Knowledge, Attitude & Practices regarding Hearing Loss and its prevention among the general Population of Haryana: A Community Based Study.

Hearing loss is an increasingly recognized global public health concern with profound medical, social, and economic implications. The World Health Organization estimates that over 1.5 billion individuals worldwide experience some degree of hearing impairment, of whom nearly 430 million require rehabilitation services.1-3 This burden is projected to escalate further due to population aging, urbanization, and widespread exposure to environmental and recreational noise. Beyond its clinical dimension, hearing loss significantly compromises communication ability, educational attainment, employment opportunities, and psychosocial well-being, thereby contributing to long-term disability and reduced quality of life.4-6

 

Importantly, a substantial proportion of hearing loss is preventable. Noise-induced hearing loss, one of the most common forms, has emerged as a critical concern in both developed and developing nations.7,8 Rapid technological advancements, including the ubiquitous use of personal listening devices, increased exposure to amplified music, occupational noise in industrial settings, and urban environmental noise, have amplified the risk among younger and working-age populations. Despite the availability of preventive measures—such as safe listening practices, use of protective devices, and early screening—awareness and adoption of these strategies remain suboptimal.9,10

 

In the Indian context, hearing impairment constitutes a significant yet often neglected public health issue. Limited awareness, social stigma, delayed diagnosis, and inadequate access to audiological services further exacerbate its impact.11-13 Haryana, a rapidly developing state with expanding industrialization and urbanization, presents a unique setting where environmental and occupational noise exposure may be increasing. However, community-level awareness regarding hearing health, preventive practices, and early healthcare-seeking behavior remains inadequately explored.

 

Assessment of Knowledge, Attitude, and Practices (KAP) provides a comprehensive framework for understanding how individuals perceive and respond to health-related issues. Knowledge reflects awareness and understanding of hearing loss and its risk factors; attitude encompasses beliefs, perceptions, and readiness to adopt preventive measures; while practices represent actual behaviors related to hearing protection and healthcare utilization. Disparities between knowledge and practice are frequently observed, where individuals may be aware of risks but fail to adopt protective behaviors due to misconceptions, negligence, or socio-cultural influences.

 

Existing literature suggests that although general awareness of hearing loss may be present, critical gaps persist in understanding preventable risk factors such as prolonged exposure to high-decibel sound, unsafe use of earphones, and the importance of routine hearing evaluation.14-17 Furthermore, attitudes toward hearing protection are often influenced by perceived susceptibility, social norms, and accessibility of healthcare services. These gaps collectively contribute to the growing burden of preventable hearing impairment.

 

Given the preventable nature of a significant proportion of hearing loss and its far-reaching consequences, it is essential to evaluate community-level knowledge, attitudes, and practices to inform targeted public health interventions. However, there is a paucity of region-specific data assessing these dimensions among the general population of Haryana.

 

Therefore, the present study aims to assess the knowledge, attitude, and practices regarding hearing loss and its prevention among the general population of Haryana through a community-based approach. The findings of this study are expected to identify critical gaps in awareness and behavior, thereby providing evidence for designing effective educational strategies, strengthening preventive measures, and promoting hearing health at the population level.

Study Design and Setting

A community-based descriptive cross-sectional study was conducted to assess the knowledge, attitude, and practices (KAP) regarding hearing loss and its prevention among the general population of Haryana, India. The study was carried out over a period of four months (September to December, 2025) using a structured, self-administered online questionnaire. The digital mode of data collection was adopted to facilitate wider geographic reach, ease of participation, and rapid data acquisition across different regions of the state.

 

Study Population

The study population comprised adults aged 18 years and above who had been residing in Haryana for at least one year prior to participation. Participants were required to have access to a smartphone or computer and the ability to read and understand the questionnaire independently.

 

Inclusion Criteria

•              Adults aged ≥18 years

•              Residents of Haryana for ≥1 year

•              Willing to participate and provide digital informed consent

•              Able to complete an online questionnaire independently

 

Exclusion Criteria

•              Healthcare professionals (doctors, audiologists, ENT specialists, nurses, and medical students) to avoid professional knowledge bias

•              Individuals with known severe hearing impairment affecting comprehension

•              Incomplete or duplicate responses

•              Respondents residing outside Haryana

 

 

 

Sample Size Determination

The sample size was calculated using the single population proportion formula, assuming a 50% prevalence of adequate knowledge regarding hearing loss prevention (due to lack of prior regional data), with a 95% confidence interval and a 5% margin of error. The minimum required sample size was estimated to be 384 participants. To improve precision and compensate for incomplete responses, the final target sample size was increased to 420 participants.

 

Sampling Technique and Data Collection

A non-probability convenience sampling technique was used. Data were collected exclusively through an online Google Form questionnaire. The survey link was disseminated via multiple digital platforms, including WhatsApp, email, and social media groups, as well as through community networks and educational institutions across Haryana.

The first section of the Google Form contained a brief description of the study objectives, assurance of confidentiality, and a digital informed consent statement. Only participants who provided consent were allowed to proceed to the questionnaire. The average time required to complete the survey was approximately 8–12 minutes. To ensure data quality, duplicate entries were restricted using Google Form settings, and incomplete responses were excluded from analysis.

 

Data Collection Instrument

A structured and pre-tested questionnaire was developed based on a comprehensive review of relevant literature on hearing loss awareness, prevention strategies, and KAP studies. The questionnaire was designed in simple, non-technical language to ensure clarity and accessibility for the general population.

The instrument consisted of four sections:

 

Section I: Socio-Demographic Characteristics

This section included variables such as age, gender, educational status, occupation, monthly household income, and area of residence (urban/semi-urban/rural).

 

Section II: Knowledge Regarding Hearing Loss and Its Prevention

This section assessed participants’ awareness regarding:

•              Causes of hearing loss (noise exposure, infections, aging, ototoxic drugs)

•              Risk factors (prolonged headphone use, loud environments, occupational exposure)

•              Early symptoms (hearing difficulty, tinnitus)

•              Preventive measures (safe listening practices, ear protection, regular hearing check-ups)

Each correct response was awarded one point, while incorrect or “don’t know” responses were scored zero.

 

Section III: Attitude Toward Hearing Loss and Prevention

Participants’ attitudes were evaluated using statements related to:

•              Perceived seriousness of hearing loss

•              Perceived susceptibility to hearing impairment

•              Importance of preventive measures

•              Willingness to adopt safe listening behaviors

•              Healthcare-seeking attitudes

Responses were recorded using a three-point Likert scale (Agree, Neutral, Disagree), and appropriate responses were scored accordingly.

 

Section IV: Practices Related to Hearing Health

This section assessed behavioral patterns, including:

•              Use of earphones/headphones and listening habits

•              Exposure to loud noise environments

•              Use of hearing protection measures

•              Frequency of hearing check-ups

•              Response to hearing-related symptoms

Responses were analyzed to determine safe and unsafe practices.

 

Scoring Criteria

Knowledge Score

•              Excellent: ≥75% correct responses

•              Good: 50–74%

•              Fair: 25–49%

•              Poor: <25%

 

Attitude Score

•              Positive attitude

•              Moderate attitude

•              Neutral/mixed attitude

•              Negative attitude

 

Practice Score

•              Good practices

•              Moderate practices

•              Poor practices

 

Validation and Reliability

The questionnaire underwent content and face validation by a panel of experts, including an otorhinolaryngologist (ENT specialist), a public health expert, and a biostatistician. Necessary revisions were made to ensure clarity, relevance, and scientific accuracy.

A pilot study was conducted among 40 participants (excluded from final analysis) to evaluate feasibility and comprehension. Reliability testing demonstrated good internal consistency, with Cronbach’s alpha ≥0.80.

 

Data Management and Statistical Analysis

Data collected through Google Forms were exported to Microsoft Excel for cleaning and coding. Statistical analysis was performed using IBM SPSS Statistics (Version 26.0).

Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize socio-demographic variables and KAP scores. Inferential statistics included:

•              Chi-square test to assess associations between KAP variables and socio-demographic factors

•              Pearson’s correlation coefficient to determine relationships among knowledge, attitude, and practice scores

A p-value of <0.05 was considered statistically significant.

 

Ethical Considerations

Participation was voluntary, and digital informed consent was obtained prior to questionnaire completion. Anonymity and confidentiality were strictly maintained, and no personal identifiers were collected. Data were used solely for research purposes in accordance with ethical guidelines for human subject research.

The study included 420 participants, with the majority belonging to the 26–35 years age group (28.6%), followed by 18–25 years (25.7%). Females constituted a slightly higher proportion (53.3%) compared to males. Most participants were graduates (42.4%) or postgraduates (37.6%), indicating a relatively well-educated population. In terms of occupation, a significant proportion were service/professionals (38.6%), followed by homemakers and students. The majority of respondents reported a monthly household income between ₹25,001–50,000 (32.9%), and most resided in urban areas (71.0%), reflecting a predominantly urban and educated study cohort.

 

TABLE 1: Socio-Demographic Characteristics of Study Participants (n = 420)

 

Knowledge regarding hearing loss and its prevention was generally moderate to good among participants. High awareness was observed regarding causes of hearing loss (82.4%), preventive measures (83.8%), and the impact of hearing loss on communication and social life (85.2%). A substantial proportion correctly identified harmful effects of prolonged exposure to loud noise and unsafe earphone use. However, knowledge gaps were evident in specific areas such as the concept of the 60/60 safe listening rule (53.3%), ototoxic medications (56.2%), and age-related hearing loss (57.6%), indicating incomplete understanding of certain technical and preventive aspects.

 

TABLE 2: Knowledge Regarding Hearing Loss and Its Prevention Among the General Population of Haryana (n = 420)

 

Attitude toward hearing loss and its prevention was largely positive among participants. A majority agreed that hearing loss is a serious health concern (75.7%) and significantly affects quality of life (79.0%). Most respondents acknowledged the importance of safe listening practices, early medical consultation, and hearing protection in noisy environments. Additionally, strong support was observed for increasing public awareness (82.9%) and government-led initiatives (84.8%). However, moderate misconceptions persisted regarding susceptibility among younger individuals and the necessity of protective measures, indicating scope for behavioral change interventions.

 

 

TABLE 3: Attitude Toward Hearing Loss and Its Prevention Among the General Population of Haryana (n = 420)

 

Practice patterns related to hearing loss prevention were variable and less optimal compared to knowledge and attitude. A majority of participants reported regular use of earphones (73.3%), with a considerable proportion listening at high volume levels (42.4%) and being exposed to loud environments (64.8%).

 

Adoption of safe practices such as limiting listening duration (43.8%), following safe listening rules (38.6%), and using hearing protection devices (32.9%) was relatively low. Although 59.0% reported consulting a doctor for hearing-related issues, only 37.1% had undergone hearing check-ups.

 

Risky behaviors such as frequent use of cotton buds (56.7%) and ignoring early symptoms (51.0%) were also observed.

 

 

 

 

TABLE 4: Practices Related to Hearing Loss and Its Prevention Among the General Population of Haryana (n = 420)

 

Overall, knowledge scores were predominantly good (44.3%) or excellent (23.3%), indicating a satisfactory level of awareness among participants. Attitude scores showed that most participants had moderate (46.2%) to positive attitudes (24.3%) toward hearing health.

 

However, practice scores were comparatively lower, with only 21.0% demonstrating good preventive practices and nearly half exhibiting moderate practices (47.1%).

 

The mean scores further suggest that while knowledge and attitudes are relatively favorable, their translation into appropriate preventive behaviors remains suboptimal.

 

 

 

TABLE 5: Overall Knowledge, Attitude, and Practice (KAP) Score Distribution Among the General Population of Haryana (n = 420)

Level	Score Range (out of 20)	Knowledge n (%)	Attitude n (%)	Practice n (%)
Excellent / Positive / Good (≥75%)	15–20	98 (23.3)	102 (24.3)	88 (21.0)
Good / Moderate / Moderate (50–74%)	10–14	186 (44.3)	194 (46.2)	198 (47.1)
Fair / Neutral / Low (25–49%)	5–9	94 (22.4)	82 (19.5)	90 (21.4)
Poor / Negative / Poor (<25%)	0–4	42 (10.0)	42 (10.0)	44 (10.5)
Mean ± SD	—	13.5 ± 3.2	13.2 ± 3.4	12.8 ± 3.6

 

Knowledge regarding hearing loss showed statistically significant associations with age (p=0.004), educational level (p<0.001), occupation (p=0.005), and monthly income (p=0.006). Higher knowledge levels were observed among older participants, those with higher educational attainment, professionals, and individuals with higher income levels. Gender and area of residence did not show significant associations, although urban participants demonstrated relatively better knowledge trends compared to semi-urban residents.

 

TABLE 6: Association Between Socio-Demographic Variables and Knowledge Regarding Hearing Loss Among the General Population of Haryana (n = 420)

 

Attitude toward hearing loss and its prevention was significantly associated with age (p=0.006), educational level (p<0.001), occupation (p=0.010), and monthly income (p=0.011).

 

Participants with higher education and income levels exhibited more positive attitudes toward hearing health and preventive practices. Professionals demonstrated better attitude scores compared to other occupational groups.

 

However, gender and area of residence were not statistically significant, although urban participants showed relatively more favorable attitudes.

 

TABLE 7: Association Between Socio-Demographic Variables and Attitude Toward Hearing Loss and Its Prevention Among the General Population of Haryana (n = 420)

 

Practices related to hearing loss prevention were significantly associated with age (p=0.008), educational level (p<0.001), occupation (p=0.012), and monthly income (p=0.014).

 

Participants with higher education, professional occupations, and higher income levels demonstrated more appropriate preventive practices.

 

Younger individuals and those with lower educational status showed comparatively poorer practices. Gender and area of residence were not significantly associated, although urban participants exhibited slightly better practice patterns.

 

 

 

TABLE 8: Association Between Socio-Demographic Variables and Practices Related to Hearing Loss Prevention Among the General Population of Haryana (n = 420)

 

Correlation analysis revealed significant positive relationships among knowledge, attitude, and practice scores. Knowledge demonstrated a moderate positive correlation with attitude (r=0.472) and a strong positive correlation with practice (r=0.558).

 

Attitude also showed a moderate positive correlation with practice (r=0.438). These findings indicate that higher knowledge levels are associated with more positive attitudes and better preventive practices, highlighting the critical role of awareness in influencing health-related behavior.

 

 

 

TABLE 9: Correlation Between Knowledge, Attitude, and Practice (KAP) Scores Among the General Population of Haryana (n = 420)

 

Pearson’s Correlation Coefficient (r)

**Correlation is significant at the 0.01 level (2-tailed)

The present study assessed knowledge, attitude, and practices (KAP) regarding hearing loss and its prevention among the general population of Haryana in the context of increasing exposure to environmental and recreational noise. The findings provide important insights into the current level of awareness, prevailing perceptions, and behavioral patterns related to hearing health, highlighting both strengths and critical gaps.

 

Knowledge Regarding Hearing Loss

The study revealed that overall knowledge regarding hearing loss and its prevention was moderate to good, with a majority of participants demonstrating good or excellent awareness levels. High awareness was observed regarding common causes of hearing loss, such as prolonged exposure to loud noise and unsafe earphone use, as well as its impact on communication and quality of life. This suggests that general information about hearing health is increasingly accessible, possibly due to growing digital exposure and public health messaging. However, notable gaps were identified in more specific and technical aspects, including safe listening practices (such as the 60/60 rule), understanding of ototoxic medications, and age-related hearing loss (presbycusis). These findings indicate that while participants may be familiar with general concepts, deeper and more practical knowledge required for effective prevention remains insufficient. Similar trends have been reported in previous KAP studies, where basic awareness exists but detailed understanding of preventive strategies is lacking.18-21

 

Attitude Toward Hearing Loss and Prevention

Attitude toward hearing loss was generally positive among participants, with most recognizing it as a significant health concern and acknowledging its impact on quality of life. A large proportion expressed agreement with the importance of preventive measures, early medical consultation, and hearing protection in noisy environments. Additionally, there was strong support for increasing public awareness and implementing government-led initiatives, reflecting a favorable mindset toward hearing health promotion. Despite this, certain misconceptions persisted. Some participants underestimated the susceptibility of younger individuals to hearing loss or did not fully appreciate the necessity of consistent preventive practices. These findings suggest that although attitudes are largely favorable, they may not always translate into a strong perceived personal risk, which is essential for behavioral change. This gap between awareness and perceived vulnerability is a common challenge in preventive health behavior.

 

Practices Related to Hearing Loss Prevention

In contrast to knowledge and attitude, practices related to hearing loss prevention were relatively suboptimal. A significant proportion of participants reported regular use of earphones, often at high volume levels, and frequent exposure to loud environments. Adoption of protective behaviors—such as limiting listening duration, following safe listening rules, and using hearing protection devices—was comparatively low. Furthermore, although many participants acknowledged the importance of early medical consultation, only a smaller proportion had undergone hearing check-ups, and a considerable number reported ignoring early symptoms of hearing loss. Risky practices such as frequent use of cotton buds were also prevalent. These findings highlight a clear disconnect between knowledge/attitude and actual behavior, emphasizing that awareness alone is insufficient to ensure adoption of preventive practices.

 

KAP Relationship and Behavioral Gap

One of the key findings of this study is the significant positive correlation between knowledge, attitude, and practices. Higher knowledge levels were associated with more positive attitudes and better preventive practices, reinforcing the critical role of awareness in influencing health behavior. The strongest correlation observed between knowledge and practice suggests that improving knowledge may directly contribute to better adoption of safe hearing practices. However, despite these correlations, the persistence of unsafe practices indicates the presence of a “knowledge–practice gap.” Individuals may be aware of risks but fail to adopt preventive behaviors due to factors such as convenience, lifestyle habits, lack of perceived immediate harm, or social influences. This highlights the need for interventions that not only provide information but also promote behavioral change through motivation, reinforcement, and accessibility of preventive measures.

 

Influence of Socio-Demographic Factors

The study demonstrated that education, occupation, income, and age were significantly associated with knowledge, attitude, and practices. Participants with higher educational levels and income demonstrated better awareness, more positive attitudes, and more appropriate practices. Professionals also showed more favorable KAP profiles compared to other occupational groups. These findings underscore the role of socioeconomic factors in shaping health literacy and behavior. Individuals with higher education and income are more likely to access reliable information, understand health risks, and adopt preventive measures. Conversely, lower socioeconomic groups may face barriers such as limited awareness, reduced access to healthcare services, and competing priorities, which can hinder preventive practices.

 

Gender and area of residence did not show statistically significant associations, although urban participants demonstrated relatively better trends. This may reflect increasing digital penetration and access to information across different population groups, potentially reducing traditional disparities. Overall, the study demonstrates that while awareness and attitudes toward hearing loss are relatively favorable among the general population of Haryana, significant gaps persist in preventive practices. The findings highlight the need for targeted, behavior-focused interventions to bridge the gap between knowledge and action and to promote effective hearing loss prevention strategies at the community level.22-24

 

Public Health Implications

The findings of this study have important public health implications. The moderate-to-good levels of knowledge and positive attitudes provide a strong foundation for implementing preventive strategies. However, the gap in actual practices highlights the need for targeted interventions focusing on behavior change rather than awareness alone. Health education programs should emphasize practical aspects of hearing loss prevention, such as safe listening habits, limiting exposure to loud noise, and the importance of regular hearing check-ups.

 

Digital platforms, social media campaigns, and community-based awareness programs can be utilized to disseminate accurate and actionable information. Additionally, incorporating hearing health education into school and workplace settings may help address risk factors among younger and working populations. Healthcare professionals also play a crucial role in promoting hearing health by providing counseling, encouraging early screening, and reinforcing preventive behaviors. Policy-level interventions, including regulations on noise exposure and promotion of safe listening standards, are equally important in reducing the burden of preventable hearing loss.

 

Strengths and Limitations

A key strength of this study is its comprehensive assessment of knowledge, attitude, and practices within a single framework, allowing for a holistic understanding of hearing health awareness and behavior. The relatively large sample size enhances the reliability of the findings. However, certain limitations must be acknowledged. The use of an online questionnaire may have led to overrepresentation of younger, educated, and digitally literate individuals, potentially limiting generalizability to rural or less literate populations. Self-reported data may be subject to recall and response bias. Additionally, the use of convenience sampling limits the ability to establish population-level estimates.

The present study demonstrates that the general population of Haryana possesses moderate-to-good knowledge and generally positive attitudes regarding hearing loss and its prevention. However, significant gaps persist in the adoption of safe hearing practices, particularly related to prolonged earphone use, high-volume listening, and limited utilization of preventive measures such as hearing protection and regular check-ups.

 

Socio-demographic factors, especially education, occupation, and income, significantly influenced knowledge, attitude, and practices. Furthermore, the positive correlation between knowledge, attitude, and practices highlights the critical role of awareness in shaping preventive behavior. These findings emphasize that while awareness is improving, translating knowledge into consistent and safe practices remains a key challenge in hearing loss prevention.

 

RECOMMENDATIONS

To address the identified gaps and promote hearing health at the community level, the following recommendations are proposed:

•          Strengthening Public Awareness Campaigns: Develop targeted educational programs focusing on safe listening practices, early symptoms of hearing loss, and preventive strategies using digital media, community outreach, and mass communication platforms.

•          Promoting Safe Listening Behavior: Encourage adoption of practical measures such as limiting earphone use, maintaining safe volume levels (e.g., 60/60 rule), and reducing exposure to loud environments through behavior change communication strategies.

•          Integration into School and Workplace Programs: Incorporate hearing health education into school curricula and occupational health programs, especially in high-risk environments, to promote early awareness and preventive habits.

•          Enhancing Access to Screening Services: Facilitate periodic hearing screening camps and promote routine hearing check-ups, particularly for high-risk groups, to enable early detection and timely intervention.

•          Role of Healthcare Professionals: Strengthen patient counseling by healthcare providers regarding hearing loss risks, safe listening practices, and the importance of early consultation.

•          Policy and Regulatory Measures: Implement and enforce regulations to control environmental and occupational noise levels, and promote safe listening standards for personal audio devices.

Use of Digital Health Platforms: Utilize mobile applications, online resources, and telehealth platforms to disseminate accurate information and improve accessibility to hearing health services.

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