Reducing Disparities in Access to Hearing Healthcare on the U.S.-Mexico Border

减少美墨边境听力保健服务的差异

• 批准号: 9328057
• 负责人: NICOLE L MARRONE
• 金额: $ 52.58万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-17 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9328057
• 关键词: Address; Adult; American Speech-Language-Hearing Association; Americas; Area; Arizona; Audiology; Benchmarking; Caring; Chronic; Chronic Care; Clinical; Communication impairment; Communities; Community Health Aides; Community Health Centers; Community Healthcare; Data; Development; Diabetes Mellitus; Education; Effectiveness; Elderly; Epidemic; Evidence based practice; Faculty; Family; Federally Qualified Health Center; Goals; Grant; Health; Health Services Accessibility; Health education; Healthcare; Healthy People 2020; Hearing; Hearing Aids; Heart Diseases; Hispanics; Improve Access; Individual; Interdisciplinary Study; Intervention; Intervention Studies; Language; Latino; Lead; Measurable; Mediation; Mexican Americans; Mexico; Mission; Modeling; National Institute on Deafness and Other Communication Disorders; Needs Assessment; Outcome; Partner Communications; Patients; Phase; Population Heterogeneity; Positioning Attribute; Prevalence; Prevention Research; Process; Provider; Public Health; Quality of life; Randomized Controlled Trials; Rehabilitation therapy; Research; Research Methodology; Research Personnel; Resources; Rural; Rural Community; Rural Health; Rural Population; Scientist; Self Management; Services; Social support; Support Groups; Testing; Training; Universities; base; community based participatory research; comparative effectiveness; cost; cost effective; cultural competence; disparity reduction; evidence base; health belief; health care availability; health care delivery; health care quality; health disparity; health literacy; hearing impairment; hearing screening; improved; improved functioning; individual patient; innovation; interdisciplinary collaboration; member; novel strategies; outreach; patient oriented; programs; public health relevance; research study; standard care; trial design

DESCRIPTION (provided by applicant): The purpose of this proposal is to develop (R21) and test the effectiveness (R33) of an innovative community health worker intervention to expand access to hearing healthcare among older adults facing health disparities. The community health worker model has been used successfully in U.S.-Mexico border communities to increase access to healthcare and self-management for a range of chronic conditions. The innovation of this proposal is to combine this evidence-based public health model with low-cost, community-based audiologic rehabilitation to reduce disparities in access to care for chronic hearing loss. I many rural communities facing health disparities, hearing aids are inaccessible to the people who need them due to financial barriers, and there are typically no other avenues to reduce the burden of hearing loss on quality of life. The hypothesis is that a community health worker (Promotora) model will be effective and relevant in reducing hearing health disparities via health education, social support, and language mediation. Given that the current prevalence of treatment for chronic hearing loss is low, it is essential that researchers collaborate with members of the community and providers to assess the state of care prior to and during the development of alternative interventions. The phased development approach (RFA-DC-12-003) lends itself to the iterative process that is critical to creating a sustainable and culturally relvant approach to make hearing healthcare more accessible within communities facing health disparities. The specific aims are divided across the two phases of research. The R21 phase includes Aim 1) Develop and implement a needs assessment identifying factors that underlie barriers to access in an older Hispanic/Latino population and Aim 2) Conduct a pilot intervention research study assessing the feasibility of community-based audiologic rehabilitation combined with a community health worker intervention to improve access to care. The R33 phase includes subsequent aims to validate the clinical utility of the novel approach and to track longitudinal outcomes, two important benchmarks for evidence-based practice. These include Aim 3) Determine the comparative effectiveness of Promatora interventions for chronic hearing loss relative to a standard care approach in a randomized controlled trial design; and 4) Assess longitudinal quality of life outcomes from the entry point of hearing screening through hearing rehabilitation. The partners on this grant include audiology faculty from the University of Arizona public health researchers from the Arizona Prevention Research Center, and community health workers at the Mariposa Community Health Center, a federally qualified health center on the U.S.-Mexico border. This unique interdisciplinary research team offers a significant opportunity to unite current research areas and expertise to develop a low- cost, deliverable, and effective alternative intervention that yields measurable improvements in quality of life for individual patients and their families, as well as a more sustainable and cost-effective model of hearing healthcare delivery in rural health settings with diverse populations.

描述（由申请人提供）：本提案的目的是开发（R21）和测试创新社区卫生工作者干预措施的有效性（R33），以扩大面临健康差异的老年人获得听力保健的机会。社区卫生工作者模式已在美国成功应用-墨西哥边境社区，以增加获得医疗保健和自我管理的一系列慢性病。该提案的创新之处在于将联合收割机这一循证公共卫生模式与低成本、以社区为基础的听力康复相结合，以减少慢性听力损失患者在获得护理方面的差异。在许多面临健康差距的农村社区，由于经济障碍，需要助听器的人无法获得助听器，并且通常没有其他途径可以减轻听力损失对生活质量的负担。假设是，社区卫生工作者（Promotora）模式将是有效的，相关的，通过健康教育，社会支持和语言调解，减少听力健康的差距。鉴于目前慢性听力损失治疗的流行率较低，研究人员必须与社区成员和提供者合作，在开发替代干预措施之前和期间评估护理状况。分阶段开发方法（RFA-DC-12-003）适用于迭代过程，这对于创建可持续和文化相关的方法至关重要，以便在面临健康差异的社区内更容易获得听力保健。具体目标分为两个研究阶段。R21阶段包括目标1）制定和实施需求评估，确定老年西班牙裔/拉丁裔人群获得治疗的障碍因素，以及目标2）进行试点干预研究，评估基于社区的听力康复与社区卫生工作者干预相结合的可行性，以改善获得治疗的机会。R33阶段包括随后的目标，以验证新方法的临床效用和跟踪纵向结果，这是循证实践的两个重要基准。这些目标包括：3）在随机对照试验设计中确定Promatora干预措施相对于标准护理方法对慢性听力损失的比较有效性; 4）从听力筛查到听力康复的切入点评估纵向生活质量结果。这项资助的合作伙伴包括来自亚利桑那州预防研究中心的亚利桑那大学公共卫生研究人员的听力学教师，以及马里波萨社区卫生中心的社区卫生工作者，该中心是美国联邦政府合格的卫生中心。墨西哥边境。这个独特的跨学科研究团队提供了一个重要的机会，可以联合当前的研究领域和专业知识，开发一种低成本、可交付且有效的替代干预措施，为个体患者及其家人的生活质量带来可衡量的改善，以及一个更可持续和更具成本效益的模型。在人口多元化的农村卫生环境中提供听力保健服务。