Maternal Anxiety and Satisfaction with Newborn Hearing Screening: The English Example

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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 Department of Health (England).
• Email rachel.a.crockett_at_kcl.ac.uk

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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.

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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.

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The Screening Process
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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.

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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.
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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

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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 20-80 with higher
  scores indicating higher anxiety.
• a normal score is 35, clinical cut off is 42.
• reliability in this sample was .81.(n346)

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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.

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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 (n354)

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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 (n338)

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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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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)

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• 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

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• 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

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• 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

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• 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?

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• 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

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• 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

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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).

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Aim I Maternal State Anxiety
a
a
a
a
Dissimilar letters indicate significant
differences
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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 1997.
• Group 1 Mother (OAE clear responses)

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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)

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Aim IWorry about Babys Hearing
b
b
a
a
Dissimilar letters indicate significant
differences
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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)

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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)
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Aim I Certainty about Babys Hearing
a
a
b
b
Dissimilar letters indicate significant
differences
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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)

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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)

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Aim I Attitudes towards NHSP
a
a
b
b
Dissimilar letters indicate significant
differences
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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)

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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)

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Aim I Satisfaction with NHSP
a,b
a
b,c
c
Dissimilar letters indicate significant
differences
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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)

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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)

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Aim 1Summary of Findings
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Aim II Knowledge about NHSP
a
a
a
a
Dissimilar letters indicate significant
differences
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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)

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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)

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Aim II Correlates of Knowledge about NHSP
correlation significant at 0.05 level,
correlation significant at 0.01 level.
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Knowledge, Worry and Certainty.

• Aimto 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.

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Knowledge and Certainty in Group 4 (bilateral
referral).

• 7/8 knowledge items-no association
• 1 knowledge item did show an association

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

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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

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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.