Intervention for Hearing Health Among Native Americans

Hearing loss has significant impact on the life of Native Americans (NAs) to participate in daily life practices that require good hearing. Noise-induced hearing loss (NIHL) is an irreversible chronic injury caused by repeated or high-intensity noise exposure. It is a major public health problem that affects 40 million (24%) adults aged 20-69 years in the United States. NAs are particularly at-risk because of conditions that disproportionately expose them to noises such as socio-environmental factors. NIHL is the only type of hearing loss that is nearly 100% preventable with appropriate education and early detection. However, no intervention has been developed to address the understudied issue of NIHL among NA adults. This randomized controlled study will test the effectiveness of a peer-group discussion model, Talking Circles (TCs), and hearing protection training program delivered in partnership with a regional population with high occupational and recreational noise exposure. The model integrates established hearing conservation education methods with screening services and behavioral assessments. A needs assessment conducted with community health partners indicated limited awareness of early hearing loss detection and a high volume of hearing aid requests. The intervention will include facilitator training for local implementation and a delayed-intervention control to assess knowledge gains and protective behavior changes. The study has three specific aims: Aim 1. To test the effectiveness of the innovative NA based TCI to increase NIHL-related knowledge and hearing protection behaviors; Aim 2. To train TCI Facilitators to deliver the hearing protection intervention independently, supporting future implementation within the partnering community; and Aim 3. To determine the prevalence of hearing loss in NA adults. A total of 400 NA adults will be enrolled through community partners and assigned to either the intervention or a delayed-control group. The primary hypothesis is that participants receiving the education program will show greater improvements in knowledge and hearing protection use at 6- and 12-month follow-up compared to the control group. The program will also evaluate long-term implementation feasibility using local training teams. The goal of this research is to inform scalable strategies for hearing loss prevention in regions with high noise exposure and improve access to preventive tools in noise-exposed communities.