Mobile technologies for delivering hearing care through community health workers

通过社区卫生工作者提供听力保健的移动技术

• 批准号: 10686132
• 负责人: David Moore
• 金额: $ 17.27万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-18 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10686132
• 关键词: Acclimatization; Address; Adoption; Africa South of the Sahara; Algorithms; Behavioral; Blinded; Caring; Cellular Phone; Child; Clinic; Clinical; Clinical Trials; Communication; Communities; Community Health Aides; Country; Data; Decentralization; Detection; Devices; Diagnosis; Diagnosis Clinical Trials; Diagnostic; Differential Diagnosis; Digit structure; Ear; Equipment; Equity; Family; Foundations; Funding; Goals; Healthcare; Hearing; Hearing Aids; Hearing Tests; Income; Individual; Industrialization; International; Intervention; Knowledge; Laboratories; Language; Low income; Machine Learning; Medical; Methods; Modeling; Noise; Nursery Schools; Ohio; Otoscopy; Outcome; Participant; Patient Self-Report; Penetration; Performance; Persons; Phase; Population; Procedures; Process; Public Health; Randomized, Controlled Trials; Rehabilitation therapy; School Teachers; Sensorineural Hearing Loss; Service delivery model; Services; South African; Support System; Techniques; Technology; Testing; Text; Time; Training; Training Activity; Translating; Triage; Underserved Population; United States National Institutes of Health; Validation; Variant; Vision; Voice; Work; Writing; community engagement; community setting; cost; data modeling; digital; disability; evidence base; experience; functional outcomes; global health; grandchild; hearing impairment; hearing screening; high standard; improved; innovation; low and middle-income countries; mHealth; mobile computing; novel; outreach; poor communities; programs; randomized, controlled study; rehabilitation service; response; scale up; segregation; smartphone application; sound; speech in noise; texting support; time use; usability

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.

R21 R33 摘要/摘要 听力损失是一个日益严重的重大公共卫生问题，特别是在低收入和中等收入国家 （中低收入国家）世界上大约 80% 的听力损失人口居住在这些国家。我们的愿景是提供良好的 为中低收入国家及周边地区服务不足的人群提供优质、负担得起且可持续的听力保健服务 世界。我们建议验证并试验用于端到端听力护理的创新移动医疗模式 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进行首次测试 听力，然后，如果需要，对设备进行编程，以提供金标准康复。过程中 十五分钟后，用户及其家人应该能够体验到沟通方式的巨大变化 能力。验配会议结束后，将通过创新的移动医疗信息支持继续提供支持 他们的新助听器以及与 CHW 的沟通以排除故障。在本次融资的 R21 阶段， 我们将实现三个目标，以验证为所有人提供更好听力的旅程中的关键步骤。对于目标 1，我们将 在俄亥俄州辛辛那提进行临床工作，并在低收入南非与社区卫生工作者一起开展社区工作 社区确认助听器可提供最高标准的听力测试精度。这 听力测试将成为更全面的诊断包的一部分，涉及新颖的物理（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 符合金标准和传统临床验配标准的助听器。在社区环境中，我们还将 通过包括社区卫生工作者和用户来确定可用性。培训和支持社区卫生工作者对于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。 将使用多种技术让社区卫生工作者参与该过程的每个阶段，例如，调整现有的 发现模块在之前的听力筛查推广中很有用。新聘用的社区卫生工作者将进行试驾并 评估培训。该目标的另一部分是开始开发移动医疗用户支持系统（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翻译到本地 我们已经证明，使用 WhatsApp 来提高对语言（例如科萨语）的了解可以提高听力知识 幼儿教师流失。在R33阶段的资助中，重点缩小到两项临床试验。在第一个（目标 4)，我们询问基于智能手机、CHW 辅助的助听器是否成功地为他们带来了好处 用户。在第二个试验（目标 5）中，我们询问目标 3 中开发的移动医疗用户支持系统是否是 有效地提供效益。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，我们将使用人工智能对目标 1-5 的数据进行建模，以进行整体听力评估。积极的自我报告 结果和模型应为扩大到下一个级别、区域和国家试验铺平道路 如果成功的话，对于中低收入国家的数百万人来说将具有巨大的个人意义。他们还将开放 这是国际上采用这种创新的、移动医疗驱动的、基于社区的听力保健模式的大门。

项目成果

Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study.

• DOI: 10.2196/46043
• 发表时间: 2023-08-23
• 期刊: JMIR formative research
• 影响因子: 2.2

Effectiveness of an Over-the-Counter Self-fitting Hearing Aid Compared With an Audiologist-Fitted Hearing Aid: A Randomized Clinical Trial.

与听力学家合适的助听器相比，非处方自身助听器的有效性：一项随机临床试验。

• DOI: 10.1001/jamaoto.2023.0376
• 发表时间: 2023-06-01
• 期刊: JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY
• 影响因子: 7.8
• 作者: De Sousa, Karina C.;Manchaiah, Vinaya;Moore, David R.;Graham, Marien A.;Swanepoel, De Wet
• 通讯作者: Swanepoel, De Wet