Baseline Knowledge, Attitudes, and Practices of Healthcare Practitioners in Rizal Province, Philippines toward Implementing the Universal Newborn Hearing Screening Program

Abstract

Objective: The study describes the current knowledge, attitudes, and practices of selected healthcare practitioners in Rizal Province regarding the implementation of the universal newborn hearing screening program (UNSHP).

Materials and Methods: A descriptive phenomenologic research design through focus group discussions with pediatric and OBGYN consultants in a government hospital, nurses from private primary and secondary hospitals, midwives from private birthing homes, and rural health workers.

Results: Knowledge: Most participants lacked specific knowledge on hearing loss and its implications in the UNHSP. Atttitudes: All participants recognized that they had important roles in implementing the program except the OBGYN consultants as they felt that information about the UNHSP should be provided by pediatricians. Practices: The lack of a screening device, trained personnel, and a referral network were the most common barriers in implementing the program.

Conclusion: Most participants were able to determine the advantages and disadvantages of implementing the UNHSP. However, less than half of the participants admitted to have an established protocol to give access to newborn hearing screening services. Establishment of an information dissemination protocol and materials may be beneficial in the absence of funding for screening devices.

Keywords: Universal Newborn Hearing Screening, Hearing for Life Project, KAP

Full text

Baseline Knowledge, Attitudes, and Practices
of Healthcare Practitioners in Rizal Province,
Philippines toward Implementing the
Universal Newborn Hearing Screening Program
Carlos Diego A. Rozul,1 Ernesto R. Gregorio, Jr.2 and Charloe M. Chiong3,4
1College of Medicine and College of Allied Medical Professions, University of the Philippines Manila
2Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila
3Philippine National Ear Institute, National Institutes of Health, University of the Philippines Manila
4Department of Otorhinolaryngology, College of Medicine and Philippine General Hospital, University of the Philippines Manila
ABSTRACT
Objecve. The study describes the current knowledge, atudes, and pracces of healthcare praconers in Rizal
province regarding the implementaon of the universal newborn hearing screening program (UNHSP).
Materials and Methods. A descripve phenomenologic research design through focus group discussions with
pediatric and OBGYN consultants in a government hospital, nurses from private primary and secondary hospitals,
midwives from private birthing homes, and rural health workers.
Results. Atudes. All parcipants recognized that they had important roles in implemenng the program except
the OBGYN consultants as they felt that informaon about the UNHSP should be provided by pediatricians.
Pracces. The lack of a screening device, trained personnel, and a referral network were the most common barriers
in implemenng the program. Knowledge. Most parcipants lacked specic knowledge about hearing loss and its
implicaons in the UNHSP.
Conclusion. Most parcipants were able to determine the advantages and disadvantages of implemenng the
UNHSP. However, less than half of the parcipants admied to have an established protocol to give access to
newborn hearing screening services. Establishment of an informaon disseminaon protocol and materials may
be benecial in the absence of funding for screening devices.
Key Words: Universal Newborn Hearing Screening, Hearing for Life Project, KAP
INTRODUCTION
Congenital hearing loss aects approximately 0.1%-4.3%
of infants worldwide.1-7 Garg, Singh, and Khurana8 noted
that the reduction of neonatal mortality in India resulted
in increasing the need to cope with dierent disabilities.
Locally, a study by Chiong et al.9 revealed that bilateral
profound hearing loss aected 0.14% of Filipino infants
and found to be related with developmental delays. is
called for an actionable national policy on universal newborn
hearing screening for the benet of these aected babies.
In 2009, the Philippines implemented Republic Act
9709 otherwise known as the Universal Newborn Hearing
Screening and Intervention Act.10 is feat made the
Philippines as one of the few countries that advocated the
legislation of universal newborn hearing screening along
Paper presented at the 3rd Graduate Students’ Colloquium,
April 10, 2019, Cherry Blossoms Hotel, Ermita, Manila.
Corresponding author: Carlos Diego A. Rozul, RPm
College of Medicine University of the Philippines Manila
547 Pedro Gil St., Ermita, Manila 1000, Philippines
Email: carozul@up.edu.ph
ACTA MEDICA PHILIPPINA VOL. 54 NO. 2 2020134
ORIGINAL ARTICLE

with Great Britain, United States of America, Germany,
and Poland.11 Universal newborn hearing screening has been
proven to increase early diagnosis and treatment of hearing
loss12-15 which can prevent speech and language delays16,
reduce the age of cochlear implantation17, and found to
be cost-eective even with a tracking system.18 Similarly,
Santos-Cortez and Chiong19 reported that a universal
newborn hearing screening program was cost-eective in
the Philippines.
Awareness, as well as the knowledge and attitudes of the
healthcare practitioners also play a role in the eectiveness
of the program.12,20 Factors aecting maternal attitudes
toward universal newborn hearing screening included their
own knowledge of the hearing screening process21,22 and
risk factors,23-24 availability of resources,25 cost, knowledge
and attitudes of healthcare professionals6,23 and the
knowledge and attitudes of an extended family.25
Dierent healthcare practitioners serve in various
ways towards the success of a universal newborn hearing
screening program. Biernath, Holstrum, and Eichwald26
suggest that midwives play a signicant role in a birthing
center setting especially when the center does not have
equipment for newborn hearing screening. Midwives are
responsible for educating and counseling parents during
pregnancy and during the postpartum period regarding the
benets of universal newborn hearing screening. Moreover,
they play a critical role in connecting parents to centers
who have the necessary equipment for newborn hearing
screening as well as collaborate with other professionals to
ensure follow-up. Bower and St. John27 emphasize the role
of the medical doctor such as otolaryngologist in the routine
assessment of hearing status, completion of diagnostic
testing for identied children with hearing loss, and referral
to other professionals for intervention such as the pediatric
audiologist and the speech and language pathologist.
According to Scheepers, Swanepoel, and le Roux,12
healthcare professional knowledge and team collaboration
are some of the signicant contributors in the decision-
making process of parents regarding newborn hearing
screening following cost and parent knowledge. Olusanya,
Luxon, and Wirz20 found that physicians play a signicant
role in early detection of congenital hearing loss by
inuencing positive parental attitude and adequate parental
knowledge. It is important to evaluate the knowledge
and attitude of healthcare practitioners towards universal
newborn hearing screening in the Philippine setting. Previous
studies28-29 used questionnaires to gauge the knowledge,
attitudes, and practices of dierent healthcare practitioners
involved in newborn hearing screening.
In summary, there is a global trend for instituting
more eective methods in improving awareness, training,
and delivery of newborn hearing screening services to
increase healthcare practitioner competence and condence,
raise parental knowledge and attitude, and maximize
developmental outcomes. e current study is believed
to contribute to the successful implementation of the
Universal Newborn Hearing Screening and Intervention
Act in Rizal. Furthermore, it aims to describe the knowledge,
attitudes, practices of healthcare practitioners in Rizal toward
the implementation of the UNHSP.
MATERIALS AND METHODS
Study Design
e study utilized a descriptive phenomenologic
research design in exploring the knowledge, attitudes, and
practices of healthcare practitioners toward implementing
the universal newborn hearing screening program in
Rizal province.
Parcipants
e current study investigated the knowledge, attitudes,
and practices of healthcare practitioners involved in the
implementation of newborn hearing screening. In the context
of this study, purposive sampling was utilized to source ve
midwives from birthing homes, twelve rural healthcare
workers from rural health units, three pediatric consultants,
ve nurses from primary and secondary hospitals, and three
OBGYN consultants from tertiary hospitals in Rizal province.
Healthcare practitioners from the Rizal area were chosen due
to the limited number of certied universal newborn hearing
screening centers in the area, most of which are located
within the periphery of Metro Manila (Taytay, Cainta, and
Antipolo City) and calls for a strong referral system in the
area. Stratied sampling was attempted according to the
number of recognized health institutions by the Department
of Health Region IV-A Oce, however the targeted number
of participants was not achieved due to refusal of participation
of selected and alternatively selected institutions.
Data Collecon
Healthcare institutions from Rizal were randomly
selected from the June 2017 registry of certied newborn
screening centers provided by the Department of Health
Region IV-A Oce. Letters of request for approval and
participation in the study were given to the Region IV-A
Oce of the Department of Health and the selected health
institutions. After approval, coordination with the sta
managers or their equivalent was done to set a schedule for
the focus group discussions (FGDs) with the potential study
participants. ere was a total of 43 health institutions that
were invited to participate in the study. However, only 39
institutions were located at the designated addresses provided
by the Department of Health. Out of the ve tertiary hospitals,
only one agreed to participate and sent three pediatric
and OBGYN consultants. Of the ten primary/secondary
hospitals invited, ve agreed to participate and committed to
send six participants, however only ve were able to attend.
Out of the 13 rural health units invited, there were nine who
agreed to participate. However, only 12 participants from
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the rural health units came from eight institutions. e 12
rural health workers were divided into two groups with six
participants each. Out of the 16 birthing homes intended to be
included, only 12 were located and only four birthing homes
agreed to participate providing a total of ve participants.
An external venue was reserved for data collection –
the Executive Secretary Room of the Municipal Oce of
Taytay. A total of 60 healthcare practitioners were intended
to participate in the data collection. ere were six FGDs
conducted grouped according to profession (midwives,
nurses, rural health workers, pediatric consultants, and
OBGYN consultants). Each participant was given an
informed consent form that explains the rationale of the
study, potential risks and benets of participating, access to
results, and the condential and anonymous treatment of
collected data. Afterwards, a demographic data sheet was
given to characterize the composition of the group. e
discussion revolved around their knowledge, attitudes, and
practices toward implementing the universal newborn hearing
screening program. With free and prior informed consent,
the session was recorded using a video and audio recording
device. Tokens of appreciation were given after the discussion
following a short lecture about the Universal Newborn
Hearing Screening and Intervention Act of the Philippines.
Data Analysis
Multimedia recordings from the FGDs were transcribed
by an external transcriber hired by the primary researcher.
e transcriber was asked to delete all les after turning over
the transcriptions. A thematic analysis was done to synthesize
the ndings from the collected data with the help of the
qualitative data analysis program NVIVO 12. Data were coded
by one of the primary investigators according to Knowledge
(correct and incorrect facts about the UNHSP, and pediatric
hearing loss), Attitudes (positive and negative towards
their role in implementing newborn hearing screening, and
positive and negative towards online modules as a modality
for training), and Practices (barriers and facilitating factors
to practice). e same investigator then identied themes
by reviewing the relationships of the answers of each FGD.
RESULTS
e focus group discussions were held in six separate
groups. Two groups were composed of rural health workers,
one group of private primary/secondary hospital nurses, one
group of OBGYN consultants in a government hospital,
one group of pediatric consultants in a government hospital,
and another group composed of midwives from private
birthing homes. Table 1 shows general characteristics of
participants per group while Table 2 shows the specic
characteristics of the participants in relation to UNHS.
During the FGDs, the participants were seemingly
reluctant to fully engage when asked about knowledge on
the UNHSP. However, when asked about their attitudes
and practices regarding UNHSP, participants were
much more expressive. ere were participants who were
dominating each topic discussed, but all participants were
given the chance to share their insight from their practice or
institution’s settings. ere were instances where participants
in the FGD involving the RHU sta discussed topics
among themselves, but these were opened up to the group.
After each topic was discussed, a general summary was given
to which participants agreed that the summary reected
how they viewed the UNHSP. e FGDs lasted for 40 to
90 minutes. A total of four themes were identied after the
FGDs shown in Table 3.
DISCUSSION
Currently, the Newborn Hearing Screening Reference
Center (NHSRC) not only maintains records of newborns
who have undergone the service. ey also disseminate
certication courses on the policies and procedures related
to the UNHSP including stop criteria during testing with
otoacoustic emission (OAE) and automated acoustic
brainstem response (AABR), counseling, referral to health
professionals, PhilHealth reimbursement, and reporting of
results to the NHSRC. Dissemination of protocols for those
without OAE and AABR are stipulated in the Manual of
Procedures, but do not have their own certication course.29
Table 1. General Demographics of Parcipants Divided by Focus Group Discussion Groupings
Focus Group Discussion Sex Age (years)
Range Mean Age Standard
Deviaon Age
Years of
Experience Range
Mean Years of
Experience
Standard Deviaon
Years of Experience
M F
Rural Health Workers 1 0 6 22 - 61 46.33 13.19 2 - 27 11.83 9.81
Rural Health Workers 2 2 4 25 - 58 42.67 11.86 1 - 25 13.83 9.89
Private Primary/Secondary
Hospital Nurses
05 23 - 44 30.4 8.14 0.83 - 10 5.37 3.83
Government Hospital
Pediatrician Consultants
03 37 - 51 43.33 7.09 8 - 21 13.00 7.00
Government Hospital
OBGYN Consultants
03 33 - 54 40.67 11.59 3 - 21 10.00 9.64
Private Birthing
Home Midwives
05 19 - 49 36.4 12.28 0.5 - 38 17.10 15.50
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Table 2. Specic Demographics of Parcipnats Divided by Focus Group Discussion Groupings
Focus Group Discussion
Sex Claimed to
know about
UNHS
Source of Informaon
about UNHS
Presence
of UNHS
in Aiated
Facility
Refers to
Facilies
with UNHS
Directly
Involved in
Screening
Babies
M F
Rural Health Workers 1
Barangay Health Worker 0 1 1 Paents 0 0 0
Nurse 0 3 3 Grandchildren,
Colleagues, Pracce
111
Midwife 0 2 2 Seminar, Books/Journals 211
Rural Health Workers 2
RHU Liaison 101Classroom 0 10
Midwife 0 2 2 Seminar, Books/Journals 0 20
Medical Technologist 1 1 2 Seminar, Books/Journals 0 1 1
Nurse 0 10N/A 000
Private Primary/Secondary Hospital Nurses
NICU Nurse 0 2 2 Colleagues, Pracce 212
OR Nurse 0 2 2 Seminar, Colleagues 121
Nursing Assistant 0 1 1 Colleagues 1 1 1
Government Hospital Pediatrician Consultants
Pediatrician Consultants 0 3 2 Colleagues 000
Government Hospital OBGYN Consultants
OBGYN Consultants 0 3 2 Colleagues, Private Hospitals 0 0 0
Private Birthing Home Midwives
Birthing Home
Owner and Midwife
03 1 Seminar 10 0
Sta Midwife 0 2 1 Classroom 0 0 0
Overall 2 / 28 26 / 28 22 / 28 8 / 28 10 / 28 7 / 28
Table 3. Themac Analysis Matrix
Domain Theme Examples
Knowledge
Lack of Specic
Knowledge on Raonale
and Implementaon
of UNHSP
Risk Factors
Age of hearing detecon
Submission of records to NHSRC
Referral aer detecon of hearing loss
Atudes
Lack of Informaon
Disseminaon Protocol
Interdependence of midwives, nurses, OBGYN, pediatricians, and RHWs on informaon disseminaon
Unclear roles for OBGYN
Cognive Dissonance
Regarding Roles Played
in Implemenng
the UNHSP
NHS is not a privilege
No biases on infant's risk factors
Determined benets of UNHSP
Pracces
Does not refer to facilies
Does not follow up on NHS
Lack of Accesibility to
Training and Services
Does not know how to become cered
Suggested to make informaon for parents and praconers more available (ex: directories)
Cercaon with CPD points
Open to online modules as a modality for training, except RHW
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Lack of Specic Knowledge on Raonale and
Implementaon of UNHSP
All participants had various ideas with regard to how
hearing loss can aect the life of a child and the family.
e most common responses included its negative eects
on accomplishing tasks and developing skills that require
normal hearing such as understanding verbal instruction,
acquiring normal speech, learning concepts especially in
school, and developing cognitive skills. All participants also
recognized that hearing loss can negatively aect a child’s
psychosocial development. More than half of the participants
shared how a child with hearing loss becomes vulnerable
to bullying especially in school.
“As far as I know, infection lang pero I don’t know
lang kung related kasi, parang wala pa naman akong
na literature about dun sa alcohol and then dun sa
nicotine at yung mga drugs. I’m not really ano.” (As
far as I know, infection is the only cause, but I don’t
know if it’s related to alcohol, nicotine, and drugs since
I haven’t read literature regarding it.) 31, female,
Sta Midwife
All the participants mentioned that the impact of
a child with hearing loss also extended to the family of
the individual with normal hearing. Most commonly
this relates to family communication, coping with grief
and stigma of having a “special child”, and the economic
impact of managing the condition. e participants cited
varied causes of hearing loss in children. All participants
mentioned prenatal and postnatal infections and accidents
as cause of hearing loss in children. However, when asked
for specic infections, only a few were able to give examples,
most of which revolved around cerumen impaction, and
foreign objects.
Similar to the ndings of Ignacio, Olveda, and Yap,28
participants had limited knowledge on the screening itself.
When asked how hearing loss could be detected, almost
all participants referred to newborn hearing screening as
a “hearing test” that can detect hearing loss in newborns.
Most cited eects on developmental milestones relating
to hearing and speech. Less than half however said that
relying on developmental milestones was not enough. One
pediatrician shared that hearing loss can be detected though
clapping hands during a follow up physical examination.
However, a pediatrician consultant rebutted the statement
by acknowledging the dierent severities of hearing loss in
which clapping of hands may not be eective. is sentiment
was shared by one midwife/clinic owner as well.
All participants shared that if hearing loss would be
detected during screening, they would refer to a specialist
such as an ENT or EENT doctor. When asked what kind of
intervention could be done, only less than half gave specic
examples. Surgery was cited as a possible intervention by a
majority, however none were able to specify what would be
done. Hearing aids were also cited. Cochlear implants and
additional diagnostic testing were only mentioned by one
pediatrician consultant. When parents refuse UNHS, half
of participants that oer the service did not seek written
consent. Across facilities that oered newborn hearing
screening, less than half reported that the service is not
reimbursable through Philhealth.
Cognive Dissonance regarding Roles Played in
Implemenng the UNHSP
Similar to ndings of Moeller, White, and Shisler30
all participants recognized that newborn hearing screening
should be given to all newborns as “it is not a privilege”.
Some cited that having the child screened is a parent’s
duty and is mandated by law. ere was no mention in
prioritizing newborn hearing screening according to number
of risk factors. However, most midwives, OBGYNs, and
pediatricians had reservations to tell parents of patients about
newborn hearing screening due to cost and accessibility of
additional testing and intervention services. Most nurses
shared their doubts with the newborn hearing screening
device due to inconsistent results.
“Sa akin, bale, hindi mo made-detect kung ano po
ba talaga yung condition niya: kung siya ba’y autistic,
or late lang ba talaga. Kasi di po ba may kanya-
kanyang kategorya ‘yan? ” (For me, you won’t detect the
true condition, if the child has autism or has delays,
because these conditions have their own categories,
don’t they?) 47, female, Rural Health Unit Midwife
All participants shared that there were benets to
the universal newborn hearing screening program. ese
benets centered around early detection and intervention
to prevent any developmental delays. Two rural health
midwives shared that it is important to screen for hearing
loss so that specialists may give an accurate diagnosis to the
parent of the child in case other conditions exist that are
associated or similar to the presentation of hearing loss in
a child.
All participants except the OBGYN consultants felt
that it was their duty to at least inform parents regarding the
universal newborn hearing screening. Rural health workers
share that information on the UNHSP should be given
during pre-marital counseling. Only those directly involved
in the newborn hearing screening procedure mentioned
that they have the duty to explain to the parents the initial
results of the screening, such as to look out for the child’s
response to sounds and speech development.
Moreover, rural health workers and private birthing
home midwives feel that their role is to facilitate the
parent’s access to a comprehensive service. For pediatrician
consultants, they admitted that upholding the UNHSP
is pertinent in their duty as doctor, pediatrician, and
government employee. Participating nurses added that
promoting and implementing the universal newborn hearing
screening program is important to avoid being reprimanded
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by their superiors when patients claim they do not know
about the service. Rural health workers shared that they
had a responsibility to advocate within their respective
municipalities/cities the establishment, budgeting, and strict
implementation of the UNHSP through collaboration with
their municipal health ocers and local investment plan for
health in Rizal. Findings from hospital and lying-in based
practitioners were consistent with previous studies.20,26-27
Knowing their roles and benets of the program, but
not implementing the UNHSP has created conict among
the healthcare practitioners, similar to that of Festinger’s
concept of cognitive dissonance.31 As one midwife/birthing
home owner expressed her discontent with behavioral
methods of hearing screening, and has outsourced newborn
hearing screening services. For some pediatric consultants,
they would inform patients from private hospitals
regarding the UNHSP.
e participants shared various challenges with regard
to the implementation of the universal newborn hearing
screening program. Most notable was the absence of a
universal newborn hearing screening program within their
facility. All participants except the private primary/secondary
hospital nurses, and two midwives however claimed to be
unaware of nearby facilities that have newborn hearing
screening services.
Lack of Informaon Disseminaon Protocol
One Operating Room (OR) nurse shared that it would
be best if OBGYN doctors would be the rst to inform
the parents about newborn hearing screening, to which all
other private primary/secondary nurses agreed. However, the
OBGYN consultants felt that informing parents regarding
the UNHSP was outside of their scope of practice and
should be handled by the pediatricians which they cited
as not a problem in a hospital setting due to the quick
turnover of patients. e pediatrician consultants however
expressed that they found it dicult to fulll their roles to
have regular follow-ups with their patients as they express
that most of their patients prefer to go to the nearest rural
health unit for follow-ups services such as immunizations.
e pediatrician consultants shared that they only see their
patients again when the child has other illnesses wherein
follow-up on UNHS is less of a priority.
“Usually kasi nagiging problem talaga yung
medyo oldies kasi. Kasi parang they follow yung old
way talaga. Katulad yung sa example yang pagbibigkis
kasi diba usually uso tayo dati bigkis. Ngayon kasi
hindi na e. Parang sila, ‘Bakit? Bakit ganyan?’ Tapos
di mo lalagyan. Pag akyat mo meron na silang bigkis.”
(Usually the problem is with the older people, because
they follow the old ways. For example, wrapping the
practice of bigkis, when it’s outdated. ey usually react
with ‘Why? Why not put a bigkis?’ When you don’t put
one, and you visit them upstairs, you’ll nd that they
have put a bigkis already.) 23, female, OR Nurse
is gives insight that parents had no standard point-
person to gain information regarding the UNHSP. is
coincides with experiences of participants who are involved
in the procedure regarding diculty to communicate
the benets and importance of UNHS to new parents
and extended family which relates to other newborn care
practices of new parents and extended family.
Lack of Accessibility to Training and Services
Rural health unit medical technologists and nurses, as
well as one private birthing home midwife/clinic owner were
interested to become certied newborn hearing screening
personnel. However, half of the private birthing home
midwives were more concerned with coordinating with
certied personnel to start providing the service. Across
all participants, access to easy-to-read reference materials
such as pamphlets to be given to parents, or posters to put
in the facility can help them to implement the newborn
hearing screening program. Private primary/secondary
nurses suggested that these materials can be given to
parents upon admission. Rural health workers expressed
that these materials could also help discuss newborn hearing
screening during pre-marital and pre-natal counseling
programs. Private birthing home midwives asked if there
could be multimedia materials about newborn hearing
screening to present in their waiting rooms and share within
their professional Facebook groups.
When asked how they view online modules as a
modality for training newborn hearing screening personnel,
all participants except rural health workers agreed that
this would be benecial for them. e private primary/
secondary hospital nurses were very interested as they
see it as an opportunity to gain continuing professional
development (CPD) points for their professional license
renewal. ey were particularly interested in learning the
actual protocol for newborn hearing screening since they
claim that the one they use in their respective facilities were
vague. Private birthing home midwives admitted that they
nd it dicult to leave their facility for CPD seminars, so
they shared how online modules would be benecial for
them. Moreover, they shared that they have an online portal
for registered midwives to access CPD training modules
to gain points. Pediatricians and OBGYN consultants also
claimed to be interested in learning the process of newborn
hearing screening as a means to expand their skillset.
Cost of the online training was also a concern among
interested participants.
Rural health workers expressed their apprehension with
regard to online modules. More than half pointed out that it
would be dicult for people who do not yet know how to use
a computer. Less than half expressed their apprehension with
the quality of learning that they may receive from an online
course. All rural health workers preferred to have hands-on
and face-to-face training. Less than half suggested to cascade
the training modules to local government units instead. Only
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rural health workers recognized however, that they have to
utilize the online modality since some of their work already
requires the use of a computer such as PhilHealth claims.
CONCLUSION
e current study explored the knowledge, attitudes,
and practices of healthcare practitioners in Rizal province,
Philippines with regard to the implementation of the
universal newborn hearing screening program. e FGDs
revealed that the participants had a lack of specic knowledge
regarding the rationale and implementation of the UNHSP.
is includes risk factors for hearing loss, when newborn
hearing screening should be administered, when hearing
loss could be detected, the need to submit records of UNHS
results, and steps to take after a conrmed refer result with
the newborn hearing screening device.
All, except the OBGYN consultants shared that
their role in implementing the universal newborn hearing
screening program is to inform parents about the benets, and
facilitate access to these services. All participants admitted
that newborn hearing screening services should be provided
to all newborns, and that it is benecial to the child, however
more than half of participants do not refer their patients to
facilities with this service. Additional costs in accessing these
services were also cited by a majority of participants as a
reason why they do not refer patients to UNHS services.
Participants were reliant on other healthcare practitioners
to rst inform parents about universal newborn hearing
screening. Participating nurses suggested that it should
be rst introduced by OBGYN practitioners (OBGYNs),
however OBGYNs felt that it is within the scope of the
pediatricians, who on the other hand, nd it dicult to
follow up on newborn hearing screening since most patients
consult in rural health centers rather than in hospitals.
Prevalent among the responses of the participants in
the focus group discussions were the claims of not knowing
how one can apply to become a certied newborn hearing
screening personnel or center. All except rural health
workers saw online training modules as a viable modality for
training to become newborn hearing screening personnel.
Recommendaons
Development of an information education campaign
targeted for healthcare practitioners and parents would
be benecial in the implementation of the UNHSP in
the area. Print and multimedia materials were among
the most suggested forms for the informational material
containing Philhealth coverage, risk factors, developmental
milestones, and additional steps for those with a refer result.
Alongside the campaign, an information dissemination
protocol can benet the implementation of the program as
it builds ownership to healthcare practitioners to inform
and facilitate parents’ access to newborn hearing screen
services. Furthermore, building a regularly updated local
directory of facilities with screening, diagnostic, and
intervention services can encourage healthcare practitioners
to connect their patients to more accessible institutions.
Proactive coordination with uncertied centers to facilitate
the certication process can also be benecial for the
surveillance, monitoring, and evaluation of the program.
Implementation of online training modules may best
target private hospital nurses, private birthing home midwives,
and pediatricians, as they expressed their interest in the
modality. Rural health workers however felt that cascading
the modules down to local government units would be best as
they are skeptical with regard to the validity of learning the
concept through an online medium, as well as their ability
to use a computer. A blended learning approach may also
be benecial in implementing the online training modules.
For future researchers, it is recommended that a
psychometric tool to assess knowledge, attitudes, and
practices of healthcare practitioners be developed for
a more ecient data collection. e inclusion of more
healthcare practitioners in dierent settings such as
otorhinolaryngologists, municipal health ocers, and
general practitioners can give a clearer picture of the
situation in the locality. It is also recommended that future
researchers replicate this study in other rural areas of the
Philippines to gain insight on unique situations healthcare
practitioners are in with regard to implementation of the
program. Comparative analyses between and among areas in
the Philippines can also give deeper insight to the current
state of the program’s implementation.
Statement of Authorship
All authors participated in data collection and analysis,
and approved the nal version submitted.
Author Disclosure
All authors declared no conicts of interest.
Funding Source
is paper was partially funded by the Philippine
California Advanced Research Institute for Health
Innovation and Translational Medicine Project 2015-001:
Increasing the Rates of Newborn Hearing Screening with
Novel Technologies and TeleHealth.
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