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

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 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.