Feasibility and effectiveness of a hybrid teleaudiology model for accessible hearing healthcare: a mixed-methods study in Northern India

Abstract Background An estimated 63 million people in India have disabling hearing loss, yet access to hearing healthcare remains limited due to high costs, long travel distances, severe shortage of audiologists, and low awareness. Traditional in-person services struggle to meet demand in resource-constrained settings. This study aimed to develop and evaluate the feasibility and effectiveness of a hybrid teleaudiology model that combines remote online screening and rehabilitation with targeted in-person diagnostic evaluation and hearing aid fitting to overcome these barriers. Methods A prospective mixed-methods feasibility study was conducted at a tertiary care centre in northern India from May 2022 to February 2023. Adults aged 18 years and above, fluent in Hindi and with access to a smartphone or computer, completed an online Digit-in-Noise screening test in Hindi. Those who failed the screening and demonstrated high motivation and readiness proceeded to in-person comprehensive audiological assessment, hearing aid trial, and fitting. A culturally adapted Hindi multimedia rehabilitation programme was delivered asynchronously online, supplemented by synchronous counselling. Primary outcomes included change in communication ability (measured by the Abbreviated Profile of Hearing Aid Benefit questionnaire), patient satisfaction, and qualitative feedback. Data were analysed using non-parametric tests, linear regression, and thematic analysis. Results Of 392 individuals who completed online screening, 160 (40.8%) failed and 125 (78.1%) attended in-person evaluation. Hearing aids were trialled in 120 participants and purchased by 114 (95.0% of those trialed). Communication difficulty decreased markedly after hearing aid use (global score from 60.72 ± 15.20 to 18.08 ± 6.61; p < 0.0001). Patient satisfaction was very high, with 92.2% satisfied or delighted with the overall service and 100% rating the multimedia rehabilitation videos as advantageous. Most participants (86.3%) preferred the hybrid delivery model. Conclusions The hybrid teleaudiology model integrating remote screening, targeted in-person care, and online rehabilitation is feasible, clinically effective, and highly acceptable in the Indian context. It substantially improves communication outcomes and patient satisfaction while offering potential to improve access to hearing healthcare services. The model offers a scalable solution for hearing healthcare delivery in low- and middle-income countries and merits evaluation in larger, randomised studies and rural settings.