title: Rural barriers to early diagnosis and treatment of infant hearing loss in Appalachia.
abstract: OBJECTIVE
  The purpose of this study was to assess regional parental barriers in the diagnostic and therapeutic process after abnormal newborn hearing screening (NHS) testing.
  
  
  METHODS
  Cross-sectional questionnaire study.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  Parents of infants who failed NHS in Kentucky from January 2009 to February 2012.
  
  
  METHODS
  Demographic information, county of origin, attitudes and perceptions regarding NHS, and barriers in the NHS diagnostic process.
  
  
  RESULTS
  There were 460 participants in the study, which included 25.4% of parents from the Appalachian region. Twenty-one percent of Appalachian parents found the process on newborn hearing testing difficult. Appalachian parents were more likely to have no more than 12 years of education (odds ratio [OR], 1.7; p = 0.02) and Medicaid insurance (OR, 2.3; p < 0.001) compared with non-Appalachian parents. A higher percentage of Appalachian parents were unaware of the NHS results at the time of hospital discharge than non-Appalachians (14% versus 7%, p = 0.03). Distance from the diagnostic/therapeutic center represented was a significant barrier for Appalachian parents (OR, 2.8; p = 0.001). Compared with urban parents, a greater percentage of rural parents had never heard of a cochlear implant (p = 0.01). Appalachian parents expressed a strong interest in telemedicine and a desire for closer services.
  
  
  CONCLUSIONS
  Multiple barriers including education, distance, accessibility, and socioeconomic factors can affect timely diagnosis and treatment of congenital hearing loss for children residing in rural areas. Educational and telemedicine programs may benefit parents in Appalachia as well as parents in other rural areas.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington †University of Kentucky College of Medicine, Lexington; ‡Cabinet for Health and Family Services Commission for Children With Special Health Care Needs, Louisville; and §Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
authors.forename: Bryan
authors.initials: B
authors.lastname: Hardin
authors.forename: Christopher
authors.initials: C
authors.lastname: Rayle
authors.forename: Cathy
authors.initials: C
authors.lastname: Lester
authors.forename: Christina R
authors.initials: CR
authors.lastname: Studts
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
mesh_terms: D001061:Appalachian Region; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D034381:Hearing Loss / Q000151:congenital / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States