Background: Hearing aid help-seeking and uptake remain low despite technological advancements and increased accessibility. Understanding the enablers and barriers influencing these behaviors is essential for improving strategies to promote hearing-health-care use.

Purpose: This study explores user perspectives on hearing aid help-seeking and uptake in the United States, using the COM-B model to analyze behavioral enablers and barriers among prescription and over-the-counter (OTC) device users.

Research Design: A qualitative study using an inductive thematic analysis framework.

Study Sample: Participants (n=41) included adult hearing aid users from the Hearing Tracker (n=37) website community and the Lexie Hearing database (n=4). Participants had a mean age of 69 years (11 SD; range 36-88), and 68% were male.

Data Collection and Analysis: Semi-structured interviews were conducted virtually, transcribed verbatim, and analyzed using thematic analysis. Themes and sub-themes were mapped onto the Capability, Opportunity, Motivation–Behavior (COM-B) model to explore the behavioral drivers of hearing aid help-seeking and uptake.

Results: The analysis, framed within the COM-B model, identified 20 themes and 55 sub-themes across two overarching categories of enablers and barriers to help-seeking and hearing aid uptake. For hearing aid help-seeking, Opportunity factors (e.g., Support from HCPs and social networks and trial periods) and otivation factors (e.g., Job performance and self perceived need) were primary enablers, while preconceived beliefs (capability), fear of dependence(Motivation), stigma and cost (opportunity) , acted as key barriers. For hearing-aid uptake, Capability factors (e.g., ability to make adjustments on an app and technology advancements levels), Opportunity factors (e.g., support and guidance from HCP, device trials, and affordability), and Motivation factors (e.g., Social interaction) promoted adoption, whereas lack of informational counselling (Capability), device functionality, limited insurance coverage, negative HCP experiences (Opportunity), and Stigma (Motivation) discouraged uptake.

Conclusions: Hearing aid help-seeking and uptake are influenced by a complex interplay of capability, opportunity, and motivation factors. Targeted interventions addressing stigma, affordability, and user expectations, especially for the growing OTC population, can improve adoption.

Clinical relevance statement: Understanding enablers and barriers to hearing aid help-seeking and uptake can guide audiologists in developing more personalized, motivation-based counseling strategies. The findings highlight practical approaches for addressing stigma and affordability concerns, enhancing user autonomy, and personalizing support for both prescription and OTC hearing aid users, ultimately improving patient engagement and hearing-health-care outcomes.