Hearing Healthcare Assessment in Rural Communities (HHARC)

PROJECT SUMMARY
Hearing loss in adults is the third most common chronic health condition in the United States with a prevalence
of over 20% in younger adults and over 40% in older adults. Untreated hearing loss causes a measurable impact
on health and social, occupational, and emotional well-being of adults. Only 26% of adults have had a diagnostic
hearing test within the past 5 years and delayed hearing loss diagnosis and treatment may lead to communication
impairment with profound effects on education, employment, and overall health. The prevalence of hearing loss
is higher among adults living in rural communities compared with those in urban settings; furthermore, rural
adults with hearing loss may never receive treatment or may be delayed in diagnosis and/or treatment compared
with urban adults. Rural health clinics (RHCs) represent a federally designated health system care that provides
primary care within rural underserved communities; however, hearing healthcare services have not been a
significant component of RHC care delivery. RHCs are ideally positioned to partner with rural communities to
develop an intervention that can help rural adults navigate different aspects of hearing healthcare such as
education, prevention, screening, diagnosis, and treatment. The goal of this study is to assess the utilization of
hearing healthcare among rural adults through RHCs with the R21 phase of the program and then develop a
culturally responsive RHC patient navigation program (PNP) to promote utilization of hearing healthcare. To
conduct this study, we will partner with 10 high-need under-resourced RHCs within rural Appalachian counties
in Kentucky and utilize the PRECEDE-PROCEED model (PPM) to systematically assess the rural adult hearing
health and healthcare priorities, needs, and resources to inform intervention development. During the R21 phase
we will 1) conduct a social and epidemiological assessment of rural adult hearing healthcare and 2) assess the
organizational and environmental factors influencing hearing healthcare utilization in RHCs. The milestones of
the R21 include the determination of the prevalence of hearing loss and hearing healthcare utilization in rural
adults, establishment of rural adult hearing healthcare priorities, and development of a community advisory board
and a rural provider taskforce. During the R33 phase we will 1) develop of a community-based hearing healthcare
patient navigation program for RHCs and 2) pilot test the rural hearing healthcare navigation program. The
milestones of the R33 phase include the development of a PNP protocol, assessment of the impact of the
navigator on rural adults obtaining diagnostic audiogram, and evaluation of the PNP feasibility, acceptability, and
appropriateness. This study is significant because it aims to reduce access to care barriers to timely diagnostic
hearing testing for rural adults to prevent negative consequences. This research is innovative in development
and pilot testing of a novel intervention not previously assessed in adult hearing healthcare within an RHC setting.
Our results will impact the field by partnering with communities to inform the development and delivery of
innovative patient supportive interventions to improve rural hearing healthcare access.

Grant Number: 5R33DC019602-05
NIH Institute/Center: NIH
Principal Investigator: Matthew Bush