Implementing a Community Health Worker Model for Providing Hearing Healthcare Services to Older Adults

 描述（由申请人提供）：鉴于人口老龄化，迫切需要确保老年人负担得起和获得听力保健（HHC）的策略。然而，目前可用的HHC的唯一建立的模型是基于诊所的听力学评估，提供放大，以及后续护理和康复咨询，这是高度时间密集型的，昂贵的，并且依赖于个人反复旅行的能力。 临床医生的办公室本提案的总体目标是开发和测试一个 社区卫生工作者（CHW）的方法，通过以社区为基础的参与性研究，为低收入和主要是少数民族的老年人提供基本水平的HHC。在过去的一年里，我们已经制定了HEARS（通过可扩展的研究和解决方案实现听力平等）干预措施的框架，该框架将在本提案中进行完善和测试。HEARS干预是一个两小时的干预，由社区保健工作者在社区提供，包括听力筛查、为参与者及其交流伙伴提供康复咨询，以及立即提供和培训使用放大设备。我们的提案有以下目标：R21目标1通过CBPR和社会设计方法，与社区咨询委员会和科学委员会合作，最终确定HEARS干预的协议和内容。R33目标1制定课程和手册，培训社区卫生工作者提供HEARS干预，同时与社区咨询和科学合作，确保保真度、有效性和安全性。 委员会。R33目标2招募和培训一个由1名听力学家和5名CHW组成的听力学家-CHW护理团队进行HEARS干预，并严格评估培训计划。R33目的3：对听力学家-CHW团队在巴尔的摩市独立生活的低收入和主要是少数民族老年人的立即治疗和3个月延迟治疗组中提供的HEARS干预进行随机对照试验（RCT）。这项随机对照试验纳入了150名受试者，将有把握在3个月随访时检测到立即治疗组和延迟治疗组之间老年人听力障碍量表评分差异为0.4或更大的效应量。这项建议汇集了来自多个领域的调查人员和专家组成的多学科小组（耳鼻喉科，听力学，老年学，社会设计，护理，公共卫生），是一个高度合作的努力跨越学术界（约翰霍普金斯大学医学、护理和公共卫生学院;马里兰州艺术学院社会设计中心），政府（巴尔的摩市），一个社区咨询委员会，以及提供社区服务的非营利组织。为老年人的听力损失制定负担得起的，可获得的和可扩展的干预措施是一项重要的公共卫生 考虑到越来越多的证据表明听力损失对健康老龄化的影响，这一创新提案将导致这种干预的发展，并引入听力学家领导的CHW团队的模式，以满足老龄化人口日益增长的HHC需求。

 DESCRIPTION (provided by applicant): Strategies to ensure affordability and access to hearing healthcare (HHC) for older adults are urgently needed given the aging of the population. However, the only established model of HHC available presently is clinic- based audiologic evaluation, provision of amplification, and follow-up care and rehabilitative counselling which is highly time intensive, expensive, and dependent on the individual's ability to travel repeatedly to the clinician's office. The overarching objective of this present proposal is to develop and test a community health worker (CHW) approach to providing a basic level of HHC to low-income and primarily minority older adults through community-based participatory research. Over the past year, we have developed the framework for the HEARS (Hearing Equality through Accessible Research and Solutions) intervention that will be refined and tested in this proposal. The HEARS intervention is a two-hour intervention that has been designed to be delivered by a CHW in the community and consists of hearing screening, rehabilitative counseling for the participant and his/her communication partner, and immediate provision and training in the use of an amplification device. Our proposal has the following aims: R21 Aim 1 To finalize the protocol and content of the HEARS intervention in collaboration with the community advisory committee and scientific committee through CBPR and social design methodologies. R33 Aim 1 To develop curriculum and manuals for training CHWs to deliver the HEARS intervention while ensuring fidelity, efficacy, and safety in collaboration with the community advisory and scientific committees. R33 Aim 2 To recruit and train an audiologist-CHW care team of 1 audiologist and 5 CHWs in the HEARS intervention and rigorously assess the training program. R33 Aim 3 To conduct a randomized controlled trial (RCT) of the HEARS intervention delivered by the audiologist-CHW team in an immediate treatment and 3-month delayed treatment group of low income and primarily minority older adults living independently in Baltimore City. This RCT of 150 participants will be powered to detect a 0.4 effect size or greater score difference on the Hearing Handicap Inventory for the Elderly between the immediate-treatment and delayed-treatment groups at 3 months follow-up. This proposal brings together a multidisciplinary team of investigators and experts from multiple fields (otolaryngology, audiology, gerontology, social design, nursing, public health) and is a highly collaborative effort spanning academia (Johns Hopkins University Schools of Medicine, Nursing, and Public Health; Maryland Institute College of Art Center for Social Design), government (Baltimore City), a community advisory committee, and non-profit organizations providing community-based services. Developing affordable, accessible, and scalable interventions for hearing loss in older adults is a critical public health priority given growing evidence of the consequences of hearing loss for healthy aging. This innovative proposal will result in the development of such an intervention and introduce the model of an audiologist-led team of CHWs to address the growing HHC needs of the aging population.