Abstract
Objectives: Understanding the determinants of hearing aid use is important to improve the provision of hearing healthcare. Prior research has indicated that materials in the clinic and online, as well as audiologists' language during appointments, require a higher literacy level than most patients possess. We hypothesized that low health literacy is a barrier to entry in hearing healthcare, and therefore that health literacy would be positively correlated with the probability of hearing aid use. Design: We performed retrospective analyses of the Health and Retirement Study, a longitudinal survey of American adults of retirement age. Objective health literacy was measured in different but overlapping subsamples using subsets of the Test of Functional Health Literacy in Adults and the Rapid Estimate of Adult Literacy in Medicine (n = 1240, n = 1586, and n = 2412). Subjective health literacy was assessed using a single-question screener in a larger sample (n = 8362). Separate discrete time models including common covariates of hearing aid use were constructed for each subsample. Results: Objective health literacy measures did not correlate significantly with hearing aid use when age, gender, race/ethnicity, self-assessed hearing ability, and net income were included in the models. Subjective health literacy did correlate significantly with hearing aid use in the complete model, with lower subjective health literacy correlated with lower odds of reporting hearing aid use. Conclusions: Taken at face value, the results provide mixed evidence for a link between health literacy and hearing aid use. The results from the analysis of the largest sample, using the subjective health literacy measure, were consistent with the hypothesis that low health literacy is a barrier to hearing aid use. However, this was not supported by the analysis of the objective health literacy measures in these samples. Further research using full health literacy measurement tools and capturing other relevant variables would offer clarification on this conflict. The literacy level of clinical materials and conversation is a modifiable potential factor in hearing aid uptake, so further clinical and research consideration is warranted.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 386-394 |
| Number of pages | 9 |
| Journal | Ear and hearing |
| Volume | 41 |
| Issue number | 2 |
| DOIs | |
| State | Published - 2019 |
Funding
The Health and Retirement Study is supported by NIA U01AG009740 and the Social Security Administration. The design of HRS is presented in great detail elsewhere (HRS Staff 2008). Briefly, it is a longitudinal survey of households with at least one person of retirement age funded by the National Institute on Aging (NIA U01AG009740) and has been under the aegis of the University of Michigan since its inception in 1992. The core survey is administered every two years to the sample of approximately 20,000 respondents, and has an overall response rate of greater than 80% (HRS Staff 2017). The core survey includes questions regarding demographic information, healthcare use, work status, family structure, mental and physical health, finances, housing, and more. This survey is administered using telephone and face-to-face interviews. In addition, off-year surveys probe different or novel topics, such as educational expenses, internet use, and health literacy via mail, telephone, or internet-administered surveys to different subsamples of the overall HRS sample. Deidentified data are available for download directly from the HRS website. The present study used data from the 1992–2014 biennial Core Surveys, as well as the 2009 Internet Survey, the 2011 Health Care Mail Survey, and the 2013 Health Care and Nutrition Study. Unique identifiers allow for tracking of individual respondents or households over multiple HRS surveys.
Keywords
- Health literacy
- Hearing aid uptake
ASJC Scopus subject areas
- Otorhinolaryngology
- Speech and Hearing