Informational counselling on occupational noise-induced hearing loss among construction workers in South Africa: gaps in health and safety communication and implications for hearing conservation

Background Occupational noise-induced hearing loss (ONIHL) is a preventable yet highly prevalent occupational disease, particularly in the construction sector where workers are routinely exposed to hazardous noise levels. In South Africa and other low- and middle-income countries (LMICs), health and safety training is implemented; however, limited evidence exists on whether such training adequately supports effective hearing conservation. Examining the nature and content of informational counselling provided to construction workers is critical for identifying gaps in hearing conservation programmes (HCPs). Methods A cross-sectional mixed-methods study was conducted among construction workers at selected worksites in South Africa using a paper-based questionnaire. Data collected included demographic characteristics, exposure to general health and safety information, receipt of ONIHL-specific counselling, awareness of HCPs, and methods of information delivery. Quantitative data were analysed using descriptive statistics and exploratory inferential analyses, while qualitative responses were analysed thematically to explore workers’ perceptions and experiences of informational counselling. Results All participants (100%) reported receiving general health and safety information; however, only one-third (33%) reported receiving counselling related specifically to occupational noise exposure or hearing loss. Most workers (77%) indicated that they had not received any formal information about hearing conservation programmes, and fewer than half (47%) were aware of the long-term risks associated with noise exposure. Informational counselling was predominantly delivered verbally (67%), with limited use of written or digital formats. Qualitative findings showed that hearing health was largely framed in terms of hearing protection device use, with minimal emphasis on cumulative exposure, early signs of hearing loss, or audiological monitoring. Conclusions Despite widespread safety training, informational counselling on ONIHL among construction workers in South Africa remains limited and narrowly focused. These findings highlight a disconnect between safety training compliance and meaningful hearing health literacy, highlighting the need to integrate comprehensive, audiology-informed counselling into construction-sector health and safety programmes.