Evaluation of General Practitioners' awareness of hearing screening in the elderly

Evaluation of General Practitioners' awareness of hearing screening in the elderly | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of General Practitioners' awareness of hearing screening in the elderly Jianli Ge, Shasha Geng, Qingqing Li, Hua Jiang, Xiaoming Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-970328/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives The aim of this study is to assess the awareness of community general practitioners on hearing screening for the elderly. Methods From January to February 2019, 367 general practitioners from 12 community health service centers, distributed in urban and suburban areas of Pudong District, Shanghai, were investigated with self-designed questionnaires. Results The general practitioners had poor understandings of the definition and onset of presbycusis. The accuracy of answers regarding the high-risk factors of presbycusis was zero. The top-three common hearing screening methods selected by general practitioners were screening version of the Hearing Handicap Inventory for the Elderly (HHIE-s) (94.55%), self-auditory assessment (83.65%), and pure-tone audiometry (77.66%). As for the attitudinal evaluation of hearing screening, 49.59% of the participants thought it was highly meaningful, 48.77% thought that early intervention would have clinical benefits. However, 52.59% of the participants believed it was necessary for specialists to complete the auditory screening in the community, and 13.62% thought hearing screening was impracticable in community. Conclusion Our questionnaire suggested that general practitioners were aware of the knowledge of hearing screening and agreed with its significance. But further training is highly demanded to promote the professional skills for general practitioners in community. General Practice Geriatrics & Gerontology The elderly General Practitioners Hearing screening Presbycusis Figures Figure 1 Figure 2 Introduction The aging of population is one of the most prominent demographic changes since the late twentieth century, becoming a severe challenge for many countries. The definition of presbycusis refers to the decline of auditory function caused by aging, which is the third of most common health condition affecting older adults after heart disease and arthritis [ 1 – 2 ] . The 2nd WHO Cooperative Center for Deafness Prevention StrategicPlanConference disclosed that mild presbycusis could reduce communication and basic living abilities of the elderly and might even lead to depression or other psychological diseases in severe cases [ 3 – 4 ] . The prevalence of Alzheimer's disease in the elderly with mild, moderate, and severe hearing loss is twice, three, and five times higher than that of the elderly with normal hearing ability. It may even increase the risk of all-cause death in the elderly [ 2 ] . Presbycusis is characterized by symmetrical hearing loss in both ears at the initial stage, partly accompanied by tinnitus, which will ultimately lead to cognitive decline. Early screening and intervention for hearing loss in the elderly are expected to slow down the process, reduce the incidence of disability, and improve the quality of life [ 5 – 6 ] . Hearing screening for newborns has been carried out by primary health service centers for more than 20 years, achieving satisfying clinical results, while hearing screening for the elderly is still in its infancy [ 7 – 9 ] . The clinical standard hearing test and intervention technology model cannot consider both accuracy and cost-effectiveness. General practitioners undertake the task of non-infectious chronic diseases (NCDs) management for the elderly in the community. The management of presbycusis can refer to NCDs. Therefore, we hope to further evaluate the feasibility of community screening by general practitioners. At present, there are many studies on the screening methods of presbycusis [ 10 – 12 ] and the health beliefs of patients with hearing loss [ 13 – 14 ] , but there are few evaluations on the general practitioners' knowledge, beliefs, and practice of senile hearing screening. The purpose of our study is to evaluate the mastery of general practitioners in the knowledge of hearing screening for the elderly through a questionnaire survey and to provide basic guidance for the implementation and improvement of hearing screening in community. Methods Participants Questionnaire was designed under the guidance of audiology experts. Thirty fifth general practitioners (unlimited nature) from each one of 12 community health service centers in Pudong New District, Shanghai, with a total of 420, were recruited by convenience sampling method. Finally, 367 doctors provided effective questionnaires, and the response rate was 87.4%. Questionnaire Design The questionnaire was comprised by four sections of force-choice scales, possible responses were the following: complete, basic, general, little, and no agreement. The first section: general information Gender, age, educational background, occupation, length of service, whether receiving general practice continued training, etc. The second section: knowledge related to presbycusis According to relevant books such as “Auditory rehabilitation of the elderly” [ 15 ] and “Basic and Clinical Audiology” [16 ] , assessment of knowledge related to presbycusis was made from five aspects: definition, morbidity, diagnosis, high-risk factors, and harmful consequences. The third section: knowledge of hearing screening for the elderly Including detection and treatment of presbycusis, appropriate means in community, and methods of early intervention. The fourth section: necessity of hearing screening for the elderly in community Including self-attitude and awareness of presbycusis, frequency of hearing screening, clinical benefits of hearing screening, whether general practitioners need to receive specialist training in otolaryngology, and whether to organize continuing sub-specialty education and the general practitioners’ attitude towards conducting hearing screening Data collection Two investigators from Shanghai East Hospital who had been trained before the survey were responsible for the unified interpretation of the contents and options of the questionnaire individually. If there was any dispute about the results, the designer of questionnaire would make the final judgment. The unqualified questionnaires, with more than 5% of the core data missing, were rejected. The final questionnaire data was then extracted and double-checked for the analysis. Data analysis The questionnaire is designed by Wenjuanxing software, and the data is analyzed by SPSS 25.0 statistical software. Continuous variables are represented by mean ± SD, and categorical variable are represented by frequency and rate. Reliability and Validity of the questionnaire Reliability analysis refers to the degree of consistency of the results of repeated measurements of the same object using the same method. Reliability indicators are mostly expressed by correlation coefficient, which can be roughly divided into three categories: stability coefficient (consistency across time), equivalence coefficient (consistency across forms) and internal consistency coefficient (consistency across projects). The higher the reliability coefficient is, the more reliable the measurement is. Cronbachα is the most used reliability coefficient. Cronbach α coefficient greater than 0.60 is considered reliable [7]. In this study, Cronbach α coefficient is used to test the internal consistency of questionnaire setting. The content validity of the questionnaire was evaluated by the four experts (audiologist from Shanghai East hospital and Punan hospital) according to the standard judgment method and the items with low content validity had been deleted [8] . The procedure includes three steps: (1) determine the number of experts (≥ 3). (2) Experts evaluate the scale setting and dimensions, that is, whether the evaluation setting is complete and accurate, whether the content is consistent with the research objectives, and whether the setting can fully reflect the research scope. Results Evaluation of reliability and validity The internal reliability was evaluated through Cronbach's alpha coefficient. As a result, it was calculated to be 0.7 (Table 1 ). The validity analysis was judged by four experts, and the scale and the content validity ratio were also calculated. Table 1 Reliability statistics Cronbach's alpha after Item Deletion Cronbach's alpha Cronbach's alpha based on standardized items Number of items 0.665 0.7 9 Definition of presbycusis 0.7 Morbidity of presbycusis 0.7 Awareness rate of presbycusis 0.7 what will the elderly with hearing loss they do? 0.7 Significance of hearing screening 0.6 Appropriate frequency of hearing screening 0.6 Clinical benefit of hearing screening 0.6 Attitude toward continuing education and training for General Practice 0.6 Attitude toward sub specialist training 0.6 Demographic Categories Across The Study Population There were 87 males and 280 females among all the general practitioners, with 4.25% of them aged 20-30, 34.06% of them aged 30-40, 34.6% of them aged 40-50, and 7.08% of them aged over 50. Education background tips: Bachelor’s degree or below accounted for 86.65%, Graduate degree accounted for 13.35% separately. For the work seniority, 33.24% of them had 1 to 5-year work experience, 11.72% of them had 5 to 10-year work experience, 16.35% of them had 10 to 15-year work experience, and 38.69% of them worked for more than 15 years. The proportion of general practitioners who have received continuing general practice in the past five years was 73.39%. In addition, the proportion of those who obtained the title of attending doctor or above was 67.8%. As whole, the selected practitioners covered different ages, work seniorities, and educational levels (Table 2 ). Table 2 Demographic categories across the study population Characteristics Combined sample(n=367) Sex Male Female 87(23.7%) 280(76.3%) Education background below Bachelor degree Bachelor degree Graduate degree 23(6.3%) 295(80.4%) 49(13.4%) Age(years old) 20-30 30-40 40-50 >50 89(24.3%) 125(34.1%) 127(34.6%) 26(7.1%) Work seniority(years) 1-5 5-10 10-15 >15 122(33.2%) 43(11.7%) 60(16.4%) 142(38.7%) received general practice continuing education 269 (73.3%) Title Resident Attending Deputy director or above 118(32.2%) 221(60.2%) 28(7.6%) Evaluation Of Mastery Of The Practitioners In Relevant Knowledge Among all the selected general practitioners, 78.48% of them had general or at least basic knowledge of the definition of presbycusis, while 54.22% of them had little knowledge or even knew nothing about the incidence of presbycusis. 66.67% of the senior practitioners had full understanding of the above knowledge. Unfortunately, nobody made the right choice among the high-risk factors of presbycusis (Table 3 - 4 ). However, more than 80% of the general practitioners knew the adverse consequences of presbycusis (Table 5 ). The correlation analysis had then conducted based on the above data, suggesting that the overall awareness was positively correlated with the title and the work seniority with the corresponding Pearson coefficient of 0.109-0.152.(Table 6 ). Table 3 Definition and incidence of Presbycusis Fully understanding Basic understanding General understanding Little understanding Not understanding Definition 18[4.9%] 123[33.5%] 147[40.1%] 73[19.9%] 6[1.6%] Incidence 4[1.1%] 69[18.8%] 95[25.9%] 182[49.6%] 17[4.6%] Table 4 High- risk factors of Presbycusis Diabetes Hyper- lipedema Hyper- uricemia Hyper- tension Hypo- thyroidism Drug Cognitive impairment environment Right answers (%) 309 [84.2%] 211 [57.5%] 138 [37.6%] 275 [74.9%] 6 [1.6%] 31 [86.1%] 28 2[76.8%] 264 [71.9%] Table 5 Adverse consequences of presbycusis Emotional disorders Fall events Cognitive impairment Disability Right answers (%) 339 [92.7%] 296 [80.7%] 334 [91.0%] 349 [95.1%] Table 6 Pearson correlation analysis about overall awareness Whether hearing screening of elderly residents (over 60 years old) is of clinical significance? What is the most significant early intervention for presbycusis Early intervention of presbycusis will have clinical benefits Do you agree with the implementation of sub specialist training for general practitioners What is your attitude towards hearing screening for the elderly in community health service centers Education background -.020* . 110* .007* .011* -.057* .699** .035** .898** .835** .272** Work seniority .023* . 115* -.006* . 109* -.021* .660** .028** .912** .038** .692** Title . 110* . 126* .042 . 152** .015 . 036** . 015** .418** . 003** .767** *means: Pearson Correlation Coefficient; ** means: P valve ; P valve༜0.05 is significant correlation, P valve ༜ 0.01 is extremely significant correlation Among the five screening methods in the questionnaire, the top three popular choices are the HIEE-s (94.55%), Self-auditory assessment (83.65%), and Pure-tone audiometry (77.66%), which are more recognized recently [9,17−19] (Figure 1 ). As for the general practitioners’ understandings of the treatment methods for hearing loss in the elderly, the major four methods selected were audiphones, installation of the electronic cochlea implants, hyperbaric oxygen therapy, and psychotherapy. The result (Figure 2 ) suggested that the general practitioners had general understandings of the diagnosis and treatment of hearing loss in the elderly and were able to make preliminary recommendations. Assessment of Attitudes to Screening The stratified analysis of screening attitude evaluation was conducted, and the results show: 1) Only 7.36% of the general practitioners agreed that elderly residents had complete or at least basic knowledge of presbycusis, 18.53% of general practitioners considered that when hearing loss occurs, the elderly would go to community health service centers for help, while 32.15% of them believed they would go to comprehensive hospitals. 2) About 70% of the general practitioners thought hearing screening for the elderly certainly had clinical benefits and 52.29% of them agreed that screening should be carried out in community. 3) HHIE-s and pure-tone audiometry were more recommended by the participating general practitioners than subjective faces scale, Whispered voice test, [ 17 , 20 ] . 4) As for the intervention methods towards hearing loss, hearing screening, health check-up, and health record management are the three common items suggested by general practitioners.5) “Would you suggest that general practitioners carry out continuing education and training in ENT at present”, 32.24% of the general practitioners chose “complete agreement”, 36.24% of them chose “basic agreement”, 22.07% chose “general agreement”,7.63% chose “little agreement”, and 1.63% of them chose “ no agreement”. 6) Only 41.96% and 9.26% of general practitioners completely or basically agreed to implement sub professional training. As whole, more than 50% of the general practitioners agreed that hearing screening should be carried out at primary health centers. Therefore, they agreed that early intervention can be generally achieved through regular hearing screening, physical examination, and health record management. But both elderly and general practitioners were not fully aware of the demand for hearing screening, thus further training on basic understandings of presbycusis is highly required. More than 50% of general practitioners agree to hearing screening in primary health care centers. They also recognized early intervention through regular hearing screening, physical examination, and health education. However, the elderly and general practitioners are not fully aware of the importance of regular hearing screening at the grass-roots level, so it is necessary to further strengthen professional training and health education. Discussion Nowadays, hearing loss is associated with many co-morbidities, including poorer physical health, anxiety, depression, loneliness, and isolation [ 21 – 24 ] . Despite its high prevalence, which has a significant negative impact on the quality of life and social burden, hearing loss has not been adequately treated. According to data from the Centers for Disease Control of (USA) in 2013, less than a quarter of the elderly received hearing screening. There is no unified data of the elderly in China [ 25 ] . In the United States, only one in seven adults aged 50 and older used hearing aids, with fewer than 1 in 20 working adults aged 50–70 years doing so [ 26 ] . The number of studies on hearing aid use and its related factors is extremely limited in developing countries [ 27 ] . Nearly one-third of the hearing loss patients believed they were in sub-health state, while only 9% of normal-hearing patients considered they might be in poor health [ 28 ] . Findings suggest that hearing loss has a negative impact on independence levels and thus quality of life in older people as they heavily rely on family and their community for support [ 29 ] . Perhaps earlier detection and diagnosis of hearing loss would allow for more successful treatment and rehabilitation to help retain independence and cognition which is vital in improving quality of life [ 30 ] 。Therefore, it is highly required for us to pay attention to presbycusis. At present, most studies focus on the mechanism of hearing loss and the development of portable and simple hearing screening tools [ 31–32] . The existing hearing screening mode need to be further optimized in the aspects of human and material costs, professional requirements, object compliance, specificity, and sensitivity of screening. General practitioners can provide clinical care, prevention, treatment and decision-making between doctors and patients. They are the suitable people to implement technologies which can reduce medical costs and health system costs [ 33 – 34 ] . For the elderly, hearing screening by general practitioners in community is a good choice. The questionnaire results showed that only 18.53% of general practitioners thought that community health service center should be the first choice for hearing loss of the elderly. Although they basically agree with the significance and intervention value of hearing screening for the elderly, but their willingness to screen is not synchronous, and their views on the implementation strategy are not the same. We need to further explore the reasons and accessibility measures. In 2020, World Organization of National Colleges (WONCA) applied post competency to the field of general practice, and proposed “WONCA tree model”, including 6 general practitioners’ competency, which are as follows: primary care management, community orientation, Specific problem-solving skills, comprehensive approach, person-centered care, holistic approach. By 2020, China had initially established a general practitioner system, and basically formed a unified and standardized general practitioner training mode and the service mode of first visit at primary medicine. However, the training mode of general practitioners is not perfect. The training of general practitioners is mainly focused on internal medicine and health management, but the knowledge of Ophthalmology, pediatrics, ENT, gynecology, dermatology and so on is truly little. At the same time, our questionnaire also reflects that the self-confidence of general practitioners is not high, and only 41.96% have a strong desire to obtain all kinds of specialist training. Therefore, the implementation of multi-channel continuing medical education (CME) will improve the comprehensive ability of general practitioners and promote their self-confidence, which is an important foundation for the implementation of hierarchical diagnosis and treatment, the realization of chronic disease management and the promotion of healthy aging [ 35 ] . In addition, we need to consider the following points so as to promote the general practitioners carrying out hearing screening for the elderly actively. First, we should establish a performance system to link the workload and income of hearing screening. Secondly, we need to evaluate the cost-effectiveness of hearing screening, including technical cost, labor cost, case cost, false-positive cost, etc. Therefore, the hearing screening of the elderly in the community depends on the further resources and financial support of the government. Strengths And Limitations The questionnaire was designed by us. The subjects were general practitioners. The questionnaire involves three aspects: knowledge, attitude, and practice. Only some urban areas participated in the questionnaire. The conclusion of the questionnaire has certain promotional significance. It is suggested to increase participants from different regions and backgrounds. Abbreviations Not applicable. Declarations Ethics approval and consent to participate ： Not applicable. Ethics Committee of Shanghai East Hospital, Tongji University School of Medicine Approval No. [2019] No. 028 My submission was performed in accordance with the Declaration of Helsinki . Consent for publication: Written informed consent for publication was obtained from all participants. Availability of data and material: All data generated or analyzed during this study are included in this published article and its supplementary information files. All authors agree to the data sharing. Conflicts of Interest: The authors have no competing interests. Funding: Scientific research project of Shanghai Health and Family Planning Commission (201940235) Authors' contributions: JLG: the conception and design and write of the work SSG: collection and interpretation of data QQL: analysis and interpretation of data HJ: the conception and design of the work XMS: substantively revised and approve the submitted version ALL authors have read and approved the manuscript and ensure that this is the case Acknowledgments: The authors express thanks to Professor Jirong Duan from Hearing Clinic, Punan Hospital, Shanghai. References 1.Lethbridge-Cejku M, Schiller JS, Bernadel L. 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Screening of hearing in elderly people: assessment of accuracy and reproducibility of the whispered voice test. Ciencia Saude Colet. 2017 Nov;22(11):3589-3598. 34.Yuan J，Zhao X，Hu Y，et a1．Autophagy regulates the degeneration of the auditory cortex through the AMPK-mTOR-ULK1 signaling pathway [J]．Int J Mol Med，2018，4l (4): 2086- 2098. 35.Saunders GH, Frederick MT, Arnold ML,et al, Hearing Screening in the Community. J Am Acad Audiol, 2019 Feb;30(2):145-152. Additional Declarations No competing interests reported. Supplementary Files Questionnaireforarticle.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-970328","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":60385891,"identity":"7ee305dd-a7ca-4675-801e-6cacabdb6a92","order_by":0,"name":"Jianli Ge","email":"","orcid":"","institution":"Zhongshan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianli","middleName":"","lastName":"Ge","suffix":""},{"id":60385892,"identity":"22a7afad-fbab-411f-9073-589b7752763f","order_by":1,"name":"Shasha Geng","email":"","orcid":"","institution":"Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shasha","middleName":"","lastName":"Geng","suffix":""},{"id":60385893,"identity":"b22bebd2-bae1-46f4-8fd1-b1aba087a1d4","order_by":2,"name":"Qingqing Li","email":"","orcid":"","institution":"Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qingqing","middleName":"","lastName":"Li","suffix":""},{"id":60385894,"identity":"41d4305a-c5f5-4729-9d8d-6cccff0c3004","order_by":3,"name":"Hua Jiang","email":"","orcid":"","institution":"Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Jiang","suffix":""},{"id":60385895,"identity":"4692caee-3733-4786-aa20-c0da6975a1c4","order_by":4,"name":"Xiaoming Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYPACGx42/uYDDA8MiNeSJscvcSyBIYEELYeNJRtyDBgSiFFrcO0A82feHcyJGw6c+fghoeBw4nYG5oePbuDRIjk7gU2a9wxb4obDvZslEgwOJ+5sYDM2zsGjhV86gY2Zt40HaMvZDWAtGw7wsEnj08ImnQB0WJsEUGXO4x9EaQHawiDN22YA8j4bcbaA/CI5ty0BFMhmFgkG6cYbDhPwi8HtBOYPb9v+g6Ly8Y0Pf6xlNxxvfvgYnxag0z4g85oZGJjxKscEdSSqHwWjYBSMgpEAAP2iTfjpmxv+AAAAAElFTkSuQmCC","orcid":"","institution":"Zhongshan Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiaoming","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2021-10-15 06:29:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-970328/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-970328/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":15148039,"identity":"6a28073a-7086-4970-b049-32e9f36332b7","added_by":"auto","created_at":"2021-11-02 15:42:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7380,"visible":true,"origin":"","legend":"Screening of presbycusis ","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-970328/v1/ac27149cc2f21dc78398ce2d.png"},{"id":15148040,"identity":"8ce56f4a-8e60-4257-b8b3-35c2c2217146","added_by":"auto","created_at":"2021-11-02 15:42:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7922,"visible":true,"origin":"","legend":"Screening of presbycusis","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-970328/v1/29d57072396a646c7200d0a4.png"},{"id":16127445,"identity":"e7528822-ff8f-4abb-83cb-1140ebb21ed3","added_by":"auto","created_at":"2021-12-03 01:59:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":501493,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-970328/v1/b4497837-aad5-4902-ae76-c6fb622d8e6a.pdf"},{"id":15148041,"identity":"d2094896-5cc0-4557-8b35-bb68e5e67283","added_by":"auto","created_at":"2021-11-02 15:42:15","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":80326,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaireforarticle.pdf","url":"https://assets-eu.researchsquare.com/files/rs-970328/v1/bcada6bbe48dad0d07703494.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of General Practitioners' awareness of hearing screening in the elderly","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe aging of population is one of the most prominent demographic changes since the late twentieth century, becoming a severe challenge for many countries. The definition of presbycusis refers to the decline of auditory function caused by aging, which is the third of most common health condition affecting older adults after heart disease and arthritis \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The 2nd WHO Cooperative Center for Deafness Prevention StrategicPlanConference disclosed that mild presbycusis could reduce communication and basic living abilities of the elderly and might even lead to depression or other psychological diseases in severe cases \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The prevalence of Alzheimer's disease in the elderly with mild, moderate, and severe hearing loss is twice, three, and five times higher than that of the elderly with normal hearing ability. It may even increase the risk of all-cause death in the elderly \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePresbycusis is characterized by symmetrical hearing loss in both ears at the initial stage, partly accompanied by tinnitus, which will ultimately lead to cognitive decline. Early screening and intervention for hearing loss in the elderly are expected to slow down the process, reduce the incidence of disability, and improve the quality of life \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHearing screening for newborns has been carried out by primary health service centers for more than 20 years, achieving satisfying clinical results, while hearing screening for the elderly is still in its infancy \u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The clinical standard hearing test and intervention technology model cannot consider both accuracy and cost-effectiveness. General practitioners undertake the task of non-infectious chronic diseases (NCDs) management for the elderly in the community. The management of presbycusis can refer to NCDs. Therefore, we hope to further evaluate the feasibility of community screening by general practitioners.\u003c/p\u003e \u003cp\u003eAt present, there are many studies on the screening methods of presbycusis \u003csup\u003e[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e and the health beliefs of patients with hearing loss \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, but there are few evaluations on the general practitioners' knowledge, beliefs, and practice of senile hearing screening. The purpose of our study is to evaluate the mastery of general practitioners in the knowledge of hearing screening for the elderly through a questionnaire survey and to provide basic guidance for the implementation and improvement of hearing screening in community.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuestionnaire was designed under the guidance of audiology experts. Thirty fifth general practitioners (unlimited nature) from each one of 12 community health service centers in Pudong New District, Shanghai, with a total of 420, were recruited by convenience sampling method. Finally, 367 doctors provided effective questionnaires, and the response rate was 87.4%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was comprised by four sections of force-choice scales, possible responses were the following: complete, basic, general, little, and no agreement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe first section: general information\u003c/p\u003e\n\u003cp\u003eGender, age, educational background, occupation, length of service, whether receiving general practice continued training, etc.\u003c/p\u003e\n\u003cp\u003eThe second section: knowledge related to presbycusis\u003c/p\u003e\n\u003cp\u003eAccording to relevant books such as \u0026ldquo;Auditory rehabilitation of the elderly\u0026rdquo;\u0026nbsp;\u003csup\u003e[ 15 ]\u003c/sup\u003eand \u0026ldquo;Basic and Clinical Audiology\u0026rdquo;\u003csup\u003e\u0026nbsp;[16 ]\u003c/sup\u003e, assessment of knowledge related to presbycusis was made from five aspects: definition, morbidity, diagnosis, high-risk factors, and harmful consequences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe third section: knowledge of hearing screening for the elderly\u003c/p\u003e\n\u003cp\u003eIncluding detection and treatment of presbycusis, appropriate means in community, and methods of early intervention.\u003c/p\u003e\n\u003cp\u003eThe fourth section: necessity of hearing screening for the elderly in community\u003c/p\u003e\n\u003cp\u003eIncluding self-attitude and awareness of presbycusis, frequency of hearing screening, clinical benefits of hearing screening, whether general practitioners need to receive specialist training in otolaryngology, and whether to organize continuing sub-specialty education and the general practitioners\u0026rsquo; attitude towards conducting hearing screening\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo investigators from Shanghai East Hospital who had been trained before the survey were responsible for the unified interpretation of the contents and options of the questionnaire individually. If there was any dispute about the results, the designer of questionnaire would make the final judgment. The unqualified questionnaires, with more than 5% of the core data missing, were rejected. The final questionnaire data was then extracted and double-checked for the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire is designed by Wenjuanxing software, and the data is analyzed by SPSS 25.0 statistical software. Continuous variables are represented by mean \u0026plusmn; SD, and categorical variable are represented by frequency and rate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability and Validity of the questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReliability analysis refers to the degree of consistency of the results of repeated measurements of the same object using the same method. Reliability indicators are mostly expressed by correlation coefficient, which can be roughly divided into three categories: stability coefficient (consistency across time), equivalence coefficient (consistency across forms) and internal consistency coefficient (consistency across projects). The higher the reliability coefficient is, the more reliable the measurement is. Cronbach\u0026alpha; is the most used reliability coefficient. Cronbach \u0026alpha; coefficient greater than 0.60 is considered reliable \u003csup\u003e[7].\u003c/sup\u003e In this study, Cronbach \u0026alpha; coefficient is used to test the internal consistency of questionnaire setting.\u003c/p\u003e\n\u003cp\u003eThe content validity of the questionnaire was evaluated by the four experts (audiologist from Shanghai East hospital and Punan hospital) according to the standard judgment method and the items with low content validity had been deleted \u003csup\u003e[8]\u003c/sup\u003e. The procedure includes three steps: (1) determine the number of experts (\u0026ge; 3). (2) Experts evaluate the scale setting and dimensions, that is, whether the evaluation setting is complete and accurate, whether the content is consistent with the research objectives, and whether the setting can fully reflect the research scope.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of reliability and validity\u003c/h2\u003e \u003cp\u003eThe internal reliability was evaluated through Cronbach's alpha coefficient. As a result, it was calculated to be 0.7 (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The validity analysis was judged by four experts, and the scale and the content validity ratio were also calculated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReliability statistics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCronbach's alpha after Item Deletion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach's alpha\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCronbach's alpha based on standardized items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefinition of presbycusis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorbidity of presbycusis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness rate of presbycusis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewhat will the elderly with hearing loss they do?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance of hearing screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppropriate frequency of hearing screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical benefit of hearing screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude toward continuing education and training for General Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude toward sub specialist training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch2\u003eDemographic Categories Across The Study Population\u003c/h2\u003e\n\u003cp\u003eThere were 87 males and 280 females among all the general practitioners, with 4.25% of them aged 20-30, 34.06% of them aged 30-40, 34.6% of them aged 40-50, and 7.08% of them aged over 50. Education background tips: Bachelor\u0026rsquo;s degree or below accounted for 86.65%, Graduate degree accounted for 13.35% separately. For the work seniority, 33.24% of them had 1 to 5-year work experience, 11.72% of them had 5 to 10-year work experience, 16.35% of them had 10 to 15-year work experience, and 38.69% of them worked for more than 15 years. The proportion of general practitioners who have received continuing general practice in the past five years was 73.39%. In addition, the proportion of those who obtained the title of attending doctor or above was 67.8%. As whole, the selected practitioners covered different ages, work seniorities, and educational levels (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic categories across the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombined sample(n=367)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87(23.7%)\u003c/p\u003e \u003cp\u003e280(76.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation background\u003c/p\u003e \u003cp\u003ebelow Bachelor degree\u003c/p\u003e \u003cp\u003eBachelor degree\u003c/p\u003e \u003cp\u003eGraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(6.3%)\u003c/p\u003e \u003cp\u003e295(80.4%)\u003c/p\u003e \u003cp\u003e49(13.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years old)\u003c/p\u003e \u003cp\u003e20-30\u003c/p\u003e \u003cp\u003e30-40\u003c/p\u003e \u003cp\u003e40-50\u003c/p\u003e \u003cp\u003e\u0026gt;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89(24.3%)\u003c/p\u003e \u003cp\u003e125(34.1%)\u003c/p\u003e \u003cp\u003e127(34.6%)\u003c/p\u003e \u003cp\u003e26(7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork seniority(years)\u003c/p\u003e \u003cp\u003e1-5\u003c/p\u003e \u003cp\u003e5-10\u003c/p\u003e \u003cp\u003e10-15\u003c/p\u003e \u003cp\u003e\u0026gt;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122(33.2%)\u003c/p\u003e \u003cp\u003e43(11.7%)\u003c/p\u003e \u003cp\u003e60(16.4%)\u003c/p\u003e \u003cp\u003e142(38.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ereceived general practice continuing education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e269 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003cp\u003eResident\u003c/p\u003e \u003cp\u003eAttending\u003c/p\u003e \u003cp\u003eDeputy director or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118(32.2%)\u003c/p\u003e \u003cp\u003e221(60.2%)\u003c/p\u003e \u003cp\u003e28(7.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch2\u003eEvaluation Of Mastery Of The Practitioners In Relevant Knowledge\u003c/h2\u003e\n\u003cp\u003eAmong all the selected general practitioners, 78.48% of them had general or at least basic knowledge of the definition of presbycusis, while 54.22% of them had little knowledge or even knew nothing about the incidence of presbycusis. 66.67% of the senior practitioners had full understanding of the above knowledge. Unfortunately, nobody made the right choice among the high-risk factors of presbycusis (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e-\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, more than 80% of the general practitioners knew the adverse consequences of presbycusis (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The correlation analysis had then conducted based on the above data, suggesting that the overall awareness was positively correlated with the title and the work seniority with the corresponding Pearson coefficient of 0.109-0.152.(Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDefinition and incidence of Presbycusis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully understanding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBasic understanding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGeneral understanding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLittle understanding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNot understanding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18[4.9%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123[33.5%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e147[40.1%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73[19.9%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6[1.6%]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4[1.1%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69[18.8%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95[25.9%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e182[49.6%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17[4.6%]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHigh- risk factors of Presbycusis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHyper-\u003c/p\u003e \u003cp\u003elipedema\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHyper-\u003c/p\u003e \u003cp\u003euricemia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHyper-\u003c/p\u003e \u003cp\u003etension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHypo-\u003c/p\u003e \u003cp\u003ethyroidism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDrug\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCognitive impairment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eenvironment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight answers (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e309\u003c/p\u003e \u003cp\u003e[84.2%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211\u003c/p\u003e \u003cp\u003e[57.5%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138\u003c/p\u003e \u003cp\u003e[37.6%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e275\u003c/p\u003e \u003cp\u003e[74.9%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e[1.6%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e[86.1%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e2[76.8%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e264\u003c/p\u003e \u003cp\u003e[71.9%]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdverse consequences of presbycusis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional disorders\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFall events\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCognitive impairment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDisability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight answers (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e339\u003c/p\u003e \u003cp\u003e[92.7%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e296\u003c/p\u003e \u003cp\u003e[80.7%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e334\u003c/p\u003e \u003cp\u003e[91.0%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e349\u003c/p\u003e \u003cp\u003e[95.1%]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation analysis about overall awareness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWhether hearing screening of elderly residents (over 60 years old) is of clinical significance?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eWhat is the most significant early intervention for presbycusis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEarly intervention of presbycusis will have clinical benefits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDo you agree with the implementation of sub specialist training for general practitioners\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eWhat is your attitude towards hearing screening for the elderly in community health service centers\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e-.020*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e.\u003cem\u003e110*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e.007*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.011*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-.057*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e.699**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.035**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e.898**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.835**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.272**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWork seniority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e.023*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e.\u003cem\u003e115*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-.006*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003cem\u003e109*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-.021*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e.660**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.028**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e.912**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e.038**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.692**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e.\u003cem\u003e110*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e.\u003cem\u003e126*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003cem\u003e152**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e.\u003cem\u003e036**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e.\u003cem\u003e015**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e.418**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003cem\u003e003**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.767**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e*means: Pearson Correlation Coefficient; ** means: P valve ; P valve༜0.05 is significant correlation, P valve ༜ 0.01 is extremely significant correlation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the five screening methods in the questionnaire, the top three popular choices are the HIEE-s (94.55%), Self-auditory assessment (83.65%), and Pure-tone audiometry (77.66%), which are more recognized recently \u003csup\u003e[9,17\u0026minus;19]\u003c/sup\u003e (Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). As for the general practitioners\u0026rsquo; understandings of the treatment methods for hearing loss in the elderly, the major four methods selected were audiphones, installation of the electronic cochlea implants, hyperbaric oxygen therapy, and psychotherapy. The result (Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) suggested that the general practitioners had general understandings of the diagnosis and treatment of hearing loss in the elderly and were able to make preliminary recommendations.\u003c/p\u003e\u003cp\u003eAssessment of Attitudes to Screening\u003c/p\u003e \u003cp\u003eThe stratified analysis of screening attitude evaluation was conducted, and the results show: 1) Only 7.36% of the general practitioners agreed that elderly residents had complete or at least basic knowledge of presbycusis, 18.53% of general practitioners considered that when hearing loss occurs, the elderly would go to community health service centers for help, while 32.15% of them believed they would go to comprehensive hospitals. 2) About 70% of the general practitioners thought hearing screening for the elderly certainly had clinical benefits and 52.29% of them agreed that screening should be carried out in community. 3) HHIE-s and pure-tone audiometry were more recommended by the participating general practitioners than subjective faces scale, Whispered voice test, \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. 4) As for the intervention methods towards hearing loss, hearing screening, health check-up, and health record management are the three common items suggested by general practitioners.5) \u0026ldquo;Would you suggest that general practitioners carry out continuing education and training in ENT at present\u0026rdquo;, 32.24% of the general practitioners chose \u0026ldquo;complete agreement\u0026rdquo;, 36.24% of them chose \u0026ldquo;basic agreement\u0026rdquo;, 22.07% chose \u0026ldquo;general agreement\u0026rdquo;,7.63% chose \u0026ldquo;little agreement\u0026rdquo;, and 1.63% of them chose \u0026ldquo; no agreement\u0026rdquo;. 6) Only 41.96% and 9.26% of general practitioners completely or basically agreed to implement sub professional training. As whole, more than 50% of the general practitioners agreed that hearing screening should be carried out at primary health centers. Therefore, they agreed that early intervention can be generally achieved through regular hearing screening, physical examination, and health record management. But both elderly and general practitioners were not fully aware of the demand for hearing screening, thus further training on basic understandings of presbycusis is highly required.\u003c/p\u003e \u003cp\u003eMore than 50% of general practitioners agree to hearing screening in primary health care centers. They also recognized early intervention through regular hearing screening, physical examination, and health education. However, the elderly and general practitioners are not fully aware of the importance of regular hearing screening at the grass-roots level, so it is necessary to further strengthen professional training and health education.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNowadays, hearing loss is associated with many co-morbidities, including poorer physical health, anxiety, depression, loneliness, and isolation \u003csup\u003e[\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Despite its high prevalence, which has a significant negative impact on the quality of life and social burden, hearing loss has not been adequately treated.\u003c/p\u003e \u003cp\u003eAccording to data from the Centers for Disease Control of (USA) in 2013, less than a quarter of the elderly received hearing screening. There is no unified data of the elderly in China \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In the United States, only one in seven adults aged 50 and older used hearing aids, with fewer than 1 in 20 working adults aged 50\u0026ndash;70 years doing so \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The number of studies on hearing aid use and its related factors is extremely limited in developing countries \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Nearly one-third of the hearing loss patients believed they were in sub-health state, while only 9% of normal-hearing patients considered they might be in poor health \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Findings suggest that hearing loss has a negative impact on independence levels and thus quality of life in older people as they heavily rely on family and their community for support \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Perhaps earlier detection and diagnosis of hearing loss would allow for more successful treatment and rehabilitation to help retain independence and cognition which is vital in improving quality of life \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e。Therefore, it is highly required for us to pay attention to presbycusis.\u003c/p\u003e \u003cp\u003eAt present, most studies focus on the mechanism of hearing loss and the development of portable and simple hearing screening tools \u003csup\u003e[ 31\u0026ndash;32]\u003c/sup\u003e. The existing hearing screening mode need to be further optimized in the aspects of human and material costs, professional requirements, object compliance, specificity, and sensitivity of screening. General practitioners can provide clinical care, prevention, treatment and decision-making between doctors and patients. They are the suitable people to implement technologies which can reduce medical costs and health system costs \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. For the elderly, hearing screening by general practitioners in community is a good choice.\u003c/p\u003e \u003cp\u003eThe questionnaire results showed that only 18.53% of general practitioners thought that community health service center should be the first choice for hearing loss of the elderly. Although they basically agree with the significance and intervention value of hearing screening for the elderly, but their willingness to screen is not synchronous, and their views on the implementation strategy are not the same. We need to further explore the reasons and accessibility measures.\u003c/p\u003e \u003cp\u003eIn 2020, World Organization of National Colleges (WONCA) applied post competency to the field of general practice, and proposed \u0026ldquo;WONCA tree model\u0026rdquo;, including 6 general practitioners\u0026rsquo; competency, which are as follows: primary care management, community orientation, Specific problem-solving skills, comprehensive approach, person-centered care, holistic approach. By 2020, China had initially established a general practitioner system, and basically formed a unified and standardized general practitioner training mode and the service mode of first visit at primary medicine. However, the training mode of general practitioners is not perfect. The training of general practitioners is mainly focused on internal medicine and health management, but the knowledge of Ophthalmology, pediatrics, ENT, gynecology, dermatology and so on is truly little. At the same time, our questionnaire also reflects that the self-confidence of general practitioners is not high, and only 41.96% have a strong desire to obtain all kinds of specialist training. Therefore, the implementation of multi-channel continuing medical education (CME) will improve the comprehensive ability of general practitioners and promote their self-confidence, which is an important foundation for the implementation of hierarchical diagnosis and treatment, the realization of chronic disease management and the promotion of healthy aging \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, we need to consider the following points so as to promote the general practitioners carrying out hearing screening for the elderly actively. First, we should establish a performance system to link the workload and income of hearing screening. Secondly, we need to evaluate the cost-effectiveness of hearing screening, including technical cost, labor cost, case cost, false-positive cost, etc. Therefore, the hearing screening of the elderly in the community depends on the further resources and financial support of the government.\u003c/p\u003e "},{"header":"Strengths And Limitations","content":"\u003cp\u003eThe questionnaire was designed by us.\u003c/p\u003e \u003cp\u003eThe subjects were general practitioners.\u003c/p\u003e \u003cp\u003eThe questionnaire involves three aspects: knowledge, attitude, and practice.\u003c/p\u003e \u003cp\u003eOnly some urban areas participated in the questionnaire.\u003c/p\u003e \u003cp\u003eThe conclusion of the questionnaire has certain promotional significance. It is suggested to increase participants from different regions and backgrounds.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eEthics Committee of Shanghai East Hospital, Tongji University School of Medicine\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eApproval No. [2019] No. 028\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMy submission was performed in accordance with the Declaration of Helsinki .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files. All authors agree to the data sharing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScientific research project of Shanghai\u0026ensp;Health\u0026ensp;and\u0026ensp;Family\u0026ensp;Planning\u0026ensp;Commission\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(201940235)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJLG: the conception and design and write of the work\u003c/p\u003e\n\u003cp\u003eSSG: collection and interpretation of data\u003c/p\u003e\n\u003cp\u003eQQL: analysis and interpretation of data\u003c/p\u003e\n\u003cp\u003eHJ: the conception and design of the work\u003c/p\u003e\n\u003cp\u003eXMS:\u0026nbsp;substantively revised and approve the submitted version\u003c/p\u003e\n\u003cp\u003eALL authors have read and approved the manuscript and ensure that this is the case\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express thanks to Professor Jirong Duan from Hearing Clinic, Punan Hospital, Shanghai.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.Lethbridge-Cejku M, Schiller JS, Bernadel L. 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A systematic review of studies measuring and reporting hearing aid usage in older adults since 1999: a descriptive summary of measurement tools.\u0026nbsp;PLoS One.\u0026nbsp;2012;7(3): e31831.\u003c/p\u003e\n\u003cp\u003e25. Lin FR, Niparko JK, Ferrucci L, Hearing Loss Prevalence in the United states[J] Archives of Internal Medicine, 2011, 171(20): 1851- 1852．\u003c/p\u003e\n\u003cp\u003e26.\u0026nbsp;Sarant J, Harris D, Busby P, Maruff P, Schembri A, Lemke U, Launer S. The\u003c/p\u003e\n\u003cp\u003eEffect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or\u003c/p\u003e\n\u003cp\u003eEven Improve Cognitive Function? J Clin Med. 2020 Jan 17;9(1):254.\u003c/p\u003e\n\u003cp\u003e27.\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=He+P\u0026cauthor_id=29267059\"\u003ePing He\u003c/a\u003e ,\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Wen+X\u0026cauthor_id=29267059\"\u003eXu Wen\u003c/a\u003e \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/29267059/#affiliation-1\"\u003e1\u003c/a\u003e, \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Hu+X\u0026cauthor_id=29267059\"\u003eXiangyang Hu\u003c/a\u003e , \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Gong+R\u0026cauthor_id=29267059\"\u003eRui Gong\u003c/a\u003e \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/29267059/#affiliation-1\"\u003e1\u003c/a\u003e, \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Luo+Y\u0026cauthor_id=29267059\"\u003eYanan Luo\u003c/a\u003e , \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Guo+C\u0026cauthor_id=29267059\"\u003eChao Guo\u003c/a\u003e , \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Chen+G\u0026cauthor_id=29267059\"\u003eGong Chen\u003c/a\u003e , \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Zheng+X\u0026cauthor_id=29267059\"\u003eXiaoying Zheng\u003c/a\u003e , Hearing Aid Acquisition in Chinese Older Adults with Hearing Loss. 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PMID: 25736468.\u003c/p\u003e\n\u003cp\u003e31. \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Margolis+RH\u0026cauthor_id=17252960\"\u003eRobert H Margolis\u003c/a\u003e \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/17252960/#affiliation-1\"\u003e1\u003c/a\u003e, \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Saly+GL\u0026cauthor_id=17252960\"\u003eGeorge L Saly\u003c/a\u003e, \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Le+C\u0026cauthor_id=17252960\"\u003eChap Le\u003c/a\u003e, \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Laurence+J\u0026cauthor_id=17252960\"\u003eJessica Laurence\u003c/a\u003e, Qualind: A method for assessing the accuracy of automated tests. Journal of the American Academy of Audiology, 2007, 18(1): 78-89.\u003c/p\u003e\n\u003cp\u003e32. Schulz S, Ritter J, Oertel K, Witt K, B\u0026auml;r KJ, Guntinas-Lichius O, Voss A.\u003c/p\u003e\n\u003cp\u003eAltered autonomic regulation as a cardiovascular risk marker for patients with\u003c/p\u003e\n\u003cp\u003esudden sensorineural hearing loss. Otology and Neurotology, 2014, Dec;35(10):1720-9.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e33. Labanca L, Guimar\u0026atilde;es FS, Costa-Guarisco LP, Couto EAB, Gon\u0026ccedil;alves DU. Screening of hearing in elderly people: assessment of accuracy and reproducibility of the whispered voice test. Ciencia Saude Colet. 2017 Nov;22(11):3589-3598.\u003c/p\u003e\n\u003cp\u003e34.Yuan J，Zhao X，Hu Y，et a1．Autophagy regulates the degeneration of the auditory cortex through the AMPK-mTOR-ULK1 signaling pathway [J]．Int J Mol Med，2018，4l (4): 2086- 2098.\u003c/p\u003e\n\u003cp\u003e35.Saunders GH, Frederick MT, Arnold ML,et al, Hearing Screening in the Community. J Am Acad Audiol, 2019 Feb;30(2):145-152.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"The elderly, General Practitioners, Hearing screening, Presbycusis","lastPublishedDoi":"10.21203/rs.3.rs-970328/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-970328/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe aim of this study is to assess the awareness of community general practitioners on hearing screening for the elderly.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFrom January to February 2019, 367 general practitioners from 12 community health service centers, distributed in urban and suburban areas of Pudong District, Shanghai, were investigated with self-designed questionnaires.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe general practitioners had poor understandings of the definition and onset of presbycusis. The accuracy of answers regarding the high-risk factors of presbycusis was zero. The top-three common hearing screening methods selected by general practitioners were screening version of the Hearing Handicap Inventory for the Elderly (HHIE-s) (94.55%), self-auditory assessment (83.65%), and pure-tone audiometry (77.66%). As for the attitudinal evaluation of hearing screening, 49.59% of the participants thought it was highly meaningful, 48.77% thought that early intervention would have clinical benefits. However, 52.59% of the participants believed it was necessary for specialists to complete the auditory screening in the community, and 13.62% thought hearing screening was impracticable in community.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e Our questionnaire suggested that general practitioners were aware of the knowledge of hearing screening and agreed with its significance. But further training is highly demanded to promote the professional skills for general practitioners in community.\u003c/p\u003e","manuscriptTitle":"Evaluation of General Practitioners' awareness of hearing screening in the elderly","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-11-02 15:42:12","doi":"10.21203/rs.3.rs-970328/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a98ce052-5a25-4932-baf3-07fc6456c6bc","owner":[],"postedDate":"November 2nd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":8264745,"name":"General Practice"},{"id":8264746,"name":"Geriatrics \u0026 Gerontology"}],"tags":[],"updatedAt":"2021-12-03T01:59:02+00:00","versionOfRecord":[],"versionCreatedAt":"2021-11-02 15:42:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-970328","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-970328","identity":"rs-970328","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}