Advancing Equitable Hearing Care: Innovations in Technology and Service Delivery

Abstract

Background: Hearing loss is a neglected global health priority affecting 1.5 billion persons. Global access to hearing care is severely limited with management options, like hearing aids, inaccessible to most. The cost and centralised nature of traditional service-delivery approaches in hearing care have undermined equitable access alongside poor awareness. Summary: Recent innovations in digital and mHealth hearing technologies used by health workers through task-shifting are enabling novel community-based services across the continuum of care. This narrative review explores technology-enabled hearing care in communities. We provide examples focused on our work over the past decade to explore more equitable hearing care across primary, secondary and tertiary levels of prevention. Key messages: Hearing health innovations have the potential to increase access to care, improve the quality of life for those affected by hearing loss and reduce global costs associated with untreated hearing loss. More equitable hearing care is a global health priority that requires scalable service-delivery models enabled by innovative technologies within communities and integrated into public health initiatives including hearing health promotion.

Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings: A systematic scoping review

“…These concepts are in line with recommendations from the WHO World Report on Hearing, which recommends implementation of task sharing and innovations in hearing technologies to improve global hearing health care access [ 2 ]. While this review focused on hearing aid provision, other research has indicated trained non-specialists can provide additional hearing-related services in community settings, including those related to hearing loss prevention, hearing screening and assessment, and rehabilitation [ 19 , 54 , 57 , 58 ].…”

“…There is a need for effective, low-cost, high-quality technology that supports hearing aid service delivery in LMIC or resource-limited settings by non-specialist providers [ 46 , 53 – 56 , 65 ]. Currently available technologies for use in community settings include portable equipment and innovative technologies supported by mobile health [ 53 , 54 , 56 ]. This can support service delivery by non-specialist providers in community-based settings because the equipment is easy to travel with and often does not require extensive training to operate.…”

“…Low-cost and pre-programmable hearing aids can also support community-based service delivery [ 54 ]. Nearly all studies in this review used behind-the-ear hearing aids, rather than those that require more customization, such as in-the-ear or in-the-canal types, likely because behind-the-ear hearing aids can be appropriately fit to many different patient profiles.…”

Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment

“…The easiness of use and accessibility of mHealth solutions can have an impact on self-awareness and recognition of hearing loss and foster knowledge and use of in-person services [19,23,24]. Moreover, mHealth solutions show the potential to promote more equitable healthcare in low-and mid-income countries, where access to healthcare facilities and professionals is limited [16,25]. Finally, mHealth applications that are quick and easy to use in everyday life have the potential to provide clinicians with important information at both the diagnostic and intervention phases and can help exploring and understanding daily experiences of the user with HL and facilitate more timely responses [19].…”

Smartphone-Facilitated In-Situ Hearing Aid Audiometry for Community-Based Hearing Testing

“…This study, therefore, aimed to determine the validity of automated smartphone-facilitated in-situ audiometry as part of a test and fit approach for the provision of hearing aids in low- and middle-income communities (Frisby et al 2022; Swanepoel 2023). Objectives were to determine: (i) maximum permissible ambient noise level (MPANLs) for automated in-situ PTA covered by Peltor 3M circumaural earcups; (ii) inter-device reliability of the automated in-situ PTA; (iii) accuracy and test-retest reliability of automated in-situ PTA, facilitated by an audiologist compared with audiologist-conducted clinical PTA; and (iv) comparison between in-situ audiometry and automated mobile PTA facilitated by CHWs in a community setting.…”