What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

Figures & data

Table 1. Topic guide for interviews.

Topic	Potential questions
Lifestyle	What factors of your lifestyle have affected your choice of hearing technology?
	Do you have any hobbies or activities that affected your decision?
Relationships	What did your family and friends think of your choice of hearing technology?
	Did they impact your decision?
	Did you ask anybody in your family/friends for advice about what to do?
	What impact did your choice of hearing technology have upon them – for example, travelling for Cochlear Implant, or use of Hearing Aids?
Employment	Does your hearing loss have any impact on your employment?
	Was your choice of hearing technology influenced by your employment?
Rehabilitation	What was your understanding of how the hearing technology would help you?
	How do you get along with the hearing technology you have chosen?
	How do you think the hearing technology you have not used would affect your ability to hear?
Physical appearance	What are your thoughts on the physical appearance of the hearing technology you have chosen?
	What did you think of the physical appearance of the different technology you were offered?
Surgery	If a Cochlear Implant was offered to you, what were your thoughts on the surgery?
	Would the prospect of surgery impact your decision?
	What do you know about the surgery involved in Cochlear Implant?
Travel to Cochlear Implant centre	If a Cochlear Implant has been discussed with you, what impact did the travel to the Cochlear implant centre (Bristol or Birmingham) have on your decision?
	How would you/how did you travel to the centre?
Clinicians	Did you feel you had enough information from the clinician?
	What information were you given about the different options available?
	What impact did your clinician’s opinion have upon your decision?

Table 2. Characteristics of participants.

Participant number	Gender	Age	Lifestyle	Living context	CI status	Deaf identity	BSL/oral language
P1	Female	60–69	Retired	Lives alone	Does not want CI	Hearing/deaf	Oral
P2	Female	80–89	Retired	Lives alone	Does not want CI	Hearing/deaf	Oral
P3	Female	50–59	Working	Lives with family	Does not want CI	Hearing/deaf	Oral
P4	Female	60–69	Retired	Lives alone	Does not want CI	Hearing/deaf	Oral
P5	Female	30–39	Working	Lives with friend	Wants CI	Hearing/deaf	BSL & oral
P6	Female	40–49	Working	Lives with family	Implanted with cochlear implant but does not use it	Deaf	BSL & oral
P7	Female	80–89	Retired	Lives with partner	Has cochlear implant	Hearing/deaf	Oral
P8	Female	30–39	Working	Lives alone	Has cochlear implant	Hearing/deaf	BSL & oral
P9	Male	40–49	Working	Lives alone	Awaiting CI surgery	Hearing/deaf	BSL & oral
P10	Male	80–89	Retired	Lives with partner	Awaiting CI switch on post-surgery	Hearing/deaf	Oral
P11	Male	60–69	Working	Lives alone	Has cochlear implant	Hearing/deaf	Oral
P12	Female	60–69	Retired	Lives alone with support	Has bilateral cochlear implant	Hearing/deaf	Oral
P13	Female	80–89	Retired	Lives alone	Awaiting implant switch on post-surgery	Hearing/deaf	Oral
P14	Female	60–69	Retired	Lives alone	Has cochlear implant	Hearing/deaf	Oral
P15	Female	80–89	Retired	Lives alone	Awaiting CI assessment	Hearing/deaf	Oral

Table 3. Examples of transcript quotes with their subsequent open coding with “in-vivo” elements in italics, selective coding and categorisation.

Transcript	Open coding	Selective coding	Categorisation
“I’ve had hearing aids for twenty odd years and found them completely useless” [P1]	“Hearing aids are completely useless”	Dissatisfaction with hearing aids	Ability to cope currently
“…they’re the next model up and it’s meant to be good at blocking out background noise, but it kind of just distorts everything a bit” [P5]	“Hearing aid distorts everything a bit”
“…I don’t feel a) I’m bad enough to need it…” [P1]	Not “bad enough to need” CI	Coping despite hearing loss
“…I have a long standing hearing loss so I tend to just get on with it” [P3]	“Tend to just get on with’ hearing loss”

Figure 1. The theoretical framework for decision making in adults eligible for cochlear implantation.