Disparities in hearing healthcare (HHC) persist between Hispanic/Latino adults and non-Hispanic/Latino Whites, despite similar hearing loss prevalence rates. Limited English language proficiency (LEP) significantly and neg- atively impacts general healthcare access and utilization, but interventions that take into account the preferred language and culture of patients have been shown to reduce or eliminate disparities in many areas of healthcare. Yet there is a fundamental gap in the current understanding as to whether addressing LEP will alleviate dispari- ties in HHC for Hispanic/Latino older adults. As untreated hearing loss is associated with increased risks of costly health outcomes, there is an urgent need to improve HHC service delivery, particularly to vulnerable populations such as those with LEP. The applicant's long-term goal is to develop hearing loss interventions that address the needs of vulnerable populations in the US. The overall objective of the current proposal, which is the next step toward attainment of the applicant's long-term goal, is to develop and assess the benefits of printable, Spanish- language hearing loss self-management patient education materials. The central hypothesis is that participants will demonstrate better understanding of their hearing loss difficulties, and will be better able to identify options for self-management following delivery of culturally and linguistically appropriate patient education materials. The rationale for the proposed research is that findings will contribute to the development and testing of novel inter- ventions aimed at increasing HHC access and utilization in vulnerable populations. Guided by preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Using an iterative approach with members from the target audience, develop a culturally and linguistically appropriate Spanish-language hearing loss self-man- agement program that takes into account varying health literacy backgrounds; and 2) Assess the benefits for Spanish-speaking adults with hearing loss, in terms of HHC knowledge and self-efficacy for managing hearing loss, following delivery of a Spanish-language hearing loss self-management program. Aim #1 will be addressed through utilizing focus groups consisting of representatives of the target audience to develop the education ma- terials. Aim #2 will be addressed by comparing self-efficacy for managing hearing loss in a single-group, pre/post design with 53 Hispanic/Latino adults with hearing loss who have LEP. These aims in line with advancing the overall mission of the NIDCD to “help prevent, detect, diagnose, and treat disease and disability”, as well as NIDCD's 2017-2022 Strategic Plan to address hearing health disparities. This contribution is expected to be significant because it poses to reduce language barriers to HHC experienced by US adults from Hispanic/Latino background with LEP. The proposed research is innovative because it represents a substantive departure from the status quo by delivering a hearing loss intervention that addresses the intersection of LEP and health literacy. It is expected that results will provide compelling data to include in a future R01 application aimed at reducing structural and clinical barriers to HHC access and utilization for vulnerable populations in the US.

Currently there is a scarcity of hearing loss interventions that address the literacy, cultural, and linguistic needs of the growing population of older adults from Hispanic/Latino background in the US. The outcomes of this study will address a pressing public health need to increase hearing health literacy and hearing loss self-management among older Hispanic/Latino adults with limited English language proficiency. Improvements in these outcomes address the NIDCD mission to improve the quality of hearing healthcare service delivery and address hearing healthcare disparities experienced by US adults with hearing loss.