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

项目描述 本提案的目的是开发（R21）和测试创新社区的有效性（R33） 卫生工作者干预，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成功应用-墨西哥边境社区 增加获得医疗保健和自我管理一系列慢性病的机会。的创新之处 建议联合收割机这种以证据为基础的公共卫生模式与低成本，以社区为基础的听力学 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， 健康差距，由于经济障碍，需要助听器的人无法获得助听器， 通常没有其他途径来减少听力损失对生活质量的负担。这个假设是 社区卫生工作者（Promotora）模型将有效降低听力健康 通过健康教育、社会支持和语言调解来消除不平等。鉴于目前流行的 慢性听力损失的治疗水平很低，研究人员必须与 社区和提供者在制定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， 对于创建可持续和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中。具体目标分为两个研究阶段。 R21阶段包括目标1）制定和实施需求评估，确定 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 评估社区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阶段包括后续目标，以验证临床 新方法的实用性和跟踪纵向结果，这是循证医学的两个重要基准。 实践这些包括目标3）确定Promatora干预措施对慢性 在随机对照试验设计中相对于标准护理方法的听力损失;以及4）评估 从听力筛查到听力康复的纵向生活质量结果。 这项资助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，以及马里波萨社区的社区卫生工作者 健康中心，美国联邦政府合格的健康中心-墨西哥边境。这一独特的跨学科 研究团队提供了一个重要的机会，联合目前的研究领域和专业知识，以开发一个低， 成本、可交付性和有效的替代干预措施，可使患者的生活质量得到可衡量的改善， 个人患者及其家属，以及更可持续和更具成本效益的听力模型 在不同人口的农村卫生机构提供保健服务。

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.