Smartphone hearing screening in mHealth assisted community-based primary care

Introduction: Access to ear and hearing health is a challenge in developing countries, where the burden of disabling hearing loss is greatest. This study investigated community-based identification of hearing loss using smartphone hearing screening (hearScreen™) operated by community health workers (CHWs) in terms of clinical efficacy and the reported experiences of CHWs. Method: The study comprised two phases. During phase one, 24 CHWs performed community-based hearing screening as part of their regular home visits over 12 weeks in an underserved community, using automated test protocols employed by the hearScreen™ smartphone application, operating on low-cost smartphones with calibrated headphones. During phase two, CHWs completed a questionnaire regarding their perceptions and experiences of the community-based screening programme. Results: Data analysis was conducted on the results of 108 children (2–15 years) and 598 adults (16–85 years). Referral rates for children and adults were 12% and 6.5% respectively. Noise exceeding permissible levels had a significant effect on screen results at 25 dB at 1 kHz (p<0.05). Age significantly affected adult referral rates (p < 0.05), demonstrating a lower rate (4.3%) in younger as opposed to older adults (13.2%). CHWs were positive regarding the hearScreen™ solution in terms of usability, need for services, value to community members and time efficiency. Conclusion: Smartphone-based hearing screening allows CHWs to bring hearing health care to underserved communities at a primary care level. Active noise monitoring and data management features allow for quality control and remote monitoring for surveillance and follow-up.