Background:  The stigma associated with wearing hearing aids, known as the “hearing aid effect,” remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting.

Objective: To determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely area of residence and level of education across African communities.

Method: The study used a cross-sectional design with 322 participants (161 rural, 161 urban); mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices [standard behind-the-ear hearing aid (BTE HA) with an earmould, mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, Airpod, receiver-in-canal (RIC), completely-in-canal (CIC) HA, and Personal Sound Amplification Product (PSAP)] worn by a peer model using a validated scale of eight attributes (attractiveness , age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with earmould were used as a benchmark for comparison.

Results: The hearing aid effect has diminished.  In comparison to the BTE;  the ITC, Airpod and PSAP were perceived less favourably, across all attributes. Furthermore, urban participants provided more favourable ratings compared to rural participants, with significant differences across three attribute ratings. These differences were found for attributes of hardworking for ST; attractiveness, hardworking for ITC; age for RIC and Airpod and hardworking for PSAP. Statistical differences in attractiveness ratings were observed between primary and tertiary education groups for ITC (52.4% vs. 30.4%) and PSAP (43.7% vs. 24.1%), with primary education groups generally giving higher ratings.

Conclusion: The hearing aid effect has diminished, however, it is influenced by socioeconomic variables such as educational attainment and geographical location. These outcomes emphasize the significance of taking into account patients’ socioeconomic circumstances when prescribing hearing aids.