Hearing Healthcare Assessment in Rural Communities (HHARC)

项目摘要 成人听力损失是美国第三大最常见的慢性健康状况， 在年轻人中超过20%，在老年人中超过40%。未治疗的听力损失会造成可衡量的影响 健康和社会，职业和成年人的情感幸福。只有26%的成年人接受过诊断 过去5年内的听力测试和延迟听力损失的诊断和治疗可能会导致沟通 对教育、就业和整体健康产生深远影响的障碍。听力损失的危害 生活在农村社区的成年人比生活在城市环境中的成年人更高;此外， 听力损失的成年人可能永远不会接受治疗，或者可能会延迟诊断和/或治疗， 城市成年人。农村卫生诊所（RHC）代表联邦指定的卫生系统护理， 农村服务不足社区的初级保健;然而，听力保健服务并不是一个 RHC护理服务的重要组成部分。RHC处于与农村社区合作的理想位置， 制定一项干预措施，帮助农村成年人了解听力保健的不同方面， 教育、预防、筛查、诊断和治疗。本研究的目的是评估 通过RHC和R21阶段的计划，在农村成年人中进行听力保健，然后制定一个 文化上敏感的RHC患者导航计划（PNP），以促进听力保健的利用。到 在进行这项研究时，我们将与阿巴拉契亚农村县内10个资源不足的高需求RHC合作 在肯塔基州，并利用PRECEDE-PROCEED模型（PPM）系统地评估农村成人听力 卫生和医疗保健的优先事项、需求和资源，为制定干预措施提供信息。在R21阶段 我们将1）对农村成人听力保健进行社会和流行病学评估，2）评估 影响RHC听力保健利用的组织和环境因素。的里程碑 R21包括农村听力损失患病率和听力保健利用的测定 成年人，确定农村成年人听力保健优先事项，并建立社区咨询委员会 和一个农村供应商工作组。在R33阶段，我们将：1）开发基于社区的听力保健 RHC的患者导航程序和2）试点测试农村听力保健导航程序。的 R33阶段的里程碑包括制定PNP协议，评估 导航员对农村成年人获得诊断性听力图，并评估PNP的可行性，可接受性， 适当性这项研究意义重大，因为它旨在减少获得及时诊断的护理障碍 对农村成年人进行听力测试，以防止产生不良后果。本研究具有开拓性 以及在RHC环境中对先前未在成人听力保健中评估的新型干预进行试点测试。 我们的成果将通过与社区合作来影响该领域， 创新的患者支持性干预措施，以改善农村听力保健的可及性。

PROJECT SUMMARY Hearing loss in adults is the third most common chronic health condition in the United States with a prevalence of over 20% in younger adults and over 40% in older adults. Untreated hearing loss causes a measurable impact on health and social, occupational, and emotional well-being of adults. Only 26% of adults have had a diagnostic hearing test within the past 5 years and delayed hearing loss diagnosis and treatment may lead to communication impairment with profound effects on education, employment, and overall health. The prevalence of hearing loss is higher among adults living in rural communities compared with those in urban settings; furthermore, rural adults with hearing loss may never receive treatment or may be delayed in diagnosis and/or treatment compared with urban adults. Rural health clinics (RHCs) represent a federally designated health system care that provides primary care within rural underserved communities; however, hearing healthcare services have not been a significant component of RHC care delivery. RHCs are ideally positioned to partner with rural communities to develop an intervention that can help rural adults navigate different aspects of hearing healthcare such as education, prevention, screening, diagnosis, and treatment. The goal of this study is to assess the utilization of hearing healthcare among rural adults through RHCs with the R21 phase of the program and then develop a culturally responsive RHC patient navigation program (PNP) to promote utilization of hearing healthcare. To conduct this study, we will partner with 10 high-need under-resourced RHCs within rural Appalachian counties in Kentucky and utilize the PRECEDE-PROCEED model (PPM) to systematically assess the rural adult hearing health and healthcare priorities, needs, and resources to inform intervention development. During the R21 phase we will 1) conduct a social and epidemiological assessment of rural adult hearing healthcare and 2) assess the organizational and environmental factors influencing hearing healthcare utilization in RHCs. The milestones of the R21 include the determination of the prevalence of hearing loss and hearing healthcare utilization in rural adults, establishment of rural adult hearing healthcare priorities, and development of a community advisory board and a rural provider taskforce. During the R33 phase we will 1) develop of a community-based hearing healthcare patient navigation program for RHCs and 2) pilot test the rural hearing healthcare navigation program. The milestones of the R33 phase include the development of a PNP protocol, assessment of the impact of the navigator on rural adults obtaining diagnostic audiogram, and evaluation of the PNP feasibility, acceptability, and appropriateness. This study is significant because it aims to reduce access to care barriers to timely diagnostic hearing testing for rural adults to prevent negative consequences. This research is innovative in development and pilot testing of a novel intervention not previously assessed in adult hearing healthcare within an RHC setting. Our results will impact the field by partnering with communities to inform the development and delivery of innovative patient supportive interventions to improve rural hearing healthcare access.