{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T01:54:42Z","timestamp":1783562082370,"version":"3.55.0"},"reference-count":52,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,22]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The WHO recommends task-sharing with community health workers (CHWs) to help overcome the limited access to hearing healthcare and hearing aids in low-income and middle-income settings (LMIs). This systematic review examined the feasibility, efficacy and effectiveness of CHW-facilitated hearing aid provision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Scopus and Web of Science were searched through 4 June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies in which CHWs facilitated hearing aid provision in any context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Data on study characteristics, CHW training and roles, hearing-aid outcomes and implementation factors were extracted. Study quality was determined using the National Institute of Health quality assessment tool, and level of evidence was determined using the Centre for Evidence-Based Medicine. A narrative synthesis was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six studies published between 2013 and 2025 were included. Two were conducted in high-income countries but implemented in LMI communities. Four studies were conducted in LMI countries. All provided CHW training, though content and duration varied; only one used WHO-endorsed materials. Sustained device use was high as reported at follow-ups, though only one included 12-month outcomes. All studies included validated outcome measures, including the International Outcome Inventory for Hearing Aids, Hearing Handicap Inventory for the Elderly\u2013Screening version, Abbreviated Profile of Hearing Aid Benefit and Self-Efficacy for Situational Communication Management Questionnaire. Implementation facilitators included use of local CHWs, delivery in participants\u2019 home languages, comprehensive CHW training and employing mHealth tools. Barriers included CHW scope constraints and unfamiliarity with outcome subscales in rural contexts. Only two studies used formal feasibility frameworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CHW-facilitated hearing aid provision is feasible and effective. However, variation in training and implementation highlights the need for standardised training materials, supervision models and culturally adapted outcome measures. Further research should examine long-term outcomes, cost-effectiveness and scalability using formal implementation frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108591","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T06:25:23Z","timestamp":1763101523000},"page":"e108591","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Feasibility, efficacy and effectiveness of community health worker-facilitated hearing aid provision: a systematic review"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9922-2927","authenticated-orcid":false,"given":"Caitlin","family":"Frisby","sequence":"first","affiliation":[{"name":"Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa"},{"name":"Virtual Hearing Lab, Collaborative Initiative Between the University of Colorado and the University of Pretoria, Aurora, Colorado, USA"},{"name":"hearX Foundation, Pretoria, Gauteng, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinaya","family":"Manchaiah","sequence":"additional","affiliation":[{"name":"Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa"},{"name":"Virtual Hearing Lab, Collaborative Initiative Between the University of Colorado and the University of Pretoria, Aurora, Colorado, USA"},{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, Colorado, USA"},{"name":"Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-1636","authenticated-orcid":false,"given":"De Wet","family":"Swanepoel","sequence":"additional","affiliation":[{"name":"Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa"},{"name":"Virtual Hearing Lab, Collaborative Initiative Between the University of Colorado and the University of Pretoria, Aurora, Colorado, USA"},{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"2025120413271802000_15.11.e108591.1","unstructured":"World health organization . 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