Pilot Implementation Outcomes of a Community-Based Tele- Practice Model for Identification and Rehabilitation of Children with Hearing loss within a Public-health system of a Rural District in Southern India

Background The current study is an effort to evaluate pilot outcomes of a comprehensive tele-practice model for identification and rehabilitation of hearing loss among children below 6 years of age which can then inform suitable adaptations prior to the implementation. The outcomes of tele-facilitator training, limited-efficacy measures, and caregiver acceptability and satisfaction with tele-practice were analysed. Method Two special educators were trained as tele-facilitators for tele-diagnostic testing. Screening was done using the validated SRESHT screener in the Perambalur district by trained nurses in UPHC’s at all 4 blocks until at least 5 children with ‘refer’ results were obtained. 5 children with hearing loss using amplification devices enrolled in the District Early Intervention Centre (DEIC) were enrolled for tele-rehabilitation. To measure the limited- efficacy, the outcomes of pre-pilot and post-pilot were compared. The caregiver acceptability and satisfaction with tele-practice was also assessed Results In all 12 children with ‘refer’ results loss underwent tele- diagnostic testing. Tele-rehabilitation outcomes were studied on 5 children with hearing loss already using amplification devices. When comparing the outcomes of limited -efficacy with the existing data it was found that the model identified older children with hearing loss. The time lapse between screening/hearing loss suspicion to diagnosis reduced from a median of 216 days to 8 days. For tele- rehabilitation the number of sessions attended in a span of 3 months increased from a median of zero to 3 sessions. Based on the satisfaction questionnaire, most people had a positive experience, and found the travel time to the testing site convenient and affordable. Few parents reported encountering difficulties as a result of inadequate ventilation and internet connectivity within the mobile van where tele-diagnostic testing was conducted. Conclusion The pilot outcomes suggests that a block level service enabled using tele- practice to overcome professional shortages, beneficial in reducing time gap between screening/suspicion to diagnosis and also enhanced attendance for rehabilitation. The pilot outcomes provided insights on adaptations related to screening site, test infrastructure and internet optimization that may be required before implementation.