6 – Negative Stigma

Negative stigma is one reason why some people don’t get hearing aids. Stigma is widespread in the United States. In an excellent article on stigma and hearing loss (Gagne, J.P. et al. 2009) the authors state that research shows,“The general population perceives individuals with hearing loss as being old, cognitively diminished, poor communication partners and generally uninteresting.”

The article goes into great depth about the negative effects of the stigma associated with hearing loss that often result in unwillingness to acknowledge or deal effectively with it. Similarly, Quinn and Chandoir (2009, p.635) state that research indicates that “An identity is stigmatized if it is considered a mark of failure or shame, tainting the self in the eyes of others, resulting in loss of status, employment, discrimination, personal rejection.”

The psychological effects of stigma include:  

Over all, the data shows a clear negative effect of stigma on psychological and physical health and its contribution to the social pain that result from being rejected or devalued.

Quinn and Chandoir (2009) also point out that attempts to hide the stigmatized characteristic, e.g., that one has a hearing loss, produces additional harmful effects such as, “…the worry and concern about possible devaluation alone can lead to negative outcomes. Significant cognitive and emotional resources are expended in the effort to conceal hearing loss.”

Worry about being discovered adds even more stress and produces the additional problem of being unable to find out how others, in actual fact, would respond to the stigmatized characteristic. This generates needless worry in those instances in which the hearing loss might not be considered to be a problem by other people. In such instances the social pain results from unrealistic and unwarranted predictions that exist only in the person’s imagination.

A major problem with a concealed stigma in the case of hearing loss is that it prevents the individual from doing things that would prevent or reduce communication problems such as wearing hearing aids, using other assistive equipment, and employing effective communication strategies.

Quinn and Chandoir go on to list three types of stigma that negatively affect taking appropriate action to deal with hearing loss.

Detecting Negative Stigma

It is important to detect the existence of negative stigma in consumers and their close communication partners and to help them adopt a more realistic perception of hearing loss. This will enable them to function more effectively at work and at home instead of attempting to hide the hearing loss and failing to take the steps necessary for accommodating it. Why purchase an expensive hearing aid for a consumer if she will not wear it in public? The Ida Institute has developed or adopted some excellent tools—the line and the box (see below), that can be most helpful in detecting the existence of stigma.

Helping consumers overcome the effects of stigma may be the first order of business when working with consumers. Doing so involves helping the person change attitudes and behaviors related to hearing loss. However, probably most of us have experienced how difficult it is to make even simple changes in how individuals view and do things. Eating different types or amounts of food, getting outside for a walk, or stopping smoking can be difficult to start doing and to maintain over time. Doing things differently in order to better accommodate hearing loss can be equally challenging. Sometimes, people resist making changes even when realizing the importance of doing something differently.

For example, it may be clear to the VR professional that it would be beneficial for a consumer to wear a hearing aid at work, but the consumer has not done so. It is evident to the VR professional that advising, nagging or badgering the person to wear them has been ineffective. The consumer digs in his heels and finds more excuses, tunes out, or both, refusing to consider the counselor’s advice. Fortunately, there are ways of overcoming such resistance to making desirable changes. Using another one of the tools that the Ida Institute has developed or adopted, the line, is useful for assessing how motivated a person is in terms of making a particular change.

The Line

For an issue related to wearing hearing aids at work the VR professional might ask, “How important is it to you to understand what your customers say to you at work?” Then, using the line a VR professional would ask a consumer to place a mark along the line between 0, not at all important, and 10, extremely important, to indicate the level of importance to the consumer.


(Unimportant)                                                        (Very important)

The consumer then places an “x” somewhere on the line to indicate the degree of importance. A mark close to 10 indicates that this is a very important issue for the consumer. Placing the mark at or close to the 0 indicates that this is not at all an important issue for the person. If a person placed the mark in an area indicating that the issue does have importance, ask another question for the consumer to rate along a second line.

The second question is, “How motivated are you to do what is required to increase your ability to understand what customers (coworkers, employers, etc.) say to you?”


(Not motivated)                                                                (Highly motivated)

Go through the same procedure as you did for determining the level of importance, and if the person indicated that he or she is very willing to do what is necessary, help the person find out what needs to be done to achieve that goal, such as wearing the hearing aid in order to understand more of what is being said at work.

To determine the cause of resistance for doing so, use another Ida tool, the boxseen below,which provides information about the costs and benefits for the consumer of maintaining the status quo and of making the desired changes.

If the consumer indicates that making the desired change is important and that she is willing to do what is necessary, but is still unable to make the change, it can be useful to consider using the line tool with another question. That question concerns the consumer’s perception of her or his perceived ability to do what is required. If people believe that they are unable to do something, they will not make an attempt to do it.


(unable)                                                               (Highly able)

If the person indicates low self-efficacy, feeling unable to do what is asked, the VR professional can again turn to the box to determine the factors that need to be addressed to increase the consumer’s perception of ability to do what is required.

The Box

Everything individuals do or contemplate doing has perceived costs and benefits. These costs and benefits may be categorized in terms of money, time, effort, relationships, self-esteem, status, health, mood, etc. Usually, people persist in doing something when the perceived benefits of the action outweigh the perceived costs. Conversely, people often don’t continue doing something when the costs of doing it outweigh the benefits. In the latter case, if people believe that an action is important to do, but their perception of the costs of doing it are higher than the benefits for them, they have three options:

The following is an example of the use of the box with a consumer who is not wearing hearing aids at work.

Status quo: Not wearing hearing aids at work

Suggested change: Wear the hearing aids at work

. Status Quo Change
COSTS Not understanding Discomfort
. Missing information Effort
. Being perceived as incompetent Cost of batteries etc.
. Not promoted / no salary increase Hear too much (noise)
BENEFITS Physical comfort Understand more
. Not having to own up to it Feel less stressed
. Not having to deal with hearing aid Feeling more competent
. Not having to remember to use it More at ease socially


After completing the analysis provided by the box tool, it is also helpful to ask the consumer what conclusion he or she draws from going through the costs and benefits. The conclusions drawn come from the consumer and, not the counselor, and for that reason, are more likely to result in an attempt to make the desired change(s).

Another good example of using the box relates to informing others that one has a hearing loss.  Many people are reluctant to do that, their motivation for doing so is quite low. However, once they see the costs for not doing so, they often decide that it is really in their best interest in the long-run to let people know. What are the costs and benefits of maintaining the status quo or not informing people, and what are the costs and benefits of informing them?

This example of the use of the box tool is presented below.

. Status Quo Making the change
. (not informing others) (informing others)
COSTS They think I'm not interested stupid or weird when I make mistakes due to misunderstanding what they said. Time and effort and the risk that the person will think less of me or not want to bother me.
BENEFITS I don't have to risk being rejected or devalued or need to invest the time and effort involved in informing them People will be able to know that mistakes I make are due to hearing difficulties not due to personal inadequacies. I can stop worrying that they will find out I have it.

Again, one of the major advantages of using the box is that the information obtained comes directly from the consumer, rather than from an outside source—the counselor. Therefore, it has greater validity and relevance, and the conclusions are less likely to be resisted.

When using the box, one should continue to list as many costs and benefits as possible. Doing so usually sheds light on several things that need to be addressed in order to enable consumers to do what is necessary for improving their circumstances. Additionally, it can be very useful to complete an additional box focused on the longer-term costs and benefits of doing what has been deemed to be important. Many times short-term costs are outweighed by longer-term benefits. For example, the hassle of putting on the hearing aids, dealing with the batteries, etc. is outweighed by improved relationships over time when one understands more of what is said.

Finally it can be quite illuminating to see the results of having close communication partners fill out the box focused on short and longer-term costs and benefits for them if the consumer makes the desired change. After diligently filling out the box and considering many factors, if the consumer’s motivation level is still less than sufficient for making the desired change(s), it can be helpful to use the Communication Rings.

There are instances in which the individual may not be motivated to make essential changes for him or herself, believing that they can get along just fine the way things are and deciding to maintain the status quo. In many cases when the person considers the effects of the hearing loss on many other people, even people beyond those with whom he or she lives or works, that realization can motivate the person to make some changes. It is also illuminating to see the variety of people with whom one interacts over time and to see the many ways that using assistive devices and adopting effective communication behaviors would improve the quality of the consumer’s life.

It is also the case that many people who have hearing loss are unaware of the breadth of the problems it produces in their lives. For example, some people do not relate the anxiety or depression they experience to their hearing loss. Therefore, it can be very helpful for consumers to see a listing of problems that others who have hearing loss and their communication partners have reported. Then, they often begin to realize the many ramifications of their hearing loss, and that can increase their motivation to do something positive about it.