Exploring the attitudes and perceptions of parents and healthcare stakeholders to accessing newborn screening for hearing loss in Port Harcourt, Nigeria: A qualitative study

Abstract

Background: Hearing loss is a major global public health challenge, with over 466 million people affected worldwide, including 34 million children. Early detection through newborn hearing screening (NHS) is critical for timely intervention, yet such services remain largely unavailable in low- and middle-income countries, including Nigeria. Despite evidence supporting the effectiveness of early hearing detection and intervention, uptake of NHS in Nigeria is limited. This study explored the attitudes and perceptions of parents and healthcare stakeholders towards accessing newborn hearing screening in Port Harcourt, Nigeria, with the aim of understanding the socio-cultural, institutional, and economic factors influencing participation. Methods: An interpretivist qualitative research design was employed to capture experiences and meanings from 25 purposively selected participants, including twenty parents and five healthcare stakeholders. Semi-structured interviews were conducted at the University of Port Harcourt Teaching Hospital between June and July 2022. Data were analysed using reflexive thematic analysis to identify recurrent themes and interpret the patterns of perception and behaviour influencing access to screening. Findings: Four overarching themes emerged: “Understanding and Community Perceptions,” “Contradictory and Complex Views,” “Factors in Access,” and “Promoting Access.” Major subthemes under these categories included cultural and religious beliefs framing hearing loss as a spiritual or moral punishment, leading to stigma and delayed health-seeking. Economic hardship, lack of awareness, inadequate infrastructure, and absence of national policy were identified as key barriers, albeit participants expressed openness to screening when made accessible and affordable. Conclusion and Recommendation: Access to newborn hearing screening in Nigeria is shaped by cultural beliefs, socio-economic constraints, and institutional limitations. Improving access requires culturally sensitive health education, inclusion of NHS within routine maternal and child health services, national policy development, and community engagement. These findings contribute context-specific insights to strengthen early hearing detection and intervention in low-resource settings.