Identifying Factors in Hearing Healthcare Access: The Memphis SOUND Project - 1 Hearing loss in older adults is linked to diminished quality of life, cognitive decline, and increased healthcare 2 costs,1-4,12 making it a national public health priority. Evidence suggests that hearing intervention can mitigate 3 these effects7 and lower costs,8 yet hearing healthcare engagement remains low.9 This underuse is especially 4 concerning among Black Americans, who face higher rates of hearing-related comorbidities but engage in 5 hearing intervention at significantly lower rates than other populations.15-24 Traditional research often fails to 6 capture the complex social, environmental, and ecological factors shaping hearing healthcare access. Faith- 7 based organizations offer a trusted platform to understand and address these issues,28-33 particularly in Memphis, 8 TN, where approximately 73% of older adults regularly attend religious services.45 The Memphis SOUND Project 9 applies a community-based participatory approach grounded in the PRECEDE-PROCEED Model (PPM)37 to 10 study hearing healthcare access among Black older adults. Guided by the PPM, this proposal focuses on the 11 PRECEDE phases, partnering with ten faith-based organizations to: 1) assess social and epidemiological factors 12 through on-site hearing evaluations and interviewer-administered questionnaires with 100 participants, and 2) 13 identify environmental and ecological factors through 30-40 qualitative interviews with pastors, health ministry 14 leaders, and congregants. A novel Faith Champion model35 will train trusted congregants to serve as liaisons 15 with pastors, coordinate recruitment, and strengthen cultural alignment between research and community 16 priorities. A Community Advisory Board (CAB) will guide all stages of implementation and ensure that study 17 procedures reflect community priorities. We anticipate that age, sex, social disadvantage, perceived hearing 18 disability, and related risk factors will predict hearing status, and that social and biological factors will predict 19 hearing health beliefs associated with care-seeking.19,43-53 We further expect faith leaders and congregants to 20 illuminate conditions that hinder awareness, limit trust, or constrain resource access, as well as identify 21 community assets and reinforcing influences that promote engagement.41,48 This integrative design will advance 22 understanding of how individual, social, and organizational dynamics interact to influence hearing healthcare 23 access and position our team for a larger-scale intervention trial. Completion of this study will generate new data 24 on contextual determinants of hearing healthcare access, filling critical gaps left by national datasets. Findings 25 will establish the PRECEDE phases of the PPM, laying the foundation for the PROCEED phases and informing 26 a future R01 trial of targeted intervention. More broadly, this work will provide a scalable framework for engaging 27 faith-based organizations as trusted brokers of health information. By strengthening community partnerships and 28 improving hearing healthcare access, the Memphis SOUND Project aims to reduce untreated hearing loss, 29 enhance quality of life, and lower healthcare costs for older adults. Ultimately, this work will serve as a model for 30 addressing hearing loss through sustainable community partnerships.
