Can You Hear Me Now? The Impact of Hearing Loss on Patient Health Literacy
Anthony M. Tolisano, Lilly B. Fang, Brandon Isaacson, Joe Walter Kutz, Jacob B. Hunter
Abstract
OBJECTIVE: To elucidate the impact of hearing loss on patient health literacy. STUDY DESIGN: Prospective, cross-sectional study. SETTING: Academic otology practice at a university hospital. PATIENTS: Consecutive, adult, English-speaking patients. MAIN OUTCOME MEASURES: Inadequate health literacy, defined as a composite score of less than or equal to nine on the brief health literacy screen (BHLS), was compared with patient hearing data utilizing the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification. Secondary outcome measures included comparisons of inadequate BHLS scores according to patient demographic and clinical information. RESULTS: There were 300 consecutive adult (>18 years old) patients evaluated with the BHLS at a university otology practice between February and March 2019. The median patient age was 60-years (range, 18-91 yr), a slight majority (160, 53.3%) were women, and most patients were White (241, 86.7%) and non-Hispanic (260, 91.6%). Overall, 9.7% of patients were found to have inadequate health literacy. Men had higher rates of inadequate health literacy as compared with women (13.6% versus 6.3%, odds ratio [OR] = 2.35, 95% confidence interval [CI] 1.06-5.25). Audiometric data was available for 284 (95%) patients, of which 235 (82.7%) had class A or B hearing and 49 (17.3%) had class C or D hearing. Patients with Class C or D hearing had a lower median composite BHLS score compared with patients with Class A or B hearing (11.6 versus 13.6, p < 0.0001) and an increased rate of inadequate health literacy (28.6% versus 4.7%, OR = 8.15, 95% CI 3.42-19.37). Increased age, female sex, and better hearing were independent predictors of higher BHLS scores on multivariable analysis. CONCLUSIONS: Hearing loss is an independent risk factor for inadequate health literacy. Providers should be aware of this risk and consider implementing strategies to improve counseling for this at-risk group of patients.