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

实施社区卫生工作者模式，为老年人提供听力保健服务

• 批准号: 9369472
• 负责人: FRANK R LIN
• 金额: $ 57.55万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-10 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9369472
• 关键词: Academia; Address; Adult; Advisory Committees; Affect; Aging; Arts; Audiology; Baltimore; Caring; Cities; Clinic; Collaborations; Communities; Community Health Aides; Counseling; Dementia; Development; Devices; Disabled Persons; Discipline of Nursing; Educational Curriculum; Educational workshop; Elderly; Ensure; Equipment and supply inventories; Evaluation; Exploratory/Developmental Grants Phase II; Gerontology; Gold; Government; Grant; Health; Healthcare; Hearing; Hospitalization; Hour; Independent Living; Individual; Institute of Medicine (U.S.); Institutes; Intellectual Property; Intervention; Low income; Manuals; Maryland; Methodology; Minority; Modeling; Nonprofit Organizations; Nurses; Otolaryngology; Participant; Partner Communications; Physical Function; Population; Protocols documentation; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Rehabilitation therapy; Research; Research Personnel; Risk; Safety; Screening for cancer; Services; Structure; Testing; Time; Training; Training Programs; Travel; United States; Universities; Visit; aging population; base; college; community based participatory research; community based service; cost; design; diabetes management; follow-up; health care service; healthy aging; hearing impairment; hearing screening; innovation; medical schools; mental health counseling; multidisciplinary; outreach; post intervention; public health priorities; public health relevance; rehabilitative care; social; treatment group

 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.

 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并获得听力保健 (HHC) 的策略。然而，目前唯一已建立的 HHC 模式是基于临床的听力学评估、提供扩音器以及后续护理和康复咨询，这是高度耗时、昂贵的，并且取决于个人反复前往目的地的能力。 临床医生办公室。本提案的总体目标是开发和测试 社区卫生工作者 (CHW) 的方法是通过基于社区的参与性研究，为低收入和主要是少数族裔的老年人提供基本水平的 HHC。在过去的一年里，我们制定了 HEARS（通过无障碍研究和解决方案实现听力平等）干预框架，该框架将在本提案中得到完善和测试。 HEARS 干预是一项时长两小时的干预措施，旨在由社区社区卫生工作者提供，包括听力筛查、参与者及其沟通伙伴的康复咨询，以及立即提供和培训扩音设备的使用。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 与社区咨询和科学部门合作，制定培训 CHW 实施 HEARS 干预的课程和手册，同时确保保真度、有效性和安全性 委员会。 R33 目标 2 在 HEARS 干预中招募和培训由 1 名听力学家和 5 名 CHW 组成的听力学家-CHW 护理团队，并严格评估培训计划。 R33 目标 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少数族裔老年人的立即治疗组和 3 个月延迟治疗组中实施的 HEARS 干预进行随机对照试验 (RCT)。这项由 150 名参与者参与的随机对照试验将能够在 3 个月的随访中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的 0.4 效应大小或更大的评分差异。该提案汇集了来自多个领域（耳鼻喉科、听力学、老年学、社会设计、护理、公共卫生）的多学科研究人员和专家团队，是学术界（约翰霍普金斯大学医学院、护理和公共卫生学院；马里兰艺术学院社会设计中心）、政府（巴尔的摩市）、社区咨询委员会和非营利组织的高度协作努力，提供 以社区为基础的服务。制定负担得起、可及且可扩展的针对老年人听力损失的干预措施是一项至关重要的公共卫生任务 越来越多的证据表明听力损失对健康老龄化的影响。这项创新提案将导致此类干预措施的发展，并引入由听力学家领导的社区卫生工作者团队的模式，以满足老龄化人口日益增长的 HHC 需求。