Community Perspectives on Hearing Loss in Rural Alaska.

Autor:	Inglis-Jenson M; Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA.; University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.; Norton Sound Health Corporation, Nome, Alaska, USA.; These authors contributed equally to this work., Robler SK; University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.; Norton Sound Health Corporation, Nome, Alaska, USA.; These authors contributed equally to this work., Gallo JJ; Mixed Methods Research Training Program, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Ivanoff P; Lead Parent Stakeholder, Hearing Norton Sound, Unalakleet, Alaska, USA., Ryan S; Lead Patient Partner, Hearing Norton Sound, Anchorage, Alaska, USA., Hofstetter P; Petersburg Medical Center, Petersburg, Alaska, USA., Emmett SD; University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.; Duke Global Health Institute, Durham, North Carolina, USA.; Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, Arkansas, USA.; Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Arkansas, USA.
Jazyk:	angličtina
Zdroj:	Ear and hearing [Ear Hear] 2023 Sep-Oct 01; Vol. 44 (5), pp. 1078-1087. Date of Electronic Publication: 2023 Mar 24.
DOI:	10.1097/AUD.0000000000001348
Abstrakt:	Objectives: The aim of this study is to present an explanatory model of hearing loss in the Bering Strait region of Alaska in order to contextualize the results of a cluster randomized trial and propose implications for regional hearing-related health care. Design: To promote ecological validity, or the generalizability of trial findings to real world experiences, qualitative methods (focus groups and interviews) were used within a mixed methods cluster randomized trial evaluating school hearing screening and follow-up processes in 15 communities in the Bering Strait region of Alaska. Focus groups were held between April and August 2017, and semistructured interviews were conducted between December 2018 and August 2019. Convenience sampling was used for six of the 11 focus groups to capture broad community feedback. Purposive sampling was used for the remaining five focus groups and for all interviews to capture a variety of experiences with hearing loss. Audio recordings of focus groups and interviews were transcribed, and both notes and transcripts were deidentified. All notes and transcripts were included in the analysis. The constant comparative method was used to develop a codebook by iteratively moving between transcripts and preliminary themes. Researchers then used this codebook to code data from all focus groups and interviews using qualitative analysis software (NVIVO 12, QSR International) and conducted thematic analyses to distill the findings presented in this article. Results: Participants in focus groups (n = 116) and interviews (n = 101) shared perspectives in three domains: etiology, impact, and treatment of hearing loss. Regarding etiology, participants emphasized noise-induced hearing loss but also discussed infection-related hearing loss and various causes of ear infections. Participants described the impact of hearing loss on subsistence activities, while also detailing social, academic, and economic consequences. Participants described burdensome treatment pathways that are repetitive and often travel and time intensive. Communication breakdowns within these pathways were also described. Some participants spoke positively of increased access via onsite hearing health care services in "field clinics" as well as via telemedicine services. Others described weaknesses in these processes (infrequent field clinics and communication delays in telemedicine care pathways). Participants also described home remedies and stigma surrounding the treatment for hearing loss. Conclusions: Patient-centered health care requires an understanding of context. Explanatory models of illness are context-specific ways in which patients and their networks perceive and describe the experience of an illness or disability. In this study, we documented explanatory models of hearing loss to foster ecological validity and better understand the relevance of research findings to real-life hearing-related experiences. These findings suggest several areas that should be addressed in future implementation of hearing health care interventions elsewhere in rural Alaska, including management of repetitious treatments, awareness of infection-mediated hearing loss, mistrust, and communication breakdowns. For hearing-related health care in this region, these findings suggest localized recommendations for approaches for prevention and treatment. For community-based hearing research, this study offers an example of how qualitative methods can be used to generate ecologically valid (i.e., contextually grounded) findings. Competing Interests: This work was supported by the Patient-Centered Outcomes Research Institute (PCORI-AD-1602-34571). The authors declare no conflicts of interest, financial or otherwise. The funding organizations had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the decision to submit the article for publication; or in the preparation, review, or approval of the article. (Copyright © 2023 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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