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Attitudes, Knowledge and Practices of Physicians Related to EHDI . National EHDI Conference Feb, 2006 Mary Pat Moeller, Ph.D. Boys Town National Research Hospital Karl White, Ph.D. Utah State University. Faculty Disclosure Information.

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attitudes knowledge and practices of physicians related to ehdi

Attitudes, Knowledge and Practices of Physicians Related to EHDI

National EHDI Conference

Feb, 2006

Mary Pat Moeller, Ph.D.

Boys Town National Research Hospital

Karl White, Ph.D.

Utah State University


Faculty Disclosure Information

In the past 12 months, we have not had a significant financial interest or other relationship with the manufacturers of product or providers of the services that will be discussed in our presentation

This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA nor will the presentation discuss unapproved or "off-label" uses of pharmaceuticals or devices.

overview of presentation
Overview of Presentation
  • Project Rationale
  • Results of National Survey of 1,968 physicians
  • Implications for EHDI teams
project rationale
Project Rationale
  • Newborns seen regularly by primary care physician
  • Key role in promoting follow up, making referrals and supporting families
  • Attitudes, Knowledge and Experiences influence behaviors
  • Need to understand physician perspectives
project with pediatricians
Project with Pediatricians

Formal Focus Group Work (N=27)

Pilot Focus Groups (N = 21)

Internet Based Survey (N=263); Paper Survey (N = 1,968)

Resource Development

Field test, revise & disseminate

NIDCD & MCHB supported

themes from focus groups methods
Themes from Focus Groups: Methods
  • Consider time constraints in daily practice & number of infants seen in practice life time; action oriented, just in time resources
  • Avoid dense content designed to make me an expert
  • Need for common language across disciplines
  • Low tech materials preferred by some
themes from focus groups methods7
Themes from Focus Groups: Methods
  • Attend to credible sources of information (like AAP)
  • Avoid anecdotal in favor of evidence-based content
  • Use familiar formats (e.g., Grand Rounds, algorithms, patient education materials)…but consider how to challenge the “comfort zone?”
nhs physician survey


BTNRH and NCHAM Collaboration

Mary Pat Moeller, Ph.D., Karl White, Ph.D., Lenore Shisler

  • Designed survey based on focus groups and internet responses
  • Field tested survey at medical society meetings; developed Spanish version
  • Invited state EHDI coordinators to participate
  • Mailed survey & cover letter; reminder postcard 2 weeks later
survey question examples
Survey Question Examples
  • Attitudes:
    • Do you think NHS causes parents undue anxiety or concern?
    • Do you believe UNHS is worth what it costs?
    • Please list any concerns you have about NHS, diagnosis and intervention.
survey questions examples
Survey Questions Examples
  • Practices:
    • Approximately how many children with permanent hearing loss (EXCLUDING OTITIS MEDIA) have you had in your practice over the past 3 years?
    • List any specialists to whom you routinely refer the family of a child with permanent hearing loss (list the types of specialists).
survey question examples12
Survey Question Examples
  • Knowledge:
    • What is your best estimate of the earliest age at which:
      • A child not passing the screening should be seen for follow up testing
      • A child can be definitively diagnosed with permanent hearing loss
      • A child can begin wearing hearing aids
      • A child with permanent hearing loss should be referred to early intervention
    • Enter age estimates _________________

States Involved in Survey of Physicians

N = 21 States + Puerto Rico

physician survey demographics
Physician Survey: Demographics


53.2% Male

46.8% Female

N = 1,968


62.5% Metro

24.1% Small town

13.3% Rural

Moeller, White & Shisler, 2006

practice settings
Practice Settings

Private/Community Clinic 75.6%

Hospital 10.4%

Medical School/University 5.8%

Other 3.6%

Unknown 3.7%

practice with 0 5 population
Practice with 0-5 Population

0-10 years = 40.2%

11-20 years = 28.6%

21-30 years = 22.5%

31+ years = 8.7%

importance of testing all newborns
Importance of testing all newborns

3% Pediatricians;

6% Family Practice

p < .001


positive findings
Positive Findings:
  • Most of our physicians receive screening results (88.61% >)
  • But…12% of pediatricians and 17% of family physicians receive < 50% of results!
  • Most know that infants should be referred immediately for additional testing (89.2 < 3 mos >)
  • But…24.3% unsure NHS is worth what it costs
concerns about nhs
Concerns about NHS
  • Too many false positives
  • Costs outweigh benefits
  • Loss to follow up
  • Need for training
  • Unclear about procedures; complex
  • Inconclusive results
  • Need for parent education
  • Need for funding & better equipment
ages at which 1 3 6
Ages at which….(1-3-6?)


Hearing Aids

Early Intervention

primary sources of info on nhs
Primary Sources of Info on NHS

Frequent Internet Use = 51.7%

continuing medical education most successful methods
Continuing Medical Education: Most Successful Methods
  • Learning linked to clinical practice (including tests of knowledge & evaluation of clinical practice needs)
  • Educational meetings with interactive components
  • Outreach events
  • Use of multiple interventions (e.g., Outreach + reminders; Grand rounds with case study discussion + reminders)

Davis, et al, 1995; Davis & Maxmanian, 2002

cme what does the literature say
CME: What does the literature say?
  • Specific problem or issue (e.g., question about a patient)
  • General problem (gaps in skills; knowledge related to new technology)
  • Cognitive dissonance (comparison with peers)
  • Intrinsic factorsDr. B. Schuster (2002)
adult learning methods
Adult Learning Methods
  • Diverse learning styles
  • Prefer activities that are:-Problem centered-Meaningful to life situation-Focused on immediacy of applicationBrookfield, 1986
topics judged as needs in prioritized order
Protocol for f/u

Early intervention

Contacts for more information

Screening for late onset SNHL

Patient Education Resources

Impact of HL on language

Screening at well-child visits

Hearing Aids and cochlear implants

Genetics and hearing loss

Counseling families about screening results

Screening methods

Topics Judged as Needs (In prioritized order):
most recommended resources
Most Recommended Resources
  • Protocol cards
  • Patient brochures
  • Web sites
  • On-line CME*
  • Peer education
  • Grand rounds materials
less recommended resources
Less Recommended Resources
  • CDs or DVDs to use in patient education
  • Videotapes to use in parent education

…but some offices prefer this type of material

…reinforces need for multiple avenues

big picture physicians
Big Picture: Physicians
  • Positive changes seen, but more education is needed
  • “One size” will not fit all; multiple strategies are needed
  • “Just in time” resources; protocol steps
  • Action-oriented resources focused on medical management, family counseling
  • Many topics “needed” but at a manageable level
  • Additional resources (e.g., peer education and internet) needed
next steps
Next Steps:
  • Manuscript (in preparation)
  • Work with National Nursing, PA and Nurse Practitioner Groups
  • National Midwife organizations
  • Sound Health Connections Conference held in Oct, 2005
  • Action plans developed
focus group themes consequences
Focus Group Themes: Consequences
  • NPs and nurses need no convincing about the developmental consequences of hearing loss
    • But they want resources to educate families that “tell people why you need to care about this.”
    • Barrier: “My child is not sick. He looks fine. It’s “just” a hearing loss.
focus group themes role of experience
Focus Group Themes: Role of Experience
  • Limited experience with confirmed hearing loss in infants
  • Considerable experience with babies who pass second screening
  • Leads to some “complacency” or minimizing a “refer” in talking with families
  • Reporting barriers: “Most often we are under the assumption – which is a bad assumption – that if they were not told anything, then it was a pass.”
focus group themes social barriers
Focus Group Themes: Social Barriers
  • Practical strategies for Medicaid families:
    • Recognize effects of “radar screen”
    • Increase monitoring (WIC form, checklist)
    • Combine with immunization visits
    • Increase public awareness
    • Resources to make consequences clear
focus group themes time barriers
Timing of the information

“bookends”…prenatal (classes or OB) and 2 day call; 2 week check

Don’t rely only on the hospital-based discussions

Moms are “overwhelmed, concerned with other issues”

Time is limited in office visits

Can be a barrier to continuity of care (“I just pass the buck”)

Other pressing issues may lower this one “on the radar screen”

Need resources that are sensitive to the time demands

Focus Group Themes: Time Barriers
focus group themes target groups
Focus Group Themes: Target Groups
  • Audiences that need to learn with us:
    • The Public! (example: lead)
    • Specialists: OB, ENT, Lamaze Class Teachers
    • Parents
    • Day Care Workers
    • School Nurses
    • Newborn Nursery Workers
    • Office Staff (triage, med techs)
    • Nursing Training Programs
recommended educational strategies
Journal articles


Ad in journals

Curriculum for prenatal classes

Courses with CEUs

Prenatal packets

Simple language for parents; PSAs

Nurse to nurse educational materials

Simulations (demonstrate importance!)

On line resources (English & Spanish)

Local organization meetings

Outreach with lunch

Booth at conference

Educational CDs

Free materials

Orientation packets

Recommended Educational Strategies
additional project collaborators
Additional Project Collaborators
  • Lenore Shisler, NCHAM
  • William Eiserman, NCHAM
  • Marjorie Brennan, BTNRH
  • Leisha Eiten, BTNRH
  • Joyce Bunger, Creighton University
  • Russell Smith, University of Nebraska
  • Diane Schmidt, BTNRH
  • Roger Harpster, BTNRH
  • Tom Behringer, NCHAM