A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement.

Clinics were not randomized to protocols; each site chose the screening approach that fit its workflow, so differences between clinic and home groups may reflect site or patient selection rather than the protocol alone. The home-no-encouragement group differed demographically from the clinic-with-encouragement group, with more females and fewer Black or African American patients, and this was linked to one clinic's patient mix. The clinic group reached 100% completion, so some formal tests could not be estimated. Home screening required a quiet room and a landline phone, or a cell phone with ear buds, which may have been a barrier because close to 30% of older adults use only wireless phones. The study did not measure home ambient noise, health literacy, or technology use, and the instructions were written at an 8th-grade level. Provider encouragement was read from a script without training or coaching, so the content and delivery may not represent effective provider communication. Diagnostic evaluations were offered at no cost and arranged by a study coordinator, so real-world follow-up may be lower. Follow-up was short, with 60 days for screening and 120 days for diagnostic evaluation, and the study did not know whether patients obtained hearing aids or other treatment outside the trial. The study did not compare other screening methods, so another method might have performed differently at home.

The article lists NIH extramural research support. The conflict section reports that Dr. Francis serves on Surgical Advisory Boards for Advanced Bionics and Med-El, and no other author reported a conflict of interest outside funding for the study.

Do not conclude that provider encouragement improves hearing screening at home, or that home screening is a practical substitute for clinic-based screening. Provider encouragement did not improve home completion, and the 100% completion in the clinic group may reflect access to a quiet room and landline at the visit rather than encouragement alone.