Smartphone Tests Mobilize Hearing Care in Underserved Areas : The Hearing Journal

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Teleaudiology Today

Smartphone Tests Mobilize Hearing Care in Underserved Areas

doi: 10.1097/01.HJ.0000719816.09664.3a
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The burden of hearing loss is magnified in low- and middle-income communities, where access to hearing health care services is often limited. But can mobile health technologies improve this? A study conducted in a vulnerable community in South Africa is optimistic. Researchers from the University of Pretoria investigated the use of a smartphone hearing test by community care workers (CCWs) in an HIV-affected community in Pretoria, and concluded that mobile health (mHealth) solutions “integrated into community-based screening programs may provide a cost-effective and sustainable means of providing access to hearing services, thereby reaching a larger portion of the population.”


CCWs have been established as instrumental in delivering basic health care services to disadvantaged households, decentralizing the task from professionals to community members.

The current study had two goals: to examine CCWs’ use of smartphone screening in identifying hearing loss in a vulnerable community and to describe the CCWs’ knowledge and user experience of the smartphone technology.

The CCWs who participated had no formal training in hearing care. They were only given a five-hour training session, introducing them to general ear health care and the administration of the hearScreen™ app.

The CCWs then conducted hearing screenings at the homes of 511 participants and identified those who needed to be referred for follow-up diagnostic testing by a qualified audiologist. Participants were informed of their referral via text messaging immediately after their screening.

The smartphone-aided screening lasted an average of 57.9 seconds for each adult participant—significantly faster than the two-minute average time reported by other studies, which is over two minutes. The researchers posited that this faster testing “may be attributed to the automated screening protocol, compared to manual conventional screening,” and that it “may facilitate screening of larger numbers of individuals over a shorter period.”

The test participants also showed a positive follow-up return rate. Seventy-five percent of the referred participants returned for their diagnostic testing, surpassing the benchmark rate of 70 percent. The researchers reported text messaging to be an effective strategy in increasing follow-up return rate.

After conducting the screenings, the CCWs were asked to evaluate the smartphone hearing test. Majority found the screening quick and easy to administer, and agreed to continue providing it as part of their services. They also believed that community members had a positive attitude toward the screening service.


This study was the first of its kind to look into an mHealth-assisted hearing screening delivered by minimally trained CCWs in a vulnerable community. To successfully provide this service in other communities, study co-author De Wet Swanepoel, PhD, outlined some key considerations with The Hearing Journal.

“Firstly, there should be sufficient training provided to CCWs in terms of the importance of hearing problems and its treatability to provide a larger framework of the importance of the service. Secondly, CCWs should be from the community to understand the needs and cultural context. Thirdly, mHealth technology should be digitally inclusive for ease of use and clear outcomes directing the next steps. Fourthly, the technology should allow for surveillance of test quality in terms of the environment (e.g. noise levels) and tester quality (e.g., tracking test operator reliability). Lastly, an integrated data management and referral system must be available to track performance and ensure timely follow-up.”

Swanepoel also noted that it can be challenging to popularize hearing loss screening in vulnerable communities, especially where infectious diseases, malnutrition, and socio-emotional deprivation already pose major threats.

“Hearing loss is an invisible disability and therefore goes unnoticed, especially in vulnerable populations with more obvious risks,” he said. “Motivating for existing CCW-delivered services to include a hearing screening requires advocacy and a solution that makes it simple and affordable enough to incorporate easily.”

This is even more important during this time of pandemic-related restrictions, when access to audiology services may be more constrained.

“CCWs are essential service providers and are often a lifeline for many of the vulnerable groups including child-headed households. That also makes them a bridge to community-based hearing screening even in times of pandemic-related restrictions,” said Swanepoel.

“Partnering with local NGOs offers a way to embed the screening service into a support network that can assist in the care pathway required for children who fail the screening test. These models reach groups previously cut off from care but, amongst other things, require investment, surveillance, and support to scale and ensure sustainability.”

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