press, Mill Valley, CA.

Prochaska, JO, Velicer, WF. (1997). The transtheoretical model of health behavior change. Am J Health Promot. 1997 Sep-Oct;12(1):38-48.

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    Ph.D. thesis

    Time for hearing

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    Study Partners

    This study was the PhD project of Gitte Engelund, and was carried out with the supervisory collaboration of Lars Von der Lieth, Copenhagen University, and Barry Gibson, Sheffield University.