Community-based hearing aid fitting model for adults in low-income communities facilitated by community health workers : a feasibility study

Abstract

BACKGROUND : Hearing loss affects more than 1.5 billion people worldwide, yet fewer than 10% of those who could benefit from hearing aids are able to access them. Barriers such as high costs, limited availability, and a critical shortage of trained professionals in low- and middle-income countries contribute to this gap, while emerging models of care-such as task-shifting to community healthcare workers (CHWs) supported by mHealth technologies-show promise in improving access, affordability, and outcomes in underserved communities. OBJECTIVE : To determine the feasibility and outcomes of a community-based hearing aid fitting model designed for low-income communities facilitated by community health workers (CHWs). METHOD : Using Bowen's framework, feasibility was evaluated according to service delivery and patient outcomes. A total of 25 (six male) participants were fitted with bilateral Go Prime preset, over-the-counter (OTC) hearing aids by CHWs in Khayelitsha, a low-income community in Cape Town, South Africa. Benefit and satisfaction were measured using the International Outcome Inventory for Hearing Aids (IOI-HA). An open-ended survey used to obtain their perceptions on the impact of the hearing aids on communication, the mHealth program, and willingness to purchase the hearing aids was analyzed using inductive thematic analysis. RESULTS : Pure Tone Average across participants was 57.3 dB HL (11.5 SD) in the left ear and 54 dB HL (14.2 SD) int he right ear. The majority of participants self-reported positive outcomes while using hearing aids, including good hearing in background noise. IOI-HA showed above standardized average scores of 3.91 for daily use, 4.46 for benefit, and 4.58 for satisfaction. 92% of the participants reported the hearing aids as extremely helpful, with 87.5% recommending hearing aids for others with hearing loss. Additionally, participants reported positive experiences with them Health support program and described the program as clear and helpful. CONCLUSION : The community-based hearing aid fitting model is feasible and demonstrated positive hearing aid outcomes in a low-income community. This approach, supported by mHealth technologies and CHWs, presents a promising solution to address the hearing care gap in low- and middle-income countries (LMICs).