Reducing Childhood Hearing Loss in an Alaska Native Population Through a New School Screening and Referral Process That Utilizes Mobile Health and Telemedicine
Condition: Hearing Loss
MeSH terms: Hearing Loss; Deafness
Study type: Interventional

Summary: 
      Hearing loss is a common health problem in Alaska. Up to 75% of children growing up in
      Alaskan villages experience frequent ear infections, one of the major treatable causes of
      hearing loss. Children with even mild hearing loss face many challenges. These children often
      experience speech and language delays and have trouble in school. Teens with hearing loss are
      more likely to drop out of school, and are at risk for having difficulty finding jobs as
      adults. Promptly diagnosing and treating hearing loss is important for preventing these
      consequences. Alaska mandates school-based hearing screening, but many children with hearing
      loss are not identified by the current screening protocol, and most who are referred never
      make it into the healthcare system for diagnosis and treatment.

      Alaska has already developed innovative strategies to address hearing loss. A network of
      village health clinics staffed by community health aides provide local care, and telemedicine
      has been adopted in over 250 village clinics statewide. Despite being widely available,
      telemedicine has not yet been used in school hearing screenings to speed up the referral
      process.

      Norton Sound Health Corporation has partnered with Duke and Johns Hopkins Universities to
      explore whether a new school screening and referral process that incorporates mobile, or
      mHealth, screening and telemedicine referral will reduce childhood hearing loss disparities
      in the Norton Sound region. Children from kindergarten through 12th grade in 15 Norton Sound
      villages will receive the current school screening protocol and the new mHealth screen.
      Villages will then be randomized to continue the current primary care referral process or to
      adopt telemedicine referral for school screenings. The investigators hypothesize that the new
      mHealth screening protocol will identify more children with hearing loss, and telemedicine
      referral will reduce time to diagnosis. By better identifying hearing loss and speeding up
      diagnosis and treatment, the investigators expect the burden of childhood hearing loss to
      drop, hearing-related quality of life to improve, and school performance to improve in
      villages with telemedicine referral compared to current primary care referral villages. If
      the study shows these positive effects, mHealth screening and the telemedicine referral
      process could be implemented in school districts across the state of Alaska to reducing
      childhood hearing loss disparities statewide.
    


Intervention name(s): Current Primary Care Referral Process; Telemedicine Referral Process
Intervention type(s): Other; Other
Intervention description(s): Children who screen positive for hearing loss will receive the same method each school had been using previously. This process involves a letter home to the parents, either sent with the child or by mail, requesting that the parent/caregiver bring the child to village health clinic for an evaluation.; In villages randomized to the expedited telemedicine intervention, parents of children who screen positive will receive a phone call from the school or the clinic on the day of screening notifying them of the day and time of their child's telemedicine consultation appointment. Appointments will be made same-day or next-day, with community health aides (CHAs) who have dedicated time blocked off to perform telemedicine consults. Participating children screening positive will be transported to clinic for their appointment with adult chaperones. Parents are encouraged but not required to attend, except for children grades 2 and younger, for whom parental participation will be required. Nonparticipating children in communities assigned to the expedited telemedicine intervention arm will receive standard referral following the current school primary care referral process.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research