Table 4.

Areas to focus while investigating direct-to-consumer hearing devices

Domain	Specific area
Selection and candidacy	Define a specific group of individuals
	Define the context of use
Expectations	Does lower costs correlate to lower expectation
	Differences between traditional and direct-to-consumer products
Acoustic physical fact finding (ie, electroacoustic measures)	Test box and coupler measurements Simulated real-ear measures using a KEMAR
Verification	Real ear measures
	Functional gain
User experience and perception	Fitting comfort
	Image perception
	Decision-making process of consumers
	Use and maintenance of the device
Outcome evaluation dimensions	Perceived hearing disability
	Speech perception in quiet
	Speech perception in noise
	Communication ability
	Activities and participation
	Health-related quality of life
	Tinnitus distress
Factors that may influence the outcome	Socioeconomic status
	Cost of the device
	Health literacy
	Guidance and support from hearing
	health care professional
	Aural rehabilitation
Economic evaluation	Cost analysis
	Cost-benefit analysis
	Cost-effectiveness analysis
	Cost-utility analysis

Abbreviation: KEMAR, Knowles Electronics Mannequin for Acoustic Research.