Barriers and enablers to referral of older adults to hearing care: a cross-sectional questionnaire study of Australian general practitioners

Ella C. Davine; Peter A. Busby; Sanne Peters; Jill J. Francis; David Harris; Barbra H. B. Timmer; Julia Z. Sarant

doi:10.1071/PY24224

RESEARCH ARTICLE (Open Access)

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Barriers and enablers to referral of older adults to hearing care: a cross-sectional questionnaire study of Australian general practitioners

Ella C. Davine

^A ^* , Peter A. Busby ^A , Sanne Peters ^B , Jill J. Francis ^B ^C , David Harris ^D , Barbra H. B. Timmer ^E ^F Julia Z. Sarant ^A

+ Author Affiliations

- Author Affiliations

^A University of Melbourne, Department of Audiology and Speech Pathology, Carlton, Vic 3053, Australia.

^B University of Melbourne, School of Health Sciences, Parkville, Vic 3052, Australia.

^C Ottawa Hospital Research Institute, Ottawa, ON, Canada.

^D University of Melbourne, Department of Economics, Parkville, Vic 3052, Australia.

^E Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Services, The University of Queensland, Brisbane, Qld, Australia.

^F Sonova AG, Staefa, Switzerland.

^* Correspondence to: e.davine@unimelb.edu.au

Australian Journal of Primary Health 31, PY24224 https://doi.org/10.1071/PY24224

Submitted: 20 December 2024 Accepted: 7 May 2025 Published: 3 June 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY)

Abstract

Background

Acquired hearing loss has significant negative effects on quality of life, general health, maintenance of independence, and healthy aging. Despite this, rates of self-directed help seeking are low, as are referral rates from general practice to hearing care. This study aimed to explore the barriers and enablers to general practitioner (GP) referral of adults aged 50+ years to hearing care.

Methods

A cross-sectional questionnaire was designed using the Theoretical Domains Framework of behaviour change and administered to a self-selected sample of 103 Australian GPs.

Results

Identified enablers included positive beliefs about the consequences of hearing rehabilitation and experiencing positive role models of hearing care including referral. Contextual issues such as time constraints, costs of hearing care, and limited availability of local audiology resources were the most frequently cited barriers to referral. Content analysis of free-format responses yielded 25 themes in total, eight of which were not previously documented in the published literature.

Conclusions

GP beliefs about hearing care and the outcomes of referral were generally positive, however, logistical concerns and contextual constraints such as restricted appointment times were prominent barriers to hearing care referral. Identifying the key barriers and enablers to GP referral of older adults to hearing care will facilitate the design of targeted behavioural interventions aimed at increasing referral rates. Further qualitative investigation of the key modifiable barriers and enablers identified in this study is warranted to clarify how best to address these in clinical practice.

Keywords: audiology, barriers, COM-B model, enablers, general practice, health, healthy aging, hearing care, older adults, primary care, referral, Theoretical Domains Framework.

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