Teleaudiology Implementation in Underserved Communities

Overview

Teleaudiology has the potential to expand access to hearing care in low-resource and underserved settings. However, successful implementation depends on more than technology alone. Factors such as internet access, local infrastructure, workforce capacity, and cultural context all influence whether teleaudiology models are feasible and effective.

This line of work examines how teleaudiology can be adapted for real-world use in underserved communities, with a focus on low-resource settings in the U.S.–Mexico border region and southern Mexico.

Objectives

  • Evaluate the feasibility of teleaudiology service delivery in low-resource settings
  • Identify barriers related to connectivity, infrastructure, and workforce capacity
  • Examine the role of patient-site facilitators (e.g., community health workers, technicians)
  • Assess the acceptability of teleaudiology among patients, families, and clinic staff
  • Adapt teleaudiology models for pediatric and family-centered care

Methods

This work uses a mixed-methods, implementation-focused approach:

  • Qualitative Interviews: Conducted with parents/caregivers and clinic personnel to assess perceptions, barriers, and acceptability of teleaudiology
  • Feasibility Studies: Evaluation of teleaudiology workflows in real-world clinical and community settings
  • Implementation Frameworks: Application of models (e.g., feasibility, acceptability, appropriateness) to guide evaluation
  • Technology Assessment: Use of widely available platforms (e.g., WhatsApp, Zoom) to reflect real-world constraints
  • Community-Engaged Approach: Collaboration with local partners to ensure cultural and contextual relevance

Current Status

Ongoing. Initial work has established the feasibility of using patient-site facilitators to support teleaudiology service delivery. Current studies focus on implementation in southern Mexico, including pediatric populations and families with limited internet access.

Selected Outputs

Peer-Reviewed Publications

  • Coco, L. et al. (2023). Community Health Workers as patient-site facilitators in teleaudiology hearing aid services. Ear and Hearing.
  • Coco, L. et al. (2024). “Close to my community”: A qualitative study of CHW-supported teleaudiology services. Ear and Hearing
  • Mahomed-Asmail, F., Coco, L., et al. (2025). Asynchronous telepractice in audiology: Feasibility and implementation. Perspectives of the ASHA SIGs.

Presentations

  • Teleaudiology: Beyond the Pandemic – American Academy of Audiology (2023)
  • Telepractice Helps Address Social Determinants of Health – ASHA Convention (2025)
  • Patient and Provider Perspectives Towards Teleaudiology – World Congress of Audiology (2024)

Funding

  • Prior and related work supported by federal and foundation funding focused on teleaudiology and access to care (eg F32 NIDCD).

Team

  • Principal Investigator: Laura Coco, PhD, AuD, CCC-A
  • Student researchers (AuD, MA, undergraduate)
  • Clinical and community partners in Mexico

Opportunities to Get Involved

This project offers opportunities in implementation science and global/community health:

  • Qualitative data analysis (interviews with families and providers)
  • Teleaudiology workflow development and evaluation
  • Cross-cultural and international research collaboration

For current openings, see the Open Positions page.

Why This Matters

Teleaudiology is often presented as a scalable solution to hearing healthcare access, yet many models fail to translate to low-resource settings. This work focuses on what it actually takes to implement teleaudiology in real-world contexts - ensuring that solutions are not only effective, but feasible, acceptable, and sustainable.