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

摘要 越来越多的证据表明，听力损失与社会孤立、抑郁和 认知能力下降听力损失已成为日益严重的公共卫生问题。对于那些没有可用或 听力损失的负面影响很可能会更糟， 与那些有听力保健的人相比。通过改善所有人获得护理的机会，我们可以帮助 减轻听力损失的负面影响。本申请中概述的建议具体地解决了 RFA-DC-19-001中讨论的NIDCD的问题与提供有效的康复干预有关 在社区，除了确定最低限度的技术，将取得成功的那些谁有轻度- 中度听力损失这项研究的长期目标是了解如何有限地获得 听力保健影响那些生活在国家持续贫困地区的人，此外， 有效解决这些地区居民需求的干预战略。这个单独 随机分组治疗临床试验将使用基于社区的参与性研究（CBPR）， 了解并解决听力损失患者及其家庭的需求， 中西部和亚拉巴马南部的社区。具体目标是：1）开展CBPR需求 评估，将完善我们对那些无法获得听力保健服务的人的特定听力保健需求的理解。 在中西部和南部亚拉巴马的听力保健; 2）开发一个有效的社区健康顾问 (CHA)听力康复（AR）训练计划; 3）确定个人声音放大的有效性 产品（PSAP），以减少听力障碍和改善言语知觉的成年人没有访问 听力保健，以及4）为那些无法获得听力保健的人实施成人听力康复（AR）计划。 听力保健，以改善PSAP的好处，促进PSAP的使用，并导致生活质量（QOL）的提高。 根据社区卫生协调员和顾问的需求评估和培训计划， 将实施干预计划，包括个人声音放大产品（PSAP）和 听力康复（AR）计划，针对患有轻度至中度听力损失的成年人， 健康护理据推测，PSAP的使用将显着减少听力障碍和改善语音 perception.第二个假设是，与没有接受AR计划的成年人相比，PSAP受益于 和使用将更大，沟通困难的听力条件将更好，和生活质量将积极 对于那些参与AR计划的人来说，这个项目的关键是我们最先进的移动的 一家听力诊所将前往中西部和亚拉巴马南部的偏远地区，使亚拉巴马 专门研究听力损失对那些生活在完全农村地区的人的影响， 持续贫困地区。

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.