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

Project Description
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. In 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 relevant 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.