Community health workers and mHealth systems for hearing screening in rural Nicaraguan schoolchildren

Abstract

Background We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders. Methods A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed. Results Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone. Conclusions Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.

Advancing Equitable Hearing Care: Innovations in Technology and Service Delivery

“…In LMICs, the use of mHealth audiometry screening technologies by minimally trained screeners, including CHWs and nurses, has proven effective in community-based services [19, 22–24, 43, 44]. The inclusion of stringent quality control features in these solutions, like real-time monitoring of environmental noise, tracking response times, and even doing surveillance of the facilitator’s screening quality, is essential for decentralised screening [24, 44, 45].…”

The PEN Fa’aSamoa Initiative: An Integrated Platform for Hearing and Vision Screening in Samoa

“…The specialists will accompany PEN Fa'aSamoa staff members and community health workers on their school visits to assess the students using the screening technologies. Although hearing and vision screening mobile applications have been field-tested and validated, [15][16][17][18][19][20][21][22] the pilot study will inform recommendations for the Samoan hearing and vision screening protocol to ensure maximum capture rates of children requiring referral to primary and/or specialist services, while also maintaining acceptable and manageable referral rates. (N.B.…”