The design for this study is outlined below according to each Aim.
Aim 1: To identify the effectiveness of over-the-counter hearing aids (OTC HAs) for
decreasing hearing handicap and improving speech perception in adults with no access to
hearing health care.
Aim 2: To implement an adult aural rehabilitation (AR) program for those without access
to hearing health care to improve OTC HA benefit, promote OTC HA use and lead to
increased quality of life (QOL).
Aim 1 will assess the effectiveness of OTC HAs for our participant population and Aim 2
will implement an AR program. With Aim 1, hearing loss will be assessed and an OTC HA
will be provided. Prior to the hearing evaluation, participants will be randomly placed
in one of three groups to assess the effectiveness of the AR program (Aim 2). The three
groups include those who will receive the current best practices care from an audiologist
(ABP), those who will receive the ABP plus an aural rehabilitation program (ABP+AR), and
finally, those who will receive only an OTC HA without assistance from an audiologist for
providing programming, maintenance or care information (OTC-only). Both the ABP and
OTC-only groups initially will attend general health information sessions in-place of the
AR program. Local health care providers who have training in general health areas such as
nutrition, diabetes, obesity, and heart health to name a few, will provide the General
Health and Wellness programming. Once the ABP+AR groups have completed their AR sessions,
the ABP and the OTC-only groups will attend the AR programming sessions. This testing
layout and schedule is provided in the table below.
Randomization will occur for each county visited and for the participants. Specifically,
five counties will each receive a code and these codes will be randomized to determine
when the study will take place in that area. All five regions will be included over a
one-year period. Participant randomization will occur by generating three groups of
random participant numbers and then assigning each participant to their designated group.
Only the PI and the project manager will have access to the randomization lists. The PI
will generate the randomization lists and the Project Manager will assign the
participants accordingly to each group. The randomization lists will be kept on a
password-protected computer and only accessible by the PI or Project Manager.
Audiologists will be blinded to the intervention condition for participants.
Specifically, two audiologists (A1 and A2) will conduct the initial hearing evaluations.
A2 will perform the OTC HA settings and orientations and a third audiologist (A3) will
perform the follow-up speech perception testing in weeks 8 - 9. A second post-speech
perception testing for all participants in week 14 will be conducted by A1.
The entire program will take place over a 14-week period for one county at a time. County
1 will begin at Week 1 and the remaining four regions will be stratified such that
testing will begin at Week 9, 10 or 11 consecutively for each region. The stratification
will be done to ensure that testing takes place in each area over a one-year period, and
also, to avoid simultaneous testing at two sites. Finally, all participants who complete
the study in years 1 and 2 will be invited back to complete speech perception testing and
the AR surveys one year after they complete the study.