Developmental screening : predictors of follow-up adherence in primary health care

Abstract

Background: Early identification and intervention for infants and young children with developmental delays may negate or minimise the negative effect of a disability on a child's development. Poor follow-up on early detection referrals, however, undermines the effectiveness of early intervention programmes. Objectives: To identify factors, including text message reminders, that influence follow-up adherence for early intervention after developmental screening in primary health care. A secondary objective surveyed reasons for follow-up default. Methods: The PEDS Tools was used to screen 247 high-risk children. A risk assessment questionnaire was completed with caregivers whose children were referred for speech-language and/or occupational therapy (n=106, 43%). A quasi-experimental study was employed to identify risk factors for defaulting on appointments. A thematic analysis of telephonic interviews was also employed to determine reasons for follow-up defaults. Results: Follow-up adherence was 17%. Participants who were divorced, widowed or never married were 2.88 times more likely to attend a follow-up appointment than those who were married or living together (95%, CI 0.97- 8.63). Text message reminders did not significantly improve follow-up. More than half (58%) of participants who defaulted on appointments could be reached for telephonic interviews. During the telephonic interviews 87% of participants did not report concern about their child's development. Reasons for defaulting were employment, logistical issues, other responsibilities and forgetfulness. Conclusions: Detecting possible developmental delays did not lead to acceptable follow-up adherence for early intervention services at primary health care levels. Increased awareness and education regarding the importance of development for educational success is needed.