Reducing Disparities in Access to Hearing Healthcare on the U.S.-Mexico Border

减少美墨边境听力保健服务的差异

• 批准号: 8628345
• 负责人: NICOLE L MARRONE
• 金额: $ 19.41万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-17 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628345
• 关键词: Address; Adult; American Speech-Language-Hearing Association; Americas; Area; Arizona; Audiology; Benchmarking; Caring; Chronic; Clinical; Clinical Trials Design; Communication impairment; Communities; Community Health; Community Health Centers; Community Healthcare; Data; Development; Diabetes Mellitus; Education; Effectiveness; Elderly; Epidemic; Evidence based practice; Faculty; Family; Federally Qualified Health Center; Goals; Grant; Health; Health Services Accessibility; Health education; Healthcare; Healthy People 2020; Hearing; Hearing Aids; Heart Diseases; Hispanics; Improve Access; Individual; Interdisciplinary Study; Intervention; Intervention Studies; Language; Latino; Lead; Life; Measurable; Mediation; Mexican Americans; Mexico; Mission; Modeling; National Institute on Deafness and Other Communication Disorders; Needs Assessment; Outcome; Partner Communications; Patients; Phase; Population Heterogeneity; Positioning Attribute; Prevalence; Prevention Research; Process; Provider; Public Health; Quality of life; Randomized Controlled Trials; Rehabilitation therapy; Relative (related person); Research; Research Methodology; Research Personnel; Resources; Rural; Rural Community; Rural Health; Rural Population; Scientist; Self Management; Services; Social support; Solutions; Support Groups; Testing; Training; Universities; base; community based participatory research; comparative effectiveness; cost; cost effective; cultural competence; evidence base; health belief; health care delivery; health care quality; health disparity; health literacy; hearing impairment; hearing screening; improved; improved functioning; innovation; interdisciplinary collaboration; member; novel strategies; outreach; patient oriented; programs; public health relevance; standard care

Project Description The purpose of this proposal is to develop (R21) and test the effectiveness (R33) of an innovative community health worker intervention to expand access to hearing healthcare among older adults facing health disparities. The community health worker model has been used successfully in U.S.-Mexico border communities to increase access to healthcare and self-management for a range of chronic conditions. The innovation of this proposal is to combine this evidence-based public health model with low-cost, community-based audiologic rehabilitation to reduce disparities in access to care for chronic hearing loss. In many rural communities facing health disparities, hearing aids are inaccessible to the people who need them due to financial barriers, and there are typically no other avenues to reduce the burden of hearing loss on quality of life. The hypothesis is that a community health worker (Promotora) model will be effective and relevant in reducing hearing health disparities via health education, social support, and language mediation. Given that the current prevalence of treatment for chronic hearing loss is low, it is essential that researchers collaborate with members of the community and providers to assess the state of care prior to and during the development of alternative interventions. The phased development approach (RfA-DC-12-003) lends itself to the iterative process that is critical to creating a sustainable and culturally relevant approach to make hearing healthcare more accessible within communities facing health disparities. The specific aims are divided across the two phases of research. The R21 phase includes Aim 1) Develop and implement a needs assessment identifying factors that underlie barriers to access in an older Hispanic/Latino population and Aim 2) Conduct a pilot intervention research study assessing the feasibility of community-based audiologic rehabilitation combined with a community health worker intervention to improve access to care. The R33 phase includes subsequent aims to validate the clinical utility of the novel approach and to track longitudinal outcomes, two important benchmarks for evidence-based practice. These include Aim 3) Determine the comparative effectiveness of Promatora interventions for chronic hearing loss relative to a standard care approach in a randomized controlled trial design; and 4) Assess longitudinal quality of life outcomes from the entry point of hearing screening through hearing rehabilitation. The partners on this grant include audiology faculty from the University of Arizona, public health researchers from the Arizona Prevention Research Center, and community health workers at the Mariposa Community Health Center, a federally qualified health center on the U.S.-Mexico border. This unique interdisciplinary research team offers a significant opportunity to unite current research areas and expertise to develop a low- cost, deliverable, and effective alternative intervention that yields measurable improvements in quality of life for individual patients and their families, as well as a more sustainable and cost-effective model of hearing healthcare delivery in rural health settings with diverse populations.

项目描述 该提案的目的是开发（R21）并测试创新社区的有效性（R33） 卫生工作者进行干预，以扩大面临健康差距的老年人获得听力保健的机会。 社区卫生工作者模式已在美国-墨西哥边境社区成功使用 增加对一系列慢性病的医疗保健和自我管理的机会。本次的创新 建议是将这种基于证据的公共卫生模型与低成本、基于社区的听力学相结合 康复，以减少获得慢性听力损失护理的差距。在许多农村社区面临 健康差异、由于经济障碍而需要助听器的人无法获得助听器，以及 通常没有其他途径可以减轻听力损失对生活质量的负担。假设是 社区卫生工作者 (Promotora) 模式将在减少听力健康方面有效且相关 通过健康教育、社会支持和语言调解来消除差异。鉴于目前的流行情况 慢性听力损失的治疗率很低，因此研究人员与该组织成员合作至关重要 社区和提供者在开发替代方案之前和期间评估护理状况 干预措施。分阶段开发方法 (RfA-DC-12-003) 适用于迭代过程 对于创建可持续且与文化相关的方法以使听力保健更容易获得至关重要 在面临健康差距的社区内。具体目标分为两个研究阶段。 R21 阶段包括目标 1) 制定并实施需求评估，确定潜在因素 老年西班牙裔/拉丁裔人口的获取障碍和目标 2) 进行试点干预研究 评估基于社区的听力康复与社区健康相结合的可行性的研究 工人干预以改善获得护理的机会。 R33 阶段包括验证临床的后续目标 新方法的实用性和跟踪纵向结果，这是基于证据的两个重要基准 实践。其中包括目标 3) 确定 Promatora 干预措施对慢性病的比较有效性 随机对照试验设计中与标准护理方法相关的听力损失； 4) 评估 从听力筛查到听力康复的切入点的纵向生活质量结果。 这笔赠款的合作伙伴包括亚利桑那大学的听力学教师、公共卫生研究人员 来自亚利桑那州预防研究中心和马里波萨社区的社区卫生工作者 健康中心，位于美国-墨西哥边境的具有联邦资格的健康中心。这种独特的跨学科 研究团队提供了一个重要的机会，可以结合当前的研究领域和专业知识来开发低 成本、可交付性和有效的替代干预措施，可显着改善患者的生活质量 个体患者及其家人，以及更具可持续性和成本效益的听力模式 在不同人口的农村卫生环境中提供医疗保健服务。