PP1114 - Case Study of the Knowledge and Attitudes of Hearing Loss and Hearing Screening Use at a Rural Pediatric Care Clinic

Abstract:
Rural children are often not diagnosed with HL until 20 months of age due to barriers and negative SDOH. The purpose of this case study was to assess rural PPCP’s knowledge of risk factors for HL, hearing-related milestones, and hearing screenings using a Likert-style survey and determine the need for peer-led training. Secondary to purpose, investigators sought to gauge interest in asynchronous telehealth support by AuDs. Results indicated overall limited knowledge of risk factors and positive attitudes toward training and telehealth support by AuDs. Training and telehealth support is proposed to assist PPCPs in interpreting screenings, making timely referrals, and reducing unnecessary follow-up appointments.

Summary:
The identification of congenital, progressive, or transient hearing loss (HL) and referral for early intervention services are vital to ensure healthy communication development. Families from rural areas are at a higher risk for loss to follow-up after newborn hearing screening, delay in diagnosis, and enrollment in early intervention services. Rural children were diagnosed with a permanent HL at 20 months of age, on average, over 6 times later than the JCIH position statement’s recommendation and EHDI standards (Kingsbury et al., 2022).

Health disparities caused by geographic location pose a significant challenge to pediatric health care, including hearing health care. The prevalence of certain medical conditions, including developmental delay, is suspected to be higher in rural children due to the negative social determinants of health (SDOH) associated with rurality (Bettenhausen et al., 2021).

Collaboration with Pediatric Primary Care Providers (PPCPs) and ancillary medical staff is proposed due to their monitoring of other developmental milestones, more frequent contact with patients, established trust with families, and understanding of community cultures (Davis et al., 2023). The AAP made a policy statement in 2018 recommending that PPCPs provide longitudinal developmental monitoring and should consider collaborations with multidisciplinary clinics.

The purpose of this case study was to assess rural Louisiana PPCP knowledge of risk factors for pediatric HL, hearing-related developmental milestones, and hearing screening tools using a 15-item Likert-style survey to determine the need for peer-led training on pediatric hearing-related developmental milestones and the use of developmentally appropriate hearing screening tools.

All staff at a pediatric clinic in Bogalusa, LA were asked to complete the survey. Respondents included three Registered or Certified Medical Assistants, one medical doctor, and one Licensed Practical Nurse. The outcomes revealed a general deficiency in understanding hearing-related risk factors, hearing developmental milestones, and the use of developmentally appropriate hearing screening tools. Most respondents strongly disagreed on their awareness of JCIH risk factors, leading to a subsequent lack of inquiry about these factors when obtaining a case history.

It is imperative that PPCPs have basic knowledge and training on audiologic risk factors and hearing-related milestones to facilitate timely intervention. The use of developmentally appropriate screeners could be more efficacious for pediatric assessments and assist rural clinicians in adopting a referral process.

Peer-led training and introduction of an AuD to PPCP asynchronous telehealth model is potentially advantageous to provide audiologic services to rural children. Asynchronous telehealth has been used to provide healthcare to rural children by other medical fields, including psychology and neurology (Lo & Gospe, 2019).

This case study utilized a small sample size from one rural pediatric clinic, which may not represent the knowledge and attitudes of all rural providers. Investigating the potential use of asynchronous telehealth partnership between urban healthcare specialists and rural PPCPs could improve access, decrease waiting times for urban specialists, reduce unnecessary referrals to urban specialists, and reduce health disparities caused by rurality.