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Journal of the American Academy of Audiology logoLink to Journal of the American Academy of Audiology
. 2026 Jan 1;37(1):15–23. doi: 10.3766/jaaa.240088

Health Literacy and Over-the-Counter Hearing Aid Messaging

Ariel Hatley *, Abigail Griffith *, Candice Reed *, Sara Champlin †, Sharon Miller *,✉
PMCID: PMC13086609  PMID: 40916427

Abstract

Background:

On October 17, 2022, the U.S. Food and Drug Administration (FDA) formally established a new category of hearing aids (HAs), now available over the counter (OTC). This new self-delivery model bypasses licensed practitioners, meaning consumers may rely more on manufacturer advertising to learn about OTC HA devices.

Purpose:

This study aimed to (1) document the (a) hearing-health literacy educational content strategies and (b) persuasive messaging strategies present in online advertisements from OTC manufacturers; and (2) analyze how the hearing-related advertising content changed before and after the October 17, 2022, final FDA ruling on OTC devices.

Research Design:

Pre-post content analysis.

Study Sample:

A total of 295 branded social media posts from three prominent OTC HA brands were analyzed. All posts from each manufacturer 6 months before and 6 months after the OTC HA final rule on October 17, 2022 (1 year in total) were queried and included in the sample.

Data Collection and Analysis:

A coding team systematically analyzed the content of the OTC posts. Pearson’s χ2 tests assessed differences in educational and persuasive messaging content present in the OTC posts before and after the FDA ruling.

Results:

The results revealed the majority of OTC posts simply urged consumers to visit the brand’s website, encouraged immediate product purchase, or detailed features of their OTC HAs, such as the size and discreetness of the devices. Conversely, content vital for effective health communication such as hearing-health information, hearing loss statistics, and usage guidelines were not emphasized. Examination of health literacy content before and after the FDA announcement found that posts featuring hearing-health information significantly increased after the announcement. However, overall, the number of posts containing educational or consumer-informing details about OTC HAs remained low.

Conclusions:

The findings of this study suggest OTC HA advertisements lack important hearing-health literacy content. Despite FDA approval, the observed promotional orientation of OTC HA advertisements indicates an existing gap in educational content and highlights the need to better incorporate health literacy content into OTC HA marketing to promote informed choices for adult consumers with hearing loss.

Keywords: health literacy, over-the-counter hearing aids, social media

INTRODUCTION

In the United States, approximately 40 million adults have some degree of hearing loss, with prevalence increasing with age (Hoffman et al., 2017). However, data suggest that for those who could benefit from amplification, hearing aid (HA) adoption rates are still relatively poor across all age groups (Jorgensen & Barrett, 2022; Picou, 2020). Moreover, once a hearing loss is noticed, it often takes an adult an average of 6 years to pursue amplification (Simpson et al., 2019). In an attempt to increase access by addressing known barriers to HA adoption, such as cost and access to hearing professionals (Kochkin, 2009; Kochkin et al., 2010), the U.S. Food and Drug Administration (FDA) recently created a new class of over-the-counter (OTC) HAs for adults with mild to moderate hearing loss that coexists alongside the traditional prescription HA pathway (Warren & Grassley, 2017). The final FDA rule on OTC HA devices went into effect on October 17, 2022, allowing HAs to be sold directly to consumers. The creation of the OTC HA device category represents a dramatic shift in the hearing-health-care delivery model by allowing consumers to bypass licensed hearing-health-care professionals and purchase HAs directly from manufacturers and retailers. Although the advent of OTC HAs holds promise in broadening access, a critical challenge will be how these devices are marketed to the public to ensure consumers can find and access accurate, factual information to make adequate decisions for their hearing-health care.

Health Literacy and Hearing Health

Health literacy, broadly defined as the ability to find, understand, use, and communicate about health information to make informed health-care decisions (Berkman et al., 2010; U.S. Department of Health and Human Services, 2010), will play an important role in the uptake of self-service OTC HAs. Important skills that reflect adequate health literacy include being able to actively manage one’s health, navigate the health-care system, complete medical forms, adhere to medication instructions, and find valid health information by oneself (Osborne et al., 2013). Other scholars emphasize that health literacy capacities include the “possession of knowledge about health” and denote taking in new information about a health topic as integral to health literacy development (Pleasant & Kuruvilla, 2008). Being able to distinguish factual health information from marketing material is critically important in the digital era where 70 percent of the U.S. population reports going to the internet as their first source when seeking health information (Finney Rutten et al., 2019).

Unfortunately, national estimates suggest that one out of every three U.S. adults has basic or below basic health literacy, and limited health literacy is more prevalent among adults who are 65 years of age or older (Kutner et al., 2006). Limited patient health literacy is associated with poorer overall health, greater use of emergency health services, and higher mortality (Berkman et al., 2011). In an audiology-services context, Nair and Cienkowski (2010) observed poor hearing-health literacy among HA patients because of the significant mismatch between patient reading levels and the terminology used in HA instructional materials. In addition, Wells et al. (2020) found that adults with unaided/untreated mild hearing loss were 46 percent more likely to report limited health literacy when compared with persons with normal hearing. These previous findings are concerning because the OTC model for hearing-health care requires consumers to, without support from a health-care provider, recognize a need for amplification, comprehend benefits and barriers of HA options, seek and evaluate relevant information, understand candidacy requirements, and fit and use OTC HAs correctly, all of which require a high degree of health literacy (Nair & Cienkowski, 2010). Thus, it is important to explore a range of opportunities that could support patients who might pursue HAs through OTC options.

Without required involvement from audiologists or other health-care providers, it is important to analyze how consumers and potential consumers (including caregivers) might attain information about OTC HA options. Research in this area is in its infancy given the recency of the FDA decision; however, one study found that among pharmacists who could assist consumers with the purchase of OTC HAs, 65 percent did not know that these options were available and 55 percent indicated that they were “not at all familiar” with OTC HAs (Midey et al., 2022). Another avenue for communicating about OTC HAs to the public is through messages from OTC HA manufacturers themselves. For consumers to become aware of the new OTC HA options, manufacturers may be the most immediately invested in promoting awareness and knowledge about OTC HAs. Moreover, a manufacturer may be a consumer’s only source of information about HAs, now that they can be purchased OTC. To date, the health literacy content in OTC HA advertisements has not been explored.

Promoting Hearing-Health Literacy Through Knowledge

Promotional materials from health-care brands and companies have the potential to educate the public and, in turn, promote health literacy (Mackert, 2011). This is especially relevant in the context of OTC HA manufacturers creating their own messages to communicate with consumers. For example, An and Muturi (2011) argue that direct-to-consumer (DTC) prescription advertisements “have the potential to effectively communicate health information and reduce health disparities among older consumers who have increased need for health-care information but who might experience more difficulty in understanding or using that information.” Findings from previous research suggest that it is possible for DTC advertisements to provide information about symptoms, precursors, prevalence, and misconceptions about illnesses (Bell et al., 2000), as well as help those living with an illness manage their experiences over time, albeit at limited levels. In interviews with advertising professionals, the educational aspects of DTC advertisements were seen as perhaps better than nothing in that the advertisements provided some information about health topics, but educational messages were often incorporated into advertisements when they held promise of directing viewers to pursue a given medication (Mackert, 2011).

Others argue, however, that promotional and marketing aspects of health communication are “inherently at odds” with health education (Bell et al., 2000), and that messages created by health companies in the effort to sell products simply cannot (or will not) provide straightforward education about health issues unless this information persuades consumers to buy their products. Indeed, in the context of DTC drug advertisements, a content analysis found that although the advertisements provided an average of six facts about the benefits of taking a given prescription, this information was provided in an average of only 10 seconds (Kaphingst et al., 2004). Moreover, these advertisements often highlighted and gave more weight to drug benefits than to risks (Kaphingst et al., 2004), thus inherently doing more to promote products than giving viewers ample time to decipher the associated risks. The content of messages provided by OTC HA manufacturers matters because it is possible that consumers with limited health literacy will reach these messages before other content. Indeed, individuals with lower health literacy are more likely to rely on persuasive, nonfactual sources for health information, including television, social media, blogs, and celebrities (Chen et al., 2018). To date, the educational versus persuasive content contained in OTC HA advertisements has not been systematically examined.

Study Rationale and Aims

Using the delineation between health education and promotional/persuasive health marketing as a guide, this study examined OTC HA social media messages for important health literacy content from the three manufacturers with the highest number of followers on Facebook. OTC HA advertisements from a 1-year period were analyzed to determine the prevalence of educational messaging strategies that help consumers understand health topics, including hearing-health information, hearing-health data and statistics, explanatory graphics, and explanations for how to use or care for OTC HAs. The presence of persuasive marketing messaging strategies was also analyzed by evaluating how OTC HA manufacturers promoted specific features of their products or directed consumers to visit another site.

To determine whether OTC HA manufacturers adjusted their messaging approaches to include content that promotes health literacy in their posts after OTC HAs became available, this study compared content in the advertisements for the 6 months leading up to the final OTC HA ruling in October 2022 and the 6 months after the final ruling. We hypothesized that the FDA announcement would bring large-scale attention to OTC HAs, thus prompting more conversations or inquiries from consumers. OTC HA manufacturers might leverage the two-way, flexible, and timely communication afforded by social media platforms such as Facebook (in contrast with printed marketing materials such as pamphlets or handouts) to answer questions or provide information to educate audiences about HAs and their benefits following the announcement. Moreover, given that consumers no longer need to visit a health-care professional to evaluate, purchase, and use HAs, we expected to observe manufacturers providing the public with more information, such as hearing-health facts and diagrams, through Facebook posts after the FDA announcement. Manufacturers may now be the only source of information a consumer receives about hearing-health care. The results of this study have important clinical implications because they will shed light on whether consumers with hearing loss might have access to the appropriate health information needed to make informed decisions about pursuing OTC HAs.

METHODS

Study Sample

This study queried Facebook posts from three prominent OTC HA brands. Facebook was selected because of the older demographic it serves relative to other social media sites (Auxier & Anderson, 2021). The three OTC brands were selected by analyzing the follower count of all known OTC manufacturers at the time of the study (n = 38) and selecting the three brands with the highest number of followers. The brands chosen were manufacturer A (40,000 followers), manufacturer B (17,000 followers), and manufacturer C (12,000 followers).

The final dataset contained Facebook posts from the three target OTC HA brands for a 6-month period preceding and following the FDA OTC final ruling on October 17, 2022. Thus, posts were selected if they occurred between the 1-year interval of April 17, 2022, to April 17, 2023. Posts were not included in the dataset if they contained irrelevant content, that is, a Happy Holidays post. In total, the full study contained 295 (n = 295) branded posts that were analyzed. Because this study did not enroll human subjects, it was exempt by the University of North Texas Institutional Review Board.

Coding Dimensions

To systematically analyze the messages created by OTC HA manufacturers, we created a codebook through observation of posts and discussion among the research team, as well as guidance from existing health literacy and health education criteria checklists (Doak et al., 1996; Gray et al., 2021). The codes in the following subsections were assessed related to educational messaging and persuasion strategies contained in the advertisements.

Educational Messaging Strategies

Hearing-Health Information:

Does the post include point-blank facts, recommendations, or information about hearing health? This code reflects facts about general hearing health or hearing loss. Following are some examples:

  • “Hearing loss is the third most prevalent chronic health condition facing older adults in the U.S.”

  • “Did you know? Hearing damage can occur within minutes. Literally minutes.”

  • You may not know this, but HAs have a long history. They date back to the 1700 s when people used ear trumpets to amplify sound. Luckily, the first electric HA was invented in 1898 by Miller Reese Hutchison; today, we have digital HAs that can stream media and connect us to our modern lifestyle.

Data or Statistic:

Does the post include any “data” or statistics or numbers about hearing health, including HAs, hearing loss, etc.? This includes statistics related to hearing loss, unsafe listening practices, etc. Following are some examples:

  • ‘“Over 1 billion young adults are at risk of permanent, avoidable hearing loss due to unsafe listening practices.’ —WHO.”

  • “48 million Americans with hearing loss”

Explanatory Diagram or Visual:

Does the post use diagrams or visual “infographics” to explain a concept? If you moved the image to another part of the post, would it still communicate/explain anything? The idea is that an image is used to help explain a concept such as the use of iconography; a medicine label has pictures instead of instructions. Examples include:

  • A diagram showing an HA feature

  • A picture of person running outside, with a little callout box to show a closer picture of the HA

  • A diagram comparing two types of HA

How to Use:

Does the post include information about how to use HAs? This includes tips, recommendations, reminders about charging, getting HAs wet, cleaning/maintenance, etc. Following are some examples:

  • “Weekend Tip: Whatever you have planned for the upcoming weekend, remember to take your charger with you, so you can hear, uninterrupted!”

  • “Accessorize and take care of your HAs! Why are HA accessories a necessity? Cleaning your HAs. Replacing the wax guards and domes. Drying capsules to keep them secure.”

Persuasive Messaging Strategies

Features:

Does the post describe any specific features of the HA? This includes descriptions of HA functions, even if not specific to the brand. If the HA is advertised as “small” or “discreet” (or, generally, its size and ability to be concealed are being promoted as features/selling points), these are considered HA features. Examples include:

  • Streaming

  • Program options

  • Battery power

Call to Redirect:

Does the post actively direct the viewer elsewhere, for example, to another site? Keywords include: “find out now,” “read now,” “get your pair now!” Content should not be coded as a “call to redirect” if there is simply a link to a source as a way to provide a citation. Following are some examples:

  • Discreet and easy to use—our HAs are just what you need to stay on the go. Don’t wait, purchase now: (link blinded).

  • Don’t let the beat of the music beat up your hearing health! Read more on how loud music can affect your hearing: (link blinded).

  • Check out this article to learn more about our two new HAs and the no contract subscription program: (link blinded).

  • Don’t let volume harm your hearing health. When is loud too loud? Find out more: (link blinded).

Coding Analysis

A health communication expert (S.C.), three Doctor of Audiology (AuD) students (A.H., A.G., and C.R.), and a certified audiologist (S.M.) comprised the analysis team. Using the definitions in the codebook, OTC HA advertisements were systematically coded for each domain. If the advertisement contained content relating to the domain, then a “1” was entered into the coding analysis spreadsheet, and if it was absent, a “0” was entered (Table 1).

Table 1.

Sample Coding Document Used in the Analysis Displaying the Different Messaging Domains

Brand Ad description HH info Stats Redirect Visuals Guidance Features
A Tinnitus awareness 0 1 1 0 0 0
B Take care of your ears 0 1 0 0 0 0
C Listen smarter 1 0 0 0 0 0
Open in a new tab

HH = hearing health.

The frequency of health literacy content in each domain was computed for the 295 advertisements. Pearson’s χ2 tests were performed to determine whether the frequency of health literacy content present in the advertisements changed before and after the final FDA ruling on OTC HAs.

Coding Reliability

Before commencing the study, the research team worked together through ongoing discussions to ensure they were consistent in their coding. Initial coding training began by practicing with a rough draft of the codebook with Facebook posts from a different OTC HA manufacturer (manufacturer D) whose advertisements were not included in the study sample. First-round discrepancies across coders for manufacturer D’s advertisements were identified and discussed before commencing a second round of training. In the second round of training, Facebook advertisements from another OTC HA manufacturer (manufacturer E) that were not included in the study sample were analyzed.

Reliability of the full study sample was established using 10 percent of the full study sample (n = 30 posts). Ten posts (n = 10 posts) were chosen from each of the three OTC HA brands (manufacturers A, B, and C) at various time points throughout the duration of the study. The posts were coded individually, without discussion among the coders, and the Krippendorff’s alpha reliability statistics were computed (ReCal) (Freelon, 2010, 2013). Krippendorff’s alpha values ranged from 0.64 (hearing health information) to 0.84 (OTC features); these values demonstrate significant intercoder agreement (Landis & Koch, 1977; Zapf et al., 2016). Calculation of reliability values for the visuals code was not possible due to the limited number of instances in the reliability dataset.

RESULTS

Message Content in OTC HA Advertisements

The number of posts containing important educational messaging content (hearing-health information, hearing-health statistics, how-to guidance, and visuals) and persuasive messaging content (redirects or links to additional hearing-health information, OTC HA features) over the entire 1-year period (n = 295 posts) is displayed in Figure 1.

Figure 1.

Figure 1.

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Total number of advertisements by content type from three OTC HA manufacturers over a 1-year period.

Overall, of the 295 posts across the three OTC manufacturers, 9.8 percent of OTC HA advertisements sampled contained facts, recommendations, or general information about hearing health and hearing loss. In addition, 4.4 percent of posts across OTC HA manufacturers included numbers and/or statistics to relay information to potential consumers about hearing health, hearing loss, or HAs. For the how-to-use guidance domain, 3.7 percent of posts contained content related to how to use and care for OTC HAs. The analysis also revealed a sparse utilization of diagrams or visuals, because 2 percent of the manufacturers incorporated these elements in their posts. Nineteen percent of posts contained persuasive marketing content related to the features present in OTC HAs, including descriptions of the product size or discreetness of the device. Finally, regarding calls to redirect, 49.8 percent of all posts contained content where consumers would need to click a link to “learn more” about the OTC HA product.

Message Content Before and After the FDA Final Ruling

Pearson’s χ2 tests were performed to quantify whether the frequency of important health communication content changed in the 6 months before and after the final FDA ruling on October 17, 2022. As shown in Figure 2, after the final ruling, the only domain with significantly more content in the 6 months after OTC HAs became available was hearing-health information content (χ2 = 3.88, df = 1, p < 0.05). There was no change in hearing-health statistics (χ2 = 0.008, df = 1, p > 0.05), how-to guidance (χ2 = 0.432, df = 1, p > 0.05), product features (χ2 = 2.446, df = 1, p > 0.05), calls to redirect (χ2 = 0.084, df = 1, p > 0.05), or visuals (χ2 = 0.001, df = 1, p > 0.05).

Figure 2.

Figure 2.

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Number of advertisements by content type 6 months before and 6 months after the FDA final OTC ruling on October 17, 2022.

DISCUSSION

This content analysis study scrutinized social media advertisements from three prominent OTC HA manufacturers for educational versus persuasive content. In addition, to determine whether OTC HA manufacturers adjusted marketing strategies once the devices became available, educational and persuasive messaging content was compared for advertisements posted 6 months before and after the final FDA ruling on OTC HAs. Our results suggested that OTC HA advertisements were devoid of important hearing-health content known to promote health literacy, and the content present in the advertisements was mostly unchanged after the OTC devices became available. These results have important implications regarding the potential uptake of OTC HAs.

OTC HA Advertisement Content Analysis

To the best of our knowledge, this study is the first to examine the health-communication content of OTC HA advertisements. Our findings suggested that OTC HA manufacturers did not promote hearing-health literacy via the content of their social media posts, but instead mainly used persuasive messaging in their advertisements. Of the advertisements surveyed, only 10 percent contained any hearing-health information, whereas less than 5 percent of advertisements contained hearing data, statistics, how-to information, or visual guidance. Strict facts and recommendations represent a potent form of health literacy, and their use is arguably the most common form seen, being featured in nearly every avenue of health communication, generally. This straightforward approach to health literacy facilitates comprehension by providing patients with crucial information, such as content related to hearing-health and hearing-loss symptoms. Because relevant facts and recommendations are vital for patient decision-making, it was disappointing how infrequently hearing-health information or statistics were used in the majority of OTC HA advertisements surveyed. Minimally, consumers need and deserve to understand the fundamentals of hearing health and loss before purchasing an OTC HA device. Similarly, visual aids are an effective tool for enhancing working memory (Cohen et al., 2009) and can be harnessed to explain difficult concepts more readily, such as degrees of hearing loss, which makes their low utilization unfortunate as well.

In contrast, in the persuasive content analysis domain, roughly 20 percent of advertisements contained content related to the selling points of OTC HAs through their features. However, many of the advertisements simply highlighted the size and discreet nature of the devices as opposed to explaining how the features addressed the consequences of hearing loss. This approach is potentially problematic because previous work has documented that marketing campaigns that focus on the small size and invisibility of prescription HAs can actually negatively reinforce stigmas attached to HAs such as the need to conceal hearing loss (David & Werner, 2016; Kochkin, 1993; Wallhagen, 2010). Moreover, some of our more recent findings suggest that OTC HA manufacturer advertisements actually limit contact with HAs and persons with hearing loss in their social media posts (Champlin et al., 2025), mechanisms known to reduce stigmatic behavior (Allport, 1954; Pettigrew, 1998; Pettigrew & Tropp, 2006). Thus, the focus on the small size and discreetness of OTC HAs may be counterproductive to increasing uptake of the devices (Kochkin, 1993).

Although OTC HAs are designed to broaden access to amplification, exposure to mainly persuasive marketing messages about these devices, as opposed to educational content, could have unintended negative consequences on knowledge and behavioral outcomes, especially if a consumer does not have adequate health literacy skills. Such was the case for the promotion of weight-management medications, wherein previous work showed that promoting specific remedies to weight management was associated with less healthy behaviors such as consuming more cookies, rather than fewer, a finding that interacted with health literacy (defined as consumer remedy knowledge in the study) (Bolton et al., 2015). Promotional messages without educational content can create the idea that a product may provide a quick fix that requires few to no changes in lifestyle; as Bolton et al. (2015) describe, “Why put effort into living a healthy lifestyle when a weight-management remedy can take care of the problem?” In the case of OTC HAs, it is possible that the promotional advertising approach from manufacturers communicates that an OTC option might serve as a quick and easy fix to treating hearing loss that requires no fine-tuning, acclimatization period, or changes in communication strategies that could potentially lead to frustration and reduced satisfaction with the devices.

The present results showed a significant increase in hearing-health information in the 6 months after the final FDA OTC HA ruling (Figure 2), which is encouraging. However, despite the increase, the overall number of advertisements containing hearing-health information was still low, with only one advertisement containing hearing-health information in the 6 months before the final ruling and only 28 advertisements in the 6 months following. The single advertisement from the 6 months before the final FDA ruling shared content about the importance of using hearing protection around loud noises. Of the 28 advertisements posted in the 6 months after the final FDA ruling, most focused on defining hearing loss, hearing conservation, and the risks of untreated hearing loss. However, five advertisements did contain content related to OTC HA outcomes, barriers to HA uptake, and OTC HA candidacy criteria. Overall, although a few advertisements contained some new specific information related to the groundbreaking FDA final ruling, there was limited evidence that the OTC HA manufacturers used the announcement as leverage to increase the visibility of their products on social media.

Health Literacy and OTC HA Advertisements

This study did not assess hearing-health literacy in potential OTC HA consumers, but our results suggest an opportunity exists for manufacturers to promote informed OTC HA choices by improving the educational messaging of their social media posts. In the area of health education, various guidelines exist for creating health information and materials that are suitable for all audiences, regardless of health literacy level. For example, Doak et al. (1996) created the Suitability Assessment of Materials checklist for print materials, which includes criteria such as establishing a clear message purpose, a lack of technical jargon, simple and relevant illustrations, and matching the content with the needs of the audience. Although these and other guidelines serve as valuable resources for creating patient-focused health messages, previous research finds that many materials do not adhere to recommendations. For example, of 66 existing resources offered in Australia about HIV/AIDS, only 8 percent of the resources scored greater than 50 percent on the Health Literacy INDEX (Gray et al., 2021). Another large-scale study evaluated patient education content from 2,585 resources and found that only 2 percent met the American Medical Association–recommended sixth-grade reading level. Even when expanded to the National Institutes of Health–recommended eighth-grade reading level, only 8 percent of the materials met the recommendations (Rooney et al., 2021).

The OTC HA industry is in its infancy, and large-scale health literacy analyses of available content are lacking; however, a recent study found that online OTC HA content was written above recommended patient reading levels (Shah et al., 2024). In the same study, it was documented that access to online OTC HA content required consumers to click multiple links to obtain credible information (Shah et al., 2024). This finding is consistent with the results of the present study where the most common type of OTC HA advertising content was redirection, requiring consumers to click additional links to find out more information, with most links simply redirecting consumers to sites where purchase of the devices was encouraged. Taken together, there is limited evidence that OTC HA content available online via search or manufacturer advertising follows recommended guidelines for promoting hearing-health literacy (Doak et al., 1996) and increased access to the devices.

Study Limitations

Only a limited number of OTC HA brands were included and analyzed for educational versus persuasive messaging content in this study. Although the brands were chosen for their sizable social media following, it would be beneficial to analyze content from a broader sample of manufacturers. This study also limited data collection solely to Facebook. The main reason being legal restrictions to conduct research based on content seen on other social media platforms, such as TikTok. Although Facebook connects manufacturers to consumers, it likely does so mainly for marketing purposes. Thus, the manufacturers’ individual websites might be a better source for educational outreach materials for consumers. We also did not analyze OTC HA content and messaging from other forms of public communication, such as television commercials. In the future, it will be important to perform similar content analyses in other media domains, including manufacturer websites, to better understand consumer exposure to OTC HA content. Future work will also need to measure hearing-health literacy in potential OTC HA consumers and analyze interactions with online OTC HA content.

CONCLUSIONS

The results of this content analysis study found OTC HA advertisements contain mainly persuasive messaging content as opposed to educational content that could promote hearing-health literacy. Moreover, our results suggest OTC HA manufacturers did not adjust their advertising approaches before and after the final FDA ruling that created the new OTC HA class. Our results highlight that a significant opportunity exists to better promote informed choices for adult consumers with hearing loss by incorporating educational content into OTC HA marketing content.

Abbreviations

DTC

direct-to-consumer

FDA

U.S. Food and Drug Administration

HA

hearing aid

OTC

over the counter

Footnotes

Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.

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