Improving Access and Affordability of Adult Hearing Healthcare: Effectiveness of Community-based Interventions in West Central and South Alabama

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Abstract Mounting evidence suggests that hearing loss is associated with social isolation, depression and cognitive decline. Loss of hearing has become a growing public health concern. For those with no available or affordable hearing healthcare resources, the negative effects of hearing loss are most likely worse when compared to those with access to hearing healthcare. By improving access to care for all, we can help to mitigate the negative effects of hearing loss. The proposal outlined in this application specifically addresses concerns of NIDCD discussed in RFA-DC-19-001 related to the delivery of effective rehabilitation interventions in communities, in addition to identifying minimal technology that will achieve success for those who have mild- to-moderate hearing loss. The long term goals of this line of research are to understand how limited access to hearing health care affects those who live in persistently poor regions of the state, and additionally, to identify intervention strategies that will effectively address the needs of those who live in these areas. This individually randomized group treatment clinical trial will use community-based participatory research (CBPR) to understand and address the needs of those with hearing loss and their families living in underserved communities of West Central and South Alabama. The specific aims are to 1) conduct a CBPR needs assessment that will refine our understanding of specific hearing health care needs for those with no access to hearing health care in West Central and South Alabama; 2) develop an effective community health advisor (CHA) aural rehabilitation (AR) training program; 3) identify the effectiveness of personal sound amplification products (PSAPs) for decreasing hearing handicap and improving speech perception in adults with no access to hearing health care, and 4) implement an adult aural rehabilitation (AR) program for those without access to hearing health care to improve PSAP benefit, promote PSAP use and lead to increased quality of life (QOL). Following the needs assessment and training program for community health coordinators and advisors, an intervention plan will be implemented consisting of personal sound amplification products (PSAPs) and an aural rehabilitation (AR) program for adults with mild-to-moderate hearing loss who have no access to hearing healthcare. It is hypothesized that PSAP use will significantly decrease hearing handicap and improve speech perception. A second hypothesis is that compared to adults who did not receive the AR program, PSAP benefit and use will be greater, communication in difficult listening conditions will be better, and QOL will be positively affected for those who did participate in the AR program. Vital to this project is our state-of-the-art mobile audiology clinic which will travel to remote areas of West Central and South Alabama, making Alabama uniquely poised to examine the effects of hearing loss on those who live in completely rural areas and persistent poverty regions.