Effect of a Community Health Worker–Delivered Personal Sound Amplification Device on Self-Perceived Communication Function in Older Adults With Hearing Loss

Abstract

ImportanceAge-related hearing loss that impairs daily communication is associated with adverse health outcomes, but use of hearing aids by older adults is low and disparities exist.ObjectiveTo test whether an affordable, accessible hearing care intervention, delivered by community health workers using over-the-counter hearing technology, could improve self-perceived communication function among older adults with hearing loss compared with a wait-list control.Design, Setting, and ParticipantsOpen-label randomized clinical trial conducted between April 2018 and October 2019 with 3-month data collection completed in June 2020. The trial took place at 13 community sites, including affordable independent housing complexes (n = 10), senior centers (n = 2), and an older adult social club (n = 1) in Baltimore, Maryland. A total of 151 participants aged 60 years or older with hearing loss were randomized.InterventionsParticipants were randomized to receive a community health worker–delivered hearing care intervention (n = 78) or to a wait-list control group (n = 73). The 2-hour intervention consisted of fitting a low-cost amplification device and instruction.Main Outcomes and MeasuresThe primary outcome was change in self-perceived communication function (Hearing Handicap Inventory for the Elderly–Screening Version [HHIE-S]; score range, 0-40; higher scores indicate poorer function) from baseline to 3 months postrandomization. The average treatment effect was estimated using the doubly robust weighted least squares estimator, which uses an outcome regression model weighted by the inverse probability of attrition to account for baseline covariate imbalance and missing data.ResultsAmong 151 participants randomized (mean age, 76.7 [SD, 8.0] years; 101 [67.8%] women; 65 [43%] self-identified as African American; 96 [63.6%] with low income [<$25 000 annual household income]), 136 (90.1%) completed 3-month follow-up for the primary outcome. In the intervention group, 90.5% completed the intervention session and reported at least 1 hour of daily amplification use at 3 months postrandomization. Mean scores for the HHIE-S were 21.7 (SD, 9.4) at baseline and 7.9 (SD, 9.2) at 3 months (change of –13.2 [SD, 10.3]) in the intervention group, and 20.1 (SD, 10.1) at baseline and 21 (SD, 9.1) at 3 months (change of 0.6 [SD, 7.1]) in the control group. Self-perceived communication function significantly improved in the intervention group compared with the control group, with an estimated average treatment effect of the intervention of a –12.98-point HHIE-S change (95% CI, –15.51 to –10.42). No study-related adverse events were reported.Conclusions and RelevanceAmong older adults with hearing loss, a community health worker–delivered personal sound amplification device intervention, compared with a wait-list control, significantly improved self-perceived communication function at 3 months. Findings are limited by the absence of a sham control, and further research is needed to understand effectiveness compared with other types of care delivery models and amplification devices.Trial RegistrationClinicalTrials.gov Identifier: NCT03442296

Potential Clinical and Economic Outcomes of Over-the-Counter Hearing Aids in the US

“…While several personal sound amplification devices demonstrated similar speech understanding to traditional hearing aids, their outcome on health-related quality of life remains unknown . Further, a recent randomized clinical trial found that community health worker–delivered personal sound amplification devices improved patient-rated communication . We found that the maximum potential monetary value (or EVPI) of further research projects clarifying several of these uncertain parameters for OTC hearing aids is $25.6 billion, indicating that research investments into the effects of OTC hearing aid provisions are likely warranted.…”

Advancing Equitable Hearing Care: Innovations in Technology and Service Delivery

“…A recent review [12] of Community-Based Hearing Rehabilitation (CBHR) reports on the value of this approach to improve access to hearing care. The majority of studies, however, are from high-income countries and focus on screening and assessment [13]. More research in LMICs where accessibility challenges are greatest is necessary across the hearing care journey to develop and support global action for improved access to care.…”

Long COVID and COVID-Induced Ménière's Disease: Overview and Recommendations

“…Programs involving paraprofessionals such as CHWs rather than medical personnel have been successful in supporting client health, including members of populations that are typically seen as "hard-to-reach" [36]. Notably, one program in which CHWs delivered hearing aids to elders living independently in the community found that self-reported communication skills of the experimental group improved significantly (p ≤ 0.05) compared to those of a control group [37]. CHWs could also educate individuals on methods for "falling safely" by controlling anxiety, avoiding panic, and protecting vulnerable parts of the body (e.g., as described by Zimmerman) [38].…”