Improving Access and Affordability of Adult Hearing Healthcare: Effectiveness of Community-based Interventions in West Central and South Alabama

摘要 越来越多的证据表明，听力损失与社交孤立、抑郁和 认知能力下降。听力丧失已经成为一个日益严重的公共卫生问题。对于那些没有可用的或 负担得起的听力保健资源，听力损失的负面影响在以下情况下最有可能更严重 与那些可以获得听力保健的人相比。通过改善所有人获得护理的机会，我们可以帮助 减轻听力损失的负面影响。本申请中概述的提案专门针对 RFA-DC-19-001中讨论的NIDCD对提供有效康复干预措施的关切 在社区中，除了确定最低限度的技术将为那些患有轻度- 中中度听力损失。这一系列研究的长期目标是了解有限的获取 听力保健会影响那些生活在该州长期贫困地区的人，此外，还会识别 将有效满足生活在这些地区的人的需求的干预战略。这是单独的 随机分组治疗临床试验将使用基于社区的参与性研究(CBPR)来 了解并满足听力损失患者及其家人的需求 阿拉巴马州西部、中部和南部的社区。具体目标是1)进行CBPR需求 评估将完善我们对那些无法接触到听力的人的具体听力保健需求的理解 阿拉巴马州西部、中部和南部的听力保健；2)发展有效的社区卫生顾问 (CHA)听力康复(AR)训练计划；3)确定个人扩声的有效性 用于减少听力障碍和改善无法接触的成年人的言语知觉的产品(PSAP) 听力保健，以及4)为那些无法获得听力保健的人实施成人听力康复(AR)计划 听力保健，以改善PSAP的好处，促进PSAP的使用，并导致提高生活质量(QOL)。 在对社区卫生协调员和顾问进行需求评估和培训方案之后， 将实施干预计划，包括个人扩声产品(PSAP)和 为无法获得听力的轻至中度听力损失的成年人提供听力康复(AR)计划 医疗保健。据推测，PSAP的使用将显著减少听力障碍并改善言语能力 感知力。第二个假设是，与没有接受AR计划的成年人相比，PSAP受益 而且使用量会更大，在困难的听力条件下的沟通会更好，生活质量会更积极 对于那些确实参与了AR计划的人来说，这一点是受影响的。对这个项目至关重要的是我们最先进的手机 将前往阿拉巴马州中西部和南部偏远地区的听力诊所，使阿拉巴马州 独一无二地准备研究听力损失对完全生活在农村地区和 持续贫困地区。

Abstract Mounting evidence suggests that hearing loss is associated with social isolation, depression and cognitive decline. Loss of hearing has become a growing public health concern. For those with no available or affordable hearing healthcare resources, the negative effects of hearing loss are most likely worse when compared to those with access to hearing healthcare. By improving access to care for all, we can help to mitigate the negative effects of hearing loss. The proposal outlined in this application specifically addresses concerns of NIDCD discussed in RFA-DC-19-001 related to the delivery of effective rehabilitation interventions in communities, in addition to identifying minimal technology that will achieve success for those who have mild- to-moderate hearing loss. The long term goals of this line of research are to understand how limited access to hearing health care affects those who live in persistently poor regions of the state, and additionally, to identify intervention strategies that will effectively address the needs of those who live in these areas. This individually randomized group treatment clinical trial will use community-based participatory research (CBPR) to understand and address the needs of those with hearing loss and their families living in underserved communities of West Central and South Alabama. The specific aims are to 1) conduct a CBPR needs assessment that will refine our understanding of specific hearing health care needs for those with no access to hearing health care in West Central and South Alabama; 2) develop an effective community health advisor (CHA) aural rehabilitation (AR) training program; 3) identify the effectiveness of personal sound amplification products (PSAPs) for decreasing hearing handicap and improving speech perception in adults with no access to hearing health care, and 4) implement an adult aural rehabilitation (AR) program for those without access to hearing health care to improve PSAP benefit, promote PSAP use and lead to increased quality of life (QOL). Following the needs assessment and training program for community health coordinators and advisors, an intervention plan will be implemented consisting of personal sound amplification products (PSAPs) and an aural rehabilitation (AR) program for adults with mild-to-moderate hearing loss who have no access to hearing healthcare. It is hypothesized that PSAP use will significantly decrease hearing handicap and improve speech perception. A second hypothesis is that compared to adults who did not receive the AR program, PSAP benefit and use will be greater, communication in difficult listening conditions will be better, and QOL will be positively affected for those who did participate in the AR program. Vital to this project is our state-of-the-art mobile audiology clinic which will travel to remote areas of West Central and South Alabama, making Alabama uniquely poised to examine the effects of hearing loss on those who live in completely rural areas and persistent poverty regions.