Technology Use and Hearing Care Intervention Outcomes: A Secondary Analysis of a Randomized Clinical Trial

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.

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.

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.

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.

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.

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..

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.

ClinicalTrials.gov Identifier: NCT03442296.