Development of an assessement tool that measures change of knowledge, attitude and practice of mothers towards universal newborn hearing screening programme.
Graham, Christine John.
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Hearing loss is a common cause of disability and has increasingly become a global burden. Although Universal Newborn Hearing Screening Programme (UNHSP), as a public health initiative, provides detection and management services for childhood hearing loss, the loss to follow-up remains a challenge. For the optimal prevention of long-term speech-language, cognitive and social disability working with the communities concerned is important. Accordingly, this thesis reports on the process of developing a knowledge, attitude and practice (KAP) tool that captures mothers’ understanding of childhood hearing loss and newborn hearing screening in Amajuba District, KwaZulu-Natal, South Africa. This research pursued an exploratory sequential, mixed method design which combines both qualitative and quantitative methodological approaches. For the qualitative approach, focus group interviews, using an interview guide, were conducted with the aim of identifying content area for the development of the tool. Inductive thematic analysis was used to analyse data. The themes identified were used to develop a tool which was then validated by face and content validity and which was analysed using descriptive statistics and content validity index respectively. A test-retest repeatability study was undertaken to assess stability then analysed with Cohen’s kappa coefficient. Thereafter, a KAP survey was conducted to obtain a baseline. Nine themes were obtained for the qualitative study: Perception of deafness; causes of deafness; identification of deafness; detection and treatment; beliefs; feelings; health seeking behaviours; further examination and support. A validated KAP tool was developed with twenty-nine items: 6 – demography; 6 – knowledge; 6 – attitude; 6 – practice and 5 – awareness. Both scale content validity index and item content validity index scored 1 for comprehensiveness and relevancy and 97% of participants stated that the tool was appropriate for face validity. Test-retest repeatability study results showed a Cohen’s Kappa Coefficient of 0.87 (95% CI: 0.87, 0.87) for stability. The baseline KAP showed limited knowledge regarding childhood hearing loss amongst mothers in terms of a newborn hearing loss, causes, detection and treatment. Cultural factors such as birth and ancestral rituals were identified amongst the causes of hearing loss. However, the attitude towards early detection of hearing loss was positive and most mothers would accept screening if offered, although acceptance could be impeded by lack of finance, fear of equipment and the time required. Nonetheless, a health facility was mentioned as the first point of consultation and treatment. These research outcomes have demonstrated the feasibility of developing a validated KAP tool regarding childhood hearing loss and newborn hearing screening. The reported inadequate knowledge of mothers’ KAP has informed practitioners and policy makers of the existing needs of this community. The outcomes will also allow for tailor-made awareness strategies comprised of health education and promotion of newborn and childhood hearing.