PROJECT SUMMARY/ABSTRACT Age-related hearing loss is a substantial national problem due to its high prevalence and significant quality- of-life consequences. Although hearing aids (HAs) are the primary choice for the management of age-related hearing loss, the adoption rate of HAs is quite low. A commonly reported barrier to HA uptake is that HAs ob- tained in the traditional healthcare pathway, which requires multiple visits to a licensed professional (e.g., audi- ologists) for hearing loss diagnosis and the month(s) long process of fitting and fine-tuning HAs, are not afford- able or accessible. We refer to this healthcare pathway as the AUD pathway. As an alternative pathway to im- prove affordability and accessibility of hearing healthcare, the over-the-counter (OTC) pathway uses a direct- to-consumer service-delivery model and enables users to self-determine hearing loss, self-fit the HA, and self- manage device without professional support. Although the OTC pathway has become popular, little is known about how potential users determine the right pathway for themselves (OTC vs. AUD) and how the OTC pathway impacts users’ long-term well-being. To guide potential users in their selection of one pathway over the other and to improve well-being of people with hearing loss, our project aims to characterize the entire OTC patient journey and compare that with the AUD journey, from pathway selection, through patient outcomes and consequences of unsuccessful HA expe- riences. Aim 1 seeks to understand the decision-making processes used by individuals to choose between the OTC and AUD pathways (i.e., what factors they consider and what personal characteristics drive the decision). Aim 2 seeks to determine the long-term (12 months) course of OTC outcomes (e.g., HA satisfaction) com- pared with that of the AUD pathway and to establish the individual differences (e.g., finger dexterity) that ex- plain the variance in long-term outcomes of each pathway. Aim 3 seeks to understand what people think and do following unsuccessful OTC experiences and whether this is the same as for the AUD pathway (Aim 3). To achieve our aims, we will conduct a two-site (Iowa and Vanderbilt), mixed-methods, longitudinal study in which participants choose their preferred healthcare pathways (OTC vs. AUD). Participants will purchase HAs up-front, but will be able to return the devices for a refund within the manufacturers’ trial periods. After selecting a pathway (Aim 1), participants will be contacted at 1-, 6- and 12-months post-fitting. At each contact, depend- ing on the status of HA usage we will assess HA outcomes (Aim 2) or the engagement with hearing healthcare behaviors (e.g., adopting new HAs, Aim 3). Our project will generate crucial data that will help us develop tools (e.g., decision aids) that adults with hearing loss can use to make informed decisions regarding hearing healthcare, and help ensure that the OTC pathway has a positive impact on their well-being.