Extending Capacity for Affordable, Accessible Hearing Care through Peer Mentorship

项目摘要 获得听力保健的机会不平等，老年人之间的差距很大。尽管有证据表明 社区卫生工作者（CHW）护理模式作为解决健康差异的方法，社区提供 听力保健模式才刚刚开始。在现有的努力中，只有HEARS（听力健康公平） 通过可持续研究和解决方案）干预是专门为老年人设计的，包括 提供非处方（OTC）听力技术在社区环境中，通过理论驱动的 approach. HEARS干预措施是在2015年至2020年期间在NIDCD支持下设计和测试的 (R22/R33 DC 015062），以解决老年人在听力保健方面遇到的常见障碍，特别是 少数民族和低收入老年人。随机对照试验的初步数据 证明HEARS作为完全由老年人在社区中提供的首次实物干预的有效性 使用OTC听力技术的成人同伴导师，其结果与听力学家的助听器匹配相当。 随着OTC设备的日益普及和对新护理模式需求的不断增长， 干预措施即将大规模实施。为了将HEARS付诸实践，我们建议与当地 地区老龄机构（AAAs）是一个由公共和私人非营利机构组成的全国性网络， 为老年人提供就地养老服务。该提案将完成HEARS干预包和测试 由社区听力学家完全在社区环境中提供HEARS干预 与AAA中的老年人同伴导师合作，为更广泛的实施定位HEARS计划 通过AAA。该建议的目标如下： 听力学家主管手册，反映听力学家的需求，并确保安全性，有效性， 在科学和社区咨询委员会的指导下，同侪导师提供的干预措施的忠实性。 R33目标1招募及培训一个由2名听力学家及9名朋辈导师组成的听力学家-朋辈导师护理小组（3 每个研究中心）通过合作伙伴AAA（n=3）评估培训师课程。R33目标2为管理社区- 通过在整个马里兰州的3个AAA提供HEARS干预的基于实用的试验， 受试者3个月干预试验（n=100/AAA研究中心）。目标3制定一项执行战略， 通过基于障碍的混合方法，通过AAA提供的HEARS干预， 在务实的审判中遇到的推动因素。这项建议汇集了一个多学科的团队， 研究人员在学术界，政府和非营利组织的高度合作努力。这 一项提案将严格扩展利用OTC设备的社区提供听力护理的证据 和CHW合作的护理，并将直接告知HEARS干预措施的实施和扩大。

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.