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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 22  |  Issue : 3  |  Page : 183-187

Knowledge and attitude of pediatric hearing impairment among general physicians and medical interns in coastal Karnataka, India


Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India

Date of Web Publication8-Aug-2016

Correspondence Address:
Dr. Krishna Yerraguntla
Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.187980

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  Abstract 

Objective: The objectives of the present study were to investigate and compare the knowledge and attitude among general physicians in primary health-care centers and medical interns. Materials and Methods: A questionnaire-based observational study design was implemented to assess and compare the knowledge and attitude of physicians and medical interns regarding pediatric hearing impairment in setups that have speech and hearing services and that do not offer these services.
Results: The general physicians and medical interns showed a positive attitude toward different issues such as importance of hearing in development of speech and language, importance of hearing as a sense, need of hearing screening in newborns, consideration of suspicion of hearing loss by parents, and need of speech therapy.
Conclusion: Even though the participants showed adequate knowledge and attitude toward pediatric hearing impairment, there are certain areas that need attention and awareness development. There is also a need to introduce speech and hearing settings at all hospitals as this will ensure a better awareness about the role of the professionals and enable more referrals.

Keywords: Attitude, Interns, Knowledge, Pediatric hearing impairment, Physicians


How to cite this article:
Yerraguntla K, Ravi R, Gore S. Knowledge and attitude of pediatric hearing impairment among general physicians and medical interns in coastal Karnataka, India. Indian J Otol 2016;22:183-7

How to cite this URL:
Yerraguntla K, Ravi R, Gore S. Knowledge and attitude of pediatric hearing impairment among general physicians and medical interns in coastal Karnataka, India. Indian J Otol [serial online] 2016 [cited 2019 Nov 20];22:183-7. Available from: http://www.indianjotol.org/text.asp?2016/22/3/183/187980


  Introduction Top


The auditory sense forms an important component of communication and it is essential for the normal mental and communication development of the child. The hearing loss in the early years of life can have an adverse and long-term impact on speech, language, cognition, social and emotional development.[1] Early identification and intervention of hearing loss plays a vital role for normal speech and language development.[2] Literature suggests that children who are from developing countries and are disabled face more discrimination, exploitation, and restricted social access.[3]

Medical practitioners, particularly general practitioners, pediatricians, otorhinolaryngologists (ENTs), obstetricians/gynecologists, and audiologists, are often involved together in the hearing testing of newborns and children. They often work together in different setups such as hospitals, clinics, and private. General practitioners, pediatricians, and otorhinolaryngologists play an important role in guiding patients and their families through diagnostic and treatment procedures.[4] They play an important role in the successful implementation of newborn hearing screening programs and early hearing detection and intervention programs.

According to the Joint Committee on Infant Hearing,[5] infants and toddlers with permanent hearing loss should be referred to an otolaryngologist with specific knowledge of pediatric hearing who can provide medical clearance for amplification, as well as to a geneticist and an ophthalmologist. One of the main factors that affect the early diagnosis and intervention of hearing loss is inadequate knowledge by medical personnel.[6] Even in countries where universal newborn hearing screening (UNHS) has been performed for years, the knowledge and attitude of physicians have been reported to be an important concern.[4]

A knowledge and attitude survey aims to understand what people know about a certain concept or problem and how they react toward it.[7] Moeller et al.[8] surveyed primary care physicians in the United States of America. Nearly, 81.6% of the physicians replied that it is very important to screen all newborns at birth and provided strong support for UNHS. The findings of a recent survey among midwives on NHS revealed that the midwives are in constant direct contact with the parents and therefore, play an important role in ensuring good follow-up.[9]

According to the National Center for Hearing Assessment and Management,[10] when an infant fails in the newborn hearing screening, the infant's primary health-care provider should always be notified about the need for a follow-up screening and further audiological testing, if required. Further, it was reported that only 73% of the screening coordinators informed the primary care physicians on this issue. In another study on physicians, only 12% of the pediatricians and 17% of the family physicians responded that they receive screening results on >50% of their patients.[8]

Need for the study

It is critically important that physicians and medicine interns should have the most current information available related to different facts about pediatric hearing loss. To provide appropriate support to primary health-care providers, the audiologists should have an understanding about the physicians' knowledge- and attitude-related pediatric hearing loss and audiological management. The present research attempts to understand the knowledge and attitude of issues in pediatric hearing loss among general physicians and medical interns in coastal Karnataka using a questionnaire.

The aim of the present study is to investigate and compare the knowledge and attitude about pediatric hearing impairment among medical interns and general physicians in coastal Karnataka.


  Materials and Methods Top


Participants

A questionnaire-based observational study design was used to assess the knowledge and attitude of pediatric hearing impairment among three groups of randomly selected medical professionals. Group I consisted of general physicians who were working in primary health-care centers (PHCs). Group II consisted of medical interns from a setup where speech and hearing services were available. Group III consisted of medical interns working in government hospitals where speech and hearing services were unavailable.

Questionnaire

A questionnaire developed by López-Vázquez et al.[6] was adopted with modifications that were culturally and socially relevant. The questionnaire aimed to assess the knowledge and attitude toward pediatric hearing loss. The questions targeted areas such as general impression about hearing, importance of parent's suspicion of hearing loss, importance of hearing screening, risk factors, hearing tests, and various rehabilitation options.

Questions numbered 1, 3, 5, 8, and 9 targeted toward investigating the attitudes of the participants. These questions were to be rated on a five-point Likert scale, with five denoting strongly agree and one denoting strongly disagree. Questions 2, 4, 6, and 7 aimed to examine the knowledge of the participants. Questions numbered 2, 4, and 7 were open-ended questions and required the participants to list the causes of hearing loss, referral, and audiological tests, respectively, while question number 6 was a closed question regarding the nature of hearing tests.

Data analysis

Descriptive statistics was used to summarize the data. The scores obtained in the attitude questions were cross-tabulated to obtain percentages. The difference in the knowledge and attitudes among the three groups was determined using Pearson's Chi-square or Fisher's exact test. P <0.05 was considered to be statistically significant. All analyses were done with SPSS 15 (SPSS Inc., South Asian Ed, Bengaluru, Karnataka, India).


  Results Top


A total of ninety participants, thirty in each group participated in knowledge and attitude survey towards pediatrics hearing loss. The participants were general physicians from PHCs, medical interns working in with and without speech and hearing services.

Attitude toward pediatric hearing impairment

A blend of positive and negative statements were included to avoid repetition of the responses to all questions. For the questions assessing the attitude that were positively worded, the scoring given was as follows; strongly disagree - 0, disagree - 1, don't know - 2, agree - 3, and strongly agree - 4, while the negatively worded questions were scored as strongly disagree - 4, disagree - 3, don't know - 2, agree - 1, and strongly agree - 0.

The raw scores of the participants were converted to percentages. The summary of responses to questions assessing the attitude is stated in [Table 1].
Table 1: Summary of responses toward attitudes to pediatric hearing impairment

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The first question assessed the attitude toward the importance of hearing toward speech and language development. Majority of the respondents in all the three groups (83.3% in Group I, 63.6% in Group II, and 60% in Group III) responded that they strongly agree to the importance of hearing sense. Fisher's exact test indicated that there was no significant difference (P = 0.21) between the groups.

The question 3 targeted to investigate the attitude toward newborns' hearing screening. The statement was negatively worded as, “there is no need to do hearing screening for newborns.” As shown in [Table 1], most of the participants responded for strongly disagree and disagree to statement, which, in turn, shows a positive attitude toward hearing screening. The interns in both groups obtained almost similar scores, while the group of general physicians obtained highest scores, indicating good attitude toward newborn hearing screening. Fisher's exact test was administered, P = 0.009 showed that there was a significant difference in responses between the groups.

Question 5 assessed whether parent's suspicion regarding hearing loss can be considered as a reason for referral for detailed hearing assessment. Most of the participants (Group I - 83.33%, Group II - 90%, and Group III - 93.33%) either strongly agreed or agreed with the fact that there is a need to consider the suspicion of hearing loss during hearing assessment procedure. Fisher's exact test was administered, P = 0.001 revealed a significant difference between the groups.

Question 8 was designed to investigate attitude toward the need of hearing aid in children with hearing loss. In this question, intentionally, a conditional clause was included (“whenever necessary“) to facilitate the answer. Although majority of the participants indicated the need of hearing aids, still a significant number of participants were unaware about this issue or they do not agree with it. However, Fisher's exact test did not reveal a significant difference between the groups (P = 0.07). The final item of the questionnaire questioned the participant's attitude toward the need of speech therapy and auditory training after fitting hearing aid in children with hearing impairment. Majority of the participants (Group I - 83.3%, Group II - 80%, and Group III - 80%) indicated a positive attitude toward the need of speech therapy and auditory training after providing appropriate amplification in children with hearing impairment. The Fisher's exact test (P = 0.006) revealed a significant difference between responses of different groups.

Knowledge regarding pediatric hearing impairment

The question 3 was an open-ended question where the participants were asked to list the risk factors that can cause hearing loss in infants. The responses of the participants were as shown in [Figure 1].
Figure 1: Responses to risk factors for hearing loss

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The 4th question was open-ended, where the participant had to name which specialist they refer to for hearing evaluation. The responses to this question revealed that most referrals were made to ENT professionals rather than to audiologists. From Group I, 76.67% (23) of the professionals mentioned that they refer to an ENT, while remaining 23.33% (7) refer to a pediatrician; none of them refer to an audiologist. From Group II, 96.67% (29) refer to an ENT and 3.33% (1) to an audiologist. From Group III, 93.33% (28) refer to an ENT and 3.33% (1) each to a pediatrician and an audiologist.

The 6th question which was a multiple choice question, where participants were asked about the two important features of hearing assessment; noninvasiveness and age at which tests can be performed. There were four options provided, of which option (a) noninvasive and performed at any age was the correct answer. Most of the participants responded correctly (Group I - 63.33%, Group II - 70%, and Group III - 73.33%). The data were observed to follow normal distribution and hence, Pearson's Chi–square test was applied, P = 0.78 revealed no significant difference between responses. In question 7, participants were asked to list all the hearing tests that they are aware of used for assessing the hearing sensitivity in children. The responses have been displayed in [Figure 2].
Figure 2: Responses to hearing tests that can be used

Click here to view


The general physicians listed the maximum number of tests. Pure tone audiometry (PTA) was commonly noted by all participants followed by tuning fork test (TFT), auditory brainstem responses (ABRs), and oto-acoustic emissions. Immittance audiometry and visual reinforcement were noted least. However, 11% of the total participants did not report even a single test.


  Discussion Top


The successful implementation of any health-related venture lies in the appropriate knowledge and attitude of the professionals involved. The findings from some Western studies have shown lack of awareness about the issue of pediatric hearing loss.[6],[11] In a study by Olusanya and Roberts,[11] it was concluded that medical students demonstrated greater awareness of early detection possibilities for infant hearing loss as compared to physicians, although both the groups had limited knowledge in terms of some important risk factors. In another survey on hearing loss prevention in Mexico,[6] it was demonstrated that a lack of knowledge and supportive attitude among general practitioners was identified to be the factors that lead to delay in hearing loss identification and diagnosis.

The present study aimed to investigate the knowledge and attitude of general physicians and interns working in two types of settings toward pediatric hearing impairment. Questions were arranged to maintain a sequence starting from awareness of the problem, followed by suspicion, diagnosis, and rehabilitation options. However, it is difficult to explore and measure attitudes. The scale that Likert proposed in 1932 has been a useful tool for attitude testing.[12] The questions to assess the attitude were to be rated on a five-point rating scale.

For the question on the importance of hearing sense in speech and language development (question number 1), most of the participants showed a positive attitude, higher number of general physicians has comparatively better attitude as compared to interns.

Most of the participants in the present study supported that parental concern is enough to warrant the need for hearing testing. These findings are in tune with another study carried out on physicians working in Mexico, where 84.6% of the participants responded as agree or strongly agree.[6] In a study conducted in the Department of Health, Minnesota, 89% of the medical professionals responded that they were aware about the presence of newborn hearing screening and its importance.[13] In the present study also, an overall good attitude was indicated toward the importance of newborn hearing screening.

In the present study, more than 50% of the participants in all the three groups responded as strongly agree or agree that children can be fitted with hearing aids. In a study done on physicians working in Mexico,[6] 40% responded to agree or strongly agree, while almost 32% responded as disagree or strongly disagree. Auditory training and speech therapy are essential aspects in the overall treatment of children with hearing loss. In the present study, 81.1% of the participants gave importance to the need of auditory and speech therapy that was similar to a previous study which has reported 90.5% of positive responses.

A vast majority of participants listed toxoplasmosis, rubella, cytomegalovirus, and herpes (TORCH) infections, congenital anomalies, and trauma among the main risk factors for causing hearing loss in children. Similar findings were reported in a previous study, where TORCH and ototoxic drugs were the main risk factors.[6] The responses to question on which the professional is frequently referred for hearing testing, majority indicated toward ENT professionals. However, it was surprising to note that even interns and physicians who are aware about the speech and hearing setup did not indicate referral to an audiologist. This is in contrast to the Western scenario, where 43.7% indicated referral to an audiologist.[6]

It is crucial that physicians of any specialty know about the noninvasiveness and age-related characteristics of hearing tests to guide families for appropriate and timely diagnosis and treatment. When asked regarding the nature of hearing tests whether invasive or not and whether these tests can be administered at any age, more than 60% of the participants in all the three groups responded correctly. This was more than that reported in the previous study,[6] where 45.7% responded correctly. In a study carried out in Mexico, 45.7% of the physicians gave the correct answer that hearing tests are noninvasive and can be performed at any age.[6]

When asked to list the names of tests that can be used for hearing testing in children, the most common response was PTA followed by TFT and then ABRs. These were similar to the findings in the study carried out in Mexico with PTA being most common followed by ABR and TFT.[6]


  Conclusion Top


Importance of early identification and intervention has been well established in pediatric cases with hearing loss. Early identification and intervention can be influenced by many factors, and awareness among medical professional has been an important factor in this process. It is important for an audiologist to be aware about the knowledge and attitude on early identification and intervention among general physicians and also medical interns. The present study investigates the knowledge and attitude towards pediatric hearing loss in general physicians from PHCs, medical interns working in setups with and without speech and hearing services. General physicians and medical interns showed a positive attitude toward different issues such as importance of hearing in the development of speech and language, importance of hearing as a sense, need of hearing screening in newborns, consideration of suspicion of hearing loss by parents, and need of speech therapy. Most of the participants are aware of the common risk factors causing hearing loss in children and tests used for hearing assessment. It was clear from the responses that the general physicians and interns would prefer to refer pediatric cases to ENTs, and the role of audiologist as a referral source is not prominent. To conclude, the participants demonstrated an overall good knowledge and attitude about basic issues related to pediatric hearing loss. However, there are lacunae in certain areas where there is a need to increase awareness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Olusanya BO, Ruben RJ, Parving A. Reducing the burden of communication disorders in the developing world: An opportunity for the millennium development project. JAMA 2006;296:441-4.  Back to cited text no. 1
    
2.
Northern JL, Downs MP. Hearing in Children. Baltimore, MD: The Williams and Wilkins Co.; 1978.  Back to cited text no. 2
    
3.
United Nations (UN). Monitoring child disability in developing countries: Results from the multiple indicator cluster surveys. USA: United Nations Children's Funds, University of Wisconsin; 2008.  Back to cited text no. 3
    
4.
Moorjani P, Fortnum H. Dissemination of information to general practitioners: A questionnaire survey. BMC Fam Pract 2004;5:27.  Back to cited text no. 4
    
5.
American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007;120:898-921.  Back to cited text no. 5
    
6.
López-Vázquez M, Berruecos P, Lopez LE, Cacho J. Attitude and knowledge of hearing loss among medical doctors selected to initiate a residency in Mexico. Int J Audiol 2009;48:101-7.  Back to cited text no. 6
    
7.
Kaliyaperumal K. Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study; 2004. Available from: http://www.laico.org/v2020resource/files/guideline_kap_Jan_mar04.pdf. [Last retrieved on 2014 Dec 26].  Back to cited text no. 7
    
8.
Moeller MP, White KR, Shisler L. Primary care physicians' knowledge, attitudes, and practices related to newborn hearing screening. Pediatrics 2006;118:1357-70.  Back to cited text no. 8
    
9.
Goedert MH, Moeller MP, White KR. Midwives' knowledge, attitudes, and practices related to newborn hearing screening. J Midwifery Womens Health 2011;56:147-53.  Back to cited text no. 9
    
10.
National Center for Hearing Assessment and Management (NCHAM). Universal Newborn Hearing Screening: Summary Statistics of UNHS in the United States. Available from: http://www.infanthearing.org/status/unhsstate.html. [Last retrieved on 2011 Apr 18].  Back to cited text no. 10
    
11.
Olusanya BO, Roberts AA. Physician education on infant hearing loss in a developing country. Dev Neurorehabil 2006;9:373-7.  Back to cited text no. 11
    
12.
Uebersax JS. Likert Scales: Dispelling the Confusion. Statistical Methods for Rater Agreement; 2006. Available from: http://www.ourworld.compuserve.com/homepages/jsuebersax/likert2.html. [Last retrieved on 2007 Jun 26].  Back to cited text no. 12
    
13.
Brown NC, James K, Liu J, Hatcher PA, Li Y. Newborn hearing screening. An assessment of knowledge, attitudes, and practice among Minnesota physicians. Minn Med 2006;89:50-4.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Systematic review of knowledge of, attitudes towards, and practices for newborn hearing screening among healthcare professionals
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International Journal of Pediatric Otorhinolaryngology. 2017;
[Pubmed] | [DOI]



 

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