Strategies to Scale-Up Global Access and Uptake of Hearing Screening: A Systematic Review

I. ABSTRACT Introduction: Although interventions to address hearing loss exist, access is inequitably distributed across geographic, socioeconomic, and racial axes globally. We sought to determine which scale-up strategies could be useful to bolster the uptake of hearing screening to reduce the global burden of hearing loss. We then provide targeted policy recommendations to aid the implementation of these strategies. Methods: After evaluating articles from five databases using our inclusion/exclusion criteria, we extracted qualitative and statistical evidence related to the uptake of neonatal, child, and adult hearing screening (NHS, CHS, and AHS), specifically their use, adherence, and satisfaction. Two reviewers independently assessed article quality using the Mixed Methods Appraisal Tool (2018). We then categorized and compared the success of interventions. Results: Of the 225 articles screened, 29 studies fit our inclusion criteria. Of the 29 articles, 18 describe findings targeting NHS scale-up interventions, five CHS, four AHS, one NHS/CHS, and one CHS/AHS. Interventions assessed were educational (n=3), policy and systemic (n=3), telehealth (n=2), financial and funding (n=2), expanded screening (n=6), and restructured screening programs (n=7). The evidence from these articles suggests that restructure screening programs, the most documented intervention type, could be the most effective in increasing uptake generally and across HIC and UMIC settings, with no null results. Discussion: We recommend policies and interventions that restructure screening programs or expand their reach as strong options to allocate resources toward in both high- and low-resource settings, relative to existing intervention types previously attempted. More research pertaining to scale-up, especially in lower-income settings, is necessary, however, to make the most appropriate recommendations.