Technology Use and Hearing Care Intervention Outcomes

Importance: Over-the-counter (OTC) hearing aids often rely on digital technologies that may limit access for older adults with low technology use. Community health worker (CHW)-delivered interventions may help overcome these barriers, but it is unclear whether baseline technology usage modifies intervention efficacy. Objective: To evaluate whether an older adult's baseline technology use modifies the effect of a CHW-delivered hearing care intervention incorporating OTC hearing devices on self-perceived communication function. Design, Setting, and Participants: This secondary post hoc subgroup analysis used data from the HEARS (Hearing Health Equity Through Accessible Research & Solutions) study, a parallel-group 1:1 randomized clinical trial with waitlist controls that was conducted between April 2018 and October 2019. HEARS recruited older adults (age ≥ 60 years) with untreated hearing loss and self-reported communication difficulties from 13 community sites, including affordable independent housing complexes and senior centers, in Baltimore, Maryland. The primary end point was assessed at 3 months postrandomization, with additional descriptive follow-up through 12 months postintervention. Data were analyzed from August 2023 to March 2026. Intervention: A CHW-delivered hearing care intervention that includes the provision of a low-cost OTC hearing device, device orientation, and navigational support or a wait-list control. Main Outcomes and Measures: Change from baseline score on the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) at 3 months postrandomization was the primary outcome. Participants were classified as technology-connected if they reported recent use of a smartphone, computer or tablet, the internet, or email or text messaging. Intervention effects were estimated using doubly robust weighted least squares, stratified by technology use. Results: The analysis comprised 151 participants (mean [SD] age, 76.7 [8.0] years; 101 females [67.8%]), of whom 108 (71.5%) were technology-connected. At 3 months postrandomization, HHIE-S scores decreased by a mean of 14.1 (95% CI, -17.6 to -9.9) points among technology-connected participants and by 12.5 (95% CI, -16.2 to -5.2) points among not-connected participants compared with their respective controls. The estimated difference in treatment effect between groups was -1.6 (95% CI, -7.8 to 4.1) points.. Conclusions and Relevance: This secondary analysis of a randomized clinical trial found that the estimated treatment effects of a CHW-delivered hearing care intervention were consistent across strata of participants' baseline technology use. These exploratory findings suggest that navigational support may mitigate technology-related barriers in hearing care interventions for older adults. Trial Registration: ClinicalTrials.gov Identifier: NCT03442296.