Community Health Workers and teleaudiology as a culturally-relevant approach to improving access to hearing health care

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Many rural and under-resourced areas lack audiology services, exacerbating hearing health care disparities. In the United States, hearing loss impacts an estimated 50 million individuals aged 65 years and older. Access to hearing aid rehabilitation can improve health outcomes, yet an uneven geographic distribution of audiologists across the U.S. results in communities that lack services. In teleaudiology, an audiologist delivers care to a patient from a remote workplace via videoconferencing technology, minimizing the barrier of geography. Evidence has demonstrated the clinical equivalence of teleaudiology to face-to-face procedures, including in the area of hearing aid fitting and verification. However, additional barriers to accessibility affecting disparity populations, including socioeconomic and cultural differences, are known to contribute to poor health service utilization. In teleaudiology, a facilitator is located at the patient site to assist with hands-on tasks, under the supervision of the remote audiologist. Community Health Workers may be a feasible patient-site support for teleaudiology due to their established role in health promotion for disparity populations. For decades, Community Health Workers have supported a number of disease-specific (e.g. Diabetes) and general health areas by providing community-receptive health education, patient advocacy, and integrating with patient-care teams. Given their established history of addressing disparities in a vast range of other health areas, Community Health Workers have been identified for their emergent role in reducing disparities in access to hearing health care (Marrone et al., 2017; Marrone, Ingram et al., 2016). The proposed research builds on the Sponsors’ ongoing research with an established Community Health Worker program serving Hispanic/Latino older adults with hearing loss. The proposed study aims to test the feasibility of an innovative approach in which Community Health Workers serve as the patient-site support for teleaudiology. The hypothesis is that providing evidence-based audiology services delivered via teleaudiology with patient-site support from Community Health Workers will lead to improved access to care, and therefore improved hearing health outcomes. In this project, remote hearing aid fittings will be delivered by an audiologist with patient-site support from a Community Health Worker for a cohort of older adults (>65 years) from a rural area that has been identified as under-resourced for hearing health care. Hearing aid benefit will be measured quantitatively via standardized patient-reported outcome measures, and qualitatively via focus groups. We expect hearing aid benefit to be improved at 3 months in an immediate intervention group relative to a waitlist comparison group, and for outcomes to be maintained at 6 months. The proposed research and training plans are supported by a multidisciplinary team of researchers with a longstanding history of collaboration across audiology, public health, telemedicine, and community health. The overall goal aligns with the NIDCD research priority to generate evidence for high-quality, accessible hearing health care in under-resourced areas. !