Addressing Hearing Health Care Disparities among Older Adults in a US-Mexico Border Community

Abstract

Hearing loss is associated with cognitive decline and impairment in daily living activities. Access to hearing health care has broad implications for healthy aging of the U.S. population. This qualitative study investigated factors related to the socio-ecological domains of hearing health in a U.S.–Mexico border community experiencing disparities in access to care. A multidisciplinary research team partnered with community health workers (CHWs) from a Federally Qualified Health Center (FQHC) in designing the study. CHWs conducted interviews with people with hearing loss (n = 20) and focus groups with their family/friends (n = 27) and with members of the community-at-large (n = 47). The research team conducted interviews with FQHC providers and staff (n = 12). Individuals experienced depression, sadness, and social isolation, as well as frustration and even anger regarding communication. Family members experienced negative impacts of deteriorating communication, but expressed few coping strategies. There was general agreement across data sources that hearing loss was not routinely addressed within primary care and assistive hearing technology was generally unaffordable. Community members described stigma related to hearing loss and a need for greater access to hearing health care and broader community education. Findings confirm the causal sequence of hearing impairment on quality of life aggravated by socioeconomic conditions and lack of access to hearing health care. Hearing loss requires a comprehensive and innovative public health response across the socio-ecological framework that includes both individual communication intervention and greater access to hearing health resources. CHWs can be effective in tailoring intervention strategies to community characteristics.

Interventional Audiology to Address Hearing Health Care Disparities: Oyendo Bien Pilot Study

“…In terms of scale, the project as a pilot study was an intentionally small, yet imperative, step toward building trust and capacity for a health education program in a topic area (hearing) that was viewed as highly new to the health center. 23 Based on the outcomes of this research, we propose that an important aspect of future program development and training within community-based interventional audiology should be a process to define the community-clinical linkages between public health and audiology. Such a process would involve identifying local resources (both community based and within health care institutions), defining roles, and establishing collaborations between CHWs/ promotoras and appropriate health care providers for referral, such as audiologists, primary care physicians, as well as other specialists.…”

“…The current study was an evolution of an academic-community collaboration between audiology, public health, and a rural federally qualified health center (FQHC) to increase community engagement on hearing and to develop a culturally relevant hearing health education outreach program for Hispanic/ Latino older adults. 23 The CHWs involved in health promotion activities at the FQHC received specialized training about hearing loss and communicating effectively with individuals and families with hearing loss. 24 In the current research, CHWs served as cultural brokers and community health educators.…”

“…The community assessment yielded a rich dataset in which both experiences and perceptions of hearing loss were expressed from a variety of perspectives; these have also been previously explored within the Socio-ecological Model and reported elsewhere. 23…”

Geographic Distribution of the Hearing Aid Dispensing Workforce: A Teleaudiology Planning Assessment for Arizona

“…Previous studies have identified rural/urban differences in workforce distribution across the country in primary care and otolaryngology (Vickery & Cabrera-Muffly, 2016). In addition, a community needs assessment in a rural part of Arizona identified that there is a high need for hearing health care services locally (Ingram et al, 2016). Therefore, we hypothesized that members of the hearing aid dispensing workforce would be concentrated to more densely populated areas of the state.…”

Translating Public Health Practices: Community-Based Approaches for Addressing Hearing Health Care Disparities

“…The Oyendo Bien pilot study leveraged a longstanding relationship between an academic institution and a rural FQHC to conduct systematically a community needs assessment and build a basis for steering subsequent work. 57 Findings from qualitative assessments informed the iterative development of the pilot program by adapting them into core intervention components. 26 Applications of CBPR helps translate research findings into social change by integrating community participation from the beginning.…”