Community Health Workers as Patient-Site Facilitators in Adult Hearing Aid Services via Synchronous Teleaudiology: Feasibility Results from the Conexiones Randomized Controlled Trial

Abstract

Objectives: The purpose of this study was to investigate the feasibility of Community Health Workers (CHWs) as patient-site facilitators in teleaudiology-facilitated hearing aid services to improve hearing aid rehabilitation outcomes for older Hispanic/Latino adults in a medically underserved, rural, US-Mexico border community. Design: A total of 28 adults (aged 55 to 89) with bilateral hearing loss participated in this study. Individuals were randomized to one of two teleaudiology intervention arms that differed at the level of the patient-site facilitator. Participants in the experimental group were assisted locally by trained CHW facilitators. Participants in the control group were assisted locally by trained university student facilitators. Synchronous (real-time) teleaudiology hearing aid services took place with participants located at a rural community health center and the clinician located a university 70 miles away. The results of this feasibility study are presented within the reach, effectiveness, adoption, implementation fidelity, and maintenance implementation framework. Results: Regarding reach, the participants in this study population are historically under-represented in research (primarily low-income Hispanic/Latino older adults). A total of 57 individuals were recruited, 47 were consented and assessed for eligibility and 28 individuals met inclusion criteria and were randomized. The average age of participants was 73.9 years, (range: 55 to 89 years) and most individuals were female (75%). Most participants (86%) reported having incomes less than $20,000 annually. Effectiveness results (via the Self Efficacy for Situational Communication Management Questionnaire) showed that both groups (CHW and control) significantly improved listening self-efficacy from pre-fitting baseline and no difference between groups was observed. Regarding datalogging, at the short-term follow-up, participants in the CHW group wore their hearing aids for more hours/day on average compared with participants in the control group. Implementation fidelity was high for both groups. Long-term maintenance of CHW-supported teleaudiology appears feasible given that training and institutional support is in place. Conclusions: Teleaudiology-delivered hearing aid services were feasible when facilitated locally by trained CHWs. Future efficacy and effectiveness research is warranted with CHWs and teleaudiology, potentially leading to a significant reduction in barriers for rural and medically under-resourced communities.

Implementation factors influencing the sustained provision of tele-audiology services: insights from a combined methodology of scoping review and qualitative semistructured interviews

“…While the use of implementation research and/or outcome frameworks for translating evidence-based practice to clinical service delivery is gaining momentum, it is still underused in tele-audiology service implementations. Only one recent study reported the use of implementation science framework to investigate the feasibility outcomes of a 17-week tele-audiology hearing aid service 65. Similar efforts for long-term implementation will offer deeper insights on sustainability aspects.…”

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review

“…CBPR is compatible with a variety of research methodologies: randomized control trials, mixed methods studies, surveys, qualitative studies, and quasi-experimental studies (Viswanathan et al 2004). The CBPR approach has been successfully employed in these hearing healthcare research studies: the Oyendo Bien clinical trial (Marrone et al 2017), the Conexiones clinical trial (Coco et al 2023), and the Hearing Norton Sound clinical trial (Emmett et al 2019).…”

Prioritizing Hearing Aid Service Delivery Models for Low-Income Communities

“…This mHealth program has demonstrated the potential for low-cost, scalable impact, with positive reports on applicability and accessibility from all community members 16 . The use of CHWs facilitating teleaudiology has also been shown to be a feasible strategy for adults 17 . Service-delivery models that utilize CHW allow scarce resources like trained professionals such as audiologists to support these programs through training, remote monitoring, and surveillance.…”