How Community Health Workers Support Hearing Loss Intervention

December 29, 2022 - Listen up: a new program out of the Johns Hopkins Cochlear Center for Hearing and Public Health shows that community health workers can effectively connect low-income seniors with hearing aids.

The pilot program indicated that interpersonal connection about shared lived experience made all the difference in the community health program. The researchers reported in the Journal of the American Medical Association (JAMA) that folks who connected with a community health worker were more likely to report communication improvement at a three-month follow-up.

“This trial validates a model of hearing care that empowers community health workers to reach older adults with untreated hearing loss. The HEARS program connects individuals with a hearing device and needed education,” Carrie Nieman, MD, MPH, an otologist and core faculty at the Johns Hopkins Cochlear Center for Hearing and Public Health, said in a statement.

“The reach of the HEARS program is amplified by newly available over-the-counter hearing aids, providing older adults the tools they need to age well,” added Nieman, who is also first author of the clinical trial and co-creator of the pilot model, titled HEARS.

Hearing loss is increasingly recognized as a public health issue, as the National Academies, the White House, and the World Health Organization (WHO) have implemented strategies to address hearing loss. Hearing loss has been linked to a higher risk of dementia, cognitive decline, greater healthcare costs, and adverse outcomes, the researchers said.

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But although two-thirds of adults over age 70 have some level of hearing loss, only about a fifth use a hearing aid, mostly because of limited insurance coverage and the high cost of hearing aids. Lack of access is even more common in low-income adults and people of color.

The pilot program, dubbed Hearing health Equity through Accessible Research and Solutions (HEARS), employs community health workers to better connect with low-income people with hearing loss. Community health workers meet one-on-one with their peers living in low-income housing to discuss the basics of hearing loss and communication strategies, and to offer them an over-the-counter amplification device provided by HEARS.

Sessions lasted about two hours and were monitored by local audiologists.

The researchers recruited 151 patients for the trial, about half of whom were in the HEARS intervention group. The other half of the participants were a control group added to a waitlist.

The team measured communication function using the Hearing Handicap Inventory for the Elderly, a 40-point scale on which a higher score indicates poorer function. Pilot participants reported their communication function at baseline and three months after the intervention.

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Unsurprisingly, patients included in the HEARS intervention showed greater improvement in their communication function. Nine in 10 of these patients completed the session with the community health worker and reported using the hearing aid for at least an hour each day for the three months after their sessions.

And that resulted in tangible communication improvements. At baseline, both the intervention and control groups reported communication function at about 20 on the 40-point scale.

After three months, the control group reported about the same score—21 points—but the intervention group reported a dramatic improvement—around 8 points.

Those improvements are evident because intervention group participants used a hearing aid. But the researchers emphasized that without the community health workers, those patients would not have accessed a hearing aid.

For one thing, community health workers were instrumental in explaining the amplification device to their peers, who the researchers said tended to have lower digital health literacy.

“The cohort’s low baseline use of technology, including smartphone ownership, underscored the need for diverse approaches to enable a spectrum of older adults to benefit from hearing technologies, many of which require some degree of technology access and literacy,” the researchers wrote in the study’s discussion.

“Hence, although more affordable hearing aids are available directly over the counter to US consumers as directed by the US Food and Drug Administration, many older adults may still not be able to benefit from such technologies without the concurrent availability of hearing care services.”

The study is novel because it demonstrates a more effective way to reach low-income seniors who need hearing loss intervention. Community health workers share lived experiences with these folks, according to one worker employed by the pilot.

“They came to us and received help from us because we are just like them — we are seniors,” Renee Hicks, a CHW who provided hearing devices and education to her peers, said in a press release. “They would learn from us because we were living in the same community. It helped health-wise, too; people were coming out of their apartments and participating in activities.”

Healthcare providers leading the pilot acknowledged the strengths community health workers bring to these kinds of public health interventions.

The point is not to replace clinicians, according to Nieman, but rather to “recruit and train community health workers who share some of the same lived experiences as those who go without hearing care, which represents the vast majority of older adults with hearing loss. From this position, CHWs can gain trust and connect with their clients in ways that hearing care professionals, like myself, often cannot.”