Health Literacy and Self-Reported Hearing Aid Use in the Health and Retirement Study

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.