Community-Informed Adaptation of a School-Based Hearing Health Intervention: Formative Evaluation for an Effectiveness-Implementation Trial
Alexandra E. Quimby, Meade Inglis-Jenson, Matthew J. Hirschfeld, Jo Volkheimer, Ryan Mortenson, Hannah Lane, Janet Prvu Bettger, Susan D. Emmett, Samantha Kleindienst RoblerObjectives:
The objective of this study was to identify factors to adapt the design, implementation, evaluation, and scalability of the Specialty Telemedicine Access for Referrals (STAR) model, an evidence-based model for school hearing screening and telemedicine follow-up.
Design:
The authors conducted a formative evaluation to adapt the STAR model using community feedback to codesign the intervention, implementation, and evaluation of the model in preparation for a mixed-methods, hybrid type 1 effectiveness-implementation trial in three distinct rural regions of Alaska. Using snowball sampling, the authors recruited individuals from participating regions who had experience with either school hearing screening or the ear and hearing healthcare pathway. After providing informed consent, participants completed virtual semi-structured interviews on the components of STAR (school hearing screening, telemedicine follow-up, and communication between schools, healthcare providers, and families). The authors used rapid analysis methodology to summarize the data and identify constructs. Data were then coded using four of five domains from the Consolidated Framework for Implementation Research: innovation (changes that are new to the people implementing them), individuals (attributes of people involved in the implementation), inner setting (characteristics of the organizations where the intervention is taking place), and outer setting (external factors that influence implementation). The authors developed action items to adapt the trial’s design, implementation, evaluation, and scalability.
Results:
From March to December 2022, study staff conducted 23 semi-structured interviews with individuals representing school staff, healthcare providers, and parents. The authors identified 19 Consolidated Framework for Implementation Research constructs across the four domains (innovation, individuals, inner setting, outer setting), yielding 43 actions in the following categories: STAR model adaptations, training materials, implementation plans, implementation evaluation, Community Advisory Board feedback, and scalability. Examples included revising parent forms to capture the primary care provider to support referrals, updating training materials with guidance on scheduling screening days, updating the implementation plan with guidance on privacy-compliant communication and documentation of screening results, adding measures to the implementation evaluation to document which communication platforms and pathways school staff use, seeking Community Advisory Board input on strategies to cultivate buy-in for evidence-based practices, and adding evaluation metrics to inform cost projections for scalability.
Conclusions:
This formative evaluation enabled community-informed design, implementation, and evaluation of the adapted school hearing screening and telemedicine follow-up model in an effectiveness-implementation trial. The evaluation also prompted changes to consider for expanding the reach of the model. Findings highlight the value of formative evaluations and rapid qualitative analysis methods for guiding codesigned, evidence-based interventions in hearing health research.