See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/306049148

mHealth Improves Access to Community-based Hearing Care

Article  in  Hearing Journal · August 2016

DOI: 10.1097/01.HJ.0000491120.97166.e3

CITATIONS READS

4 128

1 author:

DeWet Swanepoel
University of Pretoria
248 PUBLICATIONS   4,197 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Improving hearing care access View project

Service delivery View project

All content following this page was uploaded by DeWet Swanepoel on 22 March 2018.

The user has requested enhancement of the downloaded file.

Audiology without Borders

mHealth Improves Access to

Community-based Hearing Care
By De Wet Swanepoel, PhD

N
on-fatal conditions such as
hearing loss are increasingly
becoming dominant contrib-
utors to the burden of dis-
ease. For example, the latest Global
Burden of Disease Study estimated that
1.23 billion people had some form of
hearing impairment (20 dB or more), of
which 414.5 million had moderate or
greater hearing loss. This ranks hearing
loss as the 5th most significant contribu-
tor to the global burden of disease based
on years lived with disability.
The impact of hearing loss prevalence
on the global burden of disease is further
exacerbated by the inaccessibility of
hearing health services for the majority of
the world’s population. In sub-Saharan
Africa, for example, many countries have
more than a million people per hearing
health provider (bit.ly/29fyA6X; WHO,
Figure 1. Child being screened with hearScreen App using a calibrated head-
2013a). This shortage is also evident in
phone.
high-income countries with training pro-
grams that are unable to meet the rising demand for hearing are necessary. One of the burgeoning fields in health service
loss services among the aging population (Windmill. J Am provision is mHealth, broadly defined as any use of mobile
Acad Audiol 2013;24[5]:407). technology to address health care challenges such as ac-
cess, quality, affordability, matching of resources,
and behavioral norms (bit.ly/29fAxA9). It demon-
Considering the scale of the hearing loss burden strates the promise to improve access and well-
being of people around the world.
and the limited access to hearing health care, There has been a growing interest to employ
alternative solutions are necessary. mHealth in ear and hearing health care provision
as a means of improving access to care, espe-
cially in underserved regions across the globe
Early access to ear and hearing health care is key to ensur- (Clark. Disabil Rehabil Assist Technol 2014;9[5]:408). One
ing optimal outcomes. In fact, up to 50 percent of hearing loss of these developments is an innovative smartphone applica-
cases could be prevented through primary and secondary tion developed at the University of Pretoria in South Africa
measures (WHO, 2013b). People with permanent hearing called hearScreen (Figs. 1 & 2). While there are many end-
loss but have early access to appropriate care can have excel- user apps available that provide some form of hearing test,
lent outcomes and endure minimal impact of the disability and none of these allow for actual calibration of headphones ac-
its associated psychosocial difficulties. cording to international and national standards (e.g., ISO,
Considering the scale of the hearing loss burden and the ANSI). hearScreen features accurate headphone calibration
limited access to hearing health care, alternative solutions according to mandatory standards using a low-cost smart-
phone. This validated application automates screening pro-
Dr. Swanepoel is a professor in audiology at the University of Pre- tocols and interpretation for adults and children according
toria, South Africa, and a senior research fellow at the Ear Science to best practice guidelines. It has a simple, user-friendly in-
Institute Australia, with adjunct positions at the University of terface and onscreen instructions that allow screening to
Western Australia and the University of Texas at Dallas. He serves
also as associate editor for the International Journal of Audiology,
be facilitated by people with minimal training. The smart-
president-elect for the International Society of Audiology and co-chair for phone microphone is equipped with intelligent real-time
the telehealth task force of the American Academy of Audiology. noise monitoring to evaluate if test outcomes are influenced

30 The Hearing Journal  August 2016

Audiology without Borders
Figure 2. Example screenshots from selected hearScreen operation screen: (from L-R) homescreen, signal presen-
tation, and results page. Note: The hearScreen application is intellectual property owned, patented and trademarked by
the University of Pretoria (De Wet Swanepoel is registered as lead inventor).
by environmental noise. All patient details and ­results are
captured intuitively on the smartphone and u ­ ploaded to a
cloud-based server for remote data management and surveil-
lance. Geotagged results link patients with the closest hear-
ing health care providers.
These features make hearScreen uniquely suited to
­community-based hearing health care centers with mini-
mally trained personnel (Swanepoel. Int J Audiol 2014;
53[12]:841). A recent evaluation of the use of hearScreen
on school children demonstrated similar sensitivity and
specificity compared with existing screening audiometers
(Mahomed. Ear Hear 2016;37[1]:e11). The screenings
were done using a low-cost smartphone ($80) and supra-
aural headphones. A follow-up study is currently investigat-
ing a model in which schools have their own hearScreen
devices to allow teachers or other personnel to conduct
screening at logistically convenient times. This model also
allows for prompt screening of children who demonstrate
academic failure or behavioural difficulties during the
course of an academic year or for those whose parents or
teachers have concerns.
In another community-based project, 24 community
health care workers (CHWs) from an underserved commu-
nity used their smartphones, which they employ for health
registrations and risk assessments in homes, to conduct
hearing screenings with a calibrated headphone linked to
the hearScreen application. They screened close to 1,000
children and adults in their homes over a 12-week period.
Patients were linked to their closest primary health care
clinic for follow-up services. The consensus amongst
CHWs was that the hearing tests were easy to conduct
32 The Hearing Journal 
View publication stats
and community members valued the service (Yousuf. J
Telemed Telecare 2015).
Innovative mHealth solutions like hearScreen present
new ways to offer health care access to people at a grass-
roots level. A low-cost solution can be made widely avail-
able so that laypersons can administer hearing screenings.
In fact, this type of solution can change school hearing
health models by providing schools with their own devices
to take responsibility for the hearing health of students.
Similarly, CHWs or other community members can conduct
screening in homes. Screening results managed centrally
allow for direct reporting to parents or patients by email or
text messaging, while linking them with the closest hearing
health providers. Integrated cloud-based data management
and surveillance provide detailed reporting of program effi-
cacy and patient- and service-provider linkages.
The rapid advances in technology and global connectivity
are offering hearing health care providers not only new tools
but also new models of service-delivery for community-based
ear and hearing health care. mHealth for hearing is a young
and dynamic field that will certainly benefit underserved com-
munities. 
Audiology Without Borders
This column is edited by active humanitarians Jackie Clark,
PhD, and King Chung, PhD. Tell us about your hearing
health care programs at HJ@wolterskluwer.com. Read
past columns in this special collection at bit.ly/HJAudWB
August 2016