Table 4 Description of intervention and usual care groups according to the Template for Intervention Description and Replication (TIDieR)
Item | TIDieR criterion | Intervention (initiative) | Usual care |
|---|---|---|---|
1 | Brief name | Hearing for Learning Initiative (HfLI): training and employment of Ear Health Facilitators. The intervention is multi-modal—training, integration, employment and service delivery to achieve the primary outcome of increase ear and hearing service enhancement | Usual Primary Health Care (PHC), plus the HfLI will provide annual half-day in-service clinical workshops during the control period if required. |
2 | Why: describe any rationale, theory or goal of the elements essential to the intervention | The NT experiences ongoing high prevalence of otitis media, hearing loss and associated disadvantage among Aboriginal children This may be explained in-part by: • Poor adherence to evidence-based guidelines in PHC • Long wait lists for specialist services and high rates of non-attendance • High turnover of remote health workforce There is evidence that • Health facilitators can improve guideline adherence • Video otoscopy by non-health professionals is as good as GPs The HfLI applies a multi-modal approach to addressing the burden of disease through expanding PHC services with local Ear Health Facilitators trained in use of new technologies for ear and hearing assessments. | Control period half-day workshops will keep control communities interested and included. Control period half-day workshops will be evaluated and are not expected to contaminate the control periods. |
3 | What (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers | Materials for training Ear Health Facilitators (EHFs) Cert II modules in Aboriginal Primary Health Care (Workplace Health and Safety, Working with Aboriginal clients, write simple workplace information) (HLT20113), delivered under a Third-Party Agreement with the Registered Training Organisation, Central Australian Remote Health Development Services, Alice Springs Ear and Hearing Health Training manual (Menzies) 2020 OM Guidelines. Otitis media guidelines for Aboriginal and Torres Strait Islander children. OMapp, posters etc. Ear and hearing surveillance equipment consist of otoscope, tympanometer, hearScreen, Parent-Evaluated Listening and Understanding Measure (PLUM) and Hear & Talk Scale (HATS). [Hearing Australia]. | Control period half-day workshops will not provide materials. PHCs have standard materials including Central Australian Rural Practitioners Association, (CARPA) manual, Guidelines for Otitis Media in Aboriginal and Torres Strait Islander populations (2020). |
4 | What (procedures): describe each of the procedures, activities or processes used in the intervention, including any enabling or support activities | We established support for the intervention through a Participation Agreement signed at Departmental level and including a Schedule of Services for each participating community which sets out the roles and responsibilities of each collaborating partner, as well as for the Ear Health Facilitator when working with the health service, community, or school. Training consists of 120 h delivered on-country during 6 weeks over a 3-month period. The first 2 weeks cover the Cert II modules, followed by 4 weeks of skills training in ear and hearing health screening including otoscopy, video otoscopy, tympanometry, and hearScreen. Integration consists of three 2-day visits by the Senior CTRO who will work with the Ear Health Facilitator and the health service to establish induction, supervision, workplans, work station and secure storage of data. Ongoing training will include advanced data management skills, obtaining informed consent and working with specialist services (audiology and tele-otology). Employment of Ear Health Facilitators in the health service (0.5FTE) will be reimbursed by the HfLI. The service will provide supervision and resources to enable day-to-day case load and priorities to be achieved. Refresher training: 6-monthly on-site visits by the CTROs will assess EHF retention | Control period half-day workshops will include theory, epidemiology, microbiology and briefing on best practice based on CARPA and 2020 OM Guidelines. Community health services provide induction for remote area nurses, doctors and Aboriginal health practitioners (AHPs) including a 1h seminar on ear and hearing health, often given in part by Menzies Ear Health Research Program staff. Training in video otoscopy and tympanometry is not generally provided. |
5 | Who provided: for each category of intervention provider (for example, psychologist, nursing assistant), describe their expertise, background and any specific training given | Trainers: registered nurses who have Cert IV in Training and Assessment are employed as Clinical Training Research Officers (CTROs). Trainees receive in-community Cert II modules in Aboriginal Primary Health Care and training in ear and hearing health, video otoscopy, tympanometry and hearScreen. Ear Health Facilitators: Ear Health Trainees are community members nominated by the Community Reference Group, health service, school and other community members. Eligibility includes live in community, speak language of the community and English, pass literacy learning numeracy, have clearance for working with children (OCHRE card) and police check. They should have an interest in the ear and hearing health of children in their community. Ear Health Trainees are paid a casual wage during training. To graduate as EHFs, the trainees must not have missed more than 2 days of training, must pass the three Cert II modules in Aboriginal Primary Health Care and have demonstrated knowledge and clinical competency in ear and hearing screening. The EHFs are selected for employment by the health service, with recommendations from the training team and Community Reference Group. The EHFs then undergo an Integration phase, delivered by a trainer together with health service staff to ensure safe and effective placement into the workforce. The Health Service is reimbursed the wages of the EHF by the HfLI until the end of the project. Service delivery: ear and hearing screening will be delivered by EHFs with supervision from a health professional. | The HfLI trainers will provide annual half-day in-service clinical workshops during the control period if required. Control period half-day workshops will be via questionnaires. |
6 | How: describe the modes of delivery (such as face to face or by some other mechanism, such as internet or telephone) of the intervention and whether it was provided individually or in a group | Training: delivered by two trainers or trainer and a community engagement officer face to face in community for a group of trainees. Appropriate venues are selected by the Community Reference Group. These should meet WHS standards, have power, bathroom facilities (wash basin) and space for 5 trainees and two trainers. Integration of the EHF within the Health Service: delivered face to face with trainer over 3 visits, plus phone support. Health service champion and supervisor to manage WHS, day to day case load. Service delivery: EHFs deliver ear and hearing screening services in community face-to-face for children 0 to 16 years of age. | Workforce: Control period half-day workshops will be evaluated via questionnaires. Service delivery: Usual care face to face ear assessments for individual children who present to the health service. School screening. |
7 | Where: describe the types of location where the intervention occurred, including any necessary infrastructure or relevant features | 20 remote or rural communities across the NT were eligible if there were at least 100 children 0 to 16 years of age and there was a PHC Service that prioritises ear and hearing health, a school and infrastructure to support training. PHC services will be provided with a video otoscope, tympanometer and hearScreen device/s for use by the EHFs. Service delivery: EHFs deliver ear and hearing services in community at home, in school, kindergarten or at the clinic. The Schedule of Services sets out the responsibilities of each partner including infrastructure requirements. | Control period half-day workshops will be evaluated via questionnaires. |
8 | When and how much: describe the number of times the intervention was delivered and over what period of time, including the number of sessions, their schedule, and their duration, intensity or dose | Training intervention: 120 h delivered on-country during 6 weeks over a 3-month period commencing at date allocated. EHF integration into Health Service: over 3 months during 3 visits by trainer in addition to phone support. Service delivery: Ear and Hearing services intervention: the EHFs (on average 0.5 FTE per community) will screen at least 100 children every 6 months in each community. The EHFs will also assist families and teachers with strategies to enhance school attendance and learning. | Control period half-day workshops will be evaluated via questionnaires. |
9 | Tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how | Training: up to five Ear Health Trainees will be paid on a casual basis to undertake the training course. Trainees must not miss more than 2 days of the 24-day course to qualify for employment as an EHF. The trainers who fly-in fly-out are not able to make up for missed training sessions for individuals. The group can negotiate most suitable dates for training to occur, within constraints of the program, flights, accommodation and commitments to other communities. Employment: the fulltime equivalent (FTE) for employment of Ear Health Facilitators will be 0.5 per community (10 FTEs in total). For statistical analyses, the target sample size for each community is 100 children seen per 6 months. Service delivery: priority children will be determined by the service and according to 2020 OM Guideline recommendations. | N/A |
10 | Modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when, how) | Not at this stage | N/A |
11 | How well (planned): if intervention adherence or fidelity was assessed, describe how and by whom; if any strategies were used to maintain or improve fidelity, describe them | All aspects of adherence will be measured. Training: attendance at training will be documented via timesheets. Fidelity will be assessed by Cert II processes and clinical competency by the trainers. Employment: strategies used to maintain or improve fidelity. The EHFs will be supported by their supervisor and nominated champion and mentor and will have regular contact via phone with their trainers. Evaluation questionnaires and interviews will be used to monitor adherence and fidelity. Service delivery: trainers will visit communities 6-monthly to deliver refresher training and identify fidelity (technical skills and data collection). Six-monthly data retrieval from the PCIS or Communicare systems will show the productivity of the intervention in terms of services delivered by the initiative. | Control period half-day workshops will be evaluated via questionnaires. |
12 | How well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned | This will be reported in terms of process and impact for workforce and health measures. | Control period half-day workshops will be evaluated via questionnaires. |