Digital Interventions for First-Time Hearing Aid Users: A Systematic Review and Meta-Analysis of Efficacy and Effectiveness.

Only nine trials were available and several were small (10 to 343 people), so modest but real effects could have been missed. Most randomised trials were judged to have 'some concerns' for risk of bias, usually because they did not report how they concealed who was allocated to which group, had no registered or pre-specified analysis plan, and relied on participants' own reports while participants knew which treatment they were receiving. The two single-arm studies and the one non-randomised trial were at serious risk of bias; without a control group, their improvements may simply reflect the natural adjustment that happens in the first weeks and months of hearing aid use. Nearly everyone in the studies had a smartphone or computer and reasonable digital confidence, so the findings say nothing about people who are not digitally confident or equipped. Outcome measures differed widely between studies, and even the same questionnaire was sometimes scored as a total and sometimes item by item, so only four outcomes could be pooled. Follow-up was short in many studies, so nothing is known about longer-term effects. Six of the 11 studies did not state which outcome was primary, so it is hard to judge how much weight each result deserves. Much of the knowledge and skills evidence comes from studies of one programme, C2Hear, so it may not extend to other digital tools.

The authors report that they received no financial support for the research, authorship or publication of the article, and declared no potential conflicts of interest.

Do not read the large improvements reported in the two single-arm studies, or the subgroup result in poorer users, as evidence that digital programmes increase hearing aid use. The single-arm studies had no control group, and first-time hearing aid users improve with standard fitting alone. Across the trials that did have a control group, hearing aid use did not differ, and the benefit among people using their aids less than 70% of the time at baseline came from one subgroup analysis in one trial.