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

项目说明 本提案的目的是开发(R21)并测试创新社区的有效性(R33 卫生工作者干预，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墨边境社区成功应用 为一系列慢性病增加获得医疗保健和自我管理的机会。它的创新之处在于 建议将这种基于证据的公共卫生模式与低成本、以社区为基础的听力学相结合 康复，以减少在获得慢性听力损失护理方面的差距。在许多农村社区面临着 由于经济困难，需要助听器的人无法获得健康差距，以及 通常没有其他途径来减轻听力损失对生活质量的负担。假设是 社区卫生工作者(Promota)模式在减少听力健康方面将是有效和相关的 通过健康教育、社会支持和语言调解，消除性别差异。考虑到目前的流行率 慢性听力损失的治疗很低，因此研究人员与 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)适合迭代过程，即 对于创建一种可持续的、与文化相关的方法，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。具体目标在研究的两个阶段进行划分。 R21阶段包括目标1)开发和实施需求评估，确定构成基础的因素 老年拉美裔/拉丁裔人群的准入障碍和目标2)开展试点干预研究 社区听力学康复结合社区健康可行性评估研究 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，这是循证的两个重要基准 练习一下。这些目标包括3)确定普罗马托拉干预措施对慢性疾病的相对有效性 随机对照试验设计中与标准护理方法相关的听力损失；以及4)评估 从听力筛查的切入点到听力康复的纵向生活质量结果。 这笔赠款的合作伙伴包括来自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，这是一家位于美墨边境的联邦合格健康中心。这种独特的跨学科 研究团队提供了一个重要的机会，可以将当前的研究领域和专业知识结合起来，以开发低成本的 成本、可交付和有效的替代干预措施，可显著改善 个别患者及其家属，以及更可持续和更具成本效益的听证模式 在具有不同人口的农村卫生环境中提供保健服务。

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.