According to the research results, function quality has a significant positive impact on communication effectiveness (H1 is supported), which is consistent with the conclusions of previous studies (26, 57, 72, 73). Gugenheimer, Plaumann (57) pointed out that hearing aids with high communication quality functions enable all participants in a conversation to achieve communication objectives in the most convenient manner. Based on Information Theory (116) and the principle of the integrity of key information in communication (117), effective communication requires the transmission of complete and accurate information. However, due to inherent factors and external conditions, information might be lost or distorted during transmission, either artificially or naturally. From the perspective of product factors, AR hearing aids receive external sounds and convert them into visible information for users with hearing impairments. The more microphones and better sound collection functions the AR glasses have, the clearer the external sounds they can detect and the more accurate the converted text information will be, leading to better communication results for the user. Furthermore, objective factors in some scenarios, such as lighting brightness and background noise, can influence users' social communication (118). A hearing aid with higher function quality means it has stronger interference resistance, allowing it to receive correct and complete sound information in complex situations. The environmental adaptability principle of efficacy theory (119) also states that only when hearing aids, serving as intermediaries for sound transmission, possess various high-quality functions suitable for different environments, will individuals with hearing impairments be able to communicate in complex situations.
Perceived interactivity speed has a significant positive impact on communication effectiveness (H2 is supported), which suggests that the interaction speed of AR hearing-assistive glasses plays an important role in the communication outcomes for individuals with hearing impairments. When using AR hearing-assistive glasses, individuals with hearing impairments primarily rely on visual information to understand and participate in communication. If the AR glasses can rapidly capture, process, and display visual information, they can quickly access dialogue content, voice-to-text translations, and other crucial information, and respond accordingly. This instant feedback helps reduce delays and misunderstandings in communication, enhancing communication effectiveness. Additionally, interaction speed represents a temporal characteristic, and communication typically prefers immediacy and real-time interactions. Long pauses and lags can weaken communication outcomes (76). The swift perceived interactivity speed of AR hearing-assistive glasses ensures timely and efficient interactive responses. Individuals with hearing impairments can receive pertinent information in real-time as others speak, achieving a synchronous rhythm in communication. This helps prevent interruptions in conversations, making the entire communication process more natural, relaxed, and smooth (57), thereby enhancing the communication efficiency and quality of individuals with hearing impairments.
Perceived ease of use has a significant positive impact on communication effectiveness (H3 is supported). AR hearing-assistive glasses possess numerous powerful features, implying there might be many areas requiring user operations, such as controls related to font size, position, color, contrast, and keyword settings. If these adjustments can be made easily, users wouldn't need to constantly control and tweak the device during conversations. The hearing assistive device would then become intuitive to use and gradually fade into the background (120), allowing individuals with hearing impairments to focus more on the conversation, thereby enhancing communication outcomes and experience. Furthermore, as a novel technological product, clear instructions and simple controls can reduce the learning curve for individuals with hearing impairments, thereby enhancing their intention and efficiency in usage, and benefiting from it. Conversely, if the product interface and operation are overly complex, it may hinder hearing-impaired users from benefiting from these technologies (30).
It's worth noting that even though function quality, perceived interaction speed, and perceived ease of use all have significant positive impacts on communication effectiveness, and perceived ease of use has a stronger influence on communication effectiveness (0.426 > 0.256 > 0.250). The reason for this might be related to the unique ways individuals with hearing impairments receive information and their cognitive processing methods. Before using hearing aids, people with hearing impairments can still perceive sound. To communicate, they might intentionally or unintentionally employ various skills. For instance, they might attempt to fill in the gaps of indistinct sounds, fragments, or words by imagining the details they didn't hear, and use their knowledge, memories, and experiences to deduce the logic of the conversation (121). Over time, they may grasp the gist of a conversation by merely catching a few keywords. Thus, for AR hearing-assistive glasses, even if the accuracy of voice-to-text isn't very high or the conversion speed is slow, individuals can still construct a complete dialogue scene using their imagination and reasoning skills. Additionally, those with hearing impairments can use non-verbal strategies to enhance communication, such as observing the speaker's body language, facial expressions, and the context to deduce the meaning, emotions, and attitudes of the conversation (122, 123, 124). With these skills and strategies, they might communicate smoothly even if the AR glasses' function and interaction speed are not of high quality. In contrast, the perceived ease of use of AR hearing-assistive glasses has a more significant effect on communication. On the one hand, as a novel hearing-assistive tool, AR glasses differ considerably from traditional hearing aids, which require professional adjustments at specialized medical institutions, leaving users with no need for personal adjustments. However, AR glasses demand user interaction, which can occur at any stage of communication, emphasizing the importance of usability. On the other hand, the function and interaction speed of the glasses are implicit, while the user's operation of the glasses is explicit and visible to both parties. If the glasses are challenging to use, users might need to adjust them repeatedly during conversations, not only wasting time and causing communication delays but also diverting their attention. Not focusing on the interlocutor during a conversation is considered impolite and might make the other party feel disrespected (125). Therefore, the influence of perceived ease of use on communication effectiveness can create a chain reaction, much like the butterfly effect, resulting in a stronger impact. However, function quality and perceived interaction speed also have positive significant impacts on communication effectiveness and should not be overlooked during the design and development processes.
Secondly, communication effectiveness has a significant positive impact on both social image and confidence (H4 and H5 are supported). With the assistance of AR glasses, effective two-way communication allows understanding and expressing information clearly, preventing many awkward situations such as being unable to participate in group conversations, missing important information, or not responding promptly, which helps avoid feelings of marginalization and inferiority, enhancing conversational confidence. Furthermore, compared to confidence, social image is more significantly influenced by communication effectiveness. This could be because the stigmatization and negative social image of those with hearing impairments are often directly related to communication challenges (96). With the support of AR hearing-assistive glasses, people with hearing impairments can establish effective two-way communication, build a positive image, and gain more recognition, respect, and equality in social life, education, and career development (97). Additionally, a notable advantage of using AR glasses for communication is the ability to maintain eye contact during conversations, allowing the reading of facial expressions and non-verbal actions (57), which means that individuals with hearing impairments convey signals of attention, respect, interaction, and interest to their conversation partners (126). This can greatly affect the conversation partner's impression, respect, and perception (127), thereby shaping social image. Confidence, however, is influenced by various factors, including innate physiological factors like age, personality, and stress resilience, as well as acquired environmental influences like life experiences, education level, and professional roles (128, 129, 130). For users with hearing impairments, good communication is just one of the factors that influence their confidence, as it's also affected by other aspects. Therefore, compared to confidence, the influence of communication effectiveness on social image is more direct and thus stronger.
Social image has a significant positive impact on confidence (H6 is supported), which is consistent with the findings of previous studies (100, 101, 102). According to Tajfel and Turner (131), when individuals feel recognized and affirmed within their social group, their confidence is boosted. People with hearing impairments often do not consider themselves as disabled (132). Therefore, they desire to establish an image of capability equal to those with normal hearing. However, this desire often contradicts the use of hearing-assistive devices because the distinctive appearance of most of these devices inadvertently reveals their hearing deficiencies. Unlike other hearing aids that might expose one's hearing challenges, AR glasses possess high social acceptability and low stigmatization. They can enhance communication abilities without disclosing hearing impairments. Once this positive social image is recognized by others, it can boost positive emotions and confidence.
Lastly, both social image and confidence have a significant positive impact on the intention to use (H7 and H8 are supported). Social Identity Theory (131) suggests that individuals not only perceive themselves as independent entities but also as members of social groups, and they seek recognition from these groups. Therefore, the social image they exhibit is crucial. When individuals with hearing impairments gain a wholesome social image by using AR glasses, integrating them into the mainstream group, they are more likely to accept and adopt hearing-assistive technology. Conversely, devices that expose their hearing deficiencies are likely to be rejected (24). Furthermore, compared to social image, confidence has a stronger impact on the intention to use (0.534 > 0.296). This might be due to confidence serving as an intrinsic factor, exerting a more direct inner drive on usage intention, while the social image, as an external factor, primarily plays a supporting role. The construction of social image is rooted in others' perceptions and attitudes, an external push. This external force typically undergoes self-awareness, filtration, absorption, and rational analysis before it internalizes and influences behavior. Throughout this process, users filter some external factors based on their self-perception, reducing the impact of these factors to some extent. In contrast, confidence, being an intrinsic driver, can directly influence behavior choices (119), and hence has a more potent influence. Confidence is a robust internal motivator. Especially for unique groups, confidence plays an even more crucial role since the hearing-impaired face more challenges and obstacles, requiring the encouragement and support of confidence (133). AR hearing-assistive glasses equip users with the ability to communicate normally, and with continued use, they establish more social confidence. These users will increasingly believe that they can enhance communication through technology, thus being more inclined to use AR hearing-assistive glasses.
From the overall path of the structural equation, social factors (social image) and individual factors (confidence) are the decisive elements influencing the intention to use AR hearing-assistive glasses, whereas technological factors (function quality, perceived interaction speed, and perceived ease of use) serve merely as essential prerequisites and foundations and do not directly determine the intention to use AR hearing-assistive glasses. Social factors exert a massive influence on individual behaviors. Mead (134) pointed out that social relations and personal experiences determine human behavior. dos Santos, Ferrari (31) also confirmed in their research that if assistive technology draws negative attention and images, users will refrain from using it, even if the device promises functional improvements. Intrinsic personal factors also play a pivotal role in affecting individual behaviors. Hearing assistive technologies and products can enhance a user's physical condition and boost their confidence (135). Someon's confidence typically amplifies motivation and significantly impacts behavioral decisions (99). Hence, both individual intrinsic factors and social factors should be considered to an equal extent (31). Technological factors don't directly influence behavioral intentions but impact them through social and individual factors as mediation. This is primarily because AR hearing-assistive glasses are mass-produced products. Due to the diversity of individual needs, subjective attitudes, and the influence of social external factors, different users with hearing impairments differ significantly in aspects like gender, age, degree of hearing loss, the extent of assistive needs, usage experience, as well as the social environment, interpersonal relationship demands, and the level of social support (136, 137, 138). These factors could potentially interfere with or alter an individual's intention to use, causing decisions not solely based on product performance.