Self-perceived Ability to Understand Speech does not Influence CRC Screening Adherence Among Sign Language Users

Early detection of colorectal cancer (CRC) through screening improves survival and reduces mortality, yet adherence is shaped by education and communication barriers. Such systemic barriers are relevant for the deaf, deafblind, and hard of hearing (DDBHH) population using American Sign Language (ASL). While educational attainment is closely linked to cancer screening, less is understood about whether an individual's self-perceived ability to communicate in spoken language settings influences screening behavior. In this study, we examine 'functional hearing ability,' defined as a person's self-perception of their ability to understand what someone says in a quiet room, and its relationship to CRC screening adherence. Using the National Cancer Institute's Health Information National Trends Survey in ASL and U.S. Preventive Services Task Force (USPSTF) CRC screening guidelines, we surveyed 600 ASL-using adults from July 2023 to June 2025. Multivariable logistic regression tested associations between self-perceived ability to understand spoken language in a quiet room (understand well vs. cannot understand well in a quiet room) and screening adherence, adjusting for age, education, their interaction, race, and marital status. Significance was set at p ≤ 0.05. Functional hearing ability was not significantly associated with CRC screening [OR 0.86 (95% CI: 0.58-1.27); p = 0.44]. However, the interaction between age and education remained significant (p = 0.04). College graduates were more likely to follow screening guidelines compared to non-graduates, though this benefit diminished with age [age 45-54: OR 2.47 (1.30-4.70); 55-64: OR 1.25 (0.72-2.17); 65-74: OR 0.75 (0.39-1.46)]. Hispanic [OR 0.80 (0.53-1.19)] and Other races [OR 0.50 (0.31-0.80)] were also less likely to be screened than White participants (p = 0.02). Findings suggest functional hearing ability, defined as perceived ability to understand a speaker in a quiet room, alone does not predict screening adherence. Addressing educational disparities, through ASL-fluent community health workers or patient navigators, may improve increasing CRC screening rates in the DDBHH community.