PROJECT SUMMARY Access to hearing care is unequal with large disparities among older adults. Despite evidence that supports community health worker (CHW) care models as an approach to health disparities, community-delivered hearing care models are only beginning. Among existing efforts, only the HEARS (Hearing Health Equity through Accessible Research & Solutions) intervention is specifically designed for older adults and includes the provision of over-the-counter (OTC) hearing technology in a community setting through a theory-driven approach. The HEARS intervention was designed and tested with NIDCD support from 2015 to 2020 (R22/R33DC015062) to address common barriers to hearing care experienced by older adults, particularly racial/ethnic minority and low-income older adults. Preliminary data from the randomized controlled trial demonstrate the efficacy of HEARS as a first-in-kind intervention delivered entirely in the community by older adult peer mentors using OTC hearing technology with outcomes on par to hearing aids fit by audiologists. With increasing availability of OTC devices and a growing demand for new care models, the HEARS intervention is poised to be brought to scale. To move HEARS into practice, we propose partnering with local Area Agencies on Aging (AAAs), a national network of public and private non-profit agencies who provide services to older adults aging in place. This proposal will complete the HEARS intervention package and test the delivery of the HEARS intervention entirely within a community setting by community-based audiologists working with older adult peer mentors in AAAs, positioning the HEARS program for broader implementation through AAAs. The proposal has the following aims: R21 Aim 1 To develop the train-the-trainer curriculum and manuals for audiologist supervisors that reflect the needs of audiologists and ensure the safety, efficacy, and fidelity of a peer mentor-delivered intervention as guided by the Scientific and Community Advisory Boards. R33 Aim 1 To recruit and train an audiologist-peer mentor care team of 2 audiologists and 9 peer mentors (3 per site) through partner AAAs (n=3) to assess the trainer curriculum. R33 Aim 2 To conduct a community- based pragmatic trial of delivering the HEARS intervention through 3 AAAs throughout Maryland via a within- subject 3-month intervention trial (n=100 per AAA site). R33 Aim 3 To develop an implementation strategy for the HEARS intervention as delivered through AAAs via a mixed methods approach based on the barriers and enablers encountered in the pragmatic trial. This proposal brings together a multidisciplinary team of investigators in a highly collaborative effort spanning academia, government, and non-profit organizations. This proposal will rigorously extend evidence for a community-delivered hearing care that leverages OTC devices and CHW-partnered care and will directly inform the implementation and scaleup of the HEARS intervention.

PROJECT NARRATIVE Significant hearing health care disparities exist among older adults by race/ethnicity and socioeconomic position but community health worker models of care, as an efficacious approach to addressing disparities, have been underutilized within hearing care. This innovative and multidisciplinary proposal will advance the development and testing of a theory-driven, evidence-based hearing care intervention delivered by older adult peer mentors that leverages the growing market of over-the-counter hearing technology. The proposal will position the hearing care intervention for future implementation and scaling within a national network of aging service providers.