research22 (repaired)uz
Post on 28-Mar-2015
1.366 Views
Preview:
TRANSCRIPT
University of perpetual Help System
Sto. Nino, Binan, Laguna
College of Nursing
Mother’s Knowledge and Attitude towards Newborn Screening
Submitted by:
Castro, Nicky Joy F.
Javellana, Abigail P.
Juarez, Wilma C.
Lacuit, Arlyn T.
Landrito, Michelle O.
1 | P a g e
Chapter 1
The Problem and Its Setting
INTRODUCTION
Newborn Screening is a simple method to find out if your baby has congenital
metabolic disorder that may lead to retardation
and even death. It is a preventive health service that should be available to all
neonates. Newborn Screening no longer refers to the screening test itself, but
encompasses the entire element essential to all neonates to have access to a screening
system that has optimal quality and performance.DOH,(2006)
Newborn Screening is recognized internationally as an essential preventive
public health program for the identification only of disorders among newborns that can
affect their long term health detection, diagnosis and treatment for specific genetic
disorders. Metabolic infectious congenital disorders can lead to significant reduction of
death, disease and associated disabilities. Guthrie,(2000)
In the Philippines, newborn screening program has been mandated by
Presidential Proclamation No. 540 signed by President Gloria Macapagal Arroyo in
2004 in pursuant to the Early Childhood Care and Development Act (ECCD) which aims
to promote the rights of children survival, development and special protection of the
children with full recognition of the nature of childhood and its specific needs.
The advancement of newborn screening in developed countries has succeeded in
reducing morbidity and mortality associated with certain congenital disorders. Screening
within the first few days after birth allows timely medical intervention for diagnostic
patient resulting in more favorable outcomes. Through prompt and appropriate medical
2 | P a g e
management, affected children identified though newborn screening can lead to normal
lives. There is still a lack of public awareness concerning the benefits of newborn
screening. The recently passed newborn screening act of 2004 will ensure that every
newborn in the Philippines is given the opportunity to be offered newborn screening.
This policy statement describes the role of the pediatrician, parents, hospital
administrators and government. It supports the effort of the Department of Health and
the National Institute of Health towards the nationwide implementation of newborn
screening. Diane B. Paul,(2008)
Dr. Juanita Basilio, medical officer 7 of the NCDPC said “Newborn Screening is
an essential public health strategy that enables the early detection of several inheritable
conditions which, if left untreated, could lead to mental retardation or even death.
Newborn screening can result to the early diagnosis and treatment of abnormalities
which when properly treated and connected can lead to the child’s normal growth and
development”.
Dr. Basilio Iso said “there is urgent need to create public awareness on the
important of newborn screening. Newborn screening is an integral part of routine
newborn care in many countries but in the Philippines, only about 2 percent of newborn
are properly screened for detects”. Manila bulletin,(2006)
Many of these are metabolic disorders often called "inborn errors of
metabolism" that interfere with the body's use of nutrients to maintain healthy tissues
and produce energy. Other disorders that screening can detect include problems with
hormones or the blood. In general, metabolic and other inherited disorders can hinder
3 | P a g e
an infant's normal physical and mental development in a variety of ways. And parents
can pass along the gene for a certain disorder without even knowing that they're
carriers. With a simple blood test, doctors often can tell whether newborns have certain
conditions that could eventually cause problems. Even though these conditions are
considered rare and most babies are given a clean bill of health, early diagnosis and
proper treatment can make the difference between lifelong impairment and healthy
development.
In the early 1960s, scientist Robert Guthrie, PhD, developed a blood test that
could determine whether newborns had the metabolic disorder phenylketonuria (PKU).
People with PKU lack an enzyme needed to process the amino acid phenylalanine,
which is necessary for normal growth in kids and for normal protein use throughout life.
However, if too much phenylalanine builds up, it damages the brain tissue and can
eventually cause substantial developmental delay. If kids born with PKU are put on a
special diet right away, they can avoid the developmental delay the condition caused in
past generations and lead normal lives. Since the development of the PKU test,
researchers have developed additional blood tests that can screen newborns for other
disorders that, unless detected and treated early, can cause physical problems,
developmental delay, and in some cases, death. (Louis E. Bartoshesky, MD, MPH)
This study aims to evaluate Barangay. Sto Niňo Biňan Laguna to explore
mothers’ knowledge and attitudes towards newborn screening. Specifically, there
awareness and on how they respond with regards to newborn screening. It generally
aimed to evaluate the extent of their knowledge, attitude and the compliance of mothers
towards newborn screening.
4 | P a g e
Theoretical/ Conceptual Framework
The Casey Model of Nursing (1988) comprises the five concepts of child, family,
health, environment and the nurse. The philosophy behind the model is that the best
people to care for the child is the family with the help from various professional staff.
There should therefore be a partnership between parents and caregivers.
In connection to the study, Philosophy represents the unity and relationship between
the nurse and the family to achieve the best health condition of the child as possible.
This includes the responsibility of the nurses to undergo the child into Newborn
Screening to evaluate the possible abnormalities that may occur to the child.
The theory of Human Becoming by Parse (1995) emphasizes free choice of personal
meaning in relating value priorities, co-creating of rhythmical patterns in exchange with
the environment. Parse believed that each choice opens certain opportunities while
closing others since each individual makes his or her choices, the role of the nurse is
that of guidance not decision maker.
In relation to the study the nurse serve as a guide for women in gathering correct
information on newborn screening and during their decision making concerning the
screening of their child.
Using both theories, a nurse can utilize the philosophy, purpose and practice of
nursing while serving as a guide to the mothers in order for them to make the right
decision that are advantageous to their children when it comes to the benefits of
newborn screening test.
Operational Framework
5 | P a g e
This study deals with the level extent of knowledge and attitudes towards newborn
screening. The operational model shows the significant relationship of independent and
dependent.
The independent variable is the level of mother’s knowledge on newborn screening.
The researchers wanted to evaluate the extent of knowledge of each mother and other
member of the family regarding on the importance of newborn screening and what it is
all about.
The dependent variable is the attitude of mother’s towards the newborn screening.
Newborn screening is an organized process of identifying medical conditions in
newborn babies that, if untreated, can cause developmental delays, serious illness, or
even death. Generally, these conditions cause no symptoms in the first days of life.
Screening programs have therefore been developed to identify and treat babies with
these conditions before permanent damage occurs.
6 | P a g e
Mothers demographic Profile
Age
Educational Attainment
Diagram of the extent of
knowledge, practices in the importance of newborn screening among
selected respondents of Barangay Sto. Niňo Biňan, Laguna.
Statement of the Problem
7 | P a g e
Mothers demographic Profile
Age
Educational Attainment
Extent of knowledge about newborn screening
Attitude of mothers about Newborn Screening
Ensure women to
have adequate
time to consider
screening information
The purpose of this study was to evaluate the knowledge and attitude of mothers
on newborn screening in the selected respondents of Barangay Sto.Niňo Biňan
Laguna.
Specifically, the study will seek to answer the following questions:
1. What is the demographic profile of the mothers in terms of the ff:
1.1 Age
1.2 Educational attainment
2. What is the knowledge of mothers on newborn screening?
3. What is the attitude towards newborn screening?
4. Is there a significant relationship between the knowledge of the mother and
their attitude towards newborn screening?
Statement of the Hypothesis
There is no significant relationship between the knowledge of the mothers and their
attitude towards newborn screening.
Assumption of the Study
8 | P a g e
The researchers assume that:
1. Newborn screening is a must for babies after giving birth.
2. Providing knowledge to the parents will let them ensure that they recognize their
responsibilities in promoting their child’s right to health and full development
3. Newborn screening is critical for the baby to receive treatment that may be life
saving.
Scope and Delimitation of the Study The scope of the study is all about the knowledge and attitudes of the mothers
about newborn screening. The researcher chooses the Brgy. Sto Niňo, Biňan, Laguna
as their representative respondents.
Their primary reason is to evaluate the mother’s knowledge and their attitudes
towards newborn screening and the educational program provided to them. The
researcher s will get only 50 respondents so that the result will be easy to measure.
Significance of the Study
Through strong advocacy and good communication, the attitude and knowledge of the
public especially the mothers will help them understand screening advantages and
importance in promoting wellness.
Study will benefit the following:
9 | P a g e
Selected Respondents. One of the beneficiary of the study for they will learn the
importance newborn screening, the advantages and the kind of attitude they need to
have.
Siblings of the selected Respondent especially the newborn and the infants. They
can prevent diseases if they can have newborn screening and with the help of the
extent of knowledge of their mothers.
Health Care Team. This will provide an inference that they can utilize to produce
awareness on the importance of newborn screening in a community setting with health
education dissemination. It can facilitate in an intervention to increase health education
program about newborn screening in amending the process if information giving about
specific information of the said program.
Nursing Profession. This will provide them an initial assessment on the knowledge
and attitude of mothers towards newborn screening which can be a basis of the
promotion of health among children in the community through health teaching.
Nurse Education. This may introduce a way of helping nursing student in nurturing
their chosen career by making them see the real and practical site where nursing
service is very much needed. This can also develop their efficiency as nurse educator in
formulating tools for health teaching.
Nursing Student. They will benefit from the study because development of health
education program can build their confidence in facing people in the community through
information giving. This can also enhance their inquiring on the important of screening in
the promotion of health.
10 | P a g e
Future Researchers. This study will serve as reference for future studies using the
same or different variables.
Definition of Terms
The following terms and concepts were used and defined within the context of the
study.
Newborn. Means a child from the time of complete delivery to 30 days old.
Newborn screening. is a simple procedure to find out if your baby has a congenital
metabolic disorder that may lead to mental retardation and even death if left untreated.
Evaluation. Process of evaluating the extent of respondent’s idea in newborn screening
Parent education. It refers to the various means of providing parents or legal
guardian’s information about newborn screening.
Health Care Provider. The term means physicians, nurses, midwives, nursing aides
and traditional birth attendants.
Attitude. Refers to the mental and emotional position or feeling of the respondent with
regards to their compliance towards newborn screening
Knowledge. Is an accumulated fact, truth, principle, information and understanding
regarding newborn screening.
CHAPTER 2
Review of Related Literature and Studies
11 | P a g e
Through the review of related literature and related studies, researcher was
provided the knowledge and background on the topic or subject being studied. Reading
these literature and studies will help the researchers determine what has been done in
the past and will give the researchers pointers on how to develop or make some
progress on the status of the study.
State of the Art
The information that was gathered contributes knowledge and understanding not only of
the researchers but as well as the respondents were taken into consideration. Similar studies
were derived from thesis, books, journals, magazines, and internet that were utilized to explore
generally accepted views, principles and theories which could either be supportive or
contraindicating to researcher’s data.
Related Literature
Newborn screening is an organized process of identifying medical conditions in
newborn babies that, if untreated, can cause developmental delays, serious illness, or
even death. Generally, these conditions cause no symptoms in the first days of life.
Screening programs have therefore been developed to identify and treat babies with
these conditions before permanent damage occurs. In the United States, these
programs are usually mandated by state public health laws. In 1964, phenylketonuria
(PKU) became the first disorder subject to generalized newborn screening.
Phenylketonuria causes mental retardation due to the baby's inability to metabolize the
amino acid phenylalanine, which then accumulates in the blood. It can be successfully
treated with a diet low in phenylalanine. PKU is diagnosed through a blood sample.
Since 1964, technological advances allow screening for many more diseases on the
12 | P a g e
same blood sample, including adrenal hyperplasia, biotinidase deficiency, blood
sample, including cystic fibrosis, galactosemia, homogystinuria, hypothyroidism, maple
syrup urine disease, and sickle cell disease. Abnormal results are reported to the baby's
doctor with recommendations for further confirmatory testing and treatment. Screening
for hearing impairment was implemented in the 1970s. Initially, only known risk factors,
such as a family history, prompted a hearing test. In the 1990s, universal newborn
hearing screening began to be implemented in the United States and in Europe.
Children with moderate to severe hearing impairment benefit by diagnosis and
treatment early in life to maximize speech and language development. (John H.
Vollman, 2002)
Many public health departments promote newborn screening through a routine
blood and hearing test performed at the hospital after birth to detect rare conditions.
Although conditions like galactosemia, phenylketonuria (PKU), sickle cell anemia,
adrenal hyperplasia, Cystic Fibrosis, and hearing loss are rare, they can all significantly
impact the life of affected newborns and their families. Some of these and other
conditions commonly screened for in heel stick tests can even be fatal. Many of the
conditions that state health departments often mandate in screening panels can also be
treated and improved if identified early, potentially saving lives and millions of health
care dollars in later treatment procedures or emergency visits that could be avoided by
early detection. (Katherine Brind'Amour, 2009)
DOH ensure that Newborn Screening Centers are strategically located in order to be
accessible to the relevant public and provide services that comply with the standards
13 | P a g e
approved by the Committee upon the recommendation of the NIH. No Newborn
Screening Center shall be allowed to operate unless it has been duly accredited by the
DOH based on the standards set forth by the Committee. At a minimum, every Newborn
Screening Center shall: (i) have a certified laboratory performing all tests included in the
newborn screening program, (ii) have a recall/follow up programs for infants found
positive for any and all of the heritable conditions; (iii) be supervised and staffed by
trained personnel who have been duly qualified by the NIH; and (iv) submit to periodic
announced or unannounced inspections by the Reference Center in order to evaluate
and ensure quality Newborn Screening Center performance.
Newborn screening for a metabolic disorder could lead to false positives, adding
stress to parents, costing money and possibly subjecting a baby to unnecessary follow-
up treatment and dietary restrictions. But the benefits of diagnosing these children early
and preventing the risk of mental retardation, disability or death outweigh the costs of a
false positive. Published studies of expanded newborn screening in a U.S. setting have
resulted in favorable cost-effective ratios for screening for this illness but did not include
primary data for quality of life effects for a false positive screen. Results show that
newborn screening remains cost-effective after accounting for the measured loss in
quality of life associated with a false positive screen." (Lisa A. Prosser,Ph. D.)
Related Studies
14 | P a g e
When examining the interrelation between psychosocial factor and preventive
health behavior, it is important to recognize the knowledge is of paramount importance
in the formulation of perception which is commonly referred to as belief and attitude in
the behavioral literature. The health belief model related largely to the cognitive factors
predisposing a person to a health behavior, concluding with a belief in ones self efficacy
for the behavior. The model leaves much still to be explained by factors enabling and
reinforcing one’s behavior and these factors become increasingly important when the
model is used to explain and predict more complex lifestyle behavior that needs to be
maintained over a lifetime.
In the study of Gennaccaro M, Waisbren SE, Marsden D. (2005), The knowledge
gap in expanded newborn screening: survey results from pediatricians in
Massachusetts. Massachusetts currently offers an optional expanded newborn
screening program that tests for 20 biochemical genetic disorders in addition to the
mandated newborn screening tests, including phenylketonuria (PKU) and nine other
biochemical genetic disorders. We conducted a mail survey of 550 pediatricians listed in
the 2000 Massachusetts Healthcare Directory to determine pediatricians' preparedness
in discussing expanded newborn screening and its results with families, and to
determine in what specific format physicians in Massachusetts would prefer to receive
educational materials and updates. Of surveys mailed, 35% (190/550) were returned
within the allotted 3 weeks: 25 pediatricians (14%) were unaware of expanded newborn
screening; 78 respondents (42%) indicated feeling less than prepared talking about test
results with families; 100 pediatricians (54%) indicated a lack of information about
metabolic disorders; 134 (73%) preferred information sent in postal mailings, 62 (34%)
15 | P a g e
preferred grand rounds, 60 (33%) preferred educational seminars, and 58 (32%)
preferred websites. Other formats receiving preferences of less than 30% included e-
mail (27%), phone calls (8%), video (6%), and distance learning (1%). Pediatricians are
ill-prepared for expanded newborn screening for biochemical genetic disorders. To
address this problem, pediatricians in Massachusetts indicated a preference for
unsolicited periodic mailings including short reviews and brochures.
Effect of Informed Parental Consent on Mothers' Knowledge of Newborn
Screening (Holtzman, Faden and Horn, 1983), for them to determine whether
knowledge was improved as a result of obtaining informed consent from parents for
newborn screening of their infants for phenylketonuria (PKU) and other hereditary
metabolic disorders, new mothers in seven Maryland hospitals were interviewed either
before receiving a standard disclosure (n = 210) or after giving consent (n = 418). The
mean knowledge score of the women interviewed after giving consent was significantly
higher (P < .001). Receiving the disclosure was a more powerful predictor of knowledge
score, accounting for 40% of the variance, than demographic factors, which accounted
for 9%. Women whose consent was obtained just prior to discharge tended to have
lower knowledge scores than women whose consent was obtained earlier (P = .03).
Women with higher knowledge scores were somewhat less likely to favor consent than
women with lower scores. Although consent may not be appropriate for some low-risk
procedures, informing parents can be easily and inexpensively accomplished.
Davis TC, Humiston SG, Arnold CL, et al.,(2007), they had a research on how
knowledgeable are parents of newborns and their healthcare providers about newborn
screening. What are their impressions, as well as those of newborn screening
16 | P a g e
professionals, about the content and timing of newborn screening education. Purposeful
sample of 51 parents (16–39 y, 94% women) of infants <1 year of age who had
experience with newborn screening; 78 healthcare professionals (23–72 y, 55%
women) who provided prenatal or newborn care (24 family physicians, 17 pediatricians,
11 obstetricians, 11 labour and delivery nurses, and 15 other professionals); and 9 state
newborn screening professionals (35–60 y, 67% women) (4 nurses, 3 physicians, 1
social worker, and 1 laboratory supervisor). 22 focus groups were conducted, each
lasting about 1 hour, with 2–12 individuals per group. Most focus groups were
conducted in person and audiotaped. 1 focus group and 3 individual interviews were
conducted by telephone. Group moderators used scripted questions developed
specifically for each type of participant. The main themes were identified and
categorized.
The term attitude is widely used by the public to denote a psychological state that
predisposes a person to act favorably or unfavorably to an event or situation. This
viewpoint favors defining attitude as having several component and restricted definition.
(Allport, 1954) defined attitude as a mental and neural state of readiness, organized
through experience, exerting a directive or dynamic influence upon the individuals
response to all objects and situation with which it is related.(p.810)
(Eagly and Chaiken, 1993), define attitude as a psychological tendency that is
expressed by evaluating a particular entity with some degree of favor or disfavor.(p.1)
Although formal definition of attitude vary, most contemporary social psychologist seen
17 | P a g e
to agree that the characteristics attribute of attitude is its evaluation (pro-con, positive-
negative) dimension (Ajzen, 1993, Ajzen 1989, Fishbein and Ajzen, 1975).
The Pediatricians' Attitudes Toward Expanding Newborn Screening (Acharya,MD,
Ackerman,AB, Ross MD, 2005), Traditional population screening focuses on conditions
for which early treatment prevents severe morbidity and mortality. The classic example
in pediatrics is newborn screening for phenylketonuria, which began in the 1960s. In
1968, Wilson and Jungner delineated 10 criteria that would justify population screening.
These criteria have been reaffirmed by many newborn screening task forces as the
standard for adding conditions to newborn screening programs. Today, however, some
newborn screening programs are expanding to include conditions that may not meet all
of the traditional screening criteria. Little is known about pediatricians' attitudes toward
expanding screening. We examine the attitudes of pediatricians and pediatric
subspecialists toward screening for cystic fibrosis (CF), Duchenne muscular dystrophy
(DMD), fragile X, and type 1 diabetes. METHODS: A cross-sectional survey was
conducted of 600 pediatricians, including those who are members of the section of
genetics, endocrinology, pulmonology, and neurology of the American Academy of
Pediatrics. For each condition, pediatricians were queried about (1) testing high-risk
infants, (2) newborn screening, and (3) population screening or testing beyond the
newborn period. Demographic data were also collected. RESULTS: A total of 232 (43%)
of 537 eligible pediatricians returned surveys. More than 75% support testing high-risk
infants for all conditions except type 1 diabetes. CF was the only condition for which
>50% supported newborn screening. Newborn screening was preferred over screening
older infants for all conditions except fragile X. Subspecialty affiliation did not have a
18 | P a g e
significant impact with respect to attitudes about testing high-risk children, newborn
screening, or screening beyond infancy. We analyzed the data by the number of
patients with the queried condition under the physician's care and by the number of
affected family members. Neither aspect was significant. We also analyzed the data by
gender, by year of residency graduation, and by geographic location. None of these
factors revealed significant differences in responses. For each condition, 8% to 41% of
physicians would personally choose to test their own infant. We found that physicians'
opinion about what they would want for their own children correlated with their attitude
about population newborn screening. Those who would personally choose testing of
their own infants were highly likely to support newborn screening for CF (98%), DMD
(94%), and fragile X (98%), but only 78% of those who would personally opt for newborn
screening of type 1 diabetes would also endorse population-based screening. This was
statistically significant for each condition. Those who would choose not to test their own
infants were significantly less likely to support newborn screening of the general
population. One third of those who did not want to test their own newborns for CF
supported population screening, whereas only one fifth supported DMD and fragile X
population screening. For type 1 diabetes, 98% of those who would not personally
choose newborn testing did not want it offered as a population screening program.
CONCLUSION: Most physicians support diagnostic genetic testing of high-risk children
but are less supportive of expanding newborn screening, particularly for conditions that
do not meet the Wilson and Jungner criteria. Willingness to expand newborn screening
does not correlate with professional characteristics but rather with personal interest in
testing of their own children.
19 | P a g e
Pediatricians' Attitudes about Screening Newborns for Infectious Diseases (Schittek,
Koopman and Ross, 2010), the U.S. Health Resources and Services Administration
(HRSA) commissioned the American College of Medical Genetics (ACMG) to
recommend a uniform newborn screening (NBS) panel. The ACMG sent out a survey to
stakeholders to evaluate 80 metabolic and genetic conditions and 3 infectious diseases
(Human Immunodeficiency Virus (HIV), Toxoplasmosis (Toxo), and Cytomegalovirus
(CMV)). In March 2005, the ACMG/HRSA report recommended a panel including 29
metabolic and genetic conditions and 25 secondary targets. This panel was endorsed
by the newly-formed U.S. Advisory Committee on Heritable Disorders and Genetic
Diseases in Newborns and Children (Advisory Committee). Decisions about infectious
diseases were deferred by the ACMG/HRSA committee due to limited survey responses
and lack of expertise of surveyed stakeholders and committee members. The Advisory
Committee has not pursued these conditions further. In this manuscript, we examine the
attitudes of U.S. pediatricians toward targeted and universal screening of newborns for
these three infectious diseases. Members of the American Academy of Pediatrics (AAP)
sections of infectious disease (n = 150) and community pediatrics (n = 150) plus 13
contributors to the AAP Red Book were surveyed by email or fax. Of eligible
pediatricians, 113 of 297 (38%) returned surveys. Seventy-four percent supported either
targeted or universal NBS for HIV, 57% for Toxo, but only 42% for CMV. The majority of
respondents support screening newborns for HIV and Toxo. The Advisory Committee
ought to solicit a systematic evaluation of these conditions to determine whether they
should be included in the uniform panel. As a conclusion, These are the first data about
the perceived utility of testing and screening infants for HIV, Toxo, and CMV in the
20 | P a g e
United States by two groups of pediatric providers. Both community pediatricians and
infectious disease physicians are highly supportive of population screening for HIV and
more modestly supportive of screening for Toxo, but reject population screening for
CMV given current testing methods and treatments. These findings signal the need for
the Advisory Committee to evaluate infectious diseases for inclusion into the uniform
panel.
In the study on developing a conjoint analysis survey of parenteral attitudes
regarding voluntary newborn screening ( Whitehead,Brown and Layton,2010), Newborn
screening for genetic conditions is conducted in all 50 states, but parent’s opinions of
such screening are largely unknown. As newborn screening has expanded from a few
relatively common conditions requiring early treatment to a broader spectrum of
conditions with uncertain prognosis, it is important to understand parent’s views. Stated
preference surveys provide quantifiable data on parent preferences about features of
newborn screening tests, that economic value of testing and the effect of a test’s
features on its probable uptake and value.
They conducted formative research and developed a stated preference survey
on parent’s preferences regarding voluntary newborn screening. We reviewed the
literature on parent’s attitudes towards newborn screening and factors related to those
attitudes and developed a list of condition and test attributes. They narrowed the list by
expert review and conducted focus groups with parents of infants to determine if they
understood the attributes and to see which attributes parent’s viewed as relevant.
21 | P a g e
They found that some parent’s struggled with the probability-based attributes.
The most relevant attributes were developmental disability, physical disability,
incidence, recurrence, lifespan, sensitivity and cost. The survey developed from this
study could provide data for economic evaluation, test prioritization and educational
material development.
RELATIONSHIP OF KNOWLEDGE AND ATTITUDE
In the Elaboration Likelihood Model, or ELM (Petty and Cacioppo, 1986), cognitive
processing is the central route and affective processing, is often associated with the
peripheral route. The central route pertains to an elaborate cognitive processing of
information while the peripheral route relies on cues or feelings.
The ELM suggest that true attitude change only happens through the central
processing route that incorporate both cognitive and affective component as opposed to
the more heuristics-based peripheral route. This suggests that motivation through
emotion alone will not result in an attitude change.
(Lang CW, Stark AP, Acharya K and Ross LF, 2009) Maternal knowledge and
attitudes about newborn screening for sickle cell disease and cystic fibrosis in where
Illinois introduced mandatory newborn screening (NBS) for sickle cell disease (SCD) in
1989 and for cystic fibrosis (CF) in 2008. We examined maternal understanding of NBS
for SCD and CF, and their knowledge of the genetics, symptoms, and treatments of
both conditions. Our methods consisted of conducting interviews of inpatient post-
partum women (>18 years and English speaking). Our results showed that of the 388
22 | P a g e
eligible participants, 34 self-identified as sickle cell carriers, 1 with SCD and 1 as a CF
carrier. Almost 3/4 were African American (282/387). Although all but 5 women had
prenatal care, only 35% (133/378) recalled their prenatal care provider mentioning NBS,
and only 56% (217/388) of participants recalled nursery staff mentioning NBS. There
was more self-reported familiarity with SCD (3.32/5) than CF (1.97/5, P < 0.001). Over
2/3 (260/388) of participants could not answer CF knowledge questions because they
had never heard of CF. Among those who had heard of the conditions, mean
knowledge scores were 66% for SCD (n = 372) and 63% for CF (n = 128). Bivariate
analysis identified education, age, race, marital status, and insurance status as
statistically significant. After linear regression education remained significant for both
conditions. We conclude that in a sample of predominantly African American post-
partum women, we found poor understanding of NBS, greater familiarity with SCD, and
significant knowledge gaps for both SCD and CF. There are many missed educational
opportunities for educating parents about NBS and specific conditions included in NBS
panels in both the obstetric clinics and the nursery.
Maternal views on infant hearing loss in a developing country (Olusanya, LUxon and
Wirz, 2006), is concern on Parental support for infant hearing loss. OBJECTIVE: To
elicit the views of mothers and would-be mothers in order to ascertain their knowledge
on infant hearing loss and their attitudes towards infant hearing screening. METHODS:
A structured questionnaire consisting of 15 questions was administered to 101 mothers
(mean age 31.6 ± 7.3 years, range: 21–55 years) attending two community hospitals in
Lagos, Nigeria. The responses were evaluated by descriptive statistics, factor analysis
of the principal components and multiple regression analysis. The reliability of the two
23 | P a g e
main domains (knowledge and attitude) was tested for internal consistency by
Cronbach's alpha coefficient. RESULTS: Maternal knowledge was highest for measles
(73%; mean score 2.54) and ear discharge (73%; mean score 2.51) but low for birth
asphyxia (37%; mean score 1.90), traditional medicine (42%; mean score 2.03) and
jaundice (47%; mean score 2.09) as causes of hearing loss. Attitude towards neonatal
screening was positive in majority of mothers (92%; mean score 2.84) and there was a
high acceptance of hearing aids as an early intervention option (84%; mean score 2.70).
Five factors (eigenvalue > 1) were extracted after principal component analysis with the
attitude variables loading highly and exclusively on one factor. Age was the only
demographic variable that was associated with a domain (knowledge) after multiple
regression analysis. The component scales for the two domains were highly internally
consistent (alpha coefficients of 0.84 and 0.83). CONCLUSION: Contrary to the
concerns often expressed about parental support for infant hearing screening programs
in developing countries, this study suggests that current parental knowledge and
attitude favor early detection and intervention of childhood hearing impairment.
Moeller PhD, White PhD and Shisler MS, (2006), Primary Care Physicians'
Knowledge, Attitudes, and Practices Related to Newborn Hearing Screening in where
the Universal newborn hearing screening focuses on providing the earliest possible
diagnosis for infants with permanent hearing loss. The goal is to prevent or minimize the
consequences of sensorineural hearing loss on speech and language development
through timely and effective diagnosis and interventions. Pediatricians are in a key
position to educate families about the importance of follow-up, if they are well informed.
The objective of this study was to survey the attitudes, practices, and knowledge of
24 | P a g e
primary care physicians in relation to newborn hearing screening and follow-up.
METHODS. A survey was created on the basis of input from focus groups with primary
care physicians. Surveys (n = 12211) were sent to primary care physicians in 21 states
and 1 territory (Puerto Rico) regarding practices, knowledge, and attitudes related to
universal newborn hearing screening. The response rate was 16.1% (n = 1968).
RESULTS. Physicians reported a high level of support for universal newborn hearing
screening; 81.6% judged it to be very important to screen all newborns for hearing loss
at birth. Although physicians reported confidence in talking with parents about screening
results, they indicated a lack of confidence in discussing follow-up procedures and
intervention needs. Several important gaps in knowledge were identified, and these
represent priorities for education, as based on their relevance to medical management
and parent support. Physicians expressed a strong preference for action-oriented
resources. CONCLUSION. Pediatricians and other primary care providers recognize the
benefits of early detection and intervention for permanent hearing loss in infants. The
current system of newborn hearing screening can be enhanced by strengthening the
medical community's involvement in the process from screening to follow-up. Physician
roles will be supported through the provision of action-oriented resources that educate
parents about the importance of follow-up and that prepare professionals to incorporate
appropriate surveillance procedures in daily practice.
Gary Hoffman (2003), screening mass population for congenital disorders has
proven to be a very successful and well accepted public health activity. Most babies
born with one of the screened for disorders appear very normal at birth and don’t show
clinical symptoms for a few weeks or months after birth. Even when clinical symptoms
25 | P a g e
are obvious, the diagnosis is often difficult due to similarities with other childhood
medical conditions and is often too late to reverse the clinical damage that has already
occurred. Therefore, for maximum benefit to the infant, detection must occur before
clinical symptoms are evident. Children affected with these disorders, without early
detection and treatment, usually depend upon other state funded programs for long
term care.
DOH (2005), The Department of Health (DOH) will intensify efforts to improve
newborn screening (NBS) services in the country, saying nothing much has improved
since the passage of the Newborn Screening Act in 2004. DOH records showed that as
of December 2007, only 15.6 percent or 234,000 of the 1.5 million babies born annually
have undergone NBS procedures. Dr. Yolanda Oliveros, director of the DOH’s National
Center for Disease Prevention and Control, said that NBS is important because it could
detect and help stop debilitating illnesses of infants. “Newborn screening is a very
simple procedure that can save the lives of the newborn. It will ensure that newborns
will grow healthy and normally. We hope that parents would allow their infants to go
through this procedure,” she said. Oliveros noted that NBS procedure costs only P550.
In NBS, blood is extracted from an infant’s foot to test for five illnesses – congenital
hypothyrodism (CH), congenital adrenal hyperplasia (CAH), galactosemia (GAL),
phenylketonuria (PKU), glucose-6-phosphate dehydrogenase deficiency (G6PD Def).
CH is caused by lack or absence of thyroid hormone which is essential for the growth of
the brain and body, while CAH is an endocrine disorder that causes severe salt loss,
dehydration and abnormally high levels of male sex hormones in both boys and girls.
GAL, on the other hand, prevents babies from processing galactose or the sugar in the
26 | P a g e
milk, leading to liver and brain damage and cataracts. Babies with PKU experience
excessive accumulation of phenylalanine in the blood, causing brain damage. Those
with G6PD Def suffer hemolytic anemia due to lack of the G6PD enzyme. The
procedure is ideally done on the second or third day after a child is born but it can also
be performed 24 hours from birth. Some disorders are not detected if the test is done
earlier. Oliveros noted that prior to 2005, NBS coverage was a dismal three to five
percent. This improved two years later when the DOH beefed up its information
campaign about the program and after the Philippine Health Insurance Corp. began
including the procedure in its benefit packages. The DOH has made NBS a “mandatory
licensing requirement for all hospitals.” Last Feb. 1, Health Secretary Francisco Duque
III reiterated this requirement in a memorandum to all DOH officials and hospital
directors.
Gaps to be bridged by the Present Study
The studies presented above are relevant to the present study. It has almost same
issues with regards to the awareness, their attitudes and knowledge about newborn
screening. The professional mentioned in the above studies has differ and come up with
the same idea on the said topic. A past interview was made orally and in written and it
ended up by the same reasons and idea of the respondent involve in the study. Majority
of the respondent don’t have enough knowledge in the importance of newborn
screening and the diseases that may occur if newborn screening is not applied.
Synthesis of the Art
27 | P a g e
Gary Hoffman (2003), screening mass population for congenital disorders has
proven to be a very successful and well accepted public health activity. Most babies
born with one of the screened for disorders appear very normal at birth and don’t show
clinical symptoms for a few weeks or months after birth. Therefore, for maximum benefit
to the infant, detection must occur before clinical symptoms are evident. Children
affected with these disorders, without early detection and treatment, usually depend
upon other state funded programs for long term care.
DOH based on the standards set forth by the Committee. At a minimum, every
Newborn Screening Center shall: (i) have a certified laboratory performing all tests
included in the newborn screening program, (ii) have a recall/follow up programs for
infants found positive for any and all of the heritable conditions; (iii) be supervised and
staffed by trained personnel who have been duly qualified by the NIH; and (iv) submit to
periodic announced or unannounced inspections by the Reference Center in order to
evaluate and ensure quality Newborn Screening Center performance.
Carlie Driscoll, PhD, Ensuring optimal health for newborns is a concern shared by a
whole host of medical and allied health professionals. Clinicians, researchers, and
policymakers from a diverse range of specialties regularly engage in collaborative
practice in the first stage of attaining this goal; in the early detection of newborn
diseases and disorders. In order to provide the highest quality of service, the
Audiologist, for example, must not only be well versed in hearing screening systems,
but also in genetic screening, as the new frontier of screening brings an amalgamation
of these previously distinct systems.
28 | P a g e
Newborn screening for a metabolic disorder could lead to false positives, adding stress
to parents, costing money and possibly subjecting a baby to unnecessary follow-up
treatment and dietary restrictions. But the benefits of diagnosing these children early
and preventing the risk of mental retardation, disability or death outweigh the costs of a
false positive. (Lisa A. Prosser,Ph. D.)
As a member of the health team, it is important for nurses to now the stares of
conformity regarding the newborn screening program. This will aim to determine the
campaign method and attitude on newborn screening among mothers.
CHAPTER 3
RESEARCH METHODOLOGY
29 | P a g e
This chapter represents the type of method used in the research, the respondents and
sampling method and the research instruments that have been used. It also show the
type of statistical treatment that applied in order to analyze and interpret the data
gathered information.
RESEARCH DESIGN
The descriptive method was used in his study. This is the most appropriate method in
inquiry about the present status and condition of a particular phenomenon. Concepts
and procedure of general description, analysis and classification are discussed and
illustrated in considerable detail. The researcher will utilize descriptive type of research
in order to determine the knowledge and attitude of the mothers towards newborn
screening.
SOURCE OF DATA
The studies were composed of 50 selected mother in Sto. Nino, Binan, Laguna. Books,
Journals and Internet were secondary source used to gather some information that
were included in this research. Questionnaire are use as the research tool to generate
empirical data in answering the research problem. The researcher conducts a survey in
Sto. Nino, Binan, Laguna for the researcher to process data gathering.
POPULATION OF THE STUDY
30 | P a g e
The locale of the study is in Barangay Sto. Niňo Biňan, Laguna which is suited for our
respondents. The representative respondents came from family lived in urban areas.
Ages ranged 20-30 years with the mean age of the sample being 25 years. The number
of children the women had ranged from one child to six with the averaged being four
children.
AGE FREQUENCY PERCENTAGE
20-22 13 26%
22-24 14 28%
24-26 9 18%
26-28 8 16%
28-30 6 12%
TOTAL 50 100%
EDUCATIONAL
ATTAINMENT
FREQUENCY PERCENTAGE
COLLEGE 12 24%
HIGH SCHOOL 35 70%
ELEMENTARY 3 6%
TOTAL 50 100%
The majority of the women stated that they had heard of newborn screening prior to
receiving the survey. They reported receiving information from a variety of sources.
Awareness of newborn screening:
31 | P a g e
Sources of information Most popular sources reported
Midwife 16
Previous pregnancy 8
From pamphlet 2
Family or friends 23
Internet 1
Total 50
SAMPLING TECHNIQUE
The researcher employed purposive sampling. They had specifically chosen the
respondent in the urban area / low class families.
INSTRUMENTATION AND VALIDATION
For data gathering, researchers carefully designed questionnaires to the respondents
ensuring that this information is in a form that can be objectively analyzed in order to
elicit the needed data that pertained to the topic under study. This consisted on different
parts and specific purposes. Part I collecting data on the respondents profile, Part II
deals with level of knowledge and there attitude in newborn screening. Interview was
used by the researcher to the respondents to supplement primary source of data, it also
gave opportunity for the respondent to clarify questions concerning the survey. Further,
it gave flexibility to give follow up questions or discuss issue concerning the topic of
study that was not clearly expounded by the questionnaire. The observation was also
been an excellent source of data. Observational findings are considered strong in validity
32 | P a g e
because the researcher is able to collect a depth of information about a particular
behavior.
EVALUATION OF SCORING
The options to the items of the questionnaire that were in the Likert Scale within the
continuum of five were as follows the corresponding assigned points.
Assigned points Class interval Verbal interpretation
5 4.51-5.00 Very much aware
4 3.51-4.50 Aware
3 2.51-3.50 Moderately aware
2 1.51-2.50 Less aware
1 1.00-1.50 Not aware at all
DATA GATHERING PROCEDURE:
The researchers went to Barangay Sto. Niňo Biňan, Laguna to conduct a survey but
before giving the survey form, the researchers first give letter to the respondents as a
means of asking permission. As the respondents allowed the researcher to conduct a
survey, the survey form was given individually.
STATISTICAL TREATMENT USED
33 | P a g e
To establish solution to the problem, numerical presentation and analysis of the data
gathered for this study. For in depth analysis and interpretation of data, the following
techniques were used:
1) Frequency and percentage distribution. Percentage was used to find the ratio of
frequency of response to the number of respondents by applying this formula:
P = f / N x 100
Where: P = Percentage
f = frequency
N = total number of respondent
2) Weighted Mean, used to determine the knowledge and attitude of the respondent
on the newborn screening.
The formula for weighted mean is:
∑ fx WM= --------------------- N
Where: WM = weighted mean f = frequency x = assigned weight ∑ = summation symbol N = total number of respondents
3) Pearson Product Moment Correlation, used to determine the magnitude and
direction of the relationship between (a) profile variable and level of knowledge
on newborn screening (b) profile variable and attitude on newborn screening.
The formula for Pearson r is:
n∑xy - ∑x ∑yRxy = -------------------------------- √ [n∑x2 – (∑x)2] [n∑y2 (∑y)2]
34 | P a g e
Where: r = degree of relationship between x and y
x = the observed data for the independent variable
y = the observed data for the dependent variable
n = sample size
The degree of linear relationship can be interpreted through the use of range of
value (Bermundo, 2005) for the Pearson Product Moment Correlation.
Bibliography:
35 | P a g e
K. Fant et al., Completeness and complexity of information available to parents from
newborn screening program pediatric, PEDIATRICS Vol. 115 No. 5 May 2005
C Lagoy, Impact of Expanded Newborn Screening, United States, 2006
Christine Patch PhD, MA(Ed) SRN, MCN, The American Journal of Maternal/Child
Nursing, Volume 31 Number 3 Pages 164 – 168, May/June 2006
Beth A. Tarini, MD , Dimitri A. Christakis, MD, MPH , H. Gilbert Welch, MD, MPH ,
American Academy of Pediatrics, Vol. 119 No. 2, 141 Northwest Point Blvd., Elk Grove
Village, 2007
Laura Eggertson, Pediatric Screening: Canada lags on newborn screening, CMA Media
Inc., 2005
Gary Hoffman BS, Ronald Laessig PhD, Screening Newborns for Congenital Disorders,
Wisconsin Medical Society, 2003
Sheila Crisostomo, DOH to step up newborn screening drive , The Philippine Star, 2008
Gennaccaro M, Waisbren SE, Marsden D., The knowledge gap in expanded newborn
screening: survey results from paediatricians in Massachusetts, Department of
Genetics, Children's Hospital Boston USA, 2005
36 | P a g e
Casey A. The development and use of the partnership model of nursing care In:
Glasper EA, Tucker A (eds) (1993) Advances in Child Health Nursing. London, Scutari
Press; 1993.
Parse, R. R. (1995). Illuminations: The human becoming theory in practice and research. New York: National League for Nursing.
Neil A. Holtzman MD, Ruth Faden PhD, MPH, A. Judith Chwalow DrPH, , Susan D.
Horn PhD, Effect of Informed Parental Consent on Mothers' Knowledge of Newborn
Screening, PEDIATRICS Vol. 72 No. 6, American Academy of Pediatrics, 141
Northwest Point Blvd., Elk Grove Village, 1983
Kruti Acharya, MD*, Paul D. Ackerman, AB ,Lainie Friedman Ross, MD, Ph,
Pediatricians' Attitudes Toward Expanding Newborn Screening,
PEDIATRICS Vol. 116 No. 4, 141 Northwest Point Blvd., Elk Grove Village, IL, 2005
Davis TC, Humiston SG, Arnold CL, et al, Oral and written information about newborn
screening should be concise and given to parents by primary prenatal care providers,
BMJ Publishing Group Ltd, 2007
Hanna Schittek; Joy Koopmans; Lainie Friedman Ross, Maternal and Child Health
Journal: Pediatricians' Attitudes about Screening Newborns for Infectious Diseases,
Springer, 2010
Lang CW, Stark AP, Acharya K, Ross LF., Maternal knowledge and attitudes about
newborn screening for sickle cell disease and cystic fibrosis, Department of Pediatrics,
University of Chicago, Chicago, Illinois 60637, USA., 2009
Olusanya BO; Luxon LM; Wirz SL, Maternal views on infant hearing loss in a developing
country, International journal of pediatric otorhinolaryngology , 2006
37 | P a g e
Moeller PhD, Whire PhD and Shisler MS,, Primary Care Physicians' Knowledge,
Attitudes, andPractices Related to Newborn Hearing Screening,
PEDIATRICS Vol. 118 No. 4, 2006
Vollman, John H. , Newborn Screening Encyclopedia of Public Health , HighBeam™
Research, Inc., 2002
Katherine Brind'Amour, Purpose of Newborn Screening Programs: Why Doctors Test
Infants for Hearing Loss or Rare Heritable Diseases, USA, 2009
Atty. Gerry T. Galacio, A primer on the Newborn Screening Act of 2004, famli.blogspot,
2006
Holtzman NA, Faden R, Chwalow AJ, Horn SD., Effect of informed parental consent on
mothers' knowledge of newborn screening, Pediatrics. 1983
Eagly & Chaiken (1993), Fishbein & Ajzen (1975), Glossary: Attitude, sfb504.uni-
mannheim.de, 1999
Kruti Acharya, MD*, Paul D. Ackerman, AB ,Lainie Friedman Ross, MD, PhD,
Pediatricians' Attitudes Toward Expanding Newborn Screening,
PEDIATRICS Vol. 116 No. 4 October 2005
38 | P a g e
Whitehead, N.S., Brown, D.S., & Layton, Developing a conjoint analysis survey of
parental attitudes regarding voluntary newborn screening, RTI Press Publication No.
MR-0014-1003., march 2010
Lisa Prosser, Ph.D., Research Associate Professor in the Division of General Pediatrics
at the University of Michigan Health System
Carlie Driscoll, PhD, Bradley McPherson, PhD, FAAA
kidsHealth from nemours, newborn screening tests, nemours foundation,2010
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.
Guthrie (2000), Overview of Newborn Screening, University of Massachusetts,
NNSGRC.
2006 Republic of the Philippines, Department of Health San Lazaro Compound, Sta.
Cruz, Manila
American Journal of Medical Genetics Part C: Seminars in Medical Genetics Special
Issue: Children and Genetics: Ethics and Policy Volume 148C, Issue 1, pages 8–14, 15
February 2008
COPYRIGHT 2006 Around the nation, Manila Bulletin Publishing Corp.
39 | P a g e
top related