Research Article: Mapping the content of mothers’ knowledge, attitude and practice towards universal newborn hearing screening for development of a KAP survey tool

Date Published: February 20, 2019

Publisher: Public Library of Science

Author(s): Christine Graham, Janet Seeley, Ayanda Gina, Yougan Saman, Matthew Lee Bush.


Understanding mother’s knowledge, attitude and practice (KAP) of permanent childhood hearing impairment (PCHI) is essential for the success of universal newborn hearing screening (UNHS) as poor compliance and follow-up remains a global challenge. To determine content area for a questionnaire that measures PCHI-related KAP in rural mothers, we trained moderators who interviewed 145 pregnant women (17 groups) from 5 ante-natal clinics. Interviews were recorded, transcribed, summarised and analysed using thematic framework analysis. Four knowledge themes were identified: 1) PCHI was perceived as the malfunction of hearing leading to disability; 2) a poorly-responsive/communicative child may have PCHI; 3) lifestyle, hereditary and environmental factors are significant causes of PCHI; 4) medical management of PCHI was doubted, with some advocating birth and ancestral rituals. Two themes were identified for attitude: 1) beliefs that PCHI was emotionalised due to the negative lifelong impact on the child and family; 2) UNHS processes were favourable though some preferred other belief systems. Three themes were identified for practice: 1) doctors were the first choice followed by traditional healers; 2) willingness to continue follow-up although challenges exist; 3) minimal family support during consultation. The contextualised KAP of women regarding UNHS processes and PCHI provided content area for the design of a KAP tool.

Partial Text

Permanent childhood hearing impairment (PCHI) is a significant cause of disability and can have an enduring impact on cognitive, emotional and social development particularly with regards to the functional limitations of speech and language acquisition [1]. Hearing loss may be present at birth and can result from environmental and prenatal factors, congenital infections and genetic causes [2]. Hypoxia, hyperbilirubinemia, meningitis, chronic otitis media, mumps, measles, cytomegalovirus, trauma, ototoxic drugs and head injury are causes of neonatal and childhood hearing loss [3].

The study group comprised of women aged between eighteen and forty years as shown in Table 1 below. It is important to note that there was a large group of single women in the study sample which is representative of the general status in South Africa [21].

The overall purpose of this study was to explore maternal knowledge, attitude and practice towards CHL and NHS in a rural community to identify themes for the development of a KAP survey tool. The findings suggest various factors that need to be considered in designing such a tool as the understandings and meanings given to HL and NHS are complex, spreading across individual, family, community and cultural levels.

The study has established holistic data in terms of recognising the participants in the framework of the whole (where and how they expressed the phenomena meaningful) rather than assuming irrelevance (reduction or abstraction of data) to certain aspects of their explanations. Participants perspectives on CHL and NHS clearly demonstrates how identified themes were content sufficient in each KAP domain. The methodology in this study provides empirical information that directs us to the type of questions to be included in the survey tool. The questions will comprise of perception, causes, identification, treatment of CHL, as well as likelihood acceptance of NHS, their beliefs and feelings about early detection. It also clearly influences the responses to be incorporated in the tool and guides us to include the concepts of a community’s everyday language in relation to CHL and UNHS. Accordingly, it ought to be easier in terms of developing questions that are understood by future study participants in this community.




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