Predictive Questionnaire to Identify Late Help Seeking Tendencies in Parents of Newborns Referred from Hearing Screening

Abstract

Background: India records 67,000 births each day (UNICEF, 2003) with congenital hearing loss affecting an estimated 38,883 to 215,204 newborns annually (Verma et.al, 2012). Despite this, less than 1% of newborns in India undergo hearing screening (Neuman, 2020) leading to delayed diagnosis and intervention. Even in countries with Universal Newborn Hearing Screening (UNHS), evidence shows that only 50% of the infants who fail screening receive intervention by 6 months of age (Yuan et., 2020), underscoring the importance of parental help-seeking behaviour. However, there is currently no standardized tool to predict which parents are at-risk of delaying follow up. Aim: This study aimed to develop and validate a screening questionnaire to identify parents at risk of delayed help-seeking behaviour following Newborn Hearing Screening referral, based on predictive factors previously identified by Pazhayapisharath and Maruthy (2025). Methods: A seven-item questionnaire, created based on a set of 12 predictive factors indicative of late help seeking tendency was translated to Kannada language and administered on 82 parents of infants referred from the hospitals in Mysuru, where NHS service is provided by the All India Institute of Speech and Hearing. Post administration, the follow up behaviour of the parents was tracked. The parents who returned for the evaluation were classified as early or late help seekers depending on whether they returned after 2 months or 3 months after referral. Those parents who didn’t return for follow up within the specified time periods were also considered ass late help-seekers. Demographic data was analysed using Chi-square test to examine associations with the follow up behaviour. A ROC curve was constructed to derive the score that can efficiently differentiate between the early and the late help seekers. The agreement of the questionnaire-based classification with the actual timeline was assessed through kappa coefficient. The questionnaire was further validated on 15 new set of parents. Results: Among the babies referred, only 50% followed up within 2 months and 53% within 3 months indicating significant lag in the timeline for follow ups. Rural residence and lower maternal education were significantly associated with help seeking delay. ROC analysis showed moderate diagnostic accuracy by correctly classifying 72.72% and 74.6% cases in the 2-month and 3-month criteria respectively. The kappa value was 0.456 (p=0.1) for the 2-month criteria and 0.442(p=0.118) for the 3-month criteria. The tool correctly classified 73.3% of parents in the validation sample (Kappa = 0.318). Conclusion: Delays in parental help-seeking following NHS are common and are influenced by identifiable sociodemographic factors. The developed questionnaire shows promise as a screening tool for identifying parents at risk of delayed follow-up, enabling targeted counselling and improving early intervention outcomes in newborn hearing care.