{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T03:47:14Z","timestamp":1764301634397,"version":"3.46.0"},"reference-count":28,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008626","name":"Cochlear","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008626","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001230","name":"Macquarie University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001230","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001047","name":"Ian Potter Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,13]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Multiple well-considered but siloed initiatives and programmes exist in Australia to support ear and hearing screening and assessment for Indigenous children. However, the lack of coordination of these programmes leads to inefficiencies in resource allocation and disrupts opportunities to implement a cost-effective, efficient, and easily navigable system of care. Indigenous children experience high prevalence rates of middle ear disease, as well as earlier onset, increased severity and longer infections compared with non-Indigenous children. The aims of this study are to: (1) Understand current ear and hearing screening programmes in three New South Wales communities and evaluate their strengths and limitations, (2) Strengthen, implement and evaluate ear and hearing screening programmes and (3) Identify the barriers and facilitators for scaling strengthened ear and hearing screening programmes nationally and the importance and feasibility of each factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A series of desktop searches and co-design workshops will be completed to achieve aim (1) and (2) and the results will be mapped into work-as-done and work-as-imagined using the Functional Resonance Analysis Method. Strengthened screening programmes will be implemented in communities using the criteria from national and international guidance documents and the Practical, Robust, Implementation and Sustainability Model and evaluated. Finally, workshops will be conducted with key stakeholders to identify the barriers and facilitators for scaling strengthened ear and hearing screening programmes nationally and the importance and feasibility of each factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This project has received ethics approval from the Aboriginal Health and Medical Research Council Human Research Ethics Committee (Ref: 2350\/24). Results will be disseminated to the community through the CEOs of the Aboriginal Community Controlled Health Organisations as well as published in peer-reviewed journals and presented at conferences. The findings from data collected will be used to inform the co-production of an enhanced system for ear and hearing care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111702","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T03:45:39Z","timestamp":1764301539000},"page":"e111702","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Little ears \u2013 Aboriginal programmes for hearing and EAR screening (LEAP \u2013 HEAR): a research protocol for co-design workshops to strengthen programmes"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7294-5829","authenticated-orcid":false,"given":"Kiri","family":"Mealings","sequence":"first","affiliation":[{"name":"HEAR Centre, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Halvorsen","sequence":"additional","affiliation":[{"name":"HEAR Centre, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Nash","sequence":"additional","affiliation":[{"name":"HEAR Centre, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"MacQueen","sequence":"additional","affiliation":[{"name":"Katungul Aboriginal Corporation Regional Health and Community Services, Narooma, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Ward","sequence":"additional","affiliation":[{"name":"Brewarrina Aboriginal Medical Service, Brewarrina, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine M","family":"McMahon","sequence":"additional","affiliation":[{"name":"HEAR Centre, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"2025112719453003000_15.11.e111702.1","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1017\/S0022215113003083","article-title":"Otitis media in Indigenous Australian children: review of epidemiology and risk factors","volume":"128 Suppl 1","author":"Jervis-Bardy","year":"2014","journal-title":"J Laryngol Otol"},{"key":"2025112719453003000_15.11.e111702.2","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.5694\/j.1326-5377.2009.tb02931.x","article-title":"The impact of otitis media on cognitive and educational outcomes","volume":"191","author":"Williams","year":"2009","journal-title":"Med J Aust"},{"key":"2025112719453003000_15.11.e111702.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-08570-3","article-title":"The social determinants of otitis media in aboriginal children in Australia: are we addressing the primary causes? 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San Francisco, CA: Jossey-Bass, 2003: 253\u201388."},{"key":"2025112719453003000_15.11.e111702.6","doi-asserted-by":"crossref","first-page":"386","DOI":"10.5694\/mja2.52100","article-title":"Routine ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: a national consensus statement","volume":"219","author":"Harkus","year":"2023","journal-title":"Med J Aust"},{"key":"2025112719453003000_15.11.e111702.7","first-page":"iv1","article-title":"Systems thinking for strengthening health systems in LMICs: need for a paradigm shift","volume":"27 Suppl 4","author":"Adam","year":"2012","journal-title":"Health Policy Plan"},{"key":"2025112719453003000_15.11.e111702.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12992-018-0332-2","article-title":"Characteristics of Indigenous primary health care service delivery models: a systematic scoping review","volume":"14","author":"Harfield","year":"2018","journal-title":"Global Health"},{"key":"2025112719453003000_15.11.e111702.9","unstructured":"Miller S . Examine Australian government indigenous ear and hearing health initiatives. 2017."},{"key":"2025112719453003000_15.11.e111702.10","unstructured":"Australian Government Department of Health . New national key performance indicator (nKPI) for primary health care \u2013 ear health: consultation paper. 2021."},{"key":"2025112719453003000_15.11.e111702.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09885-x","article-title":"Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach","volume":"20","author":"McCalman","year":"2020","journal-title":"BMC Public Health"},{"key":"2025112719453003000_15.11.e111702.12","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s41347-020-00180-5","article-title":"Mobile Health and Cultural Competencies as a Foundation for Telehealth Care: Scoping Review","volume":"6","author":"Hilty","year":"2021","journal-title":"J technol behav sci"},{"key":"2025112719453003000_15.11.e111702.13","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1080\/14992027.2019.1649478","article-title":"Supporting hearing health in vulnerable populations through community care workers using mHealth technologies","volume":"58","author":"van Wyk","year":"2019","journal-title":"Int J Audiol"},{"key":"2025112719453003000_15.11.e111702.14","unstructured":"ARTD Consultants . Evaluation of the Aboriginal otitis media screening program. 2008."},{"key":"2025112719453003000_15.11.e111702.15","unstructured":"Closing the Gap . National agreement on closing the gap. 2020. Available: https:\/\/www.closingthegap.gov.au\/national-agreement\/national-agreement-closing-the-gap"},{"key":"2025112719453003000_15.11.e111702.16","unstructured":"Hearing Health Sector Committee . Roadmap for hearing health. 2019."},{"key":"2025112719453003000_15.11.e111702.17","unstructured":"The department of health of Australia . Population based screening framework. In: Population based screening framework, Commonwealth of Australia (Department of Health). 2018."},{"key":"2025112719453003000_15.11.e111702.18","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.171154"},{"key":"2025112719453003000_15.11.e111702.19","unstructured":"Hollnagel E . FRAM: the functional resonance analysis method. Modelling complex socio-technical systems. 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