Pilot Study to Evaluate Hearing Aid Service Delivery Model and Measure Benefit Using Self-Report Outcome Measures Using Community Hearing Workers in a Developing Country

Hearing loss is a major handicap in developing countries with paucity of trained audiologists and limited resources. In this pilot study trained community health workers were used to provide comprehensive hearing aid services in the community. One hundred and eleven patients were fitted with semi-digital hearing aid and were evaluated over a period of six months. They were assessed using self-report outcome measure APHAB. Results show that trained CHWs are effective in detecting disabling hearing loss and in providing HAs. APHAB can identify and pick up significant improvements in communication in daily activities and provides a realistic expectation of the benefits of a hearing aid. The model of using trained CHWs to provide rehabilitative services in audiology along with self-report outcome measures can be replicated in other developing countries. 1. Introduction It is well recognized that hearing loss is the most common global disability [1]. As reported by Davis [2] (British MRC Institute of Hearing Research) the numbers with hearing impairment in developing countries is estimated to reach 500 million by the year 2015. In India, hearing loss is the third most common disability [3] and the prevalence of moderate to severe hearing loss is reported to be 6.3 percent by WHO [4]. The majority of India’s population lives in rural areas with poor facilities and accesses for evaluation of hearing and treatment being seldom available. Also, due to the paucity of trained audiologists, [5] the burden of hearing handicap is magnified. The primary goal of the study was to determine the degree and nature of benefit that could be expected in the population by using trained community workers to fit semidigital hearing aids which can be programmed easily by trained workers and quantifying benefit using APHAB which was translated in to the local language. Deafness is an expensive handicap, leading to loss of work and active participation in social activities of the community [6]. The measurement of outcomes in rehabilitative audiology has received more attention because of the need to demonstrate efficacy of treatment for consumers, carry out cost-benefit analyses. Traditionally, the outcomes of hearing aid intervention have been demonstrated using objective measures such as the functional gain [7] speech recognition [8] testing, and real ear responses [9]. An alternative to the use of objective hearing aid benefit measurements is the use of self-report methodology. In the 1980s and 1990s several other subjective measurement instruments were developed to assess