Mobile technologies for delivering hearing care through community health workers

R21 R33摘要/摘要 听力损失是一个主要的和日益增长的公共卫生问题，特别是在低收入和中等收入国家 低收入国家（LMIC），世界上约80%的听力损失人口居住在那里。我们的愿景是提供良好的 为中低收入国家和周边地区服务不足的人群提供优质、负担得起和可持续的听力保健服务。 世界我们建议验证并尝试一种创新的移动健康模式，用于端到端的听力护理 由社区卫生工作者（CHW）协助。基于智能手机的解决方案使用助听器首先测试 听力，然后，如果需要的话，编程设备，以提供黄金标准的康复。过程中 十五分钟，用户和他们的家人应该能够体验到他们的沟通方式的一步变化。 能力在试装会议之后，将继续通过创新的移动健康消息支持， 他们的新助听器和沟通与CHW故障排除。在R21阶段， 我们将讨论三个目标，这些目标证实了为所有人提供更好听力的关键步骤。目标1： 在俄亥俄州的辛辛那提开展临床工作，并在南非的低收入地区与CHW一起开展社区工作 助听器的选配是助听器选配的基础。这 听力测试将是一个更全面的诊断包的一部分，涉及新的物理（智能手机） 视频耳镜检查）和行为（噪声中的语音）数据。在目标2中，我们将评估 助听器的金标准和常规临床验配标准。在社区环境中，我们还将 通过包括CHW和用户来确定可用性。培训和支持CHW对我们的方法至关重要 在目标3中，我们将与hearX基金会的同事合作开发新的培训模块。 将使用多种技术使社区卫生工作者参与该过程的每个阶段，例如，调整现有的 在以前的听力筛查外展中发现有用的模块。新雇用的CHW将试驾， 评估培训。这一目标的另一部分是开始开发移动健康用户支持系统（应用程序）， 用于临床试验阶段（目标4和5）。信息图表和语音字节将被转换到本地 语言（如科萨语）的方法，使用WhatsApp，我们已经证明，提高听力知识 幼儿教师的流失。在R33阶段的资助中，重点缩小到两项临床试验。第一个（目标） 4），我们询问基于智能手机的CHW辅助助听器是否成功地为他们的听力提供了好处。 用户.在第二次试验（目标5）中，我们询问在目标3中开发的移动健康用户支持系统是否 有效地提供利益。这两项研究都是随机对照试验，是最高水平的临床审查。在 目标6，我们将使用AI对目标1-5的数据进行建模，以进行整体听力评估。积极，自我报告 结果和模型应该为扩展到下一个级别，区域和国家试验铺平道路 如果成功，将对中低收入国家的数百万人产生巨大的个人重要性。他们也将打开 这是国际上采用这种创新的、移动健康驱动的、以社区为基础的听力护理模式的大门。

R21 R33 Summary/Abstract Hearing loss is a major and growing public health concern, especially in low and middle income countries (LMICs) where about 80% of the world’s population with hearing loss reside. Our vision is to provide good quality, affordable, and sustainable hearing health care to underserved populations in LMICs and around the world. We propose to validate and then trial an innovative mHealth model for end-to-end hearing care facilitated by community health workers (CHWs). The smartphone-based solution uses hearing aids to first test hearing and then, if needed, programs the devices to provide gold standard rehabilitation. In the course of fifteen minutes, the user and their family should be able to experience a step change in their communicative ability. Following the fitting session, support will continue through innovative mHealth messaging support for their new hearing aids and communication with the CHW for troubleshooting. In the R21 phase of this funding, we will address three aims that validate key steps on the journey to better hearing for all. For Aim 1, we will perform clinical work in Cincinnati, Ohio and community work with CHWs in low-income South African communities to confirm that the hearing aids deliver hearing test precision to the highest standard. This audiometry will be part of a more comprehensive diagnostic package involving novel physical (smartphone video otoscopy) and behavioral (speech-in-noise) data. In Aim 2, we will evaluate the performance of the hearing aids to gold-standard and conventional clinical fitting standards. In a community setting, we will also determine usability by including CHWs and users. Training and supporting CHWs is critical for our approach and in Aim 3 we will work with our colleagues in the hearX Foundation to develop new training modules. Multiple techniques will be used to engage CHWs in each stage of the process, for example, adjusting existing modules found to be useful in previous hearing screening outreach. Freshly hired CHWs will test-drive and evaluate the training. Another part of this aim is to begin developing the mHealth user support system (apps) to be used in the clinical trial phase (Aims 4 and 5). Infographics and voice bytes will be translated to the local language (e.g. Xhosa) in an approach, using WhatsApp, we have shown to improve knowledge about hearing loss of preschool teachers. In the R33 phase of funding, the focus narrows to two clinical trials. In the first (Aim 4), we ask whether the smartphone-based, CHW-facilitated hearing aids successfully deliver benefit for their users. In the second trial (Aim 5) we ask whether an mHealth user support system, developed in Aim 3, is effective in delivering benefit. Both studies are randomized control trials, the highest level of clinical scrutiny. In Aim 6, we will model data from Aims 1-5 using AI towards a holistic hearing assessment. Positive, self-report outcomes and modeling should pave the way for an expansion to the next level, regional and national trials that, if successful, will be of huge personal importance for millions of individuals in LMICs. They will also open the gate to international adoption of this innovative, mHealth driven, community-based model of hearing care.