Improving Access to Specialty Care for Rural Children Using Enhanced Hearing Screening and Specialty Telehealth Follow-Up in Rural Kentucky Schools: Protocol for a Hybrid Effectiveness-Implementation Stepped Wedge, Cluster-Randomized Controlled Trial (Appalachian STAR Trial)

Tarika Srinivasan   ^{1, 2} , BSA, BA ;   Samantha Kleindienst Robler   ^{2, 3} , AuD, PhD ;   Elizabeth Turner   ^{4, 5} , PhD ;   Alyssa Platt   ^{4, 5} , MA ;   David Arthur   ^{4, 5} , MS ;   Janet Prvu Bettger   ^{2, 4} , ScD ;   Hannah Lane   ⁶ , PhD ;   Marissa Schuh Gebert   ^{2, 7} , MPH ;   Shayu Deshpande   ^{2, 3} , PhD ;   Nancy Schoenberg   ⁸ , PhD ;   Matthew L Bush   ⁷ , MBA, MD, PhD ;   Susan D Emmett   ^{2, 3, 9} , MPH, MD

¹ Harvard Medical School, Harvard University, Boston, United States

² Center for Hearing Health Access, University of Arkansas for Medical Sciences, Little Rock, AR, United States

³ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States

⁴ Duke Global Health Institute, Duke University, Durham, NC, United States

⁵ Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States

⁶ Department of Population Health Sciences, Duke University, Durham, United States

⁷ Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, United States

⁸ Department of Behavioral Science, University of Kentucky, Lexington, United States

⁹ Department of Epidemiology, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States