Introduction

Hearing is fundamental to language development, and consistent access to sound is critical for children with hearing loss. Effective hearing aid (HA) management plays a vital role in optimizing auditory access, yet parents often face significant challenges in managing their child’s HAs. During the fitting process, parents typically receive a brief, information-dense orientation session, which can be overwhelming due to the complex technical details and limited timeframe1. Furthermore, HA user manuals, often written in technical language, pose additional barriers to recalling and applying essential information for device management2,3.

Research shows that patients may forget up to 80% of information provided during healthcare consultations, with much of the retained information being inaccurate1,4. In HA management, initial retention rates of approximately 74% decline over time, further complicating effective device use5. In Malaysia, these challenges are compounded by a scarcity of audiological services, with only one audiologist available per 42,500 individuals6. This limited access disproportionately affects parents of children with hearing loss, who often lack prior experience with HAs and face logistical, cultural, and emotional barriers in supporting their child’s hearing needs7,8.

Parental struggles with daily HA management, including device handling and care, often lead to discrepancies between reported and actual usage. For example, parents may overestimate HA wear time by up to 2.6 h per day, reflecting challenges in understanding and managing device use9. These challenges have significant developmental implications, as studies show that children who consistently wear HAs for at least 10 h daily achieve better language outcomes compared to those with inconsistent use10.

Although audiologists provide counselling and printed materials on hearing aid management, these resources often fail to meet parents’ ongoing needs. Parents may forget essential details, leading to inconsistent hearing aid use and reduced effectiveness in supporting their child’s auditory development8. While some eHealth programs, such as the one developed by Muñoz et al.11, provide digital support for parents, many existing online educational materials remain generic, lack cultural adaptation, or do not offer structured, step-by-step guidance tailored to parents of children with hearing loss. Given these limitations, culturally adapted, accessible online resources could better support parental education and engagement in HA care.

Research has shown that multimedia interventions improve knowledge retention and practical skills12,13,14,15; however, few studies have specifically examined the effectiveness of structured, culturally adapted video-based interventions for HA management. Socio-demographic factors, such as health literacy and income, further underscore the need for affordable, user-friendly resources to empower parents in managing their child’s HAs16,17,18.

This study addresses this gap by evaluating the impact of an online video intervention designed for Malaysian parents. The findings can inform the development of scalable and sustainable e-learning resources to support parental education in hearing healthcare.

The primary aim of this study was to evaluate the effectiveness of an online module specifically designed to improve Malaysian parents’ knowledge, perceptions, confidence, and practical skills in HA management across multiple assessment points19. Hosted on YouTube, a platform accessed by approximately 80% of Malaysians20, the module incorporates bilingual content (Malay and English), culturally relevant examples, and step-by-step demonstrations tailored to varying literacy levels. By addressing critical gaps in HA management education, this research developed a practical, practical, and culturally relevant solution to empower parents with the knowledge and skills necessary to optimize their child’s hearing health and overall developmental outcomes.

Methods

Study design

This quasi-experimental study evaluated the effectiveness of an online HA management video module through pre- and post-intervention surveys administered to parents of children with hearing loss. Ethical approval was obtained from the Human Ethics Committee of Universiti Kebangsaan Malaysia (JEP-2023-101), and the study adhered to the principles of the Declaration of Helsinki. Participation was voluntary, and all participants provided written informed consent before enrolment.

Participants

Parents were recruited using diverse channels, including social media platforms (Facebook and WhatsApp groups), parent support groups, kindergartens, schools, clinics, hospitals, private HA centres, and word of mouth. Inclusion criteria were parents of children under 10 years old who had been fitted with at least one behind-the-ear (BTE) HA, had internet access, and were proficient in the Malay language. Parents were excluded if their child was a bimodal cochlear implant user or had additional disabilities beyond hearing loss. A total of 53 parents participated and completed both the pre- and post-intervention surveys. The sample size was determined based on an a priori power analysis, which indicated that a minimum of 50 participants would provide sufficient power (0.80) to detect medium effect sizes in mixed ANOVA analyses with three-time points.

Materials

Online video module on BTE hearing aid management for children

Details of the module are described in Mazlan et al.18. Briefly, the module consisted of six topics with a total runtime of 17.89 min. The content was narrated by native Malay language speakers, with subtitles available in English to enhance accessibility. The module was validated through expert review and pilot testing with parents to ensure cultural relevance, clarity, and usability. The video was hosted on YouTube, and the access link is provided in the Appendix.

Questionnaires

The pre-and post-intervention questionnaires, adapted from Muñoz et al.11, were designed to assess parental knowledge, perceptions, confidence, and HA monitoring practices. The adaptation process involved translation, back-translation, and cultural modifications to ensure the relevance of the content for Malaysian parents.

The questionnaires covered four key domains:

  1. 1.

    Knowledge (13 items): Measured parents’ understanding of essential HA management tasks, such as identifying the need for new earmolds, recognizing HA components, and performing regular device maintenance.

  2. 2.

    Perceptions (8 items): Evaluated parents’ attitudes toward the benefits, usage, and management of HAs.

  3. 3.

    Confidence (10 items): Assessed parents’ confidence in performing HA management tasks.

  4. 4.

    HA Monitoring (7 items): Examined the frequency with which parents monitored their child’s HA usage and maintenance.

All items were rated on a 5-point Likert scale, and a scoring rubric was used to categorize responses into low, moderate, or high performance for each domain.

Procedures

Participants who met the inclusion criteria were contacted via WhatsApp or email. Upon providing written informed consent, they completed a pre-intervention questionnaire administered online via Google Forms. After completing the survey, participants received a YouTube link to the validated video module.

To maximize engagement, weekly reminders were sent during the intervention period, and participants were encouraged to reach out with any technical issues. Parents were followed up 1 week after receiving the video link to see if they had watched it. Those who had not yet done so received a reminder. Additionally, the post-intervention questionnaire included a confirmation question about video completion, directing parents who answered ‘no’ to the end of the questionnaire, while those who answered ‘yes’ proceeded to the next section. Although video completion was not tracked, all parents were required to self-report how often they watched each video before and after the intervention.

Post-intervention assessments were conducted at two time points: 1 month and 2 months after participants accessed the module. Identical questionnaires were used at all time points, allowing direct comparisons of changes across the four domains.

Statistical analysis

Data were analysed using Statistical Package for the Social Science (SPSS) 25.0. Descriptive statistics were used to summarize participants’ demographic information and pre- and post-intervention scores across all domains. A mixed ANOVA evaluated changes in parents’ knowledge, perceptions, confidence, and hearing aid monitoring frequency across three-time points: pre-intervention, 1-month post-intervention, and 2-month post-intervention. This analysis assessed within-subject effects (changes over time) and between-subject effects (differences across categorical demographic factors, such as educational level). Mauchly’s test was applied to test the assumption of sphericity. If this assumption was violated, the Greenhouse–Geisser correction was used to adjust the degrees of freedom for the F-tests. Pairwise comparisons with Bonferroni adjustments explored specific differences between time points.

Results

Participant characteristics

A total of 53 parents participated in the study. Their children had a mean age of 63.5 months (SD = 31.8), with a relatively balanced gender distribution (47.2% female and 52.8% male). Most children were fitted with binaural hearing aids (79.2%), with a mean daily usage of 9.3 h (SD = 3.7). The average hearing aid experience was 32.7 months (SD = 26.2).

The majority of participating parents were mothers (77.4%), with a mean age of 36.2 years (SD = 4.9). Educational attainment varied, with 37.7% of parents holding a degree or higher qualification. Most parents (84.9%) reported household incomes within the lower-to-middle range (< Malaysian Ringgit (MYR)10,970). Detailed demographic information is presented in Table 1.

Table 1 Demographic characteristics of parents and their children.

Changes in parental outcomes over time

Analysis of parental outcomes revealed significant improvements in perceptions and confidence over time, while knowledge scores showed a positive trend without reaching statistical significance.

Perceptions showed the largest improvement over time, with significant increases observed from pre-intervention to both 1-month and 2-month follow-ups (F(1.78, 92.73) = 10.22, p < 0.001). Confidence also improved significantly over time (F(1.75, 91.02) = 5.65, p = 0.007), with significant differences noted at both follow-up time points compared to baseline. However, hearing aid monitoring frequency exhibited a delayed improvement, with a significant increase observed only between the pre-intervention assessment and the 2-month follow-up (F(2, 104) = 5.64, p = 0.002). Knowledge scores, while showing an upward trend, did not reach statistical significance (F(2, 104) = 1.70, p = 0.188). These changes are detailed in Table 2.

Table 2 Mixed ANOVA analysis of parental outcomes over time.

Effects of demographic factors on parental outcomes

Analysis of demographic factors revealed several significant associations with parental outcomes. Parental educational level was significantly associated with knowledge (F(2, 50) = 5.802, p = 0.005), perceptions (F(2, 50) = 3.452, p = 0.039), and confidence (F(2, 50) = 5.655, p = 0.006). Similarly, household income showed a significant relationship with knowledge scores (F(2, 50) = 3.378, p = 0.042).

Hearing aid use was another factor that showed significant associations across all measured domains, including knowledge, perceptions, confidence, and monitoring frequency. In contrast, no significant associations were found for parental and child age or hearing aid experience across any domains (all p > 0.05). These findings are summarized in Table 3.

Table 3 Demographic associations with parental outcomes.

Discussion

This study evaluated the effectiveness of an online video module in enhancing parental outcomes related to HA management. Significant improvements were observed in perceptions, confidence, and HA monitoring frequency, while knowledge scores remained unchanged over time. These findings highlight the intervention’s potential to promote behavioral and emotional engagement, although additional strategies may be needed to address knowledge-related outcomes.

The observed improvements in perceptions and confidence align with prior research, such as Muñoz et al.11, which reported enhanced parental confidence following a supplemental eHealth education program. The module’s culturally tailored design, incorporating bilingual subtitles and culturally relevant examples, likely improved accessibility and comprehension, enabling parents to engage effectively with the content19.

HA monitoring frequency improved significantly only at the 2-month follow-up, suggesting a gradual adaptation process. This finding aligns with behavior change theories21, which emphasize the role of consistent practice in fostering habitual behaviors. However, it contrasts with earlier findings from Muñoz et al.11, who reported faster behavioral changes. A potential explanation for this discrepancy is the lack of essential tools, such as stethoclips, reported by 28.6% of parents in this study. The absence of these tools may have delayed improvements in monitoring practices, underscoring the importance of equipping caregivers with appropriate resources to support HA care.

Although most parents in the study had experience managing their child’s HA, a small subset were first-time users. In this study, first-time users were defined as parents whose children had used HAs for less than 12 months, based on Habicht et al.22. Only two parents met this criterion, but both showed improvements following the intervention. Results showed consistent improvements across all measured outcomes. Knowledge scores increased from 33 (pre) to 38 (post) and remained stable. Perception scores improved from 34.5 (pre) to 38.5 (post-2), while confidence scores saw the most substantial increase, rising from 40 (pre) to 50 (post-2). HA monitoring scores also improved from 17 (pre) to 23.5 (post) and remained above baseline at 21.5 (post-2), indicating sustained progress. Due to the small number of first-time users (n = 2), statistical comparisons with long-term users were not feasible. However, descriptive analysis suggests that first-time users experienced similar patterns of improvement as long-term users, particularly in confidence and perception.

Non-significant changes in knowledge scores diverge from Ferguson et al.23, who reported significant gains through multimedia interventions. This discrepancy may reflect a ceiling effect, as 66% of participants demonstrated relatively high baseline knowledge, limiting measurable improvement. Additionally, the module’s duration may have been insufficient to produce substantial knowledge gains, indicating that repeated exposure or extended interventions might be necessary.

Socio-demographic factors significantly influenced outcomes, with parental educational level and household income associated with knowledge, perceptions, and confidence. These findings align with Fuentes-López et al.18 and Walker et al.9, who demonstrated that higher educational attainment and income positively impact HA management practices. While the YouTube-based intervention likely mitigated some income-related disparities, household income remains relevant for access to essential resources like batteries and cleaning materials25.

Daily HA use was positively associated with all measured outcomes, supporting findings from Muñoz et al.24. However, reliance on parent-reported data introduces potential bias, as previous research indicates that parents overestimate usage by an average of 2.6 h per day9. Incorporating objective measures in future studies could improve the reliability of these findings.

No significant associations were observed between parental or child age and outcomes, suggesting the module’s applicability across demographic groups. However, this conclusion is limited by the study’s sample size and homogeneity, warranting further research with larger, more diverse populations.

Strengths and limitations

This study’s strengths include the use of a culturally adapted video module specifically designed to address barriers in traditional HA education. The module’s bilingual content and incorporation of culturally relevant examples enhanced its accessibility and relevance for the target population. Additionally, multiple parental outcomes were evaluated using validated measures, providing robust evidence of the intervention’s effectiveness.

However, several limitations should be acknowledged. The relatively small and homogenous sample, predominantly comprising Malay parents with high educational attainment, limits the generalizability of the findings. The inclusion of only two first-time HA users made statistical comparisons with experienced users unfeasible. Future studies should recruit a larger and more diverse sample to compare first-time and experienced HA. Increasing the representation of first-time users would also allow for a better understanding of the long-term impact of such interventions on parental confidence and engagement during early HA use.

Although the study aimed to assess the impact of the online video module, prior HA experience and individual learning differences may have influenced parental outcomes. Parents with longer HA experience may have started with greater knowledge, more positive perceptions, and higher confidence in HA management, contributing to their improvements. Without a control group, it is unclear how much of these changes resulted from the intervention alone. Future research should include a control group to determine the role of HA use duration in shaping parental knowledge, perception, and confidence.

Reliance on self-reported measures, particularly for HA monitoring frequency, may introduce reporting bias. Objective measures, such as HA data logging, should be incorporated in future research to validate self-reported data. Furthermore, the study did not account for variations in HA models, features, or brands, which could have influenced parental experiences and outcomes. Addressing these factors in future research could provide a more comprehensive understanding of the intervention’s impact.

Conclusion

This study demonstrates the effectiveness of an online video module in improving parental perceptions, confidence, and HA monitoring practices, reinforcing the potential of multimedia interventions in audiological care. Integrating accessible and culturally relevant resources into routine education can address barriers in traditional approaches and support diverse populations. Future efforts should focus on optimizing the duration and content of these interventions to enhance knowledge gains and achieve sustained behavioral improvements among caregivers.