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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: [email protected]
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.
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.
The Screening Process
Maternity Unit: Well Baby Nursery
Hearing Tests conducted on the unit prior to discharge home after a baby’s birth. If screen not
completed prior to discharge, babies followed up in clinic.
First otoacoustic
emissions test (OAE)
Bilateral clear responses
No further tests
Bilateral clear responses
No further tests
No clear responses
Second OAE
No clear responses
Automated auditory brain
stem response test (AABR)
No clear responses
Baby referred for
audiological assessment
Bilateral clear responses
No further tests
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.
Flow Chart Showing Process of Data
Collection.
Screening Tests, consent to participate in study.
Clear responses received
for both ears on screening
tests.
Clear responses not
received for one or 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.
Outcome Measures
1. State Anxiety
2. Worry about baby’s hearing
3. Certainty about baby’s hearing
4. Attitudes to NHSP
5. Satisfaction with NHSP
6. Knowledge about NHSP
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.(n=346)
1. A number of statements which people have used to describe themselves are
given below. Read each statement and then circle the most appropriate
number to indicate how you feel right now, at this moment. There are no right
or wrong answers. Do not spend too much time on any one statement but
give the answer that seems to describe your present feelings best. Please
answer each question.
Not at all
Somewhat
Moderately
Very much
(a) I feel calm
1
2
3
4
(b) I feel tense
1
2
3
4
(c) I feel upset
1
2
3
4
(d) I am relaxed
1
2
3
4
(e) I feel content
1
2
3
4
(f) I am worried
1
2
3
4
2 & 3. Worry and Certainty about
Baby’s Hearing
• Two separate items:
1. How worried do you feel at the moment
about your baby’s 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.
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)
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 baby’s
hearing screening test?
4. In general, how satisfied were you with the
hearing screening test?
•  = .83 (n=338)
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.
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)
• 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
• 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
• 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
• 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?
• 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
• 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
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).
Aim I : Maternal State Anxiety
80
70
60
Mean Anxiety 50
a
a
a
a
40
30
20
Group 1
Group 2
Group 3
Group 4
Hearing Test Result Group
Dissimilar letters indicate significant differences
Mother’s 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)
Mother’s 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)
Aim I:Worry about Baby’s Hearing
7
6
5
Mean
4
Worry
3
b
a
b
a
2
1
Group 1
Group 2
Group 3
Group 4
Hearing Test Result Group
Dissimilar letters indicate significant differences
Mother’s 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)
Mother’s 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 it’s 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 there’s
plenty of things to worry about already.”
Group 3 Mother (unilateral referral)
Aim I: Certainty about Baby’s
Hearing
7
6
5
a
a
b
4
Mean
Certainty 3
b
2
1
0
Group 1
Group 2
Group 3
Group 4
Hearing Test Result Group
Dissimilar letters indicate significant differences
Mother’s Comment
“I am glad you do this test as it helps to give
me peace of mind to know that my baby’s
hearing is fine and I welcome any sort of
test that can do this and doesn’t harm the
baby. Well done and keep up the good
work.”
Group 2 Mother (AABR clear responses)
Mother’s 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)
Aim I: Attitudes towards NHSP
7
6
a
a
5
b
b
Group 3
Group 4
Mean
Positivity of 4
Attitudes
3
2
1
Group 1
Group 2
Hearing Tests Result group
Dissimilar letters indicate significant differences
Mother’s 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)
Mother’s 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)
Aim I: Satisfaction with NHSP
7
a,b
a
b,c
c
6
5
Mean
4
satisfaction
3
2
1
Group 1
Group 2
Group 3
Group 4
Hearing Test Result Group
Dissimilar letters indicate significant differences
Mother’s 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)
Mother’s 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)
Aim 1:Summary of Findings
Outcome
Differences
Gp1
Gp2
Gp3
Gp4
1.State anxiety
0
0
0
0
2. Worry
0
0


3. Certainty
0
0


4. Attitude
0
0

5. Satisfaction
0
0

0

Aim II: Knowledge about NHSP
8
a
a
a
a
7
6
Mean
Knowledge
5
4
3
2
1
0
Group 1
Group 2
Group 3
Group 4
Hearing Test result Group
Dissimilar letters indicate significant differences
Mother’s 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)
Mother’s 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)
Aim II: Correlates of Knowledge
about NHSP
Group 3
Worry Certainty Knowledge
Worry
-.578**
-.045
Certainty
.096
Knowledge
Group 4
Worry Certainty Knowledge
Worry
-.421**
-.161
Certainty
.324*
Knowledge
* correlation significant at 0.05 level, ** correlation significant at 0.01 level.
Knowledge, Worry and Certainty.
• Aim:to explore relationship of knowledge about
NHSP and worry and certainty about baby’s
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.
Knowledge and Certainty in Group 4
(bilateral referral).
• 7/8 knowledge items-no association
• 1 knowledge item did show an association:
Which of these reasons do you think is the most likely
for the baby not recording a clear response?
The baby was unsettled
The baby had fluid in the ear
The baby may have a hearing loss
Background noise when the test was carried out
The equipment was faulty
None of these
Not sure
Worry and knowledge of most likely
reasons for no clear responses in Group 4.
7
6
5
Mean worry 4
3
2
1
Correct (n=49)
Incorrect (n=5)
Understanding of most likely reasons for no
clear responses
Certainty and understanding of most likely
reasons for no clear responses in Group 4.
7
6
5
Mean
4
certainty
3
2
1
Correct (n=49)
Incorrect (n=5)
Understanding of most likely reasons for no
clear responses
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.
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
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.