Table 2. Barriers and facilitators identified for smartphone-connected hearing aids, based on the COM-B model.

COM-B domain	Facilitator	Barrier
Capability	App increased users' knowledge and understanding of how to control the hearing aid. This encouraged self-management of hearing loss.	Self-perception of poor digital literacy and skills. Increased cognitive burden due to deciding which controls to use.
Opportunity	By controlling the sound quality, participants were more likely to participate in conversations. Greater likelihood of adjusting their device in noisy situations, and so very useful.	Smartphone norms and different listening contexts, where people felt “rude” using their smartphones in company. Rapid change in environmental sounds led to a reduction in user-control, so set to automatic.
Motivation	User-control to fine-tune hearing aids enabled participants to meet their individual listening and communication needs (i.e., reduce background noise). Led to greater confidence and participation and was also seen as a benefit to others. Smartphone technology helped reduce hearing aid and self-stigma. Empowerment emerged as a key theme as people could control and use their hearing aids how and when they wanted.	Perceived generational smartphone behaviors where smartphone use is more common for younger generation.