Maternal concern and refusal toward neonatal heel-prick screening: a cross-sectional survey from Türkiye

Neonatal heel-prick screening is a key component of preventive healthcare, and its effectiveness is strongly influenced by parents' knowledge, perceptions, and willingness to engage in screening. The aim of this study was to evaluate the relationships between mothers' sociodemographic characteristics and their attitudes and behaviors toward the screening process and the level of concern they experience regarding newborn screening. This cross-sectional study included 350 mothers. Data on sociodemographic characteristics and knowledge, attitudes, and behaviors regarding neonatal heel-prick screening were collected using a researcher-developed structured questionnaire. Maternal concern, defined as a self-reported binary outcome (present/absent), was the primary outcome variable. Associations were analyzed using the chi-square test or Fisher's exact test, as appropriate, and variables with p < 0.10 in univariable analyses were entered into a multivariable Firth's penalized logistic regression model. The results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs), and a two-sided p value < 0.05 was considered to indicate statistical significance. Among 350 mothers, 17.7% reported concern related to the heel-prick test, and 9.7% refused the procedure. Concern was more common among those who refused the test (73.5% vs. 11.7%, p < 0.001) and those with vaccine concern (42.5% vs. 5.9%, p < 0.001). According to the results of the multivariable analysis, vaccine concern was the strongest independent predictor (aOR = 8.98; 95% CI: 4.56-18.69; p < 0.001), whereas rural residence (aOR = 3.18; p = 0.032) and perceiving the procedure as painful (aOR = 4.70; p < 0.001) were also significant risk factors.

This study revealed that maternal concern about heel-prick screening was associated with insufficient knowledge, negative perceptions of the procedure, concerns about the vaccine, rural residence, and cultural factors. These findings suggest that clear communication, effective education, and culturally sensitive counselling may help reduce maternal concern and improve participation in newborn screening programs.

• Parental knowledge, perceptions, and communication with healthcare professionals are important determinants of participation in newborn screening programs.

• Maternal concern toward neonatal heel-prick screening was independently associated with vaccine concern, perceived procedural pain, and rural residence, highlighting the need for targeted and culturally sensitive counselling.