Design: Using mHealth technologies for hearing aid assessment and fitting, adults aged 18 and above from two low-income communities in the Western Cape, South Africa, were provided services by trained CHWs. A mHealth acclimatization and support program in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different short message service (SMS) text messages was provided to participants immediately after the hearing aid fitting. The 20 messages were sent over 45 days. A quantitative approach with illustrative open-ended questions was utilized to measure and analyze hearing aid outcomes and participant experiences, perceptions, and opinions on the community-based rehabilitation model. Data was collected through initial face-to-face interviews, telephone interviews, and face-to-face visits post-fitting. Responses to open-ended questions were analyzed using inductive thematic analysis. The International Outcome Inventory – Hearing Aids questionnaire determined standardized hearing aid outcomes.

Results: Of the 152 adults in the community who self-reported hearing difficulties, 148 were successfully tested by CHWs during home visits. Most had normal hearing (39.9%), 24.3% had bilateral sensorineural hearing loss, 20.9% had suspected conductive hearing loss, and 14.9% had unilateral hearing loss, of which 5.4% had suspected conductive loss. Forty adults met the inclusion criteria to be fitted with hearing aids. Nineteen of these were fitted bilaterally. Positive hearing aid outcomes and minimal device handling challenges were reported 45 days post-fitting and were maintained at six months, with participants describing the mHealth program as helpful, supportive, informative, sufficient, and clear. Only three participants reported that the program did not answer all their questions about the use and maintenance of hearing aids. All hearing aid management issues, such as feedback, battery use, and pain, were successfully addressed by the CHWs. The majority (73.7%) of participants were still using their hearing aids during the six-month follow-up.

Conclusions: Implementing a hearing healthcare service-delivery model facilitated by CHWsin low-income communities is feasible. mHealth technologies used by CHWs can support scalable service-delivery models with the potential for improved access and affordability in low-income settings.