The rising prevalence of hearing loss is a global health concern. Professional hearing services are largely absent within low- and middle-income countries where appropriate skills are lacking. Task...

Introduction: Mobile health (m-health) has the potential to improve access and uptake of health services globally. Noncommunicable diseases such as hearing loss have seen increasing use of m-health approaches to improve access, scalability, penetration, quality, and convenience of health services. This scoping review describes published research in m-health supported hearing health care services across the continuum of care. Methods: A search on Scopus, MEDLINE (PubMed), and Web of Science for articles published up to July 2, 2021 was conducted. Articles in which m-health was used across a continuum of care where the primary focus was hearing health care were included. A narrative synthesis was conducted. Results: One hundred forty-six articles meeting the inclusion criteria were included in data extraction. High-income countries contributed 56% of articles, upper-middle countries 32%, lower-middle countries 8%, and low-income countries 4%. Articles identified included promotion (2%), screening (39%), diagnosis (35%), treatment (10%), and support (14%) for hearing loss. m-Health applications in high-income countries were more represented in diagnosis (62% vs. 38%), treatment (67% vs. 33%), and support (82% vs. 18%) compared with low- and middle-income countries (LMICs) except for screening (64% vs. 36%). Few studies focussed on hearing health promotion across all income brackets. Conclusions: m-Health supported hearing health care services are available across a continuum of care and various world regions, although more prevalent in high-income countries. Although great potential is demonstrated, implementation evaluations are important to further validate its widespread use and potential to make services for hearing loss more accessible in LMICs.

Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care.

Stigma has been reported as a key barrier to hearing aid uptake. This scoping review explores evidence of reported stigma associated with hearing loss and hearing aids in low- and middle-income (LMI) settings. Four databases were searched to identify studies published up to 6 November 2024. Studies mentioning stigma in relation to hearing loss or hearing aids in LMI countries or LMI settings within high-income countries were included. A narrative synthesis was conducted. Twenty-nine studies were included, with 26 conducted in LMI countries and three in LMI settings within high-income countries. Two main domains were identified: (a) stigma experienced by individuals with hearing loss, ear disease, or hearing aids and (b) experiences of stigma reported by direct communication partners. Four themes emerged from affected individuals, including (a) internalized stigma, (b) social stigma, (c) cultural beliefs, and (d) barriers to help-seeking. Communication partners' themes included (a) perception of individuals with hearing loss, (b) impact on relationships, and (c) cultural beliefs. Unique theme in LMIs is cultural beliefs that hearing loss is associated with witchcraft and curses. A limited number of studies were identified but emphasized cultural and religious beliefs as important contributing factors to stigma in LMIs.

Aim: To describe the prevalence and characteristics of hearing loss in a self-referred adult cohort in low-income South African communities and to evaluate the effectiveness of a cerumen management protocol within a community-based service setting. Background: Hearing loss affects 1.5 billion people globally, with a disproportionate impact on individuals in low- and middle-income countries (LMICs) and the elderly, often attributed to age-related factors and cerumen impaction. Despite the high prevalence, access to ear and hearing care remains challenging, particularly in LMICs, such as Africa. Methods: A total of 227 participants aged 43–102 were recruited from two community centres in low-income South African communities for hearing evaluation and cerumen management for those with cerumen impaction. A cross-sectional, predominantly quantitative approach was used. Findings: Video otoscopy of 448 ears revealed normal findings in 57.9%, cerumen impaction in 29.1%, and other abnormalities in 1.3%. The prevalence of confirmed hearing loss was 97.8%, primarily mild (45.8%), and sensorineural hearing loss (SNHL) was the most common (55.3%). Cerumen impaction accompanied hearing loss in 28.4% of cases. Post-treatment, 50.9% of participants with cerumen impaction showed normal otoscopy results, with mean hearing improvements of 16.2 dB (±17.9 SD) in the left ears and 15.8 dB (±17.2 SD) in the right ears, though overall significance was limited. Conclusion: The high prevalence of hearing loss and cerumen impaction in low-income communities emphasizes the importance of ear care in primary healthcare (PHC) settings, especially for the elderly. Effective community-based cerumen management highlights the potential of integrating community resources and task-shifting strategies for cost-effective ear care in resource-limited settings.

The majority of individuals with hearing loss worldwide reside in low- and middle-income countries (LMICs), but there is limited information regarding the characteristics of hearing loss in these regions. This descriptive study aims to address this knowledge gap by analysing audiogram patterns in LMIC populations. Greater knowledge about the properties of hearing loss in LMICs allows for improved planning of interventions. Retrospective data from 23 collaborating centres across 16 LMICs were collected. All participants were adults seeking help for hearing problems. A machine learning approach was utilised to classify the hearing threshold data and identify representative profiles. The study comprised 5773 participants. The results revealed mildly sloping audiometric patterns with varying severity. The patterns differed from previous studies conducted in high-income regions which included more steeply sloping losses. The findings also indicated a higher proportion of more severe levels of hearing loss. These variations could be attributed to population-level differences in the causative mechanisms of hearing loss in LMICs, such as a higher prevalence of infectious disease-related hearing loss. The results may also reflect differences in health seeking behaviours. This study highlights the need for tailored, scalable, hearing interventions for LMICs.