Community-based adult hearing care provided by community healthcare workers using mHealth technologies

Caitlin Frisby; Robert H Eikelboom; Faheema Mahomed-Asmail; Hannah Kuper; Tersia de Kock; Vinaya Manchaiah; De Wet Swanepoel

doi:10.1080/16549716.2022.2095784

Community-based adult hearing care provided by community healthcare workers using mHealth technologies

Glob Health Action. 2022 Dec 31;15(1):2095784. doi: 10.1080/16549716.2022.2095784.

Authors

Caitlin Frisby^{1

2}, Robert H Eikelboom^{1

3

4

5}, Faheema Mahomed-Asmail^{1

2}, Hannah Kuper⁶, Tersia de Kock⁷, Vinaya Manchaiah^{1

2

8

9

10}, De Wet Swanepoel^{1

2

3}

Affiliations

¹ Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
² Virtual Hearing Lab, Collaborative initiative between University of Colorado and the University of Pretoria, Aurora, CO, USA.
³ Ear Science Institute Australia, Subiaco, WA, Australia.
⁴ Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, WA, Australia.
⁵ Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.
⁶ International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
⁷ hearX Foundation, Pretoria, South Africa.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
⁹ UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, USA.
¹⁰ Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, India.

Abstract

Background: The rising prevalence of hearing loss is a global health concern. Professional hearing services are largely absent within low- and middle-income countries where appropriate skills are lacking. Task-shifting to community healthcare workers (CHWs) supported by mHealth technologies is an important strategy to address the problem.

Objective: To evaluate the feasibility of a community-based rehabilitation model providing hearing aids to adults in low-income communities using CHWs supported by mHealth technologies.

Method: Between September 2020 and October 2021, hearing aid assessments and fittings were implemented for adults aged 18 and above in two low-income communities in the Western Cape, South Africa, using trained CHWs. A quantitative approach with illustrative open-ended questions was utilised to measure and analyse hearing aid outcomes. Data were collected through initial face-to-face interviews, telephone interviews, and face-to-face visits post-fitting. Responses to open-ended questions were analysed using inductive thematic analysis. The International Outcome Inventory - Hearing Aids questionnaire determined standardised hearing aid outcomes.

Results: Of the 152 adults in the community who self-reported hearing difficulties, 148 were successfully tested by CHWs during home visits. Most had normal hearing (39.9%), 24.3% had bilateral sensorineural hearing loss, 20.9% had suspected conductive hearing loss, and 14.9% had unilateral hearing loss, of which 5.4% had suspected conductive loss. Forty adults met the inclusion criteria to be fitted with hearing aids. Nineteen of these were fitted bilaterally. Positive hearing aid outcomes and minimal device handling challenges were reported 45 days post-fitting and were maintained at six months. The majority (73.7%) of participants fitted were still making use of their hearing aids at the six-month follow-up.

Conclusions: Implementing a hearing healthcare service-delivery model facilitated by CHWs in low-income communities is feasible. mHealth technologies used by CHWs can support scalable service-delivery models with the potential for improved access and affordability in low-income settings.

Keywords: Community-based rehabilitation; Hearing loss; community health; low- and middle-income countries; mHealth; teleaudiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Community Health Services
Community Health Workers
Delivery of Health Care
Hearing
Hearing Loss* / epidemiology
Hearing Loss* / therapy
Humans
Telemedicine*

Grants and funding

This research article was financially supported by the Newton Advanced Fellowship Award (NP2020PA\100013,awarded to De Wet Swanepoel and Hannah Kuper), the Assistive Technology Impact Fund (ATIF) Fund (UK Aid-funded AT2030 programme led by the Global Disability Innovation Hub, awarded to the hearX Group) and the National Institute of Deafness and Communication Disorders of the National Institutes of Health (NIH) (Award Number 1R21DC019598 awarded to De Wet Swanepoel and David R. Moore).