|Year : 2014 | Volume
| Issue : 1 | Page : 20-23
Grandmothers' perspective on hearing loss in children and newborn hearing screening
Revathy Rajagopalan1, Heramba Ganapathy Selvarajan2, Anitha Rajendran2, Binu Ninan3
1 Masters Student, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
2 Department of Speech, Language and Hearing Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
3 Department of Neonatology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
|Date of Web Publication||1-Apr-2014|
Heramba Ganapathy Selvarajan
Department of Speech, Language and Hearing Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu - 600 116
Source of Support: None, Conflict of Interest: None
Aim: To study the opinions of grandmothers of newborns on hearing loss, Newborn hearing screening (NHS) and intervention options. Materials and Methods: 100 grandmothers were interviewed in a tertiary care hospital, using a questionnaire adapted from Olusanya, Luxon and Wirz (2006). The responses were analyzed using frequency distribution. Results: 63% were aware that hearing loss could be congenital. Among the causes studied, more awareness was present for family history (67%), noise exposure (62%), and ear discharge (61%). Less than 50% of the participants were aware of other causes. Majority knew that bewitchment (72%) and ancestral sins (69%) were not a cause for hearing loss. Only 20% were aware that hearing loss could be identified at birth and 12% knew about availability of NHS. 75% thought that intervention is possible for hearing loss, and 33% believed that hearing-impaired children could attend regular school, if intervened. 86% of grandmothers preferred testing soon after birth. 87% preferred OAE compared to BERA (33%) as a screening tool. Hearing aids (92%) and surgery (89%) was widely accepted as intervention for hearing loss. Conclusion: Grandmothers had good awareness on congenital hearing loss. And limited awareness was present on causes of hearing loss, identification of hearing loss at birth, NHS and intervention. Thus, indicating an urgent need to create awareness in the above areas. A demonstration of positive attitude was shown in the results towards NHS and intervention for hearing loss, which will facilitate early identification and intervention.
Keywords: Grandmothers, Newborn hearing screening, Hearing loss
|How to cite this article:|
Rajagopalan R, Selvarajan HG, Rajendran A, Ninan B. Grandmothers' perspective on hearing loss in children and newborn hearing screening. Indian J Otol 2014;20:20-3
|How to cite this URL:|
Rajagopalan R, Selvarajan HG, Rajendran A, Ninan B. Grandmothers' perspective on hearing loss in children and newborn hearing screening. Indian J Otol [serial online] 2014 [cited 2019 Jul 21];20:20-3. Available from: http://www.indianjotol.org/text.asp?2014/20/1/20/129803
| Introduction|| |
Varieties of techniques are available for identifying hearing loss in infants. In the broadest terms, these include the use of public awareness campaigns, risk indicators, behavioral tests, and physiological tests. The public awareness approach uses mass media campaigns, brochures, and checklists to educate the public about the risk factors of hearing loss in children. The idea is to create awareness among parents and other caregivers to identify the hearing loss, so that they can bring/refer the child for diagnosis and treatment. 
In India, around five out of every 1,000 newborns screened were found to have hearing loss.  Furthermore, the identification of child's hearing loss is delayed because of poor awareness about presence of hearing loss and presence of hearing screening at birth. Parental denial and lack of readiness to accept a hearing problem is linked with delays in diagnosis and hearing aid fitting. , Grandmothers are always a part of an Indian family who live with parents of a child. Any decision in the family is often influenced by the significant others like grandmothers. They have an important role in guiding parents in bringing up of a newborn. Parents often seek their advice in taking care of their children since they have the experience of bringing up a child. In India, usually mothers stay with their parents during the delivery of a child. A child is with its grandmother at least in their first 3-6 months of life. Therefore, grandmothers' knowledge and attitude may influence any decision making regarding the child in the family.
The information of knowledge on issues related to hearing loss and the attitude towards it will help in developing appropriate educational tools and in providing adequate counseling during the newborn hearing screening (NHS) program. Also there is dearth of studies on caregivers' knowledge and attitude towards issues related to hearing loss and NHS in India.
Aim of the study
- To find the grandmothers' knowledge on hearing loss, NHS and intervention of hearing loss
- To find the grandmothers' attitude towards NHS and intervention of hearing loss.
| Materials and Methods|| |
A total of 102 grandmothers of the newborns in the age range of 37-64 years (mean - 47.26 years) participated in the study. The interview was conducted at 1 or 2 days after the child's delivery, in the postnatal ward and without any interference by other family members. Since interview could not be completed in two participants, the responses of only 100 grandmothers were taken. The subjects were from different socioeconomic status and educational background.
The questionnaire has been adapted and modified from a previous study  which originally contained 15 items. The questionnaire used in this study had two categories, knowledge, and attitude [Appendix I] [Additional file 1].
- It consists of 24 items of which
- One item for the knowledge of congenital hearing loss
- 13 items for the knowledge on causes of hearing loss
- Five items for the NHS and intervention of hearing loss, and
- Five items for the attitude towards NHS and intervention of hearing loss.
A pilot study with 10 grandmothers was conducted. Based on the participants' feedback, the difficult terms in the questions were modified.
The current study was carried out with each subject separately with their consent. The pictures of otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA) testing were shown to the subjects to ask their preference of a screening tool. The average time taken for single interview was 15 min.
| Results and Discussion|| |
The results are discussed in five categories:
- Grandmothers' knowledge on congenital hearing loss
- Grandmothers' knowledge on causes of hearing loss
- Grandmothers' knowledge on NHS and intervention
- Grandmothers' attitude towards NHS and intervention.
Grandmothers' knowledge on congenital hearing loss
A total of 63% of the grandmothers were aware that hearing loss could be congenital. Eighteen percent refused the possibility of congenital hearing loss and 19% were unsure. A South African study  indicated a similar rate of awareness of the congenital hearing loss (67%) among mothers. It is well-known fact that parents of infants with congenital hearing loss would like an early identification. , Poor awareness of congenital hearing loss may lead to delayed identification and thus the intervention. The findings suggest that there needs to be further improvement in awareness percentage. They may wait till an observable sign of absence of speech beyond 1 year or till such comparisons are made by others. On the other hand, a good awareness may prepare the grandmothers to suspect hearing loss right from the birth if any facilitating them to approach the healthcare professionals as early as possible.
Grandmothers' knowledge on causes of hearing loss
Results in [Table 1] shows that grandmothers' knowledge was relatively high for family history (67%), noise exposure (62%), ear discharge (51%), and high fever (50%) as causes of hearing loss. In contrast, their knowledge was low for medication (9%), birth asphyxia (9%), and jaundice (14%). Two studies , have reported poor awareness of the above factors as a cause for hearing loss among mothers. Generally, it appears that birth complications are not considered as a cause for hearing loss.
|Table 1: Grandmothers' responses to the questions on causes of hearing loss|
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Majority of the grandmothers did not indicate bewitchment (72%) and ancestral sins (69%) as a cause for hearing loss. Many Asians, including those from India believe that a disability or deformity is karma (fate), and therefore, nothing can be done about it. It is viewed as the parent's karma to have and raise a deaf child.  Callaway  reported that in China, the attitude towards deafness tends to be very negative, particularly at the early stages. Parents of a deaf child will often spend vast sums of money initially with orthodox medical practitioners and subsequently with traditional healers before accepting rehabilitative intervention. These attitudes stem, in part, from indigenous traditions that contribute to the stigma of deafness and to resistance to both hearing aids and to sign language.
Grandmothers' knowledge on NHS and intervention
As shown in [Table 2], 75% of the grandmothers were aware that treatments are available for hearing loss, 67% knew about the speech and language difficulties, and 20% were aware that hearing loss could be identified soon after birth. Only 12% of the grandmothers were aware about the NHS. This in comparison to another study  on mothers reported a relatively higher knowledge (57%) on identification of hearing loss soon after birth. Thirty-three percent were aware that children with hearing loss could attend normal school with amplification devices. These results revealed poor information and awareness about NHS and intervention.
|Table 2: Grandmothers' responses to the questions on NHS and intervention|
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The parental decision making process is influenced by a personal value system, which is usually expressed in a positive or negative attitude towards screening.  The presence of NHS has to be addressed to the public, which helps in early identification of the hearing loss. A healthy relationship between an audiologist and the family alone can achieve this. 
Grandmothers' attitude towards NHS and intervention
[Table 3] shows that 86% of the subjects preferred hearing screening soon after birth. Eighty-seven percent of the grandmothers preferred OAE as a screening tool for testing their babies. Only 33% of grandmothers preferred BERA as a screening tool. A less preference for BERA could be owing to the electrodes placement and its connections. There was also a high acceptance of hearing aids (92%) and surgery (89%) as intervention for hearing loss. Overall, grandmothers demonstrated a positive attitude towards early detection and intervention for hearing loss. Similar results were reported in South African community  where, 99% of mothers had a positive attitude towards infant hearing screening. This is also supported a study in Nigeria  where a positive attitude for neonatal hearing screening was found in 92% of mothers; 84% had acceptance for hearing aid usage. It is encouraging; the results of the present findings were in line with developed country. 13
|Table 3: Grandmothers' responses to the questions on attitude towards NHS and intervention|
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| Conclusion|| |
- 50-70% of grandmothers were aware about congenital hearing loss, causes of hearing loss like consanguinity, noise exposure, ear discharge, high fever, and family history. About 70% of grandmothers were aware that bewitchment and ancestral sins were not cause of hearing loss
- Knowledge was limited with respect to medical complications like low birth weight, birth asphyxia and jaundice as a cause for hearing loss. They were aware about the treatments for hearing loss, the presence of speech and language difficulties in hearing impaired children
- Most of the grandmothers have a positive attitude towards NHS and intervention programs
- Grandmothers have poor knowledge on presence of NHS and intervention programs for hearing impaired children except for hearing aids
- A negative attitude was observed towards BERA as a screening tool and surgery as an intervention process for hearing loss.
Good knowledge and healthy attitude among grandmothers may positively influence the family towards the decision making for early identification and intervention of hearing loss. So, careful attention has to be provided in creating awareness and in counseling towards the factors which had poor knowledge and negative attitude. Also during counseling, family as a whole to be involved because, individual member's lack of knowledge may lead to the delay in identification and intervention of the hearing impairment.
Further research can study the knowledge and attitudes of the other members of the family and their attitudes towards hearing impaired children.
| Acknowledgments|| |
We thank the Dean of Faculties, Sri Ramachandra University and Course Chairperson, Department of Speech, Language and Hearing Sciences, Sri Ramachandra University for permitting us to do the study.
| References|| |
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[Table 1], [Table 2], [Table 3]
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