Effects of a low intensity intervention to increase hearing protector use among noise-exposed workers

Effectiveness of educational programs in hearing health: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of hearing health education programs aimed at preventing noise-induced hearing loss (NIHL), of recreational and occupational origin, by means of a systematic review and meta-analysis.

DESIGN

The search strategy was carried out in on five electronic databases, as well as referrals from experts. The risk of bias was judged, and the random effects meta-analysis was performed. The certainty of the evidence was assessed.

STUDY SAMPLE

Effectiveness studies that used educational intervention in hearing health and prevention of NIHL were included.

RESULTS

42 studies were included. The Dangerous Decibels program was the only one that could be quantitatively analysed and showed improvement in the post-intervention period of up to one week [SMD = 0.60; CI95% = 0.38-0.82; I2 = 92.5%) and after eight weeks [SMD = 0.45; CI95% = 0.26-0.63; I2 = 81.6%) compared to the baseline. The certainty of evidence was judged as very low.

CONCLUSIONS

The Dangerous Decibels program is effective after eight weeks of intervention. The other programs cannot be quantified. They still present uncertainty about their effectiveness. The level of certainty is still low for this assessment.

Efficacy of a Targeted Intervention Method to Improve the Use of Hearing Protection Devices among Agro-Industrial Workers in Malaysia

Hearing-protection devices (HPD) are crucial in protecting workers from hazardous noise exposures. Despite the mandatory implementation of hearing-conservation programmes at the workplace, compliance with proper HPD usage among workers has been shown to be poor. This study aims to develop and determine the efficacy of a targeted intervention to improve the use of HPD among noise-exposed agro-industrial workers. One group of workers was given a targeted training module, while another group received a standard training module. Their self-reported HPD use and the intention to use HPD in the future were compared to evaluate the effect of the interventions. The targeted intervention significantly increased HPD use after four months compared to the control intervention. The findings showed that improving the workers’ compliance with HPD usage is possible by implementing a well-designed training method.

Efficacy of technology-based interventions to increase the use of hearing protections among adolescent farmworkers

OBJECTIVE

Adolescent farmworkers are exposed to loud noise during farm activities. We present a prospective study that evaluated the efficacy of low-cost, technology-based intervention approaches in high schools to enhance the use of hearing protection among adolescent farmworkers.

DESIGN

Six high schools in Iowa that agreed to participate in the study were divided into three equal groups through cluster-randomisation with each group receiving one of the three formats of hearing protection intervention: (a) classroom training, (b) classroom training coupled with smartphone app training and (c) computer training. Participants completed baseline (pre-training) and six-week post-intervention surveys for assessing hearing protection knowledge, attitudes and behaviour.

STUDY SAMPLE

Seventy participants from six schools were initially enrolled but 50 completed both pre- and post-intervention surveys.

RESULTS

In most cases, all three groups showed significant improvement in hearing protection knowledge, attitude and frequency of use from pre- to post-intervention. However, changes between groups were statistically non-significant.

CONCLUSIONS

Although all three formats led to improvements on hearing protection knowledge, attitude and behaviour, the findings of the study, perhaps due to the small sample size, did not allow us to detect whether technology-based hearing protection interventions were more effective than the traditional face-to-face training for adolescent farmworkers.

Feasibility of a low-cost hearing screening in rural Indiana

Background

Hearing loss remains a neglected public health issue in the rural and agricultural communities in the United States and therefore, promotion of a low-cost hearing screening may be important for these underserved populations. The major objectives of our study were to assess feasibility of a low-cost telephone-administered hearing test in rural Indiana and to identify the challenges, barriers and viable implementation strategies associated with this test. Also, we evaluated whether a focus group session could change the hearing health attitude of rural residents.

Methods

We recruited 126 adults from six rural Indiana counties who participated in study activities in the following order: 1) a pre-focus group demographic, knowledge and attitude survey, 2) a focus group for discussing the feasibility of a telephone-administered hearing screening, 3) a post focus group attitude survey and 4) hearing was screened using an audiometer and self-assessment scale. These activities generated both qualitative and quantitative data, which were subsequently analyzed.

Results

Hearing impairment was perceived as an important public health issue. Many participants expressed interests to try the low-cost National Hearing Test (NHT). However, participants recommended NHT to be facilitated by community organizations to provide access to landline phones. The focus group turned out to be an excellent awareness building activity producing significant improvement in hearing health attitudes. Comparison of self and audiometric evaluations indicated underestimation of hearing handicap in our rural study population.

Conclusions

The study results underscore the urgent need for an effective strategy to promote low-cost hearing screening in rural US communities.

Effects of interventions on use of hearing protectors among farm operators: A randomized controlled trial

OBJECTIVE

The purpose of this study was to compare the effectiveness of three interventions designed to promote hearing protector device (HPD) use.

DESIGN

Randomized controlled trial.

STUDY SAMPLE

Farm operators (n = 491) were randomly assigned to one of five intervention groups: (1) interactive web-based information with mailed assortment of HPDs; (2) Interactive web-based information only; (3) static web-based information with mailed assortment of HPDs; (4) Static web-based information only; or (5) mailed assortment of HPDs only. Data were analysed using a mixed model approach.

RESULTS

HPD use increased among all participants, and increased more among participants receiving the mailed HPDs (with or without information) compared to participants receiving other interventions. Participants receiving the interactive web-based information had comparable increased use of HPDs to those receiving the static web-based information. Participants receiving the mailed HPDs had more positive situational influences scale scores than other participants. Program satisfaction was highest among mailed and web-based information groups.

CONCLUSIONS

A mailed assortment of hearing protectors was more effective than information. Interactive and static information delivered via web were similarly effective. Programs interested in increasing HPD use among farmers should consider making hearing protectors more available to farmers.

Attitudes toward Use of Hearing Protection Devices and Effects of an Intervention on Fit-Testing Results

This study assessed attitudes toward the use of hearing protection devices (HPDs) and the effect of an educational intervention on fit-testing results by comparing personal attenuation ratings (PAR50) before and after the intervention. Employees ( n = 327) from a large metal container manufacturer at four geographic locations were tested with a field attenuation estimation system (FAES) to identify workers ( n = 91) requiring intervention. PAR50 values significantly increased from baseline to post-intervention ( p < .001, 15.1 to 26.9) and at the 6-month follow-up ( p < .001, 95% confidence interval = −11.2, −6.3). Perceived self-efficacy scores for using HPDs significantly declined from baseline to post-intervention ( p = .006, 95% confidence interval = 0.3, 1.9), but were not significantly related to PAR50. Therefore, a FAES can assist the occupational health nurse to identify workers at high risk (low PAR50), teach proper fit and use of HPDs, and improve hearing protector selection.

WITHDRAWN: Interventions to promote the wearing of hearing protection

Review withdrawn from Issue 11, 2013 of The Cochrane Library due to the identification of an error in the data analysis. This review no longer remains a priority topic for the Cochrane Ear, Nose & Throat Disorders Group and therefore the review will not be corrected, updated and republished by this group.

The editorial group responsible for this previously published document have withdrawn it from publication.

Interventions to promote the wearing of hearing protection

BACKGROUND

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2006 and previously updated in 2009.Noise-induced hearing loss can be prevented by eliminating or lowering noise exposure levels. Where the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. Several trials have been conducted to study the effectiveness of interventions to influence the wearing of hearing protection.

OBJECTIVES

To evaluate the effectiveness of interventions to enhance the wearing of hearing protection among persons regularly exposed to high noise levels.

SEARCH METHODS

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 April 2011.

SELECTION CRITERIA

We included studies if they had a randomised design, if they were among noise exposed (> 80 dB(A)) persons, if they included an intervention to promote the wearing of hearing protection (compared to another intervention or no intervention), and if the outcome measured was the amount of use of hearing protection or a proxy measure thereof.

DATA COLLECTION AND ANALYSIS

Two authors selected relevant trials, assessed risk of bias and extracted data.

MAIN RESULTS

Seven studies, involving 4670 participants, were included.A computer-based intervention lasting 30 minutes, tailored to the risk of an individual worker, was not found to be more effective than a video providing general information among workers, around 80% of whom already used hearing protection.A four-year school-based hearing loss prevention programme found that the intervention group was twice as likely to wear some kind of hearing protection as the control group that received a baseline hearing test and two additional tests at years two and three.We conducted two meta-analyses for the comparisons 'tailored strategy (the use of communication or other types of interventions that are specific to an individual or a group and aim to change behaviour) versus non-tailored strategy' and 'tailored strategy versus a commercial video on the use of hearing protection' to look at mean percentage use of hearing protective devices (HPDs), that showed improvement in the mean use of HPDs for the tailored group. A meta-analysis of the comparison 'mixed interventions' (classroom instruction, distribution of HPDs, mailings, noise level assessments and audiometric testing) versus control (audiometric testing alone) also showed improvement in self reported use of HPDs when shooting firearms.Tailored education showed an improvement in HPD use of 8.3% versus targeted education (6.1%).

AUTHORS' CONCLUSIONS

The evidence found in this review shows that some interventions improve the mean use of hearing protection devices compared to non-intervention. Future trials should have standard outcomes and interventions to allow the combining of results in meta-analysis.

Interventions to promote the wearing of hearing protection

BACKGROUND

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2006 and previously updated in 2009.Noise-induced hearing loss can be prevented by eliminating or lowering noise exposure levels. Where the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. Several trials have been conducted to study the effectiveness of interventions to influence the wearing of hearing protection.

OBJECTIVES

To evaluate the effectiveness of interventions to enhance the wearing of hearing protection among persons regularly exposed to high noise levels.

SEARCH STRATEGY

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 April 2011.

SELECTION CRITERIA

We included studies if they had a randomised design, if they were among noise exposed (> 80 dB(A)) persons, if they included an intervention to promote the wearing of hearing protection (compared to another intervention or no intervention), and if the outcome measured was the amount of use of hearing protection or a proxy measure thereof.

DATA COLLECTION AND ANALYSIS

Two authors selected relevant trials, assessed risk of bias and extracted data.

MAIN RESULTS

Seven studies, involving 4670 participants, were included.A computer-based intervention lasting 30 minutes, tailored to the risk of an individual worker, was not found to be more effective than a video providing general information among workers, around 80% of whom already used hearing protection.A four-year school-based hearing loss prevention programme found that the intervention group was twice as likely to wear some kind of hearing protection as the control group that received a baseline hearing test and two additional tests at years two and three.We conducted two meta-analyses for the comparisons 'tailored strategy (the use of communication or other types of interventions that are specific to an individual or a group and aim to change behaviour) versus non-tailored strategy' and 'tailored strategy versus a commercial video on the use of hearing protection' to look at mean percentage use of hearing protective devices (HPDs), that showed improvement in the mean use of HPDs for the tailored group. A meta-analysis of the comparison 'mixed interventions' (classroom instruction, distribution of HPDs, mailings, noise level assessments and audiometric testing) versus control (audiometric testing alone) also showed improvement in self reported use of HPDs when shooting firearms.Tailored education showed an improvement in HPD use of 8.3% versus targeted education (6.1%).

AUTHORS' CONCLUSIONS

The evidence found in this review shows that some interventions improve the mean use of hearing protection devices compared to non-intervention. Future trials should have standard outcomes and interventions to allow the combining of results in meta-analysis.