From rights to reach: a distributive policy framework bridging health literacy education, standardised medical sign language, and healthcare access for people with hearing loss in Thailand

Abstract Background People with hearing loss in Thailand face persistent gaps between rights legislated under the Persons with Disabilities Empowerment Act B.E. 2550 and rights as experienced in everyday clinical encounters. Existing research rarely connects multi-region lived-experience evidence with concrete policy instruments. This study developed a distributive policy framework, anchored by a standardised medical sign language vocabulary and the MU-silentcare mobile application, to advance equitable health literacy and healthcare access. Methods A sequential explanatory mixed-methods, three-phase design was conducted across all seven regions of Thailand. Phase 1 used semi-structured interviews and focus group discussions with 138 purposively sampled stakeholders, including people with lived experience. Phase 2 administered a validated needs-assessment questionnaire (Cronbach’s α = 0.92; Item-Objective Congruence Index = 0.8) to 421 people with hearing loss recruited by cluster sampling; data were analysed using the modified Priority Needs Index (PNI modified ). Phase 3 combined a 14-day MU-silentcare mobile-application workshop, pre–post paired-samples t -tests on 453 participants, and policy-validation focus group discussions with 88 stakeholders. Results Phase 1 identified twelve issues across three domains: health literacy barriers, healthcare access and service-quality gaps, and systemic policy deficiencies. Phase 2 ranked healthcare access (PNI = − 0.50) and digital innovation (PNI = − 0.45) as top-priority needs; urgent-care response times received the highest importance rating ( M = 4.67/5). Phase 3 produced statistically significant improvements across all five health-literacy dimensions (overall t (452) = − 30.42, p < 0.001, Cohen’s d = 2.49); the largest effects were in symptom communication ( d = 2.47) and medical sign language knowledge ( d = 2.26). Convergent evidence yielded five evidence-traceable distributive policy proposals. Conclusions Health literacy and healthcare access barriers experienced by people with hearing loss in Thailand are produced by health-system design rather than by hearing status. The MU-silentcare application demonstrated that large gains are achievable by changing the language of the system rather than training the user. Five distributive policies, visual health-communication media standards, mandatory deaf-friendly service points, removal of mobile-device restrictions, cross-sector coordination, and equitable resource allocation, are politically feasible within a single policy cycle through ministerial regulation under the existing legal framework.