Community Health Workers as Patient-Site Facilitators in Adult Hearing Aid Services via Synchronous Teleaudiology: Feasibility Results from the Conexiones Randomized Controlled Trial.

This was a feasibility trial of 28 people, designed to test whether the service could be delivered, not whether it works. It was far too small to rule out a real difference between the two types of helper, and the authors say larger trials are needed. No one could be kept unaware of who was helping them, and participants and facilitators were physically together throughout, so knowing which group they were in could have influenced the questionnaire answers. Every participant was given hearing aids and services free of charge. Cost is one of the main reasons people in this population do not use hearing aids, and removing it for both groups may have hidden any effect of the type of helper. The control group was not entirely free of community health workers: everyone met them during recruitment, eligibility testing and consenting, and the researchers' field notes recorded two occasions when a community health worker and a control participant interacted outside the study. Most participants were already scoring near the top of the communication-confidence scale, leaving little room for one group to show an advantage over the other. The follow-up fitting happened sooner for the community health worker group (18.1 days on average) than for the student-helper group (30.8 days), a statistically significant difference that the authors assumed would not affect the results. The final outcomes visit fell at the beginning of the COVID-19 pandemic, so it had to be done by phone and hearing aid use could not be read from the devices at that timepoint. The sample was narrow: all Hispanic/Latino, mostly women, most with an annual income under US$20,000, average education to high school level, in one rural border community. The results may not apply to other groups. All participants used the same hearing aid model, chosen by the researchers rather than the patients, so results cannot be compared directly with studies using other devices. Some questionnaires were translated by the research team where no published Spanish version existed, so comparisons with studies using the original versions should be cautious.

The authors state there are no conflicts of interest, financial or otherwise. The hearing aids and the services were paid for from research grant funds, so no participant paid for their devices, and the community health workers' work on the project was supported by a community grant.

Do not read this as proof that community health workers improve hearing aid outcomes. On the main outcome, a questionnaire about hearing and communication confidence, the community health worker group and the student-helper group could not be distinguished, and everyone improved. The one difference favouring community health workers was hearing aid use at the earlier follow-up, a secondary outcome in a 28-person feasibility trial, and it had disappeared by the later visit.