Subjective-objective health literacy discrepancy, reduced healthcare utilization, and functional limitations associated with hearing loss

Abstract

Purpose Hearing loss is associated with various functional outcomes. However, its relationship with health literacy and healthcare utilization remains unclear. This study aimed to evaluate the associations of hearing loss with health literacy and healthcare utilization. Methods Data from 3,013 adults were obtained from the Ninth Korea National Health and Nutrition Examination Survey (2023). Hearing status was classified as normal hearing (<= 25 dB), mild hearing loss (> 25 to <= 40 dB), or moderate or worse hearing loss (> 40 dB). Subjective health literacy was assessed using a 10-item questionnaire, whereas objective health literacy was evaluated with a performance-based item. Healthcare utilization was assessed through participation in national health and cancer screening programs, and functional status was evaluated via self-reported activity limitations. Multivariable analyses were performed with adjustment for covariates. Results Hearing thresholds were not associated with low subjective health literacy. However, worse hearing thresholds were significantly associated with inadequate objective health literacy (p = 0.001), nonparticipation in general health screening (p = 0.001) and cancer screening (p = 0.004), and restrictions in daily and social activities (p = 0.046) in multivariable analyses. Sensitivity analyses confirmed the robustness of these associations, and the discrepancy between subjective and objective health literacy increased with hearing loss severity (both p < 0.05). Conclusion Hearing loss was associated with measurable deficits in objective health literacy and reduced preventive screening participation, and functional limitations. However, individuals with hearing loss perceived their health literacy to be intact. Considering these discrepancies, tailored, multimodal communication is needed to enhance healthcare engagement.