Mobile technologies for delivering hearing care through community health workers

R21 R33 Summary/Abstract Hearing loss is a major and growing public health concern, especially in low and middle income countries (LMICs) where about 80% of the world’s population with hearing loss reside. Our vision is to provide good quality, affordable, and sustainable hearing health care to underserved populations in LMICs and around the world. We propose to validate and then trial an innovative mHealth model for end-to-end hearing care facilitated by community health workers (CHWs). The smartphone-based solution uses hearing aids to first test hearing and then, if needed, programs the devices to provide gold standard rehabilitation. In the course of fifteen minutes, the user and their family should be able to experience a step change in their communicative ability. Following the fitting session, support will continue through innovative mHealth messaging support for their new hearing aids and communication with the CHW for troubleshooting. In the R21 phase of this funding, we will address three aims that validate key steps on the journey to better hearing for all. For Aim 1, we will perform clinical work in Cincinnati, Ohio and community work with CHWs in low-income South African communities to confirm that the hearing aids deliver hearing test precision to the highest standard. This audiometry will be part of a more comprehensive diagnostic package involving novel physical (smartphone video otoscopy) and behavioral (speech-in-noise) data. In Aim 2, we will evaluate the performance of the hearing aids to gold-standard and conventional clinical fitting standards. In a community setting, we will also determine usability by including CHWs and users. Training and supporting CHWs is critical for our approach and in Aim 3 we will work with our colleagues in the hearX Foundation to develop new training modules. Multiple techniques will be used to engage CHWs in each stage of the process, for example, adjusting existing modules found to be useful in previous hearing screening outreach. Freshly hired CHWs will test-drive and evaluate the training. Another part of this aim is to begin developing the mHealth user support system (apps) to be used in the clinical trial phase (Aims 4 and 5). Infographics and voice bytes will be translated to the local language (e.g. Xhosa) in an approach, using WhatsApp, we have shown to improve knowledge about hearing loss of preschool teachers. In the R33 phase of funding, the focus narrows to two clinical trials. In the first (Aim 4), we ask whether the smartphone-based, CHW-facilitated hearing aids successfully deliver benefit for their users. In the second trial (Aim 5) we ask whether an mHealth user support system, developed in Aim 3, is effective in delivering benefit. Both studies are randomized control trials, the highest level of clinical scrutiny. In Aim 6, we will model data from Aims 1-5 using AI towards a holistic hearing assessment. Positive, self-report outcomes and modeling should pave the way for an expansion to the next level, regional and national trials that, if successful, will be of huge personal importance for millions of individuals in LMICs. They will also open the gate to international adoption of this innovative, mHealth driven, community-based model of hearing care.