Mobile technologies for delivering hearing care through community health workers

通过社区卫生工作者提供听力保健的移动技术

• 批准号: 10686132
• 负责人: David Moore
• 金额: $ 17.27万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-18 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10686132
• 关键词: Acclimatization; Address; Adoption; Africa South of the Sahara; Algorithms; Behavioral; Blinded; Caring; Cellular Phone; Child; Clinic; Clinical; Clinical Trials; Communication; Communities; Community Health Aides; Country; Data; Decentralization; Detection; Devices; Diagnosis; Diagnosis Clinical Trials; Diagnostic; Differential Diagnosis; Digit structure; Ear; Equipment; Equity; Family; Foundations; Funding; Goals; Healthcare; Hearing; Hearing Aids; Hearing Tests; Income; Individual; Industrialization; International; Intervention; Knowledge; Laboratories; Language; Low income; Machine Learning; Medical; Methods; Modeling; Noise; Nursery Schools; Ohio; Otoscopy; Outcome; Participant; Patient Self-Report; Penetration; Performance; Persons; Phase; Population; Procedures; Process; Public Health; Randomized, Controlled Trials; Rehabilitation therapy; School Teachers; Sensorineural Hearing Loss; Service delivery model; Services; South African; Support System; Techniques; Technology; Testing; Text; Time; Training; Training Activity; Translating; Triage; Underserved Population; United States National Institutes of Health; Validation; Variant; Vision; Voice; Work; Writing; community engagement; community setting; cost; data modeling; digital; disability; evidence base; experience; functional outcomes; global health; grandchild; hearing impairment; hearing screening; high standard; improved; innovation; low and middle-income countries; mHealth; mobile computing; novel; outreach; poor communities; programs; randomized, controlled study; rehabilitation service; response; scale up; segregation; smartphone application; sound; speech in noise; texting support; time use; usability; Acclimatization; Address; Adoption; Africa South of the Sahara; Algorithms; Behavioral; Blinded; Caring; Cellular Phone; Child; Clinic; Clinical; Clinical Trials; Communication; Communities; Community Health Aides; Country; Data; Decentralization; Detection; Devices; Diagnosis; Diagnosis Clinical Trials; Diagnostic; Differential Diagnosis; Digit structure; Ear; Equipment; Equity; Family; Foundations; Funding; Goals; Healthcare; Hearing; Hearing Aids; Hearing Tests; Income; Individual; Industrialization; International; Intervention; Knowledge; Laboratories; Language; Low income; Machine Learning; Medical; Methods; Modeling; Noise; Nursery Schools; Ohio; Otoscopy; Outcome; Participant; Patient Self-Report; Penetration; Performance; Persons; Phase; Population; Procedures; Process; Public Health; Randomized, Controlled Trials; Rehabilitation therapy; School Teachers; Sensorineural Hearing Loss; Service delivery model; Services; South African; Support System; Techniques; Technology; Testing; Text; Time; Training; Training Activity; Translating; Triage; Underserved Population; United States National Institutes of Health; Validation; Variant; Vision; Voice; Work; Writing; community engagement; community setting; cost; data modeling; digital; disability; evidence base; experience; functional outcomes; global health; grandchild; hearing impairment; hearing screening; high standard; improved; innovation; low and middle-income countries; mHealth; mobile computing; novel; outreach; poor communities; programs; randomized, controlled study; rehabilitation service; response; scale up; segregation; smartphone application; sound; speech in noise; texting support; time use; usability

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.

R21 R33摘要/摘要 听力损失是一个重大的公共卫生问题，尤其是在中低收入国家 （LMIC）大约80％的全球听力损失人口居住。我们的愿景是提供良好 质量，负担得起和可持续的听力保健为LMIC和周围服务不足的人群 世界。我们建议验证并试用创新的MHealth模型进行端到端的听力 由社区卫生工作者（CHWS）促进。基于智能手机的解决方案使用助听器进行首次测试 听证会，然后在需要时为设备提供黄金标准康复。在 十五分钟，用户及其家人应该能够在交流中体验一步 能力。在安装会议之后，将通过创新的MHealth消息传递支持继续支持 他们的新助听器和与CHW进行故障排除。在此资金的R21阶段， 我们将解决三个目标，以验证所有人更好地聆听旅程的关键步骤。对于目标1，我们将 在俄亥俄州辛辛那提市进行临床工作，并在低收入南非的CHW与社区工作 社区确认助听器将听力测试精确度为最高标准。这 听力计将成为涉及新型物理（智能手机）的更全面诊断软件包的一部分 视频耳镜）和行为（噪声语音）数据。在AIM 2中，我们将评估 助听器符合金色标准和常规临床拟合标准。在社区环境中，我们也将 通过包括CHW和用户来确定可用性。培训和支持CHW对于我们的方法至关重要 在AIM 3中，我们将与赫克斯基金会的同事合作开发新的培训模块。 例如，多种技术将在过程的每个阶段参与CHW，例如调整现有 模块发现对以前的听力筛选外展很有用。新鲜雇用的CHW将测试驱动器和 评估培训。该目标的另一部分是开始开发MHealth用户支持系统（APPS） 在临床试验阶段使用（目标4和5）。信息图表和声音字节将被翻译成本地 语言（例如xhosa）在一种方法中，使用whatsapp，我们已经证明是为了提高有关听力的知识 失去学龄前老师。在R33阶段的资金阶段，焦点缩小到两个临床试验。在第一个（目标）中 4），我们询问基于智能手机的，基于CHW的助听器是否成功地为其带来了好处 用户。在第二次试验中（AIM 5），我们询问AIM 3中开发的MHealth用户支持系统是否是 有效地提供福利。两项研究都是随机对照试验，是最高水平的临床检查。在 AIM 6，我们将使用AI对AIMS 1-5的数据进行对整体听力评估进行建模。积极，自我报告 成果和建模应该为扩展到一个新的水平，区域和国家试验铺平道路 如果成功的话，对于数百万人在LMIC中的个人将是巨大的个人重要性。他们也会开放 国际采用这种创新，以MHealth驱动的，基于社区的听力模型的大门。