Reducing Disparities in Access to Hearing Healthcare on the U.S.-Mexico Border

减少美墨边境听力保健服务的差异

基本信息

批准号：
9135124
负责人：
NICOLE L MARRONE
金额：
$ 52.37万
依托单位：
UNIVERSITY OF ARIZONA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-17 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9135124
关键词：
Address Adult American Speech-Language-Hearing Association Americas Area Arizona Audiology Benchmarking Caring Chronic Clinical Communication impairment Communities Community Health Community Health Centers Community Healthcare Data Development Diabetes Mellitus Education Effectiveness Elderly Epidemic Evidence based practice Faculty Family Federally Qualified Health Center Goals Grant Health Health Services Accessibility Health education Healthcare Healthy People 2020 Hearing Hearing Aids Heart Diseases Hispanics Improve Access Individual Interdisciplinary Study Intervention Intervention Studies Language Latino Lead Life Measurable Mediation Mexican Americans Mexico Mission Modeling National Institute on Deafness and Other Communication Disorders Needs Assessment Outcome Partner Communications Patients Phase Population Heterogeneity Positioning Attribute Prevalence Prevention Research Process Provider Public Health Quality of life Randomized Controlled Trials Rehabilitation therapy Research Research Methodology Research Personnel Resources Rural Rural Community Rural Health Rural Population Scientist Self Management Services Social support Support Groups Testing Training Universities base community based participatory research comparative effectiveness cost cost effective cultural competence disparity reduction evidence base health belief health care availability health care delivery health care quality health disparity health literacy hearing impairment hearing screening improved improved functioning individual patient innovation interdisciplinary collaboration member novel strategies outreach patient oriented programs standard care trial design

项目摘要

DESCRIPTION (provided by applicant): The purpose of this proposal is to develop (R21) and test the effectiveness (R33) of an innovative community health worker intervention to expand access to hearing healthcare among older adults facing health disparities. The community health worker model has been used successfully in U.S.-Mexico border communities to increase access to healthcare and self-management for a range of chronic conditions. The innovation of this proposal is to combine this evidence-based public health model with low-cost, community-based audiologic rehabilitation to reduce disparities in access to care for chronic hearing loss. I many rural communities facing health disparities, hearing aids are inaccessible to the people who need them due to financial barriers, and there are typically no other avenues to reduce the burden of hearing loss on quality of life. The hypothesis is that a community health worker (Promotora) model will be effective and relevant in reducing hearing health disparities via health education, social support, and language mediation. Given that the current prevalence of treatment for chronic hearing loss is low, it is essential that researchers collaborate with members of the community and providers to assess the state of care prior to and during the development of alternative interventions. The phased development approach (RFA-DC-12-003) lends itself to the iterative process that is critical to creating a sustainable and culturally relvant approach to make hearing healthcare more accessible within communities facing health disparities. The specific aims are divided across the two phases of research. The R21 phase includes Aim 1) Develop and implement a needs assessment identifying factors that underlie barriers to access in an older Hispanic/Latino population and Aim 2) Conduct a pilot intervention research study assessing the feasibility of community-based audiologic rehabilitation combined with a community health worker intervention to improve access to care. The R33 phase includes subsequent aims to validate the clinical utility of the novel approach and to track longitudinal outcomes, two important benchmarks for evidence-based practice. These include Aim 3) Determine the comparative effectiveness of Promatora interventions for chronic hearing loss relative to a standard care approach in a randomized controlled trial design; and 4) Assess longitudinal quality of life outcomes from the entry point of hearing screening through hearing rehabilitation. The partners on this grant include audiology faculty from the University of Arizona public health researchers from the Arizona Prevention Research Center, and community health workers at the Mariposa Community Health Center, a federally qualified health center on the U.S.-Mexico border. This unique interdisciplinary research team offers a significant opportunity to unite current research areas and expertise to develop a low- cost, deliverable, and effective alternative intervention that yields measurable improvements in quality of life for individual patients and their families, as well as a more sustainable and cost-effective model of hearing healthcare delivery in rural health settings with diverse populations.

描述（由申请人提供）：本提案的目的是开发（R21）并测试创新社区卫生工作者干预措施的有效性（R33），以扩大面临健康差异的老年人获得听力保健的机会。社区卫生工作者模式已在美国-墨西哥边境社区成功使用，以增加一系列慢性病的医疗保健和自我管理机会。该提案的创新之处在于将这种基于证据的公共卫生模式与低成本、基于社区的听力康复相结合，以减少慢性听力损失护理的不平等。在许多面临健康差距的农村社区，由于经济障碍，有需要的人无法获得助听器，而且通常没有其他途径来减轻听力损失对生活质量的负担。假设社区卫生工作者 (Promotora) 模式将通过健康教育、社会支持和语言调解有效且相关地减少听力健康差异。鉴于目前慢性听力损失治疗的普及率较低，研究人员必须与社区成员和提供者合作，在制定替代干预措施之前和期间评估护理状况。分阶段开发方法 (RFA-DC-12-003) 适合迭代过程，这对于创建可持续且与文化相关的方法至关重要，以使面临健康差异的社区更容易获得听力保健服务。具体目标分为两个研究阶段。 R21 阶段包括目标 1) 制定和实施需求评估，确定老年西班牙裔/拉丁裔人群获取障碍的因素，以及目标 2) 进行试点干预研究，评估基于社区的听力康复与社区相结合的可行性卫生工作者进行干预，以改善获得护理的机会。 R33 阶段包括验证新方法的临床实用性和跟踪纵向结果的后续目标，这是循证实践的两个重要基准。其中包括目标 3) 在随机对照试验设计中确定 Promatora 干预措施相对于标准护理方法对慢性听力损失的比较有效性； 4) 从听力筛查到听力康复的切入点评估纵向生活质量结果。这笔赠款的合作伙伴包括亚利桑那大学的听力学教师、亚利桑那州预防研究中心的公共卫生研究人员，以及马里波萨社区健康中心的社区卫生工作者，马里波萨社区健康中心是位于美国-墨西哥边境的联邦合格健康中心。这个独特的跨学科研究团队提供了一个重要的机会，可以结合当前的研究领域和专业知识来开发低成本、可交付且有效的替代干预措施，从而显着改善个体患者及其家人的生活质量，并实现更可持续的治疗。在不同人群的农村卫生环境中提供具有成本效益的听力保健服务模式。