Training, supervision and performance of Community Health Workers in the delivery of ear and hearing care to 321 community members in rural Uganda

Abstract

Objectives: Community Health Workers are one way to address the shortage of ear and hearing care specialists in low-resource settings. However, there are few reports evaluating training and service delivery by Community Health Workers. Design, setting and participants: We trained 13 Community Health Workers in primary ear and hearing care in Mukono District, Uganda. Community Health Workers attended a two-day training workshop and received remote supervision thereafter during service delivery in the community. An ear camp was held at the local health centre every two months, where a local ENT specialist could assess referred cases. Main outcome measures: Clinical and diagnostic skills and decision-making were assessed using an Objective Structured Clinical Examination, with scores recorded at baseline and six months. Service delivery was evaluated by analysing the following: (i) number of individuals evaluated; (ii) treatments delivered; (iii) cases referred for specialist opinion; (iv) proportion of appropriately referred cases; and (v) agreement between Community Health Worker and specialist diagnosis. Results: Observed Structured Clinical Examination scores were high and stable for six months. 312 individuals were screened in the community by the Community Health Workers, with 298 classified as having an abnormality. Care was delivered in the community to 167 of these, and the remaining 131 referred to the ear camp. Diagnostic agreement was 39%, but 98% of referrals were deemed "appropriate" by the ENT specialist. 27 individuals self-presented to the ear camp without prior assessment by a Community Health Worker, and 97% of these were deemed appropriate. Conclusion: Trained Community Health Workers can play an important role in delivering ear and hearing services. Future work should look to explore this model in other contexts and/or compare it to other models of service delivery.

Community‐based assessment and rehabilitation of hearing loss: A scoping review

“…Telemedicine (shared database upload) and follow‐up assessments allowed ear health specialists such as audiologists and ENT specialists to monitor, review and conduct follow‐up assessments based on the screening results the CHWs obtained. However, O'Donovan et al (2021) used whispered voice testing for the hearing screening and ENTraview (i.e. telemedicine enabled otoscope) for the screening of ear disease.…”

“…The technology used to screen adult's hearing consisted of portable audiometers (Haanes et al, 2021), Shoebox Professional Audiometer on an iPad Mini 2 (Jayawardena et al, 2018), ENTraview device for air conduction threshold screening (Gupta et al, 2021), the hearScreen application (Yousuf Hussein et al, 2016) and as mentioned earlier, O'Donovan et al (2021) used whisper testing to screen hearing. Overall, community‐based adult hearing screening in less‐than‐ideal settings can assist in overcoming the barrier of lack of services.…”

“…De Melo et al (2010) assessed how effective an 8‐h conference‐based training for community health agents with no prior hearing health experience by pre and post training questionnaires based on the World Health Organization. O'Donovan et al (2021) evaluated the effectiveness of a 2‐day workshop and an ongoing discussion forum on WhatsApp by Observed Structured Clinical Examinations and engagement on the forum for CHWs performing screening hearing and ear disorders. Owen et al (2001) evaluated health visitors performing OAE testing who attended a community‐based universal neonatal hearing screening training.…”

“…Jayawardena et al (2018) also evaluated the feasibility to screen adults in their community in Kenya at a walk‐in clinic in Tawfiq Muslim Hospital and three local schools where audiologists and otolaryngologists are sparse. As mentioned earlier, two studies also screened adults during home‐based visits in rural areas, one associated with a community‐based primary care (O'Donovan et al, 2021; Yousuf Hussein et al, 2016).…”

“…Graduate students and nurses facilitated screenings in homes or senior activity/community‐based centres (Dodds & Harford, 1982; Haanes et al, 2021). The other four studies recruited CHWs to facilitate the screenings (Gupta et al, 2021; Jayawardena et al, 2018; O'Donovan et al, 2021; Yousuf Hussein et al, 2016).…”