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

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的有效性（R33），以扩大面临健康差距的老年人获得听力保健的机会。社区卫生工作者模式已成功地应用于美墨边境社区，以增加获得医疗保健和自我管理一系列慢性病的机会。该提案的创新之处在于将循证公共卫生模式与低成本、基于社区的听力学康复相结合，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，而且通常没有其他途径来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）模式将通过健康教育、社会支持和语言调解有效和相关地减少听力健康差距。鉴于目前慢性听力损失治疗的流行率很低，研究人员必须与社区成员和提供者合作，在制定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）适合于迭代过程，这对于创建可持续和与文化相关的方法至关重要，从而使面临健康差异的社区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，确定西班牙/拉丁裔老年人获得护理的潜在障碍因素；目标2)开展试点干预研究，评估社区听力康复与社区卫生工作者干预相结合的可行性，以改善获得护理的机会。R33阶段包括验证新方法的临床效用和跟踪纵向结果的后续目标，这是循证实践的两个重要基准。其中包括目标3)在随机对照试验设计中确定Promatora干预措施相对于标准治疗方法对慢性听力损失的比较有效性；4)评估从听力筛查起始点到听力康复的纵向生活质量结果。这项资助的合作伙伴包括亚利桑那大学的听力学教授，亚利桑那预防研究中心的公共卫生研究人员，以及马里波萨社区卫生中心的社区卫生工作者，马里波萨社区卫生中心是美国-墨西哥边境的一个联邦认证的卫生中心。这个独特的跨学科研究团队提供了一个重要的机会，将当前的研究领域和专业知识结合起来，开发一种低成本、可交付、有效的替代干预措施，为个体患者及其家庭的生活质量带来可衡量的改善，以及在农村健康环境中提供更具可持续性和成本效益的听力医疗保健模式。

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.