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Rural Health Information Hub

HEAR on the Farm

  • Need: To increase use of hearing protection among farmers and farmworkers.
  • Intervention: Researchers mailed an assortment of hearing protection devices to farmers and provided web-based information (interactive or static) about hearing conservation to see which method or combination of methods was most effective.
  • Results: All participants increased their use of hearing protection. The largest increase occurred among those who received a sampler of hearing protection devices in the mail.


Effective (About evidence-level criteria)


Researcher and farmer by tractorFarmers and farmworkers are exposed to loud noises, such as from equipment and livestock, which can lead to hearing loss and tinnitus, along with a variety of health problems, including cardiovascular disease, high blood pressure, weight gain, and elevated blood sugar. To protect this population's health, researchers at the University of Michigan conducted a nationwide study to see if mailing hearing protection devices to farmers, providing access to web-based information about hearing, or offering some combination of the two led to increased use of hearing protection.

This study was funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), and hearing protection devices (HPDs) were donated by a manufacturer.

Services offered

In a randomized controlled trial, 491 farm operators were randomly placed into one of five groups to receive:

  • HPDs, including earmuffs and ear plugs, through the mail
  • Static web-based information (like an online brochure) about hearing protection
  • HPDs through the mail plus static web-based information about hearing protection
  • HPDs through the mail plus interactive web-based information (like educational games)
  • Interactive web-based information only

Researchers did not restrict enrollment by state, but the farm operators came from the following states:

  • Colorado
  • Illinois
  • Kansas
  • Kentucky
  • Michigan
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Vermont
  • Virginia


While all participants showed an increased use of hearing protection after 6 and 12 months, the participants who received HPDs (with or without the web-based information) showed the largest increase in use.

HPD use was also higher among those who received HPDs and interactive web-based information, compared to those who received HPDs and static web-based information.

At baseline, the average use of HPDs was 29.5% of the time when exposed to loud noise. At 6 months, this percentage grew to 48.7% of the time. At 12 months, this percentage grew to 49.3% of the time.

For more information about this study:

McCullagh, M.C., Banerjee, T., Cohen, M.A., & Yang, J.J. (2016). Effects of Interventions on Use of Hearing Protectors among Farm Operators: A Randomized Controlled Trial. International Journal of Audiology, 55(0), S3-S12.


Keeping study participants engaged over the year-long study was challenging. However, farmers who participated were highly responsive to requests by the research team for continued participation. In fact, the retention of farmers in the study far exceeded expectations, with 92% of enrollees completing the 12-month study.

Researcher and ear muffs


Researchers used farm organizations like the American Farm Bureau to recruit study participants. They reported that these partnerships helped them retain participants over the course of the study. Many state Farm Bureau affiliates helped participant retention by featuring the study in their organization's newsletters and other publications.

Researchers reported that HPD use increased at a slower rate at 12 months than at six months and suggested other programs might want to resupply HPDs every few months to encourage continued use.

Contact Information

Marjorie C. McCullagh, PhD, RN, Professor
University of Michigan School of Nursing

Agricultural health and safety
Farmers and farmworkers
Hearing impairment

States served

Date added
November 12, 2019

Date updated or reviewed
November 14, 2022

Suggested citation: Rural Health Information Hub, 2022. HEAR on the Farm [online]. Rural Health Information Hub. Available at: [Accessed 24 March 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.