Abstract
BackgroundAlmost 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/designThis 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.DiscussionThe 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 registrationClinicalTrials.gov NCT03916029. Registered on 16 April 2019.
Highlights
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
Prevalence of otitis media in the Northern Territory Otitis media (OM or middle ear inflammation) is a complex condition with a continuum of diagnostic categories including otitis media with middle ear effusion (OME or ‘glue ear’), acute otitis media without perforation (AOMwoP or bulging ear drum), acute otitis media with perforation (AOMwiP or recent ‘runny ears’), or chronic suppurative otitis media (CSOM or long term ‘runny ears’ with a larger perforation), dry perforation (DP or inactive Chronic suppurative otitis media (CSOM)), or tympanostomy tube otorrhoea (TTO, ear discharge through a TT)
We found evidence from a meta-analysis of data from 23 studies and almost 1400 practices that Practice Facilitators in Primary Health Care settings can increase adoption of evidence-based guidelines by almost 3-fold [22]
Summary
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. These funding partners have no role in the design of the study, collection, analysis, or interpretation of data or in writing the manuscript. Professor Amanda Jane Leach, Menzies School of Health Research, Charles Darwin University (concept, design, funding, wrote the first draft, draft revisions and read final version). Professor Peter Stanley Morris, Menzies School of Health Research, Charles Darwin University and Royal Darwin hospital (concept, design, funding, draft revisions and read final version). Dr Jiunn-Yih Su, Menzies School of Health Research, Charles Darwin University (draft revisions and read final version). Dr Victor Maduabuchi Oguoma, Menzies School of Health Research, Charles Darwin University (biostatistician expertise draft revisions and read final version). Members’ roles are to provide advice that will ensure the trial is consistent with best-practice, is successfully completed, maintains trial integrity, is culturally appropriate and safe for Aboriginal and Torres Strait Islander communities, and has a high likelihood of successful transfer to policy and practice if the outcome is positive
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