Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing
Robyn A Cree1,2, Rebecca Bitsko2, Cheri Grimm3
1Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
High rates of loss to follow-up in Texas infants missing newborn hearing screenings highlight barriers in care access and communication. Addressing these issues is crucial for timely diagnosis and early intervention services.
Area of Science:
- Public Health
- Pediatric Audiology
- Healthcare Systems
Background:
- Untimely diagnosis of infant hearing loss can impede speech, language, and socio-emotional development.
- Texas faces significantly higher rates of loss to follow-up (LFU) or loss to documentation (LTD) for infants failing newborn hearing screenings compared to the national average.
Purpose of the Study:
- To identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas.
- To inform strategies for improving early identification and intervention for infants with hearing loss.
Main Methods:
- Conducted semistructured qualitative interviews with 56 healthcare providers across the hearing care continuum in Texas.
- Included hospital staff, audiologists, primary care physicians, and early intervention (EI) program staff from rural and urban regions.
- Analyzed interview data using conventional content analysis.
Main Results:
- Key barriers identified include challenges with family access to care, patient contact difficulties, and communication gaps between providers.
- Lack of knowledge among providers and parents, and issues with the online reporting system were also frequently cited.
- Rural providers disproportionately reported difficulties with family access and contact.
Conclusions:
- Findings underscore the need for collaborative strategies between public health and healthcare providers to enhance early identification.
- Addressing identified barriers can improve the number of children receiving timely diagnosis and beneficial early intervention services.
Objective:
Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1 vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas.
Study Design:
Data were collected through semistructured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach.
Results:
Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas.
Conclusion:
These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services.
Key Points:
· Infants with suspected hearing loss may not receive timely diagnosis or early intervention.. · We interviewed healthcare providers in Texas along the hearing care continuum.. · Findings suggest strategies to increase the number of children with hearing loss identified early..
