1
|
Findlen UM, Gerth H, Zemba A, Schuller N, Guerra G, Vaughan C, Brimmer M, Benedict J. Examining Barriers to Early Hearing Diagnosis. Am J Audiol 2024; 33:369-378. [PMID: 38416788 DOI: 10.1044/2024_aja-23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
PURPOSE Many factors create barriers for early hearing detection and intervention (EHDI), especially those related to unfavorable social determinants of health (SDOH). The primary aim of this study was to evaluate diagnostic timing of infants at risk for congenital hearing loss in consideration of known barriers. Understanding the specific barriers to early diagnosis can inform interventions to improve timeliness of diagnosis and subsequent habilitation. METHOD A retrospective chart review was completed for infants referred for diagnostic audiologic testing at a tertiary urban-setting Children's Hospital from 2018 to 2021. After exclusion criteria were applied, 1,488 infants were included in the analysis. Various factors were recorded from electronic medical records including those specific to SDOH. Time to diagnosis was derived and compared across five factors of interest that have previously been shown to impact diagnostic timeline, including (a) insurance type, (b) race/ethnicity, (c) presence of middle ear dysfunction at first auditory brainstem response (ABR), (d) proximity to diagnostic center, and (e) diagnostic timing before and during/after the COVID-19 pandemic. RESULTS Across the study time period, 77% of infants referred for diagnostic testing had confirmed diagnosis by the EHDI benchmark of 3 months. Analysis of time to diagnosis across factors of interest revealed no clinically significant differences for insurance type, race/ethnicity, proximity to diagnostic center, or timing in reference to the COVID-19 pandemic. Presence of middle ear dysfunction on first ABR was found to significantly protract final diagnostic timing. CONCLUSIONS Although some known barriers for EHDI can be universal, other factors may have a differential impact on an infant's timeline to diagnosis based on their specific location, which can interact differently with additional known barriers. Understanding local challenges will serve to better guide programs in implementing facilitators that will address their specific needs for improved outcomes.
Collapse
Affiliation(s)
- Ursula M Findlen
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Holly Gerth
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Angie Zemba
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Nicole Schuller
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Gina Guerra
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Chloe Vaughan
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Madeline Brimmer
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Jason Benedict
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus
| |
Collapse
|
2
|
Beans JA, Trinidad SB, Shane AL, Wark KA, Avey JP, Apok C, Guinn T, Robler SK, Hirschfeld M, Koeller DM, Dillard DA. The CPT1A Arctic variant: perspectives of community members and providers in two Alaska tribal health settings. J Community Genet 2023; 14:613-620. [PMID: 37847346 PMCID: PMC10725401 DOI: 10.1007/s12687-023-00684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Newborn screening in Alaska includes screening for carnitine palmitoyltransferase 1A (CPT1A) deficiency. The CPT1A Arctic variant is a variant highly prevalent among Indigenous peoples in the Arctic. In this study, we sought to elicit Alaska Native (AN) community member and AN-serving healthcare providers' knowledge and perspectives on the CPT1A Arctic variant. Focus groups with community members and healthcare providers were held in two regions of Alaska between October 2018 and January 2019. Thematic analysis was used to identify recurring constructs. Knowledge and understanding about the CPT1A Arctic variant and its health impact varied, and participants were interested in learning more about it. Additional education for healthcare professionals was recommended to improve providers' ability to communicate with family caregivers about the Arctic variant. Engagement with AN community members identified opportunities to improve educational outreach via multiple modalities for providers and caregivers on the Arctic variant, which could help to increase culturally relevant guidance and avoid stigmatization, undue worry, and unnecessary intervention. Education and guidance on the care of infants and children homozygous for the CPT1A Arctic variant could improve care and reduce negative psychosocial effects.
Collapse
Affiliation(s)
- Julie A Beans
- Research and Data Services Department, Southcentral Foundation, Anchorage, AK, USA.
| | - Susan Brown Trinidad
- Department of Bioethics & Humanities, University of Washington, Seattle, WA, USA
| | - Aliassa L Shane
- Research and Data Services Department, Southcentral Foundation, Anchorage, AK, USA
| | - Kyle A Wark
- Research and Data Services Department, Southcentral Foundation, Anchorage, AK, USA
| | - Jaedon P Avey
- Research and Data Services Department, Southcentral Foundation, Anchorage, AK, USA
| | | | - Tiffany Guinn
- Research and Data Services Department, Southcentral Foundation, Anchorage, AK, USA
| | | | - Matthew Hirschfeld
- Maternal Child Health Services, Alaska Native Medical Center, Anchorage, AK, USA
| | - David M Koeller
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Denise A Dillard
- Research and Data Services Department, Southcentral Foundation, Anchorage, AK, USA
| |
Collapse
|
3
|
Atherton KM, Poupore NS, Clemmens CS, Nietert PJ, Pecha PP. Sociodemographic Factors Affecting Loss to Follow-Up After Newborn Hearing Screening: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:1289-1300. [PMID: 36939626 PMCID: PMC10773460 DOI: 10.1002/ohn.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Universal newborn hearing screening (NBHS) has been widely implemented as a part of early hearing detection and intervention (EHDI) programs worldwide. Even with excellent provider knowledge and screening rates, many infants do not receive definitive hearing testing or intervention after initial screening. The objective of this study was to identify sociodemographic factors contributing to loss of follow-up. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the databases were searched from the date of inception through December 28, 2021. Studies containing sociodemographic information on patients who were referred to NBHS were included. Meta-analysis of odds ratios (ORs) was performed comparing rates of sociodemographic variables between patients adherent and nonadherent to follow-up. RESULTS A total of 169,238 infants from 19 studies were included. Low birth weight (OR 1.6 [95% confidence interval, CI 1.2-2.2, p < .001), racial minority (OR 1.4 [95% CI 1.2-1.6], p < .001), rural residence (OR 1.5 [95% CI 1.1-1.9], p = .005), lack of insurance (OR 1 [95% CI 1.4-2.5], p < .001), and public or state insurance (OR 1.7 [95% CI 1.2-4.2], p = .008) were associated with missed follow-up after referred NBHS. Associated maternal factors included low maternal education (OR 1.8 [95% CI 1.6-2.0], p < .001), young maternal age (OR 1.5 [95% CI 1.5-1.6], p < .001), unmarried maternal status (OR 1.5 [95% CI 1.1-1.9], p = .003), and current or former maternal smoking status (OR 1.8 [95% CI 1.4-2.2], p < .001). CONCLUSION Both infant and maternal sociodemographic factors influence follow-up compliance after referred NBHS. Focused efforts should be made by medical providers and policymakers to address these factors to ensure appropriate newborn hearing care and interventions are achieved.
Collapse
Affiliation(s)
- Kelly M. Atherton
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, South Carolina, Charleston, USA
| | - Nicolas S. Poupore
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Clarice S. Clemmens
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
4
|
Barriers to and Facilitators of Early Hearing Detection and Intervention in the United States: A Systematic Review. Ear Hear 2023; 44:448-459. [PMID: 36579673 DOI: 10.1097/aud.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Early hearing detection and intervention (EHDI) is guided by the 1-3-6 approach: screening by one month, diagnosis by 3 mo, and early intervention (EI) enrollment by 6 mo. Although screening rates remain high, successful diagnosis and EI-enrollment lag in comparison. The aim of this systematic review is to critically examine and synthesize the barriers to and facilitators of EHDI that exist for families, as they navigate the journey of congenital hearing loss diagnosis and management in the United States. Understanding barriers across each and all stages is necessary for EHDI stakeholders to develop and test novel approaches which will effectively reduce barriers to early hearing healthcare. DESIGN A systematic literature search was completed in May and August 2021 for empirical articles focusing on screening, diagnosis, and EI of children with hearing loss. Two independent reviewers completed title and abstract screening, full-text review, data extraction, and quality assessments with a third independent reviewer establishing consensus at each stage. Data synthesis was completed using the Framework Analysis approach to categorize articles into EHDI journey timepoints and individual/family-level factors versus system-level factors. RESULTS Sixty-two studies were included in the narrative synthesis. Results revealed that both individual/family-level (e.g., economic stability, medical status of the infant including middle ear involvement) and system-level barriers (e.g., system-service capacity, provider knowledge, and program quality) hinder timely diagnosis and EI for congenital hearing loss. Specific social determinants of health were noted as barriers to effective EHDI; however, system-level facilitators such as care coordination, colocation of services, and family support programs have been shown to mitigate the negative impact of those sociodemographic factors. CONCLUSIONS Many barriers exist for families to obtain appropriate and timely EHDI for their children, but system-level changes could facilitate the process and contribute to long-term outcomes improvement. Limitations of this study include limited generalizability due to the heterogeneity of EHDI programs and an inability to ascertain factor interactions.
Collapse
|
5
|
Exploring the Stories of Parents' Experiences With Infant Hearing-Loss Screening and Diagnosis in the United States. Ear Hear 2022; 44:518-529. [PMID: 36534640 DOI: 10.1097/aud.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES For the past 20 years, birthing hospitals in the United States have required newborns to undergo a hearing-loss screening before leaving the hospital. Since the initial newborn hearing screening mandates, there has been much outcome research documenting the successes and barriers of the programs. However, we know little about the experiences of their parents during the time between screening and diagnosis. We propose that elucidating the parents' experiences with newborn hearing-loss screening and diagnosis-via their own stories-is a first step toward understanding their varied experiences and has the potential to ultimately improve hearing healthcare for both children and their families. Thus, to better understand the early hearing screening and detection experience from hearing parents' perspectives, we asked the following research question: what are parents' experiences with their newborns' hearing-loss screening and diagnosis in the United States? DESIGN The present study employed a prospective, cross-sectional qualitative design. Specifically, we gathered stories from 13 hearing parents who each have a child born in the United States and diagnosed with hearing loss no later than 14 mo of age between the years of 2016 and 2020. We used thematic analysis to uncover common themes across parent narratives. Saturation was reached at interview no. 4; thus no further sampling was needed. FINDINGS Two major themes emerged from the data: (1) hearing healthcare experiences and (2) parents' early experiences during the period between their child's newborn hearing-loss screening and diagnosis. Subthemes were also uncovered. Three emergent subthemes related to health-care experiences included: (1) downplayed newborn hearing screening referrals, (2) clinician-centered care, and (3) medical expenses and health coverage. The three subthemes of the second theme were as follows: (1) parent-to-parent support, (2) "mom guilt," and (3) a new reality. CONCLUSION The present study's narrative accounts from parents about their infants' early hearing detection experiences revealed several, different subthemes that emerged from the same, mandated newborn experience in US families. These findings highlight important moments throughout the hearing-loss screening and detection process, which could benefit from more effective, family-centered hearing healthcare. This knowledge also facilitates the field's move toward improved education of future and current providers and regarding family-centered approach, which could address concerns and expectations of new parents at the very start of their newborns' hearing-loss journeys.
Collapse
|
6
|
Kingsbury S, Khvalabov N, Stirn J, Held C, Fleckenstein SM, Hendrickson K, Walker EA. Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:1060-1071. [PMID: 36275486 PMCID: PMC9585532 DOI: 10.1044/2021_persp-21-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE We review the evidence regarding barriers to hearing health care for children who are deaf or hard of hearing. BACKGROUND There are considerable data to suggest that hearing health care disparities constitute a major factor in loss to follow-up or documentation for children going through the Early Hearing Detection and Intervention process. Families are affected by a combination of factors underlying these disparities, resulting in delayed care and suboptimal developmental outcomes for children who are deaf or hard of hearing. CONCLUSIONS To address the socioeconomic, cultural, and linguistic inequities seen in the diagnosis and management of childhood hearing loss, pediatric audiologists and speech-language pathologists have a responsibility to provide culturally responsive practice to their individual clients and their families, as well as advocate for substantive changes at the policy level that impact their clients' daily lives.
Collapse
Affiliation(s)
- Sarah Kingsbury
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Nicole Khvalabov
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Jonathan Stirn
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Cara Held
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | | | - Kristi Hendrickson
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| |
Collapse
|