Community-Based Hearing Services
The World Health Organization (WHO) estimates suggest that there are 430 million people (over 5% of the world’s population) have ‘disabling’ hearing loss (432 million adults and 34 million children) across the globe who require rehabilitation services. These numbers are likely to get worse in the coming decades, with an estimated 700 million people (i.e., one in every ten people) will have disabling hearing loss by the year 2050. Moreover, disabling hearing loss is unequally distributed across the globe. Around two-thirds of individuals with hearing loss are believed to be residing in low- and middle-income countries. In addition to high prevalence of hearing loss, there are limited number of trained hearing healthcare professionals as well as limited resources making its extremely challenging to address prevent as well as treat hearing loss. In 2004, WHO estimated that only 3% of the actual need for hearing aid assistance is met in low- and middle-income countries. Although various reasons may contribute to this low number anecdotal reports suggest that the cost of hearing aids and batteries are the primary reasons for such a shortfall. Moreover, there is very limited access to accessible and reliable hearing testing that could help in identification of hearing loss early. Overall, it is clear that globally hearing health care is not available to the vast majority of persons with hearing loss.
Community-Based Rehabilitation (CBR) strategy has emerged as one of the possible solutions for improving hearing health care access to the regionally and economically disadvantaged populations. Community-based hearing services including health promotion, detection, diagnosis, treatment, and rehabilitation has been recommended by the WHO as a primary strategy to improve access and outcomes. Supported by task-shifting and innovative digital technologies (e.g., mHealth) community-based hearing care is a powerful enabler of affordable decentralized access. This project aims to explore, develop and evaluate community-based hearing service-delivery models.
This project touches on the research theme 2 (digital hearing health solutions for assessment), theme 2 (Internet- and mHealth-based interventions), theme 3 (new service delivery models), and theme 5 (synthesis of evidence). Following are the specific studies within this larger project.
Outcomes of Community-Based Hearing Aid Rehabilitation in India
Audiology India a non-governmental and non-profit organization aimed to foster hearing healthcare in India is involved in various community-based activities since 2001. Audiology India provides CBHR services in a three-phase procedure (Thammaiah et al., 2017 ASHA Perspectives). During Phase 1, detailed medical and family history is taken followed by otoscopic examination and hearing evaluation using pure tone and speech audiometry. Also, general information is provided about hearing test and ear impressions are taken for those who would need hearing aids. Hearing aid fitting, orientation and training towards hearing aid use, care, maintenance etc is provided during phase 2. In Phase 3, review of hearing aid use and troubleshooting problems reported by the hearing aid user. There is generally a 1-2 month’s gap between phases 1 and 2 and also between phases 2 and 3. The aim of the current study is to examine the outcomes of the three-phased CBHR. Our recent studies have translated several hearing questionnaires to Kannada language and have evaluated their measurement (psychometric) properties (Thammaiah et al., 2016 Aud Research; Thammaiah at el., 2017 IJA; Thammaiah et al., 2018 Disability & Rehabilitation; Thammaiah et al., 2019 IJA; Manchaiah et al., 2020 IJA). Our future studies will focus on evaluating the outcomes of CBHR.
Study Lead: Vinaya Manchaiah
Community-Based Adult Hearing Care in Low-Income Communities
Using task-shifting and innovative mHealth technologies this project utilizes trained lay health workers to provide home-based hearing assessment, hearing aid fitting and support. In partnership with the hearX foundation, hearX Group and the Assistive Technology Impact Fund.
Project lead: De Wet Swanepoel, Caitlin Frisby
Literature Review of Community-Based Assessment and Rehabilitaion of Hearing
While the WHO has advocated for the use of CBR to overcome the accessibility and affordability issues in hearing healthcare, there is limited understanding of how CBR has been applied in hearing healthcare. In particular, it is not clear how healthcare professionals have applied CBR in line with its definition. The aim of this scoping review is to identify studies on CBHR programs and to examine the context and services applied.
Study Lead: Vinaya Machaiah