Auditory intervention provided by the community health worker improves communication function

06 January 2023

3 minute read

Source/Disclosures

Disclosures: Nieman reports receiving grants from the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders. Nieman also reports that he served as a volunteer board member for the nonprofit Hearing Loss Association of America and was a cofounder and board member of the nonprofit Access HEARS. He please consult the study for all relevant information from all other authors.


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A program in which community health workers provide low-cost hearing technology to older adults significantly improved communication function, according to a randomized clinical trial published in JAMA.

Carrie L. Nieman, MD, MPH, an assistant professor in the department of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine and co-founder of Access HEARS, and colleagues wrote that although “age-related hearing loss that impairs communication daily life is associated with adverse health outcomes, “hearing aid use is low among older adults” and disparities exist.


A program that has community health workers provide low-cost hearing technology to older adults with hearing loss has significantly improved communication function. Source: AdobeStock

Therefore, they conducted a randomized clinical trial to test whether an affordable hearing care intervention using over-the-counter hearing technology provided by community health care providers can improve communication function among older adults with hearing loss.

Researchers conducted the open-label randomized clinical trial between April 2018 and October 2019 and completed the 3-month data collection in June 2020.

The trial, which took place in 10 affordable independent housing developments, two senior centers and a senior social club in Baltimore, Maryland, involved 151 people over the age of 60 and with hearing loss.

Seventy-three participants were randomly assigned to a waitlist control group, and 78 were assigned to the community health worker-provided hearing assistance intervention, which “consisted of fitting a low-cost and instructions,” wrote Nieman and colleagues.

The researchers found that, among the participants — 43% of whom self-identified as African American and 63.6% as low-income — those in the hearing care intervention reported significant improvements in self-perceived communication function. .

These improvements were measured by changes in the Hearing Disability Inventory for Seniors Screening Version Score (HHIE-S). The researchers looked at a range from 0 to 40, with higher scores indicating worse results.

At 3 months, the researchers estimated that participants in the intervention group had a mean treatment effect of -12.98 points (95% CI, -15.51 to -10.42) compared with the list control group. waiting.

In the intervention group, the 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 control group, the mean scores were:

  • 20.1 (SD, 10.1) at baseline; And
  • 21 (SD, 9.1) at 3 months (change of 0.6 [SD, 7.1]).

The researchers also noted that, to their knowledge, “this study was the largest to date of a US hearing care intervention of African-American and low-income older adults with hearing loss.”

“Unlike previous hearing studies, the cohort reflected underrepresented populations within hearing care who were largely unserved by existing care models. The cohort’s low baseline use of technology, including smartphone ownership, underlined the need for different approaches to enable a spectrum of older adults to benefit from hearing technologies, many of which require some degree of access to technology and literacy,” they wrote. “Therefore, although more affordable hearing aids are available over the counter to US consumers as directed by the US Food and Drug Administration, many older adults may still be unable to benefit from such technologies without the simultaneous availability of acoustic assistance services”.

Because the intervention, which included both a personal sound amplifying device and hearing rehabilitation, “significantly improved self-perceived communication function,” the researchers wrote, “the results support the potential for models associated to CHW in hearing care as an additional care model needed to address the increasing burden of age-related hearing loss.

In a related editorial, Tyler G. James, PhD, a postdoctoral researcher in the University of Michigan Department of Family Medicine, e Michael M. McKee, MD, MPH, an associate professor at the University of Michigan Medical School, wrote that “addressing the needs of hearing loss patients is critical to affordable and equitable health care.”

“Hearing loss is a major source of social isolation among older adults and causes disruptions in healthcare communication between physicians and patients, reducing patient satisfaction and adherence to healthcare,” they wrote. “This intervention demonstrated reductions in perceived communication difficulties comparable to the use of audiologist-fitted hearing aids, supporting the need to provide more options for addressing hearing loss. This study also adds to growing evidence of the use of community health workers as navigators. Implementing intervention through an older community health worker model also offers an opportunity to help destigmatize age-related hearing loss and hearing technologies.

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