Implementing a Community Health Worker Model for Providing Hearing Healthcare Services to Older Adults

 描述(由申请人提供)：鉴于人口老龄化，迫切需要确保老年人负担得起和获得听力保健(HHC)的战略。然而，目前可用的唯一已建立的HHC模型是基于临床的听力学评估、提供放大以及后续护理和康复咨询，这是高度耗时、昂贵的，并且依赖于个体重复旅行的能力 临床医生的办公室。本提案的总体目标是开发和测试 社区卫生工作者(CHW)通过以社区为基础的参与性研究，为低收入和主要是少数族裔的老年人提供基本水平的HHC。在过去的一年里，我们制定了通过无障碍研究和解决方案实现听力平等的干预框架，该框架将在本提案中得到完善和测试。HARS干预是一项为期两小时的干预，由社区中的CHW提供，包括听力筛查、为参与者及其沟通伙伴提供康复咨询，以及立即提供和培训使用扩音器。我们的建议有以下目标：R21目标1通过CBPR和社会设计方法，与社区咨询委员会和科学委员会合作，最终敲定HELS干预的协议和内容。R33目标1与社区咨询和科学合作，开发培训CHW的课程和手册，以提供HARS干预，同时确保保真度、有效性和安全性 委员会。R33目标2招募和培训一支由1名听力学家和5名CHW组成的听力学家-CHW护理团队，进行听力干预，并严格评估培训计划。R33目的3对在巴尔的摩市独立生活的低收入和主要是少数族裔的老年人进行一项随机对照试验(RCT)，该试验由听力学家-CHW团队在立即治疗和3个月延迟治疗组中提供。这项由150名参与者组成的随机对照试验将在3个月的随访中检测立即治疗组和延迟治疗组在老年人听力障碍量表上的效果大小或更大的分数差异。这项建议汇集了来自多个领域(耳鼻喉学、听力学、老年学、社会设计、护理、公共卫生)的多学科研究人员和专家团队，是一项高度合作的努力，涉及学术界(约翰·霍普金斯大学医学院、护理和公共卫生学院；马里兰艺术学院社会设计中心)、政府(巴尔的摩市)、社区咨询委员会和提供社区服务的非营利组织。开发负担得起的、可获得的、可扩展的老年人听力损失干预措施是一项至关重要的公共卫生 优先考虑到越来越多的证据表明听力损失对健康老龄化的影响。这一创新的建议将导致这种干预的发展，并引入由听力学家领导的CHW团队的模式，以满足老龄化人口日益增长的HHC需求。

 DESCRIPTION (provided by applicant): Strategies to ensure affordability and access to hearing healthcare (HHC) for older adults are urgently needed given the aging of the population. However, the only established model of HHC available presently is clinic- based audiologic evaluation, provision of amplification, and follow-up care and rehabilitative counselling which is highly time intensive, expensive, and dependent on the individual's ability to travel repeatedly to the clinician's office. The overarching objective of this present proposal is to develop and test a community health worker (CHW) approach to providing a basic level of HHC to low-income and primarily minority older adults through community-based participatory research. Over the past year, we have developed the framework for the HEARS (Hearing Equality through Accessible Research and Solutions) intervention that will be refined and tested in this proposal. The HEARS intervention is a two-hour intervention that has been designed to be delivered by a CHW in the community and consists of hearing screening, rehabilitative counseling for the participant and his/her communication partner, and immediate provision and training in the use of an amplification device. Our proposal has the following aims: R21 Aim 1 To finalize the protocol and content of the HEARS intervention in collaboration with the community advisory committee and scientific committee through CBPR and social design methodologies. R33 Aim 1 To develop curriculum and manuals for training CHWs to deliver the HEARS intervention while ensuring fidelity, efficacy, and safety in collaboration with the community advisory and scientific committees. R33 Aim 2 To recruit and train an audiologist-CHW care team of 1 audiologist and 5 CHWs in the HEARS intervention and rigorously assess the training program. R33 Aim 3 To conduct a randomized controlled trial (RCT) of the HEARS intervention delivered by the audiologist-CHW team in an immediate treatment and 3-month delayed treatment group of low income and primarily minority older adults living independently in Baltimore City. This RCT of 150 participants will be powered to detect a 0.4 effect size or greater score difference on the Hearing Handicap Inventory for the Elderly between the immediate-treatment and delayed-treatment groups at 3 months follow-up. This proposal brings together a multidisciplinary team of investigators and experts from multiple fields (otolaryngology, audiology, gerontology, social design, nursing, public health) and is a highly collaborative effort spanning academia (Johns Hopkins University Schools of Medicine, Nursing, and Public Health; Maryland Institute College of Art Center for Social Design), government (Baltimore City), a community advisory committee, and non-profit organizations providing community-based services. Developing affordable, accessible, and scalable interventions for hearing loss in older adults is a critical public health priority given growing evidence of the consequences of hearing loss for healthy aging. This innovative proposal will result in the development of such an intervention and introduce the model of an audiologist-led team of CHWs to address the growing HHC needs of the aging population.