Abstract
Background: Almost all Aboriginal children in remote communities have persistent bilateral otitis media affecting hearing and learning throughout early childhood and school years, with consequences for social and educational outcomes, and later employment opportunities. Current primary health care and specialist services do not have the resources to meet the complex needs of these children.
Method/design: This stepped-wedge cluster randomised trial will allocate 18 communities to one of five 6-monthly intervention start dates. Stratification will be by region and population size. The intervention (Hearing for Learning Initiative, HfLI) consists of six 20-h weeks of training (delivered over 3 months) that includes Certificate II in Aboriginal Primary Health Care (3 modules) and competencies in ear and hearing data collection (otoscopy, tympanometry and hearScreen), plus 3 weeks of assisted integration into the health service, then part-time employment as Ear Health Facilitators to the end of the trial. Unblinding will occur 6 months prior to each allocated start date, to allow Community Reference Groups to be involved in co-design of the HfLI implementation in their community. Relevant health service data will be extracted 6-monthly from all 18 communities. The primary outcome is the difference in proportion of children (0 to 16 years of age) who have at least one ear assessment (diagnosis) documented in their medical record within each 6-month period, compared to control periods (no HfLI). Secondary outcomes include data on sustainability, adherence to evidence-based clinical guidelines for otitis media, including follow-up and specialist referrals, and school attendance. Structured interviews with staff working in health and education services, Ear Health Trainees, Ear Health Facilitators and families will assess process outcomes and the HfLI broader impact.
Discussion: The impact of training and employment of Ear Health Facilitators on service enhancement will inform the health, education and employment sectors about effectiveness of skills and job creation that empowers community members to contribute to addressing issues of local importance, in this instance ear and hearing health of children. Trial registration: ClinicalTrials.gov NCT03916029. Registered on 16 April 2019.
Original language | English |
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Article number | 403 |
Pages (from-to) | 1-19 |
Number of pages | 20 |
Journal | Trials |
Volume | 22 |
Issue number | 1 |
DOIs | |
Publication status | Published - 16 Jun 2021 |
Bibliographical note
Funding Information:The Hearing for Learning Initiative is funded by the Australian Commonwealth Government, Northern Territory Government, and The Balnaves Foundation. These funding partners have no role in the design of the study, collection, analysis, or interpretation of data or in writing the manuscript.
Funding Information:
Recognition of the contribution by Aboriginal and Torres Strait Islander participants and governance members will be acknowledged. We thank the participating community Local Authorities, Regional Councils and Land Councils for providing letters of support and approvals for the HfLI. We particularly acknowledge the contributions of the following to the development of implementation plans and thank them for advice and support (alphabetical): Dr. John Boffa (Central Australian Aboriginal Congress), Dr. Christine Connors (Top End Health Service), Dr. Sinon Cooney (Katherine West Health Board), Dr. Karrina Demasi (Aboriginal Medical Services Alliance, NT), Dr. Elizabeth Moore (Aboriginal Medical Services Alliance, NT), Dr. David Reeve (Central Australian Health Service), Amarjit Anand (NT Hearing Health Service) and Denise Bainbridge (Department of Education).
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.