Identifying barriers and facilitators of hearing protection use in early-career musicians: a basis for designing interventions to promote uptake and sustained use

Figures & data

Figure 1. (a) Frequency of HPD use by early-career musicians; (b) type of HPDs most commonly used; (c) frequency of HPD use for different music-related activities.

Table 1. Barriers to and facilitators of hearing protection device use arranged according to the Capability, Opportunity, Motivation model of behaviour (COM-B) and the Theoretical Domains Framework (TDF).

Barrier/Facilitator	Description	Key quote(s)	COM-B components	TDFs	Intervention functions*
Detrimental vs. No impact of HPDs on music listening/playing/enjoyment	Whether HPD use influences musical activities dictates whether they are used on not. This may depend on the musical context (e.g. recreational use vs. performance). High-fidelity/quality earplugs that have less of an impact may be more likely to be used.	Barrier - “…it's quite tough to wear ear protection because I just can't hear what I'm doing...” – Participant 18 – Cellist Facilitator - “I think it's quite easy to get used to wearing hearing protection and still play within an ensemble or play on your own…” – Participant 58 - Percussionist	Physical capability	Skills	Tra
			Psychological capability	Memory, attention and decision processes	Tra, Env, Ena
			Automatic motivation	Reinforcement	Tra, Inc, Coe, Env
				Emotion	Per, Inc, Coe, Mod, Ena
			Reflective motivation	Social/professional role and identity	Edu, Per, Mod
				Beliefs about capabilities	Edu, Per, Mod, Ena
				Optimism	Edu, Per, Mod, Ena
				Beliefs about consequences	Edu, Per, Mod
				Goals	Edu, Per, Inc, Coe, Mod, Ena
			Physical opportunity	Environmental context and resources	Tra, Res, Env, Ena
Lack of concern vs. Concern about hearing problems	The level of concern about developing noise-induced hearing loss and/or tinnitus dictates whether HPDs are used or not. This may be contingent on perceived necessity, priorities, personal or anecdotal experience of hearing problems, and the level of knowledge about the risks of hearing damage and how to prevent them.	Barrier – “We’re not suffering from it yet, so it's not a major problem.” – Participant 76 - Clarinet player Facilitator - “…we only get one set of ears, I think it's important to look after them now so that I can still do music 20, 30 years down the line.” – Participant 28 - Oboe player	Psychological capability	Knowledge	Edu
				Memory, attention and decision processes	Tra, Env, Ena
			Automatic motivation	Reinforcement	Tra, Inc, Coe, Env
				Emotion	Per, Inc, Coe, Mod, Ena
			Reflective motivation	Optimism	Edu, Per, Mod, Ena
				Beliefs about consequences	Edu, Per, Mod
				Intentions	Edu, Per, Inc, Coe, Mod
				Goals	Edu, Per, Inc, Coe, Mod, Ena
			Physical opportunity	Environmental context and resources	Tra, Res, Env, Ena
Social pressures	Perceived pressures in the form of stigma and taboo may prevent HPD use, but normalising and encouraging HPD use may help to facilitate.	Barrier - “I think it's one of those topics people almost like to try and brush under the carpet a bit, it's not really sort of cool to talk about it…” – Participant 25 – Violinist Facilitator - “I think it's something that’s kind of growing in our kind of world, more and more people are using earplugs.” – Participant 47 - Trumpet player	Automatic motivation	Reinforcement	Tra, Inc, Coe, Env
			Reflective motivation	Social/professional role and identity	Edu, Per, Mod
			Social opportunity	Social influences	Res, Env, Mod, Ena
Lack of access vs. Ease of access to HPDs	Having HPDs readily available or not dictated their use. All music students were previously provided with high-fidelity musicians’ earplugs as part of their enrolment at the Royal Northern College of Music. Therefore, a lack of access may be due to forgetting or losing HPDs.	Barrier - “… it's not something that’s at the forefront of my mind to just go, wait, let me just grab that.” – Participant 35 – Voice Facilitator – “I’m right at the back of the second violins next to the brass section, I’ll just, you know, have them on my stand and I’ll just put them in.” – Participant 60 - Violinist	Psychological capability	Memory, attention and decision processes	Tra, Env, Ena
				Behavioural regulation	Edu, Tra, Mod, Ena
			Physical opportunity	Environmental context and resources	Tra, Res, Env, Ena
Discomfort and poor fit	Dislike of the physical sensation of HPDs in the ears or problems with fit and placement. Musicians may not take the time to persevere with their use.	Barrier – “…sometimes they're uncomfortable, they're a bit of a pain to get in and out…” – Participant 56 - Tuba player	Reflective motivation	Beliefs about consequences	Edu, Per, Mod
			Physical opportunity	Environmental context and resources	Tra, Res, Env, Ena
Affordability of high-fidelity HPDs	Although early-career musicians suggested that they may be more likely to use high-fidelity musicians’ earplugs that do not impact music performance, they also noted that these may be too expensive.	Barrier - “I would use it all the time if I could but there are quite a lot of situations where you can't wear hearing protection, or at least you can't wear the hearing protection that I can afford.” – Participant 55 - Clarinet player	Physical opportunity	Environmental context and resources	Tra, Res, Env, Ena

* Intervention functions: Edu = Education, Per = Persuasion, Inc = Incentivisation, Coe = Coercion, Tra = Training, Res = Restriction, Env = Environmental restructuring, Mod = Modelling, Ena = Enablement.