K-HEARS: Hearing Health Equity through Accessible Research and Solutions for Korean Americans

项目概要 听力损失非常普遍，但很少有老年人使用助听器，并且听力保健方面存在差异。 亚裔美国人的助听器使用率最低，但却是增长最快的群体之一 美国人口老龄化。年长的韩裔美国人 (KA)，主要只讲一种语言 第一代移民代表了一个群体，就像其他少数民族和移民群体一样，他们 面临与英语水平有限、健康素养差、导航困难相关的听力保健障碍， 和贫困。为了满足更多社区的需求，需要负担得起、方便的听力保健服务 公认的国家和社区卫生工作者护理模式在扩大获得和服务方面发挥着关键作用 提供文化响应式护理。 HEARS 干预措施（通过无障碍环境实现听力健康公平） 研究和解决方案）是一种理论驱动、基于证据的听力保健干预措施，旨在交付 通过使用非处方听力技术的同伴教育护理模式。开发了HEARS 部分由多个 PI 团队负责，此后经过改编，通过基于信仰的方式交付给年长的 KA 组织（K-HEARS）。 NIH 阶段 IB 试点研究证明了可行性、可接受性和初步结果 社区卫生工作者 (CHW) 提供的听力保健干预措施的效果，专门设计用于 两人，一名患有听力损失的老年人和他们的沟通伙伴，通过少数民族教堂进行传递。至 基于这些发现，我们现在提出一项 NIH III 期疗效试验，这是一项 2 臂整群随机试验，其中 440 组患有听力损失的老年 KA 及其沟通伙伴。我们的建议有以下内容 目标： 目标 1：测试 K-HEARS 对改善沟通功能和健康相关质量的效果 与 6 个月延迟治疗组相比，患有听力损失的老年 KA 的生活。审判是 能够检测听力障碍量表中 0.32 效应大小或更大的分数差异 立即治疗组和延迟治疗组之间 6 个月时的老年人。目标 2：评估 K- 的效果 听取关于改善第三方残疾（即由于家人或朋友的健康状况而导致的残疾） 与 6 个月相比，沟通伙伴之间的重要其他）和健康相关的生活质量 延迟治疗组。探索性目标 1：测试 K-HEARS 对二元关系的影响，如 通过干预后 6 个月的相互性来衡量。探索性目标 2：确定障碍和促进因素 以民族教会为基础的社区卫生工作者 (CHW) 听力保健模式，为未来的实施和传播提供信息。这个 项目利用了由研究人员和社区合作伙伴组成的多学科双语团队 良好的业绩记录。通过信仰组织提供听力保健尚未得到落实 已经完成，并且之前没有研究系统地设计和测试使用社区卫生工作者的听力保健干预措施 与 二元样本中的非处方听力技术。拟议的研究将告知如何 我们建设当地能力，以满足服务不足的老年人及其亲人的需求。

PROJECT SUMMARY Hearing loss is highly prevalent, yet few older adults use hearing aids and disparities in hearing care exist. Asian Americans have the lowest prevalence of hearing aid use and are one of the fastest-growing segments of the aging population in the United States. Older Korean Americans (KAs), as predominantly monolingual first-generation immigrants, represent a population, like other ethnic minority and immigrant populations, who face barriers to hearing care related to limited English proficiency, poor health literacy, navigational difficulties, and poverty. The need for affordable, accessible hearing care to meet the needs of more communities is recognized nationally and community health worker models of care serve a key role in extending access and delivering culturally responsive care. The HEARS intervention (Hearing Health Equity through Accessible Research and Solution) is a theory-driven, evidence-based hearing care intervention designed for delivery through a peer educator model of care that uses over-the-counter hearing technology. HEARS was developed in-part by the multiple PI team and has since been adapted for delivery to older KAs through faith-based organizations (K-HEARS). An NIH Stage IB pilot study demonstrated feasibility, acceptability, and preliminary efficacy of a community health worker (CHW)-delivered hearing care intervention specifically designed for dyads, an older adult with hearing loss and their communication partner, delivered through ethnic churches. To build upon these findings, we now propose an NIH Stage III efficacy trial, a 2-arm cluster randomized trial, with 440 dyads of older KAs with hearing loss and their communication partners. Our proposal has the following aims: Aim 1: To test the effect of K-HEARS on improving communication function and health-related quality of life among older KAs with hearing loss in comparison to a 6-month delayed treatment group. The trial is powered to detect a 0.32 effect size or greater score difference on the Hearing Handicap Inventory for the Elderly between the immediate and delayed treatment groups at 6 months. Aim 2: To evaluate the effect of K- HEARS on improving third-party disability (i.e., disability of family or friends due to the health condition of their significant other) and health-related quality of life among communication partners in comparison to a 6-month delayed treatment group. Exploratory Aim 1: To test the effect of K-HEARS on the dyad relationship, as measured by mutuality, 6-months post-intervention. Exploratory Aim 2: To identify the barriers and facilitators of an ethnic church-based CHW model of hearing care to inform future implementation and dissemination. This project leverages a multidisciplinary bilingual team of investigators and community partners with a demonstrated track record. The delivery of hearing care through faith-based organizations has not been done and no prior research has systematically designed and tested a hearing care intervention using CHWs with over-the-counter hearing technology in a dyadic sample. The proposed study will inform how we build local capacity to address the needs of underserved older adults and their loved ones.