IntroductionCommunity health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs.MethodsWe performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature.ResultsWe identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss.ConclusionCHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.

Standardised health-related quality of life questionnaires play an increasing role as measures of outcome in the evaluation of health care interventions. However, problems can arise when the selected functions or dimensions of such standardised measures are not in line with the intervention that is the focus of the research. Furthermore, the subjective element of quality of life makes standardised questionnaires vulnerable to the coping mechanism, thereby decreasing their sensitivity. The capability approach of the economist and philosopher Amartya Sen offers a descriptive concept that contributes to a better understanding of these problems. This article provides an introduction to the ideas of Sen for researchers who wish to go beyond the traditional framework of measuring health-related quality of life.