Extending Capacity for Affordable, Accessible Hearing Care through Peer Mentorship

项目总结 获得听力护理的机会不平等，老年人之间的差距很大。尽管有证据支持 社区卫生工作者(CHW)护理模式作为解决健康差距的一种方法，社区提供 听力护理模式才刚刚开始。在现有的努力中，只有HARES(听力健康公平 通过无障碍研究和解决方案)干预是专门为老年人设计的，包括 通过理论驱动在社区环境中提供场外(OTC)听证技术 接近。HARS干预是在2015年至2020年的NIDCD支持下设计和测试的 (R22/R33DC015062)以解决老年人在听力护理方面遇到的常见障碍，特别是 少数族裔和低收入老年人。随机对照试验的初步数据 证明HARES作为完全由老年人在社区中提供的首个同类干预措施的有效性 使用OTC听力技术的成人同伴导师，其结果与听力学家匹配的助听器相当。 随着非处方药设备的增加和对新护理模式的需求不断增长，人们听到了 干预已准备好形成规模。为了将希尔斯付诸实践，我们建议与当地合作 地区老龄机构(AAA)，一个由公共和私人非营利性机构组成的全国性网络，提供 为老龄化老年人提供的服务到位。该提案将完成HARES干预方案并进行测试 完全在社区环境中由以社区为基础的听觉学家提供听力干预 与AAA中的年长成年人同行导师合作，为HARES计划的更广泛实施定位 通过AAA。该提案有以下目标：R21目标1，制定培训员培训课程和 听力专家指导手册，反映听力专家的需求，并确保安全性、有效性和 在科学和社区咨询委员会的指导下，同伴导师提供干预的忠诚度。 R33目标1征聘和培训一支由2名听力专家和9名同伴导师组成的听力专家-同伴导师护理小组(3 每个站点)通过合作伙伴AAA(n=3)评估培训员课程。R33目标2进行一个社区- 在整个马里兰州通过3个AAA通过一个内部- 受试者为期3个月的干预试验(每个AAA站点100例)。R33目标3为以下目标制定实施战略 通过AAA通过基于障碍的混合方法提供的干预 在务实的试验中遇到的推动者。这项提议汇集了一个多学科团队， 调查人员在学术界、政府和非营利组织的高度合作努力中。这 提案将严格扩展社区提供的利用OTC设备进行听力护理的证据 和CHW合作的CARE，并将直接向HARS干预的实施和扩大提供信息。

PROJECT SUMMARY Access to hearing care is unequal with large disparities among older adults. Despite evidence that supports community health worker (CHW) care models as an approach to health disparities, community-delivered hearing care models are only beginning. Among existing efforts, only the HEARS (Hearing Health Equity through Accessible Research & Solutions) intervention is specifically designed for older adults and includes the provision of over-the-counter (OTC) hearing technology in a community setting through a theory-driven approach. The HEARS intervention was designed and tested with NIDCD support from 2015 to 2020 (R22/R33DC015062) to address common barriers to hearing care experienced by older adults, particularly racial/ethnic minority and low-income older adults. Preliminary data from the randomized controlled trial demonstrate the efficacy of HEARS as a first-in-kind intervention delivered entirely in the community by older adult peer mentors using OTC hearing technology with outcomes on par to hearing aids fit by audiologists. With increasing availability of OTC devices and a growing demand for new care models, the HEARS intervention is poised to be brought to scale. To move HEARS into practice, we propose partnering with local Area Agencies on Aging (AAAs), a national network of public and private non-profit agencies who provide services to older adults aging in place. This proposal will complete the HEARS intervention package and test the delivery of the HEARS intervention entirely within a community setting by community-based audiologists working with older adult peer mentors in AAAs, positioning the HEARS program for broader implementation through AAAs. The proposal has the following aims: R21 Aim 1 To develop the train-the-trainer curriculum and manuals for audiologist supervisors that reflect the needs of audiologists and ensure the safety, efficacy, and fidelity of a peer mentor-delivered intervention as guided by the Scientific and Community Advisory Boards. R33 Aim 1 To recruit and train an audiologist-peer mentor care team of 2 audiologists and 9 peer mentors (3 per site) through partner AAAs (n=3) to assess the trainer curriculum. R33 Aim 2 To conduct a community- based pragmatic trial of delivering the HEARS intervention through 3 AAAs throughout Maryland via a within- subject 3-month intervention trial (n=100 per AAA site). R33 Aim 3 To develop an implementation strategy for the HEARS intervention as delivered through AAAs via a mixed methods approach based on the barriers and enablers encountered in the pragmatic trial. This proposal brings together a multidisciplinary team of investigators in a highly collaborative effort spanning academia, government, and non-profit organizations. This proposal will rigorously extend evidence for a community-delivered hearing care that leverages OTC devices and CHW-partnered care and will directly inform the implementation and scaleup of the HEARS intervention.