Table 1 Developing and testing a hearing screening protocol
Aims/objectives | 1. To develop a hearing screening protocol for grade 1 learners in schools from the local school district 2. To determine the feasibility of applying the proposed protocol in the school context |
Context (at time of study) | The study was conducted in Western Cape Province in South Africa where there are vast economic disparities evident in a schooling system where over 80% of schools are categorized as public entities serving the majority of the population. Over 40% of these public schools have limited financial and human resources and experience difficulties accessing health care, including school-based hearing health services |
Problem | The nurses, as key role players in school health, identified the need for an effective hearing screening protocol which was sensitive to the limited time and human resources constraints |
Study design (include sample size) | The mixed methods study was designed in two sequential phases, namely the development phase and feasibility testing Phase 1: Development phase Methods: A focus group discussion was conducted with 5 nurses to identify their needs and test properties suited to their context A systematic literature review was conducted to appraise published evidence of effective hearing screening tests and identify two potential hearing screening tests to meet the nurses’ contextual needs Expert panel comprising 2 school nurses and 2 pediatric audiologists reviewed the synthesized data from the focus group discussion and systematic review to identify a screening protocol suited to the context. They used a Likert-type scale for ratings Phase 2: Feasibility of implementation After nurses were trained on how to implement the hearing screening protocol the feasibility was assessed through: - Observations of 4 nurses implementing the protocol with 100 grade 1 children in the school context, using an observation schedule - Conducting a test-re-test reliability and inter-tester reliability of the hearing screening using a sample of 45 randomly selected children - Determining the sensitivity and specificity of the test by comparing the test results generated by the nurses with gold standard diagnostic audiology findings |
Findings | Phase 1: Development phase The required test properties identified were as follows: (1) quick to administer, (2) easy to administer, (3) easy to interpret, (4) resistant to background noise, and (5) yield accurate results The literature review identified the distortion-product oto-acoustic emissions (DP-OAEs) and pure tone testing as suitable tests The expert panel proposed the DP-OAE as the test most likely to succeed in the context Phase 2: Feasibility of implementation The protocol was found to be feasible for nurses to implement The inter-rater reliability between nurses was generally high and consistent with international findings The sensitivity of DP OAE testing was 57% (warranting further exploration) while the specificity was 97% |
What has happened since the conclusion of the study | Upon study completion, the findings were presented to the Western Cape School Health Forum and the proposed protocol was well-received. While the challenges of implementing the protocol within the current school health program still remain, the collaborative research process has increased the school nurses’ willingness to utilize the proposed protocol |