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

描述(由申请人提供)：本建议的目的是开发(R21)并测试创新的社区卫生工作者干预的有效性(R33)，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墨边境社区成功应用，以增加一系列慢性病的医疗保健和自我管理。这一建议的创新之处在于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康复相结合，以减少获得慢性听力损失护理的差距。在许多面临健康差距的农村社区，由于经济困难，需要助听器的人无法获得助听器，而且通常没有其他途径来减轻听力损失对生活质量的负担。假设社区卫生工作者(Promota)模式将通过健康教育、社会支持和语言调解在减少听力健康差距方面有效和相关。鉴于目前慢性听力损失的治疗流行率很低，研究人员必须与社区成员和提供者合作，在开发替代干预措施之前和期间评估护理状况。分阶段发展方法(RFA-DC-12-003)有助于迭代进程，这对于创建一种可持续的和文化上相关的方法至关重要，以使面临健康差距的社区更容易获得听力保健。具体目标在研究的两个阶段进行划分。R21阶段包括目标1)制定和实施一项需求评估，确定西班牙裔/拉丁裔老年人口获取障碍的因素，以及目标2)开展一项试验性干预研究，评估以社区为基础的听力康复与社区卫生工作者干预相结合的可行性，以改善获得护理的机会。R33阶段包括验证新方法的临床实用性和跟踪纵向结果的后续目标，这是循证实践的两个重要基准。这些研究包括：目的3)在随机对照试验设计中确定Promatora治疗慢性听力损失的干预措施相对于标准护理方法的比较有效性；以及4)从听力筛查的切入点通过听力康复评估纵向生活质量结果。这笔赠款的合作伙伴包括亚利桑那大学的听力学教员、亚利桑那州预防研究中心的公共卫生研究人员，以及马里波萨社区卫生中心的社区卫生工作者，马里波萨社区卫生中心是一家位于美墨边境的联邦合格卫生中心。这一独特的跨学科研究团队提供了一个重要的机会，可以联合当前的研究领域和专业知识，开发低成本、可交付和有效的替代干预措施，从而显著提高个别患者及其家人的生活质量，并在人口多样化的农村卫生环境中提供更可持续和更具成本效益的听力保健服务模式。

DESCRIPTION (provided by applicant): 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. I 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 relvant 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.