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.

PROJECT NARRATIVE Hearing loss affects over 40 million adults in the United States and can negatively impact many areas of life for adults. The lack of access to diagnostic hearing tests prevents timely diagnosis and treatment of hearing loss, especially, among adults who live in rural areas. This study will (1) evaluate the experiences and challenges in obtaining hearing tests among adults who live in rural areas and are patients at rural health clinics, and (2) develop a program, in partnership with rural patients and medical providers, which can help rural adults get easier access to hearing tests.