Smartphone hearing screening in mHealth assisted community-based primary care

Abstract

Available ear and hearing health care services are not sufficient to meet the burden of disabling hearing loss, particularly within developing countries such as South Africa. Attempts to meet the needs of underserved populations may require a move towards community-based primary care along with the integration of recent mHealth approaches whereby primary health care personnel facilitate ear and hearing health care. The objective of this study was to determine the clinical utility of a community-based program for identification of hearing loss, using smartphone hearing screening (hearScreenTM) operated by community health care workers (CHWs), in a developing South African community and to survey experiences of the CHWs. An exploratory, descriptive cross-sectional research design was used. The study comprised two phases. During phase one, 24 CHWs were trained to conduct hearing screening in the underserved community of Mamelodi using automated test protocols (sweep performed at 1, 2 and 4kHz bilaterally at an intensity of 25dB HL for children and 35dB HL for adults), employed by the hearScreenTM mHealth solution operating on low cost Android phones using calibrated headphones (Sennheiser HD202 II). A total of 820 community members were screened for hearing loss over a 12-week period. The results were analyzed in terms of referral rates of the hearing screening program, compliance of test environment noise during screening, and time proficiency of the screenings. During phase 2, CHWs completed a questionnaire regarding their perceptions and experiences of the hearing screening program. Data analysis was conducted on 108 children (2-15 years) and 598 adults (16-85 years) screened. Referral rates for children and adults were 12% and 6.5% respectively. Noise levels only had a significant effect on referral results at low intensities of 25dB HL at 1KHz (p<0.05). Age effects were significant for adult referral rates (p<0.05) demonstrating a significantly lower referral rate in younger (below 45 years) as opposed to older (45 years and above) adults (4.3% compared to 13.2%). Majority of CHWs responded positively regarding their involvement and experiences using the hearScreenTM tool in terms of usability, need for services, value to community members and time efficiency. Results of this study indicated that community-based hearing screening programs can be successfully integrated into underserved contexts by CHWs using an mHealth solution. The hearScreenTM smartphone application offers benefits such as automated test protocols and interpretation, integrated noise monitoring, data capturing and data sharing. Appointment of a program coordinator, as well as the integration of informational counseling and minor software changes were recommended towards an effective and sustainable program.