title: Smartphone hearing screening in mHealth assisted community-based primary care.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
authors.forename: Shouneez
authors.initials: S
authors.lastname: Yousuf Hussein
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia Ear Science Institute Australia, Subiaco, Australia dewet.swanepoel@up.ac.za.
authors.forename: De
authors.initials: D
authors.lastname: Wet Swanepoel
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
authors.forename: Leigh
authors.initials: L
authors.lastname: Biagio de Jager
authors.affiliation: Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa.
authors.forename: Hermanus C
authors.initials: HC
authors.lastname: Myburgh
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia Ear Science Institute Australia, Subiaco, Australia.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eikelboom
authors.affiliation: Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
authors.forename: Jannie
authors.initials: J
authors.lastname: Hugo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods; D003150:Community Health Workers; D005260:Female; D006311:Hearing Disorders / Q000175:diagnosis; D006320:Hearing Tests / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D000068997:Smartphone; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
keywords: community-based; mHealth; primary care; smartphone; tele-assisted