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      Acceptability of the Wulira app in assessing occupational hearing loss among workers in a steel and iron manufacturing industry

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          Abstract

          Background

          Industrial workers are at a high risk of acquiring noise induced hearing loss, yet there is minimal hearing loss screening of such groups of people. Pure Tone Audiometry (PTA), the gold standard for hearing loss screening, is expensive, and not readily available at health sites. Mobile audiometry can bridge this gap. However, there is limited knowledge on its acceptability in low-income countries like Uganda. We aimed to assess the acceptability of using the Wulira App, a validated mobile phone app, in assessing hearing loss among industrial workers in Kampala.

          Methods

          We carried out a qualitative study in a steel and iron manufacturing industry in Kampala, in April 2021. Four Focus group discussions (FGDs) with 8 participants per FGD, and 12 In-depth Interviews (IDI), were conducted on the industrial workers. The industrial workers were first tested for hearing loss, then enrolled for the FGDs and IDI. A semi-structured interview guide was used. Audio recordings were transcribed verbatim. Themes were derived using thematic content analysis, borrowing from Sekhon’s model of Acceptability of Health Interventions.

          Results

          Industrial workers found the Wulira App user friendly, cheap, time saving, and an effective hearing loss assessment tool. However, barriers such as lack of smart phones, difficulty in navigating the app, and fear of getting bad news hindered the App’s acceptability, as a hearing assessment tool.

          Conclusion

          Hearing loss assessment using Wulira App was acceptable to the industry workers. There is need of informing industrial workers on the essence of carrying out regular hearing loss screening, such that barriers like fear of getting screened are overcome.

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          Most cited references30

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          Screening and management of adult hearing loss in primary care: scientific review.

          Hearing loss is the third most prevalent chronic condition in older adults and has important effects on their physical and mental health. Despite these effects, most older patients are not assessed or treated for hearing loss. To review the evidence on screening and management of hearing loss of older adults in the primary care setting. We performed a search from 1985 to 2001 using MEDLINE, HealthSTAR, EMBASE, Ageline, and the National Guideline Clearinghouse for articles and practice guidelines about screening and management of hearing loss in older adults, as well as reviewed references in these articles and those suggested by experts in hearing impairment. We reviewed articles for the most clinically important information, emphasizing randomized clinical trials, where available, and identified 1595 articles. Screening tests that reliably detect hearing loss are use of an audioscope, a hand-held combination otoscope and audiometer, and a self-administered questionnaire, the Hearing Handicap Inventory for the Elderly-Screening version. The value of routine screening for improving patient outcomes has not been evaluated in a randomized clinical trial. Screening is endorsed by most professional organizations, including the US Preventive Services Task Force. While most hearing loss in older adults is sensorineural and due to presbycusis, cerumen impaction and chronic otitis media may be present in up to 30% of elderly patients with hearing loss and can be treated by the primary care clinician. In randomized trials, hearing aids have been demonstrated to improve outcomes for patients with sensorineural hearing loss. Nonadherence to use of hearing aids is high. Prompt recognition of potentially reversible causes of hearing loss, such as sudden sensorineural hearing loss, is important to maximize the possibility of functional recovery. While untested in a clinical trial, older adults can be screened for hearing loss using simple methods, and effective treatments exist and are available for many forms of hearing loss.
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            Impact of a mHealth intervention for peer health workers on AIDS care in rural Uganda: a mixed methods evaluation of a cluster-randomized trial.

            Mobile phone access in low and middle-income countries is rapidly expanding and offers an opportunity to leverage limited human resources for health. We conducted a mixed methods evaluation of a cluster-randomized trial exploratory substudy on the impact of a mHealth (mobile phone) support intervention used by community-based peer health workers (PHW) on AIDS care in rural Uganda. 29 PHWs at 10 clinics were randomized by clinic to receive the intervention or not. PHWs used phones to call and text higher level providers with patient-specific clinical information. 970 patients cared for by the PHWs were followed over a 26 month period. No significant differences were found in patients' risk of virologic failure. Qualitative analyses found improvements in patient care and logistics and broad support for the mHealth intervention among patients, clinic staff, and PHWs. Key challenges identified included variable patient phone access, privacy concerns, and phone maintenance.
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              Challenges in using mobile phones for collection of antiretroviral therapy adherence data in a resource-limited setting.

              Frequent antiretroviral therapy adherence monitoring could detect incomplete adherence before viral rebound develops and thus potentially prevent treatment failure. Mobile phone technologies make frequent, brief adherence interviews possible in resource-limited settings; however, feasibility and acceptability are unknown. Interactive voice response (IVR) and short message service (SMS) text messaging were used to collect adherence data from 19 caregivers of HIV-infected children in Uganda. IVR calls or SMS quantifying missed doses were sent in the local language once weekly for 3-4 weeks. Qualitative interviews were conducted to assess participant impressions of the technologies. Participant interest and participation rates were high; however, weekly completion rates for adherence queries were low (0-33%), most commonly due to misunderstanding of personal identification numbers. Despite near ubiquity of mobile phone technology in resource-limited settings, individual level collection of healthcare data presents challenges. Further research is needed for effective training and incentive methods.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Software
                Role: Data curationRole: MethodologyRole: SoftwareRole: Visualization
                Role: Data curationRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: Data curationRole: Project administrationRole: Validation
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 October 2022
                2022
                : 17
                : 10
                : e0266858
                Affiliations
                [1 ] Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
                [2 ] Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
                [3 ] Climate and Health Unit, Tree Adoption Uganda, Kampala, Uganda
                [4 ] Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
                [5 ] Faculty of Health Sciences, Department of Community and Public Health, Busitema University, Mbale, Uganda
                Shahrood University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN
                Author notes

                Competing Interests: Dr. Charles Batte is part of the team that developed the Wulira App. Dr. Charles Batte and Dr. Andrew Weil Semulimi are directors at Wulira Health Limited that owns the Wulira App. The other authors have no conflict of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0003-0588-1559
                https://orcid.org/0000-0003-3716-1468
                https://orcid.org/0000-0002-9208-0313
                Article
                PONE-D-21-32084
                10.1371/journal.pone.0266858
                9543627
                36206261
                3549d53c-5021-4fb1-9e4c-a7be8fe1d7c6
                © 2022 Atukunda et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 October 2021
                : 28 March 2022
                Page count
                Figures: 0, Tables: 1, Pages: 13
                Funding
                Funded by: Government of Uganda through the Research and Innovation Fund Makerere University
                Award ID: MAKRIF/ DVCFA/ 026/ 20
                Award Recipient :
                Funded by: Fogarty International Centre of the National Institutes of Health
                Award ID: D43TW011401
                Award Recipient :
                Funded by: Fogarty International Centre of the National Institutes of Health
                Award ID: D43TW011401
                Award Recipient :
                Funded by: Research and Innovation Fund
                Award Recipient :
                This study was funded by the Government of Uganda through the Research and Innovation Fund Makerere University, Fund no. MAKRIF/ DVCFA/ 026/ 20. AWS and MN are research fellows of the MakNCD program supported by the Fogarty International Centre of the National Institutes of Health under Award Number D43TW011401. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Funders. IA was the Research and Innovation Fund grant recipient. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Computer and Information Sciences
                Software Engineering
                Computer Software
                Apps
                Engineering and Technology
                Software Engineering
                Computer Software
                Apps
                Medicine and Health Sciences
                Otorhinolaryngology
                Otology
                Hearing Disorders
                Deafness
                Engineering and Technology
                Equipment
                Communication Equipment
                Cell Phones
                Medicine and Health Sciences
                Otorhinolaryngology
                Otology
                Audiology
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Perception
                Sensory Perception
                Hearing
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Perception
                Sensory Perception
                Hearing
                Social Sciences
                Psychology
                Cognitive Psychology
                Perception
                Sensory Perception
                Hearing
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Hearing
                Biology and Life Sciences
                Anatomy
                Head
                Ears
                Medicine and Health Sciences
                Anatomy
                Head
                Ears
                Research and Analysis Methods
                Research Design
                Qualitative Studies
                Medicine and Health Sciences
                Public and Occupational Health
                Custom metadata
                Datasets used in the current study cannot be shared publicly because they contain identifiable participants’ information. Data are available on request for researchers who meet the criteria for access to confidential data from Makerere University School of Biomedical Sciences Research and Ethics Committee coordinator: irbbiomedicalsciences@ 123456gmail.com and the corresponding author.

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