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Maternal Anxiety and Satisfaction with Newborn Hearing Screening: The English Example Rachel Crockett, Theresa. M. Marteau, Kai Uus & John Bamford Funding:

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Presentation on theme: "Maternal Anxiety and Satisfaction with Newborn Hearing Screening: The English Example Rachel Crockett, Theresa. M. Marteau, Kai Uus & John Bamford Funding:"— Presentation transcript:

1 Maternal Anxiety and Satisfaction with Newborn Hearing Screening: The English Example Rachel Crockett, Theresa. M. Marteau, Kai Uus & John Bamford Funding: Department of Health (England).

2 Newborn Hearing Screening Programme Evaluation. In January 2001 a pilot study exploring the effectiveness in practice of the Newborn Hearing Screening Programme (NHSP) began in England. The Department of Health commissioned an evaluation of aspects of this implementation including maternal anxiety and satisfaction with the screen.

3 Research Aims I. To describe and compare anxiety, worry and satisfaction in mothers of babies undergoing newborn hearing screening and receiving different results. II. To examine the possible protective effect of knowledge in preventing worry.

4 The Screening Process Maternity Unit: Well Baby Nursery Hearing Tests conducted on the unit prior to discharge home after a babys birth. If screen not completed prior to discharge, babies followed up in clinic. First otoacoustic emissions test (OAE) Second OAE Automated auditory brain stem response test (AABR) Baby referred for audiological assessment No clear responses No further tests Bilateral clear responses

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6 Comparison Groups Group 1 - clear response in both ears on OAE test. Group 2 - clear response in both ears on AABR test. Group 3 - no clear response in one ear on AABR, unilateral referral. Group 4 - no clear response in either ear on AABR, bilateral referral.

7 Flow Chart Showing Process of Data Collection. Screening Tests, consent to participate in study. Clear responses not received for one or both ears on screening tests. Clear responses received for both ears on screening tests. Maternal anxiety and satisfaction questionnaires sent 3 weeks after screen completion. Diagnostic tests Follow-up maternal anxiety and satisfaction questionnaires sent 6 months after screen completion.

8 Outcome Measures 1. State Anxiety 2. Worry about babys hearing 3. Certainty about babys hearing 4. Attitudes to NHSP 5. Satisfaction with NHSP 6. Knowledge about NHSP

9 1. State Anxiety measured using shortened form of the State Trait Anxiety Inventory (STAI) developed by Marteau and Bekker (1992) from the 40 item STAI (Spielberger 1983). gives a score in the range with higher scores indicating higher anxiety. a normal score is 35, clinical cut off is 42. reliability in this sample was.81.(n=346)

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11 2 & 3. Worry and Certainty about Babys Hearing Two separate items: 1.How worried do you feel at the moment about your babys hearing? 2. How certain do you feel at the moment that your baby is normally-hearing? Response to both items measured on 7-point scale.

12 4. Attitude to Screening 1.For me, having my baby screened by the newborn hearing screening test was: beneficial-harmful. 2.For me, having my baby screened by the newborn hearing screening test was: important-unimportant. 3. For me, having my baby screened by the newborn hearing screening test was: a bad thing-a good thing. =0.84 (n=354)

13 5. Satisfaction with Screening 1. How well informed do you feel about the hearing screening test your baby had? 2.How good did you find the information you were given about the hearing screening test before your baby had it? 3. How satisfied do you feel with the information you have been given about the result of your babys hearing screening test? 4. In general, how satisfied were you with the hearing screening test? =.83 (n=338)

14 6. Knowledge of Screening Items relate to information mothers are given about the screen. 8 items in multiple choice format Understanding assessed: results and their meanings reasons for no clear responses what happens at different stages of the screen numbers of babies referred who will be found to have hearing loss.

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16 Knowledge Questions What are the possible results of the newborn hearing screening tests? (You may tick more than one answer) Clear response recorded in both ears Clear response recorded in one ear only Clear response could not be recorded in either ear None of the above Not sure Other (please state)

17 What do you think it means when a baby records a clear response in both ears on the first screening test? The baby definitely does not have a hearing loss It is highly unlikely that the baby has a hearing loss The baby might have a hearing loss It is highly likely that the baby has a hearing loss The baby definitely has a hearing loss None of these Not sure

18 What do you think it means when a clear response could NOT be recorded in one or both ears on the first screening test? The baby definitely does not have a hearing loss It is highly unlikely that the baby has a hearing loss The baby might have a hearing loss It is highly likely that the baby has a hearing loss The baby definitely has a hearing loss None of these Not sure

19 If 1000 babies had the newborn hearing screening test, about how many do you think would NOT record a clear response in one or both ears on the first screening test? All of these Most of these A few of these None of these Not sure

20 Why do you think a baby might NOT record a clear response? (You may tick more than one answer) The baby was unsettled The baby had fluid in the ear The baby had a hearing loss Background noise when the test was carried out The equipment was faulty None of these Not sure Of the above reasons, which one of these do you think might be the most likely reason?

21 When a baby has NOT recorded a clear response in one or both ears on the first screening test, what do you think happens next? The baby has another screening test The baby is diagnosed with a serious hearing loss The baby has an operation The baby has no further screening tests None of these Not sure

22 Imagine 10 babies who do NOT record a clear response in one or both ears on the first screening test go on to have further screening tests. How many do you think will be found to have a hearing loss after all these extra screening tests? All Almost all of them About half About a quarter Very few of them None of them Not sure

23 Interim Results Total sample size 357 (response rate 52%). Group 1: 102 mothers of babies receiving clear response at OAE stage (66% response rate). Group 2: 87 mothers of babies receiving clear response at AABR stage (58% response rate). Group 3: 107 mothers of babies referred for possible unilateral loss (45% response rate). Group 4: 61 mothers of babies referred for possible bilateral loss (41% response rate).

24 Aim I : Maternal State Anxiety aaaa Dissimilar letters indicate significant differences

25 Mothers Comment. I was pleased to have this test done. My 6 year old had his hearing tested at age 6 months in 1997 and failed it-he was fine (and still is) when retested. This new test has given me peace of mind and I will not have the dreadful anxiety I had in Group 1 Mother (OAE clear responses)

26 Mothers Comment I did find the first test carried out...after birth somewhat upsetting, not so much as he failed in one ear, as I was sure that his hearing was ok, but because of the equipment used which caused him some distress. Mothers are highly emotional at this time, especially in the first few days after birth, and I think for the sake of a couple of weeks it would be best to leave the test until, say 1 month after birth when Mum is more able to cope. Group 3 Mother (unilateral referral)

27 Aim I:Worry about Babys Hearing Dissimilar letters indicate significant differences aa b b

28 Mothers Comment I was very pleased with the test and it helped to prevent me from worrying about at least one less thing Group 1 Mother (OAE clear responses)

29 Mothers Comment Baby failed two tests after birth, I feel this has put undue torture onto the family about whether our baby is deaf or not. If fluid in the ears affects results, then the tests should not be given shortly after birth. At the end of the day, if the baby is deaf then its deaf, what difference does it make if you find out 2 days after birth. I feel the failed tests just make parents worry more, when theres plenty of things to worry about already. Group 3 Mother (unilateral referral)

30 Aim I: Certainty about Babys Hearing Dissimilar letters indicate significant differences a a bb

31 Mothers Comment I am glad you do this test as it helps to give me peace of mind to know that my babys hearing is fine and I welcome any sort of test that can do this and doesnt harm the baby. Well done and keep up the good work. Group 2 Mother (AABR clear responses)

32 Mothers Comment Even though I was told that there is little chance that my baby has a hearing problem it still causes me and my husband some concern. Would it not be better to conduct the tests after all possible fluid in the ear canal has gone? Group 3 Mother (unilateral referral)

33 Aim I: Attitudes towards NHSP aa b b Dissimilar letters indicate significant differences

34 Mothers Comment I found the test very helpful. The lady doing the test was excellent, calm and informative. I feel lucky to have been involved as it could pick up any problems early and they could, if possible, be sorted out and this would perhaps prevent any language problems etc in the future. Thank-you. Group 1 Mother (OAE clear responses)

35 Mothers Comment Even though the test is beneficial, I feel doing it straight away in hospital is a bad idea as mums can feel very protective towards their baby and hearing bad news can be very upsetting, especially for 1st time mums. I wish I had left the test now and waited for a few weeks ( as if there was fluid in one ear, it would have cleared by then). I could have been left worrying unnecessarily and if a 1st time mum this could lead to depression. Also, it took nearly an hour to do and the tester kept prodding my baby and trying to stick on the pads. I found this distressing as my baby was only a day old. Group 3 Mother (unilateral referral)

36 Aim I: Satisfaction with NHSP Dissimilar letters indicate significant differences a,bab,cc

37 Mothers Comment The test was very quick and the tester was very reassuring and seemed extremely knowledgeable and happy to answer my questions. Best of all it did not disturb my baby at all. Group 1 Mother (OAE clear responses)

38 Mothers Comment I think the newborn tests should not be carried out in hospital wards because they are too noisy, also maybe not the day after either as fluid in the ears after birth. Put both of these together, it wastes a lot of time and money. I think it would be better if all babies were given an appointment shortly after birth. Group 3 Mother (unilateral referral)

39 Aim 1:Summary of Findings

40 Aim II: Knowledge about NHSP Dissimilar letters indicate significant differences aaaa

41 Mothers Comment Very informative and (well) explained when my baby was unable to give a clear result for the first test. A second test was carried out but only after it had been fully explained what the procedure would be. Group 2 Mother(AABR clear responses)

42 Mothers Comment Third info leaflet (failed 2 tests) provided little additional info. At this point I was interested in % of babies, who had failed 2 tests, having hearing loss and unable to find this out from leaflet or person doing test. You also need to differentiate between unilateral hearing loss and bilateral hearing loss and give some idea of implications of former (perhaps separate leaflets for each). Group 3 Mother (unilateral referral)

43 Aim II: Correlates of Knowledge about NHSP * correlation significant at 0.05 level, ** correlation significant at 0.01 level.

44 Knowledge, Worry and Certainty. Aim:to explore relationship of knowledge about NHSP and worry and certainty about babys hearing. Levels of certainty and worry compared between those who got each knowledge item right and those who got each answer wrong. Test conducted separately for mothers of babies referred unilaterally and those referred bilaterally.

45 Knowledge and Certainty in Group 4 (bilateral referral). 7/8 knowledge items-no association 1 knowledge item did show an association:

46 Worry and knowledge of most likely reasons for no clear responses in Group 4.

47 Certainty and understanding of most likely reasons for no clear responses in Group 4.

48 The Possible Protective Effect of Knowledge Numbers were small. Correlational design so cannot infer causality. But suggests if there is understanding that the most likely reason for no clear responses is not hearing loss, getting this test result causes less uncertainty and worry.

49 Summary Overall there are high levels of satisfaction with, and positive attitudes to, NHSP and levels of state anxiety in the normal range following the screening. Receipt of results suggesting possible unilateral or bilateral hearing loss are associated with: higher levels of worry and uncertainty. less positive attitudes lower levels of satisfaction

50 Summary Among mothers of babies receiving a bilateral referral there was an association between higher knowledge and greater certainty suggesting a protective effect of knowledge. Further analyses will be conducted when data collection is complete in July 2004.


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