Hearing Screening in Older Adults in Primary Care Clinics: How the Effects of Setting and Provider Encouragement Differ by Patient Sex and Race.
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2025-03
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Abstract
Objectives
Few studies have examined how patient sex or race influence hearing healthcare, which was our study purpose.Design
We performed a secondary analysis using data from a pragmatic clinical trial that examined the effect of provider encouragement (yes/no) or setting (at-home/clinic) for older adults to follow through with routine hearing screening in primary care and the hearing healthcare pathway. Three protocols were compared: at-home screening without provider encouragement, at-home screening with provider encouragement, and in-clinic screening with provider encouragement.Results
Poisson regression (n = 627) showed few differences by patient sex but showed that Black patients in the at-home protocols were less likely to schedule or complete a formal diagnostic evaluation after a failed screening compared with Black patients in the clinic setting and White patients in all groups. Black patients, regardless of provider encouragement, were less likely to schedule or complete a diagnostic evaluation compared with White patients.Conclusions
Results suggest that in-clinic screenings may increase the use of hearing healthcare for Black patients.Type
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West, Jessica S, Judy R Dubno, Howard W Francis and Sherri L Smith (2025). Hearing Screening in Older Adults in Primary Care Clinics: How the Effects of Setting and Provider Encouragement Differ by Patient Sex and Race. Ear and hearing, 46(2). pp. 512–522. 10.1097/aud.0000000000001604 Retrieved from https://hdl.handle.net/10161/34278.
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Jessica Sayles West
Jessica is a medical sociologist who specializes in research on hearing loss, aging, and health disparities over the life course. Jessica’s work has described the “spillover” effects of hearing loss on health outcomes for both individuals and those close to them, as well as sociodemographic disparities in the onset of and life expectancy with hearing loss. Her research, which leverages both population-level data and electronic health record data, has appeared in the Journals of Gerontology, Social Science & Medicine, Ear and Hearing, and other leading journals in medical sociology, hearing, and aging research.
Jessica received a B.A. from the University of Michigan in Social Anthropology (dual Sociology/Anthropology concentration) followed by an M.P.H. in Sociomedical Sciences with a certificate in Public Health Research Methods from Columbia University’s Mailman School of Public Health. She subsequently received an M.A. and Ph.D. in Sociology with a focus in Medical Sociology and Demography at Duke University. She then completed an NIA T32 Postdoctoral Fellowship at the Duke University Aging Center under the mentorship of Matthew E. Dupre, Ph.D. (Population Health Sciences) and Sherri L. Smith, Au.D., Ph.D. (Head and Neck Surgery & Communication Sciences).
Howard Wayne Francis
Dr. Howard W. Francis, is the Richard Hall Chaney, Sr professor of Otolaryngology and inaugural Chair of the Department of Head and Neck Surgery & Communication Sciences (HNS&CS) at Duke University Medical Center, where he is also the Chief of the Medical Staff of Duke University Hospital. He is a practicing neurotologist with research interests including practice innovations and clinical outcomes in the delivery of hearing health care. He is a senior editor of the Cummings Otolaryngology-Head and Neck Surgery Text, is a Director on the American Board of Otolaryngology-Head and Neck Surgery, a past member of the Otolaryngology Residency Review Committee of the ACGME, and a member of the Board of Directors of the Alexander Graham Bell Association for the Deaf and Hard of Hearing. Dr. Francis is a past president of the Society of University Otolaryngologists, past Education Director of the American Neurotology Society, and a recipient of the 2020 American Academy of Otolaryngology-Head and Neck Surgery Presidential Citation.
After completing his high-school education in Jamaica, and his bachelor’s degree at the University of Southern California in Los Angeles, Dr. Francis earned his medical degree from the Harvard-MIT division of Health, Science and Technology at Harvard Medical School, and then completed his internship, residency and fellowship training at the Johns Hopkins Hospital. He completed his Master’s in Business Administration with a focus in medical services management at the Johns Hopkins Carey Business School. After 19 years on the faculty at Johns Hopkins during which he served as Residency Program Director, Director of the Johns Hopkins Listening Center and Vice Director of the Department, he was appointed chief of HNS&CS at Duke in March 2017, and then the first Chair of the new Department in 2019.
Sherri L Smith
Dr. Smith's core research focuses on improving the assessment and treatment of hearing loss in older adults. Specifically, her work centers on comparing the effectiveness of current hearing interventions, developing new, innovative clinical tools, and examining alternative service-delivery approaches that help patients reach their individual hearing goals and improve their quality of life.
Dr. Smith also collaborates with multi-disciplinary teams to better understand the impact of hearing loss on other health conditions and services. Current projects involve understanding the impact of hearing loss on surgical outcomes in older adults, determining the mechanisms that may explain the independent association between hearing loss and falls in older adults, and comparing different models of hearing screenings for older adults in primary care settings.
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