Factors Related to Not Following up with Recommended Screening in the Diagnosis of Newborn Hearing Loss

Background and Purpose:  The provision of hearing screenings among newborns results in early diagnosis and treatment of hearing loss.  From a public health perspective, screenings have improved linguistic competence and literacy for children who have hearing loss (Rai & Thakur, 2013). Universal newborn hearing screening (UNHS) is supported by the high incidence of hearing impairment relative to other congenital defects for which cure can be provided (Rai & Thakur, 2013). As such, UNHS 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 the failure of initial hospital screenings and recommended follow-up rescreens? 

Methods:  This prospective longitudinal study included telephone interviews with 203 parents in a large metropolitan area whose children were referred for additional screening upon not passing the initial screening completed at the birth hospital.  Parents were asked about their satisfaction with the screening process completed in the hospital and 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.  Complete follow-up data were obtained for 166 of the children approximately nine months after initial screenings to determine the status of the children’s follow-up. 

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

Results: The best fitting model, which accounted for 15.24% of the variance in being lost to follow-up (p=0.001), indicated that the greatest risk factors were not viewing hearing loss as a serious condition (OR=0.16, p=0.02), having a strong and enduring relationship with a spouse partner (OR=10.16, p=0.00) and maternal depression as expressed as worry or concern about the child (OR=0.23, p=0.01).  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 who may have hearing loss.  Helping parents understand the seriousness and consequences for not addressing hearing loss may play a critical role in bringing families back in for additional screening.  Additionally, maternal factors of post-partum depression and the strength of the relationship with a spouse/partner indicates that obstetricians providing post-partum maternal care may be able to assist in identifying parents who may be too overwhelmed to follow-up with important medical care for their newborn children.