Psychosocial Factors Associated with Loss to Follow-up in the Diagnosis of Hearing Loss in Newborns

Background and Purpose:  Hearing screenings among newborns results in early diagnosis and treatment of hearing loss even when these screenings have improved linguistic competence and literacy development for children who have hearing loss (Rai & Thakur, 2013). Universal newborn hearing screenings (UNHS) may be justified by the high incidence of hearing impairment in relation to other congenital defects for which cure can be provided (Rai & Thakur, 2013). Newborn hearing screening has become a vital public health, population-prevention strategy using early detection and intervention to prevent disability (Finitzo & Grosse, 2003).   Despite this, there has been a consistently high degree of loss to follow-up since the inception of UNHS programs, even when efforts have been made to improve follow-up rates (Centers for Disease Control, 2014).

The current study was organized around the following research question:  What psychosocial factors are associated with being lost to follow-up in babies between screening and diagnosis? 

Methods:  This prospective longitudinal study included telephone interviews with 200 parents in a large metropolitan area whose children were referred for additional screening and treatment upon not passing the initial screening completed at birth.  Parents were asked about their satisfaction with the screening process completed in the hospital, their perceptions of hearing loss in children in general.  Other measures included health locus of control, state anxiety, social supports, and depression with regard to parenting a child with a health impairment or disability.  Follow-up data were obtained approximately nine months after initial screenings from medical centers from which the families sought care to determine the status of the children’s follow-up.  Eleven out of 41 infants ultimately referred for diagnosis were LTF.

Bivariate analyses were conducted to identify factors that may be related to loss to follow-up in the infants who were ultimately diagnosed with a hearing loss.  Those variables that were significant were considered for inclusion in a binary logistic regression to identify a constellation of risk factors for loss to follow-up.

Results:  Initially, four factors were related to loss to follow-up, including having an internal health locus of control, social support, maternal depression and race. In the final logistic regression, the best fitting model, which accounted for 33.7% of the variance in being lost to follow-up (p=0.00), indicated that the greatest risk factors were having fewer health professionals with which to consult (OR=0.17, p=0.16) and being Black (OR=12.02, p=0.05).  Post-estimation testing for collinearity and goodness-of-fit indicated a good fitting model.

Conclusions and Implications:  There is ample opportunity for social work intervention to help remediate the issue of loss to follow-up for families of infants with hearing loss.  Loss to follow-up appears to be a complex problem related to access to health care, and social work can play an integral role in connecting families, particularly minorities, with needed care.  More research is needed to better understand the role race/ethnicity play in loss to follow-up.  Due to the small sample size, we believe that replication with a larger sample is necessary to tease out additional factors that impact loss to follow-up.