Community health worker-delivered hearing intervention improves communication function

A program in which community health workers deliver 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 Johns Hopkins University School of Medicine and co-founder of Access HEARS, and colleagues wrote that although “age-related hearing loss that impairs daily communication is associated with adverse health outcomes,” hearing aid use is low among older adults, “and disparities exist.”

So, they conducted a randomized clinical trial to test whether an affordable hearing care intervention that uses over-the-counter hearing technology delivered by community health care workers may improve communication function among older adults with hearing loss.

The 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 at 10 affordable independent housing complexes, two senior centers and an older adult social club in Baltimore, Maryland, included 151 people who were aged at least 60 years and had hearing loss.

Seventy-three participants were randomly assigned to a wait list control group, and 78 were assigned to the community health worker-delivered hearing care intervention, which “consisted of fitting a low-cost amplification device and instruction,” Nieman and colleagues wrote.

The researchers found that, among the participants — 43% of whom self-identified as African American and 63.6% with 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 Handicap Inventory for the Elderly–Screening Version score (HHIE-S). The researchers looked at a range of 0 to 40, with higher scores indicating worse outcomes.

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

In the intervention group, 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, 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 trial was the largest trial to date of a hearing care intervention in the U.S. of African American older adults and low-income older adults with hearing loss.”

“Unlike prior hearing-related trials, the cohort reflected populations underrepresented within hearing care who have largely gone unserved by existing care models. The cohort’s low baseline use of technology, including smartphone ownership, underscored the need for diverse approaches to enable a spectrum of older adults to benefit from hearing technologies, many of which require some degree of technology access and literacy,” they wrote. “Hence, although more affordable hearing aids are available directly over the counter to US consumers as directed by the U.S. Food and Drug Administration, many older adults may still not be able to benefit from such technologies without the concurrent availability of hearing care services.”

Because the intervention, including both a personal sound amplification device and hearing rehabilitation, “significantly improved self-perceived communication function,” the researchers wrote, “the results support the potential for CHW-partnered models within hearing care as an additional care model needed to address the growing burden of age-related hearing loss.”

In a related editorial, Tyler G. James, PhD, a postdoctoral research fellow in the department of family medicine at the University of Michigan, and Michael M. McKee, MD, MPH, an associate professor at University of Michigan Medical School, wrote that “addressing the needs of patients with hearing loss is critical to both equitable and accessible health care.”

“Hearing loss is a major source of social isolation among older adults and causes health care communication breakdowns between clinicians and patients, reducing patients’ health care satisfaction and adherence,” they wrote. “This intervention demonstrated reductions in perceived communication difficulties comparable with the use of hearing aids fitted by audiologists, supporting the need to provide multiple options to address hearing loss. This study also adds to the growing evidence for use of community health workers as navigators. Implementing the intervention through an older adult community health worker model also provides an opportunity to help destigmatize age-related hearing loss and hearing technologies.”

References:

• James TG, et al. JAMA. 2022;doi:10.1001/jama.2022.22121.
• Nieman CL, et al. JAMA. 2022;doi:10.1001/jama.2022.21820.