Bringing hearing screenings closer to the community: Lessons from Shanghai

In China, as in many countries, one of the persistent challenges in hearing care is reaching people who may have hearing loss but have not yet sought professional support.

Traditional pathways often rely on individuals recognizing a hearing difficulty and deciding to act before seeking specialist care. For some people, that journey may take time. This raises an important question for hearing care professionals: Could hearing screening become more accessible if it were incorporated into services and settings that people already use?

In Shanghai, our team has been exploring this question through community-based hearing initiatives in two different environments: a neighborhood community health service center and a university community.

Although these initiatives are still being evaluated, our early experience provides practical insights into how hearing care might be brought closer to the communities we serve.

Integrating hearing screening into community health services

Community health service centers play an important role in primary care in China. These neighborhood-based facilities provide routine health services and chronic disease management. They also offer annual health examinations, particularly for older residents.

They therefore provide an opportunity to reach people who may not otherwise seek a hearing assessment. At Hua-Jing Community Health Service Center in Shanghai, we incorporated hearing screening into existing community health activities rather than asking residents to make a separate visit to a hearing clinic.

The pathway began with a short hearing questionnaire and a digit triplet test. Pure-tone screening was then available in a mobile testing van outside the center. This was important because the health center itself did not have dedicated audiological facilities.

Over approximately two months and 26 service days, more than 1,100 people participated in hearing-related screening activities. Of these, 251 completed the pure-tone screening in the mobile van.

Among this group, approximately one-third were classified as having mild hearing loss (26-40 dB HL). More than half were classified as having moderate hearing loss (41-60 dB HL), while approximately 11% were classified as having severe hearing loss (61-80 dB HL).

These findings should be interpreted cautiously. The participants who completed pure-tone screening were not necessarily representative of the wider community, and this initiative was not designed as a population prevalence study.

However, the experience demonstrated the feasibility of adding hearing screening to an existing community health pathway. For many participants, it was also an opportunity to receive objective information about their hearing without first having to initiate a specialist appointment.

Extending hearing care into community settings

Our second initiative explored whether a familiar, non-clinical environment could also make it easier for people to engage with hearing care. Working with the Shanghai Jiao Tong University community, we invited participants, including retirees and alumni, to take part in hearing activities connected with a visit to the university’s history museum.

Participants completed hearing screening activities and had opportunities to speak informally with hearing care professionals. Some also experienced hearing aids while walking through the museum, allowing them to listen to conversation and environmental sounds in an everyday acoustic setting.

This was not a formal study of hearing aid outcomes or attitudes toward amplification. However, our observations suggested that the setting encouraged discussion about hearing and screening results.

Some participants described noticing sounds that they had not realized they were missing. Others were surprised when their screening results did not match their own perception of their hearing.

These interactions reinforced something hearing care professionals encounter frequently: recognizing hearing difficulty and deciding to seek help are not always the same thing.

What can clinicians take from these experiences?

The community health initiative was designed for the Chinese healthcare context, so the model itself may not translate directly to other settings. However, the underlying principles may be relevant to HCPs exploring ways to improve access to hearing care.

1. Integrate hearing into existing health pathways

Rather than creating a separate journey into hearing care, consider whether hearing screening can be incorporated into services people already access. Primary care visits or healthy aging programs may provide suitable opportunities, depending on the local healthcare system. Reducing the number of additional steps required may make hearing screening easier to access.

2. Consider the role of trusted community settings

Healthcare decisions are influenced by more than clinical needs. Familiarity and trust may also affect people’s willingness to engage. Partnerships with primary care providers or established community organizations may provide opportunities to introduce hearing care in environments where people already feel comfortable.

3. Combine screening with conversation

A screening result alone does not constitute a diagnosis, nor does it ensure that someone will seek further care. Community screening can also provide an opportunity for hearing care professionals to explain results and discuss appropriate next steps. Clear referral pathways are therefore an important part of any community screening program.

4. Match the tools to the purpose and setting

Community-based hearing screening may require a different approach from a conventional audiology clinic. A brief questionnaire can provide information about perceived hearing difficulties. Speech-in-noise or portable pure-tone screening may add objective information where appropriate.

The choice of tools should depend on the intended population and the purpose of the program. Importantly, screening tools should be validated for their intended use and linked to an appropriate pathway for further assessment when indicated.

From access to action

These initiatives are still evolving, and important questions remain. We need to better understand who participates and how many people identified through screening subsequently seek diagnostic assessment or hearing care. Follow-up will also be important for understanding whether community-based approaches ultimately improve hearing-related outcomes.

The Shanghai experience should therefore not be interpreted as evidence for a single model that can simply be transferred to other healthcare systems. Local healthcare infrastructure will influence how such approaches work in practice. Cultural attitudes toward hearing loss and aging may also shape participation and follow-up.

But the experience does highlight an opportunity worth exploring. Improving access to hearing care may not always require creating an entirely new pathway. Sometimes it may mean bringing hearing care into the healthcare and community pathways that people already use.

For hearing care professionals, that shifts the question from “How do we encourage more people to come to us?” to “Where else could hearing care begin?”

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About this series

This article is part of a series sharing research and perspectives on hearing care in China. View the series. Further articles will be added in the coming months.