Sánchez Daisey, Adamovich Stephanie, Ingram Maia, Harris Frances P, de Zapien Jill, Sánchez Adriana, Colina Sonia, Marrone Nicole
Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ.
Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ.
J Am Acad Audiol. 2017 Jun;28(6):562-574. doi: 10.3766/jaaa.16045.
In underserved areas, it is crucial to investigate ways of increasing access to hearing health care. The community health worker (CHW) is a model that has been applied to increase access in various health arenas. This article proposes further investigation into the application of this model to audiology.
To assess the feasibility of training CHWs about hearing loss as a possible approach to increase accessibility of hearing health support services in an underserved area.
A specialized three-phase training process for CHWs was developed, implemented, and evaluated by audiologists and public health researchers. The training process included (1) focus groups with CHWs and residents from the community to raise awareness of hearing loss among CHWs and the community; (2) a 3-hr workshop training to introduce basic topics to prepare CHWs to identify signs of hearing loss among community members and use effective communication strategies; and (3) a 24-hr multisession, interactive training >6 weeks for CHWs who would become facilitators of educational and peer-support groups for individuals with hearing loss and family members.
Twelve Spanish-speaking local CHWs employed by a federally qualified health center participated in a focus group, twelve received the general training, and four individuals with prior experience as health educators received further in-person training as facilitators of peer-education groups on hearing loss and communication.
Data was collected from each step of the three-phase training process. Thematic analysis was completed for the focus group data. Pre- and posttraining assessments and case study discussions were used to analyze results for the general workshop and the in-depth training sessions.
CHWs increased their knowledge base and confidence in effective communication strategies and developed skills in facilitating hearing education and peer-support groups. Through case study practice, CHWs demonstrated competencies and applied their learning to specific situations related to effective communication with hearing loss, family support, availability of assistive technology, use of hearing protection, and making referrals for hearing health care. Needs were identified for ongoing training in the area of use of assistive technology and addressing situations of more severe hearing loss and its effects.
Initial results suggest it is feasible to train CHWs to engage community members regarding hearing loss and facilitate culturally relevant peer-health education and peer-support groups for individuals with hearing loss and their family members. In efforts to increase access to audiological services in rural or underserved communities, application of the CHW model with a partnership of audiologists deserves further consideration as a viable approach.
在医疗服务不足的地区，研究增加听力保健服务可及性的方法至关重要。社区卫生工作者（CHW）模式已被应用于在各个卫生领域增加服务可及性。本文提议进一步研究该模式在听力学中的应用。
评估培训社区卫生工作者有关听力损失的知识，以此作为在医疗服务不足地区增加听力健康支持服务可及性的一种可能方法的可行性。
听力学家和公共卫生研究人员开发、实施并评估了一个针对社区卫生工作者的专门的三阶段培训过程。培训过程包括：（1）与社区卫生工作者和社区居民进行焦点小组讨论，以提高社区卫生工作者和社区对听力损失的认识；（2）为期3小时的工作坊培训，介绍基本主题，使社区卫生工作者能够识别社区成员中的听力损失迹象并使用有效的沟通策略；（3）为将成为听力损失患者及其家庭成员的教育和同伴支持小组促进者的社区卫生工作者提供为期6周以上的24小时多场次互动培训。
一家联邦合格健康中心雇佣的12名讲西班牙语的当地社区卫生工作者参加了焦点小组讨论，12人接受了一般培训，4名有健康教育经验的人员作为听力损失和沟通同伴教育小组的促进者接受了进一步的面对面培训。
从三阶段培训过程的每个步骤收集数据。对焦点小组数据进行了主题分析。培训前和培训后的评估以及案例研究讨论用于分析一般工作坊和深入培训课程的结果。
社区卫生工作者增加了他们在有效沟通策略方面的知识基础和信心，并培养了促进听力教育和同伴支持小组的技能。通过案例研究实践，社区卫生工作者展示了能力，并将所学应用于与听力损失有效沟通、家庭支持、辅助技术可用性、听力保护使用以及听力保健转诊相关的特定情况。确定了在辅助技术使用领域以及应对更严重听力损失情况及其影响方面进行持续培训的需求。
初步结果表明，培训社区卫生工作者让其与社区成员就听力损失问题进行接触，并为听力损失患者及其家庭成员促进具有文化相关性的同伴健康教育和同伴支持小组是可行的。在努力增加农村或医疗服务不足社区的听力学服务可及性方面，与听力学家合作应用社区卫生工作者模式作为一种可行方法值得进一步考虑。
