Health Care Access Among Deaf People

Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing

OBJECTIVE

To evaluate contraceptive provision and contraceptive care quality measures for individuals who are deaf or hard of hearing and compare these outcomes to those individuals who are not.

METHODS

We conducted a claims analysis with data from the 2014 Massachusetts All-Payer Claims Database. Among premenopausal enrollees aged 15-44, we determined provision of any contraception (yes or no) and provision by contraception type: prescription contraception (pills, patch, ring, injectables, or diaphragm), long-acting reversible contraceptive (LARC) devices, and permanent contraception (tubal sterilization). We compared these outcomes by deaf or hard-of-hearing status (yes or no). The odds of contraceptive provision were calculated with regression models adjusted for age, Medicaid insurance, a preventive health visit, and deaf or hard-of-hearing status. We calculated contraceptive care quality measures, per the U.S. Office of Population Health, as the percentage of enrollees who used: 1) LARC methods or 2) most effective or moderately effective methods (tubal sterilization, pills, patch, ring, injectables, or diaphragm).

RESULTS

We identified 1,171,838 enrollees at risk for pregnancy; 13,400 (1.1%) were deaf or hard of hearing. Among individuals who were deaf or hard of hearing, 31.4% were provided contraception (23.5% prescription contraception, 5.4% LARC, 0.7% tubal sterilization). Individuals who were deaf or hard of hearing were less likely to receive prescription contraception (adjusted odds ratio 0.92, 95% CI 0.88-0.96) than individuals who were not deaf or hard of hearing. The percentage of individuals who were deaf or hard of hearing who received most effective or moderately effective methods was less than that for individuals who were not (24.2% vs 26.3%, P<.001). There were no differences in provision of LARC or permanent contraception by deaf and hard-of-hearing status.

CONCLUSION

Individuals who were deaf or hard of hearing were less likely to receive prescription contraception than individuals who were not; factors underlying this pattern need to be examined. Provision of LARC or permanent contraception did not differ by deaf or hard-of-hearing status. These findings should be monitored and compared with data from states with different requirements for contraceptive coverage.

'The world is not only for hearing people - It's for all people': The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa

Background

Despite legal and adopted frameworks purporting access to healthcare and rehabilitation services, which are both a human right and key to developmental issues, women who are deaf and/or hard of hearing (HoH) are still excluded and experience barriers when accessing healthcare services. Largely, this is attributed to communication barriers between healthcare professionals and women who are deaf and/or HoH. There have been limited research studies carried out on women with invisible disabilities, such as deafness, especially amongst African women.

Objectives

This study sought to gain insights into the communication experiences of women who are deaf or HoH when accessing public healthcare services in hospitals in Johannesburg.

Methods

A qualitative research study employing semi-structured interviews with 10 African women who are deaf and/or HoH residing in Johannesburg, South Africa and attending government healthcare facilities was conducted. Participants were purposively selected. Data were analysed using thematic analysis.

Results

Data revealed the following themes: communication barriers resulting in compromised quality of care and infringement on participants' right to confidentiality; accommodation that is not accommodative and negative attitudes of healthcare professionals.

Conclusion

The findings of this study confirm the alienating, exclusion, marginalisation, discrimination, invisibility, lack of independence and autonomy of women who are deaf and/or HoH when accessing healthcare services. Therefore, this study argues for a need for the conscientisation of healthcare professionals on communication needs of persons who are deaf and/or HoH. This has implications for the implementation of training programmes that will address communication, reasonable accommodation and attitudes of healthcare professionals.

Caring for the Deaf: Nursing Students' Knowledge and Awareness

Navigating an increasingly complex health care system is challenging for marginalized populations, including the Deaf and hard of hearing who rely heavily on nurses' and hospital-provided interpreters' knowledge of the American Sign Language. This study examined Deaf culture knowledge and awareness among undergraduate and graduate nursing students in the United States. Study findings indicated low knowledge regarding cochlear implants, use of interpreters, and parental newborn hearing test rights. Integrating care of the deaf into all levels of nursing education will serve to promote patient health literacy and health outcomes while advancing the science of nursing education.

A Nationwide Study Examining Deafness Among Hospitalized Adults

Background It is unknown whether hospital outcomes differ among nonspeaking deaf patients compared to those without this disability. Objective This article aims to compare clinical outcomes and utilization data among patients with and without deafness. Design This study used a retrospective cohort study. Setting and Participants The participants included Nationwide Inpatient Sample, year 2017, hospitalized adults with and without diagnostic codes related to deafness and inability to speak. Method Multiple logistic and linear regression were used to compare in-hospital outcomes. Results Thirty million four hundred one thousand one hundred seventeen adults were hospitalized, and 7,180 had deafness and inability to speak related coding. Patients with deafness were older (mean age ± SEM: 59.2 ± 0.51 vs. 57.9 ± 0.09 years, p = .01), and less likely female (47.0% vs. 57.7%, p < .01) compared to controls. Those with deafness had more comorbidities compared to the controls (Charlson comorbidity score ≥ 3: 31.2% vs. 27.8%, p < .01). Mortality was higher among deaf versus controls (3.6% vs. 2.2%; p < .01); this translated into higher adjusted odds of mortality (adjusted odds ratio = 1.7. [confidence interval (CI) 1.3-2.4]; p = .01). Deaf patients had lower odds of being discharged home compared to controls {aOR} = 0.6, (CI) 0.55-0.73]; p < .01. Length of stay was longer (adjusted mean difference = 1.5 days CI [0.7-2.3]; p < .01) and hospital charges were higher, but not significantly so (adjusted mean difference = $4,193 CI [-$1,935-$10,322]; p = .18) in patients with deafness. Conclusions Hospitalized nonspeaking deaf patients had higher mortality and longer hospital stays compared to those without this condition. These results suggest that specialized attention may be warranted when deaf patients are admitted to our hospitals in hopes of reducing disparities in outcomes. Supplemental Material https://doi.org/10.23641/asha.14336663.

Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data

BACKGROUND

Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States.

OBJECTIVE

To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data.

STUDY DESIGN

We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics.

RESULTS

DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained.

CONCLUSIONS

DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.

Assessment of community pharmacists' communication and comfort levels when interacting with Deaf and hard of hearing patients

BACKGROUND

Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks.

OBJECTIVE

1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support.

METHODS

This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer's level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA.

RESULTS

A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6).

CONCLUSIONS

The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.

Comparison of Access to Primary Care Medical and Dental Appointments Between Simulated Patients Who Were Deaf and Patients Who Could Hear

Importance

Primary medical and dental clinics may accept fewer people who are deaf as patients than persons who can hear, and clinics may deny requests by patients who are deaf for American Sign Language (ASL) interpretation at appointments when necessary, creating diminished access to primary medical and dental care.

Objective

To compare the rate at which patients who are deaf are offered primary care medical or dental appointments with the rate at which appointments are offered to patients who can hear in a real-world context.

Design, Setting, and Participants

This cross-sectional study used a simulated patient (SP) call audit method. Simulated patients (4 who could hear and 4 who were deaf) followed a call script in which an adult sought to establish care, requesting new patient appointments from a statewide stratified random sample of clinicians listed in the Idaho Medical and Dental Associations member databases at 445 clinics (334 primary care and 111 general dentistry) throughout Idaho. Simulated patients who were deaf also requested interpreting services at the appointment. Calls were made between June 7 and December 6, 2018. Data analysis was conducted from December 2019 to April 2020.

Exposures

Simulated patients who were deaf or could hear called primary care medical or dental clinics from the sampling frame and requested an appointment, supplying the same basic information. In addition, SPs who were deaf requested that an ASL interpreter be provided by the clinic for the appointment.

Main Outcomes and Measures

Rates of new appointments offered and, for SPs who were deaf, whether ASL interpreter services were confirmed for the appointment.

Results

Two male and 2 female SPs who could hear were successful on 210 occasions (64.4%) when requesting a new patient appointment compared with 2 male and 2 female SPs who were deaf who were successful on 161 occasions (49.1%) (P < .001). Simulated patients who could hear were nearly 2 times more likely to secure appointments than were SPs who were deaf (adjusted odds ratio, 1.88; 95% CI, 1.27-2.79). For SPs who were deaf, 80 unsuccessful appointment requests (48.2%) were associated with a request for interpretation.

Conclusions and Relevance

The findings suggest that in a statewide representative sample, access to primary medical and dental care for patients who are deaf is significantly reduced. Patients who are deaf may not receive an appointment if they request interpreter services, even when such services are required to provide effective communication.

CONSTRUCT VALIDATION AND RELIABILITY ANALYSIS OF THE SELF-ASSESSMENT OF OCCUPATIONAL FUNCTIONING INSTRUMENT FOR DEAF PEOPLE IN THE BRAZILIAN SIGN LANGUAGE

ABSTRACT Objective: to assess construct validity and reliability of the Self-Assessment of Occupational Functioning Scale in its Brazilian Sign Language version with deaf people. Methods: a methodological research study, with a sample of 121 deaf individuals, conducted virtually from January 2018 to July 2019 with dissemination throughout Brazil. Collection took place from the Self-Assessment of Occupational Functioning Scale in its transculturally adapted version for the Brazilian Sign Language. For the analysis of construct validation, the Student's t test for independent samples was used, while internal consistency was tested with the Kuder-Richardson test. Reproducibility was analyzed by means of the test-retest technique, using the McNemar test for the items and the Intraclass Correlation Coefficient and Pearson's correlation coefficient for the scores of the domains. Results: the Self-Assessment of Occupational Functioning Scale, in its version in Brazilian Sign Language, showed to be valid and reliable for the sum of the scores, and the mean of the domains obtained good internal consistency both in the total score (0.89) and for the items of the instrument. Conclusion: the instrument showed to be valid and reliable for deaf people. Offering a validated instrument to deaf individuals may provide this collective with the opportunity to expose their needs or demands regarding occupational functioning, allowing both health professionals and researchers in the area to plan care and research studies in a more inclusive and targeted manner, enabling benefits for the deaf.

Assessing Medical Students' Knowledge of the Deaf Culture and Community in Puerto Rico: A Descriptive Study

BACKGROUND

Effective communication between health care professionals and Deaf and Hard of Hearing (D&HH) patients remains a challenge. Literature regarding health professionals' knowledge of the D&HH community and their barriers toward health care access is limited in Puerto Rico and suggests a need for research. Therefore, this descriptive study aims to evaluate future physician's knowledge about the Deaf culture and community in a student cohort at San Juan Bautista School of Medicine (SJBSM), with the objective of guiding our results toward improving our curriculum.

METHODS

Medical students answered a survey to evaluate their knowledge of D&HH patients. The survey consisted of 3 parts testing awareness, exposure, and knowledge of the Deaf community. Responses from the Knowledge section were graded using an answer key, and correct answers were added to create an overall continuous sum score per participant, with higher scores meaning higher knowledge. Participants were also asked to write in possible issues deaf patients may face when hospitalized, apart from communication problems. All data were recorded and used for descriptive analysis.

RESULTS

158 (68%) medical students participated. 63% reported exposure to D&HH people, and 80% were aware of the Deaf culture. 21% of students answered to have attended an American Sign Language (ASL) class, and 86% expressed interest in taking an ASL class. The overall percentage of correct answers from all the medical groups evaluated was 39%, with increasing percent knowledge as medical student year increased. The most frequently listed problem by respondents that deaf patients may face when hospitalized was dealing with an emergency in the hospital, such as the fire alarm.

CONCLUSION

Students from clinical years (MSIII & MSIV) showed a better understanding of the Deaf culture than students in pre-clinical years (MSI & MSII). Nevertheless, the knowledge was limited in all groups. The information generated is not only valuable for our school but the healthcare community as well. The literature related to Deaf culture, particularly in the medical setting in Puerto Rico, is limited. Therefore, there exists a need to continue investigating ways to improve medical students' education of the Deaf culture and community.

Potências e limites no cotidiano da formação acadêmica no cuidado à saúde da pessoa surda

Resumo Objetivo compreender as potências e os limites no cotidiano da formação dos estudantes de graduação no cuidado à saúde da pessoa surda. Método trata-se de um estudo qualitativo e interpretativo, fundamentado na Sociologia Compreensiva e do Cotidiano, envolvendo 18 estudantes de uma universidade federal do Sul do Brasil dos cursos de graduação em Enfermagem, Farmácia, Fonoaudiologia, Medicina, Nutrição, Odontologia e Psicologia. As fontes de evidências foram entrevistas individuais desenvolvidas no período de outubro a novembro de 2019. A análise dos dados envolveu a análise preliminar, a ordenação, as ligações-chave, a codificação e a categorização. Resultados as potências no cotidiano da formação dos estudantes no cuidado à saúde da pessoa surda mostram-se na comunicação instituinte, na tecnossocialidade no cuidado e no falar Libras e poder integrar-se à comunidade surda. Os limites mostram-se nos modelos e nas práticas formativas não inclusivas, na impessoalidade da interpretação e na falta de especificidade técnica na disciplina de Libras. Conclusão e implicações para a prática conclui-se que há a necessidade de se refletir sobre os currículos dos cursos da área da saúde, proporcionado a inclusão do cuidado à saúde da pessoa surda, a fim de capacitar os estudantes para a atuação nos diferentes níveis de complexidade.

Design suggestions for an mHealth app to facilitate communication between pharmacists and the Deaf: perspective of the Deaf community (HEARD Project)

BACKGROUND

Deaf and hard-of-hearing (DHH) patients have trouble communicating with community pharmacists and accessing the healthcare system. This study explored the views on a proposed mobile health (mHealth) app in terms of design and features, that will be able to bridge the communication gap between community pharmacists and DHH patients.

METHODS

A community-based participatory research method was utilized. Two focus group discussions (FGDs) were conducted in Malaysian sign language (BIM) with a total of 10 DHH individuals. Respondents were recruited using purposive sampling. Video-recordings were transcribed and analyzed using a thematic approach.

RESULTS

Two themes emerged: (I) challenges and scepticism of the healthcare system; and (II) features of the mHealth app. Respondents expressed fears and concerns about accessing healthcare services, and stressed on the need for sign language interpreters. There were also concerns about data privacy and security. With regard to app features, the majority preferred videos instead of text to convey information about their disease and medication, due to their lower literacy levels.

CONCLUSIONS

For an mHealth app to be effective, app designers must ensure the app is individualised according to the cultural and linguistic diversity of the target audience. Pharmacists should also educate patients on the potential benefits of the app in terms of assisting patients with their medicine-taking.

„Mixed-methods“-Studie zu Barrieren in der ambulanten Psychotherapie von Gehörlosen

Hintergrund

Trotz einer erhöhten Prävalenz von komorbiden Beeinträchtigungen und psychischen Erkrankungen gibt es für Gehörlose Barrieren in der psychotherapeutischen Behandlung.

Ziel der Studie

Diese Arbeit untersucht, wie ambulant arbeitende Therapeut*innen mit Anfragen von Gehörlosen umgehen, und welche Rahmenbedingungen für eine gelingende Behandlung benötigt werden.

Material und Methoden

Nichtärztliche niedergelassene Psychotherapeut*innen eines Stadtkreises wurden zur Teilnahme an Studie 1 eingeladen. Es beantworteten 71 von 209 angeschriebenen Psychotherapeut*innen einen Fragebogen, mit dem quantitative und qualitative Daten zum Umgang mit Therapieanfragen und zu den Rahmenbedingungen für die Behandlung erhoben wurden. In Studie 2 nahmen 8 dieser Teilnehmer*innen an einem leitfadengestützten Interview teil, in dem die Befunde aus Studie 1 zu den Voraussetzungen für eine gelingende Behandlung Gehörloser vertieft wurden.

Ergebnisse

Viele Therapeut*innen berichteten von fehlenden Erfahrungen mit Gehörlosen (n = 60; p = 84,5 %) und fehlenden Therapieanfragen von Gehörlosen (n = 69; p = 97,2 %). Zukünftige Anfragen von Gehörlosen würden 64,8 % der Therapeut*innen (n = 46) ablehnen. Diese Entscheidung hängt mit der bisherigen Erfahrung mit Gehörlosen zusammen, χ2 (1) = 6,378; p = 0,012. In Studie 2 wurden Barrieren bei der Kontaktaufnahme, der Diagnostik und der Behandlung aufgrund von Kommunikationsschwierigkeiten identifiziert.

Schlussfolgerung

Therapieanfragen von Gehörlosen werden aufgrund mangelnder Therapiekenntnisse und erwarteter Kommunikationsschwierigkeiten abgelehnt. Mithilfe einer gelingenden Kommunikation, von Fortbildungsmöglichkeiten und der Aufnahme des Themenbereichs Gehörlosigkeit ins Direktstudium Psychotherapie können diese Barrieren verringert werden.

Specialized outpatient clinic for deaf and hard-of-hearing patients in the Netherlands: Lessons learned in an attempt to improve health care

RATIONALE, AIMS, AND OBJECTIVE

A group of organizations and individuals in the Netherlands collaborated to attempt to improve access to health care and health education for deaf and hard of hearing (DHH) patients in the country. The outcome was the start of a specialized outpatient clinic named PoliDOSH. An independent research group was set up to evaluate the effect of this specialized clinic. Even though the initiative did not succeed and was closed after 2 years, an extensive analysis of the start-up and functioning of the whole process was made.

METHODS

Structured and nonstructured questionnaires and structured interviews.

RESULTS

Only a small group of DHH patients indicated that they felt a need for consultations at the PoliDOSH. It became clear that to ensure successful functioning of a specialized facility the team members should include a representative group of DHH members. All key functions should be filled by top experts in the relevant fields as well as an expert in communication and needs of the target group.

CONCLUSIONS

There is a great need for facilities to collect and disseminate information to and about DHH patients. The information should be aimed at providing psycho-education for the DHH persons themselves and health care professionals, concerning the specific needs and problems of this patient group. If a similar facility is set up in the future, thorough market research prior to start up is needed to enable the facility to connect with the needs of patients. The start-up period should allow sufficient time for the project to become known and for patients to become familiar with it and trust it.

Medical Students' Corner: Barriers to Communication During the COVID-19 Pandemic

The COVID-19 pandemic has inspired us, as medical students, to reflect upon the communication training we have received in medical school and the obstacles we have faced in the clinic due to COVID-19. We hold the view that our communication training is inadequate; this view is driven by our limited exposure to patients, a situation that is currently being exacerbated by the pandemic. The medical curriculum must be inclusive of all groups and take into account the new challenges arising during the COVID-19 pandemic.

Deaf and hard of hearing awareness training: A mentor-led workshop

BACKGROUND

People who are deaf and hard of hearing (DHH) comprise a significant and increasing proportion of the population. They face many barriers to accessing good health care and major communication challenges with health professionals. There is evidence that DHH awareness training for health professionals needs improvement but little information about how such training is incorporated into curricula. The research question we address is how to develop and deliver an effective workshop for students led by people who, by definition, have barriers to communication due to hearing loss and deafness.

METHODS

Workshop development was initiated and led by a medical student as a course project, in collaboration with DHH people, other students, and university faculty in an iterative participatory educational design process, supported by a community-based organization that provides programs and services for DHH people. Development resulted in a pilot workshop suitable for all health professional students.

RESULTS

Three workshops were attended by a total of 49 students from 10 different health disciplines. Workshops were highly rated. Thematic analysis of post-workshop reflections written by occupational therapy students showed learning in the domains of knowledge, skills (practical tips and techniques), and attitudes (assumptions, motivation, reflection).

CONCLUSIONS

Partnership with a community organization makes it feasible for DHH people to design and facilitate workshops. The organization can provide the necessary environment, technology, and support, and identify people with lived experience to be workshop mentors. Workshops help make students more aware of the needs of DHH people and motivate them to provide better care.

Reproductive Health Services for Adolescents With Hearing Impairment in Indonesia: Expectations and Reality

OBJECTIVES

Reproductive health education is essential for adolescents with hearing impairment. Since they communicate using specialized language (i.e., sign language), specialized reproductive health services in sign language is a necessity. This study aimed to describe the needs, availability, and expectations of reproductive health services among adolescents with hearing impairment.

METHODS

This study used a qualitative approach. It was carried out at a school for children with special needs in the city of Denpasar, Bali, Indonesia. Data were collected by in-depth interviews. The informants were 6 adolescents with hearing impairment aged 16-17 years and 4 other key informants, including school staff and health officers. The data were then analyzed using the thematic method.

RESULTS

We found that the informants had insufficient knowledge regarding reproductive health. There was no specific subject in the curriculum regarding this issue. Teachers did not specifically provide reproductive health information. The health service unit in the school had not been utilized well for this purpose. Furthermore, no reproductive health services were provided due to the limited number of healthcare workers who could use sign language.

CONCLUSIONS

The awareness and intentions of adolescents with hearing impairment regarding access to reproductive health services remain low. Health service units at schools should be optimized to enable schools to provide reproductive health information and services for these adolescents.

Using an OSCE to assess the potential for assistive technology to enhance communication between student pharmacists and simulated patients who are deaf/hard of hearing

OBJECTIVES

To evaluate the usefulness of assistive technology in health care interactions between student pharmacists and simulated patients who are deaf/hard of hearing and to assess changes in confidence and comfort levels (among both groups) when using assistive technology.

METHODS

Forty-nine second-year student pharmacists were enrolled in a pharmacy communication laboratory course and 8 undergraduate students were recruited during Fall 2019. The first communication laboratory interaction consisted of student pharmacists using their normal mode of communication with role-played patients who are deaf/hard of hearing to establish baseline measures; a pretest survey was administered to each participant at the conclusion of this 10-minute laboratory interaction. In the second laboratory interaction, student pharmacists used the app to assist in communicating with the simulated patients who are deaf/hard of hearing. Posttests were administered at the conclusion of this laboratory interaction.

RESULTS

Most student pharmacists and simulated patients who are deaf/hard of hearing reported feeling able to effectively communicate their needs to the other individual in their dyad (pharmacist or patient) during their health care interactions. Using an iPad (Apple Inc) app to communicate significantly increased student pharmacist and simulated patient comfort with health care communication from preintervention to postintervention.

CONCLUSION

The use of assistive technology in simulated communication laboratory interactions can enhance student pharmacist comfort in health care interactions with patients who are deaf/hard of hearing.

Validation of the WHOQOL-Bref instrument in Brazilian sign language (Libras)

PURPOSE

The recognition of the Brazilian Sign Language (Libras) as the official language of the Brazilian deaf, in 2002, reaffirms the linguistic and cultural particularities of the deaf population. Therefore, there is a lack of a validated instrument for assessing the Quality of Life of deaf people using Libras. With authorization from the World Health Organization (WHO), a version of the WHOQOL-Bref in Libras was developed, called WHOQOL-Bref/Libras. However, its psychometric properties have not been examined as yet. Therefore, the purpose of this work is to perform the psychometric validation of the WHOQOL-Bref/Libras.

METHODS

WHOQOL-Bref/Libras and a sociodemographic questionnaire were applied to 311 deaf people from the five Brazilian regions. To assess temporal stability, the questionnaire was readministered to 52 deaf people, over an interval of 2 weeks.

RESULTS

WHOQOL-Bref/Libras demonstrated satisfactory psychometric values for reliability, discriminant and construct validity, temporal stability, and internal consistency. Cronbach's alpha coefficient showed satisfactory values for each of the WHOQOL-Bref domains: Physical health (0.641), Psychological (0.705), Environment (0.710), and Overall-Bref domains (0.873). The WHOQOL-Bref/Libras is the appropriate option to assess the quality of life of deaf people who communicate through Libras.

CONCLUSION

WHOQOL-Bref/Libras had a satisfactory psychometric performance; therefore, it is a valid option that will provide autonomous participation for the deaf in quality of life investigations.

Development and Validation of an Instrument to Measure Nurses' Beliefs Toward Deaf and Hard of Hearing Interaction

BACKGROUND AND PURPOSE

Nurse-patient communication has a significant effect on health outcomes and quality of care. The purpose of this research was to develop and validate an instrument to measure nurses' beliefs toward interacting with Deaf signers, non-signing deaf, and hard of hearing (DdHH) patients.

METHODS

Initial pool items created based on literature review. Content validated by DdHH and hearing registered nurses (RNs) and certified interpreters working in healthcare. Resulting D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) administered to two groups of RNs. Two validation studies conducted.

RESULTS

Analyses demonstrated high inter-item reliability, internal consistency reliability, and stability reliability of a 25-item DdHH-IBS/RN. Confirmatory factor analysis supported hypothesized structure of the scale.

CONCLUSION

The DdHH-IBS/RN is a reliable and valid scale to measure nurses' beliefs towards DdHH interaction.

HIV-related risk behaviors and HIV testing among people with sensory disabilities in the United States

People with disabilities are an important target population for HIV prevention and treatment programs. In this study, we examined the prevalence of HIV-related risk behaviors and HIV testing among people with visual and/or hearing impairments in the United States, and compared with people without any impairments. The study was a secondary data analysis of the 2016 Behavioral Risk Factor Surveillance System. We performed weighted descriptive statistics and logistic regression analyses to determine the association between ever testing for HIV and sociodemographic characteristics, healthcare access, and HIV-related risk behaviors. The prevalence of HIV-related risk behaviors was 7.1% (95%CI = 5.4-8.8), 3.9% (95%CI = 3.0-4.9), 3.5% (95%CI = 1.5-5.4), and 5.9% (95%CI = 5.7-6.1) among those with visual, hearing, both visual and hearing, and no impairments, respectively. HIV testing among those with visual impairment was 39.7% (95%CI = 37.0-42.3) and 28.9% (95%CI = 27.3-30.5) among those with hearing impairment. Approximately 26.8% (95%CI = 21.4-32.2) of the respondents with both impairments and 38.0% (95%CI = 37.6-38.3) of those with no impairments had ever tested for HIV. In the adjusted models, the factors associated with HIV testing varied across the subgroups, with only age, race/ethnicity, and HIV-related risk behaviors common to all the four subgroups. Compared with those without any impairments, the odds of ever testing for HIV was significantly higher among respondents with hearing impairment (aOR = 1.3, 95%CI = 1.14-1.38), after controlling for sociodemographic characteristics, healthcare access, and HIV-related risk behaviors. Targeted interventions that will meet the unique needs of people with visual and/or hearing impairments are required to reduce HIV-related risk behaviors and improve uptake of HIV testing.

The moral case for sign language education

Here, a moral case is presented as to why sign languages such as Auslan should be made compulsory in general school curricula. Firstly, there are significant benefits that accrue to individuals from learning sign language. Secondly, sign language education is a matter of justice; the normalisation of sign language education and use would particularly benefit marginalised groups, such as those living with a communication disability. Finally, the integration of sign languages into the curricula would enable the flourishing of Deaf culture and go some way to resolving the tensions that have arisen from the promotion of oralist education facilitated by technologies such as cochlear implants. There are important reasons to further pursue policy proposals regarding the prioritisation of sign language in school curricula.

Access to healthcare for deaf people: a model from a middle-income country in Latin America

OBJECTIVE

To determine if there are existing healthcare access inequities among the deaf Chilean population when compared to the general Chilean population.

METHODS

Data were obtained from a population-based national survey in Chile. In total, 745 prelingually deaf individuals were identified. The number of times the person used the healthcare system was dichotomized and analyzed using a multivariate logistic regression model.

RESULTS

Prelingually deaf people had lower incomes, fewer years of education, and greater rates of unemployment and poverty when compared with the general population. Moreover, they visited more general practitioners, mental health specialists, and other medical specialists. On average, they attended more appointments for depression but had fewer general checkups and gynecological appointments than the general population.

CONCLUSIONS

Deaf people in Chile have a lower socioeconomic status than the rest of the Chilean population. The results from this study are similar to the findings reported for high-income countries, despite differences in the magnitude of the associations between being deaf and healthcare access. Further studies should be conducted to determine the health status of deaf people in Chile and other Latin American countries and what factors are associated with a significantly lower prevalence of gynecological appointments among deaf women when compared with non-deaf women.

Validação de tecnologia em libras para educação em saúde de surdos

Resumo Objetivo: Construir e validar um vídeo educativo em Libras para educação em saúde de surdos acerca da Aids e suas formas de transmissão. Métodos: Estudo de desenvolvimento metodológico, com referencial psicométrico, desenvolvido em uma escola de audiocomunicação. Participaram cinco juízes e 18 pessoas surdas. Na coleta dos dados utilizou-se escala Likert e, na análise, o Alfa de Cronbach e o Índice de Validade de Conteúdo (IVC). Resultados: O vídeo educativo “Comunicação em Libras: aprendendo sobre a Síndrome da Imunodeficiência Adquirida (Aids), tem duração de 20 minutos. O roteiro do vídeo foi dividido em três blocos e respectivos itens: Bloco A - Aids, formas de transmissão, sinais e sintomas, diagnóstico, tratamento, prevenção; Bloco B - Tipos de preservativos. Bloco C - Aids, um problema de saúde pública. Obteve-se entre os juízes IVC médio de 0,96 para os itens e de 0,90 para os critérios psicométricos de avaliação geral. Entre os surdos obteve-se IVC médio de 0,87. O Alpha de Cronbach Total para os juízes foi 0,989 e, para os surdos 0,634. Conclusão: O vídeo educativo apresenta evidências de validade e representatividade para ser utilizado na assistência e nos processos de educação em saúde do público-alvo.

Healthcare Access for the Deaf in Singapore: Overcoming Communication Barriers

Good communication between healthcare providers and patients is vital to effective healthcare. In order to understand patients' complaints, make accurate diagnoses, obtain informed consent and explain treatment regimens, clinicians must communicate well with their patients. This can be challenging when treating patients from unfamiliar cultural backgrounds, such as the Deaf. Not only are they a linguistic and cultural minority, they are also members of the world's largest and oft-forgotten minority group: the disability community. Under Article 25 of the United Nations Convention on the Rights of Persons with Disabilities ("CRPD"), persons with disabilities have rights to the same range, quality and standard of free or affordable healthcare and programmes as provided to other people. Yet communication barriers and healthcare providers' lack of familiarity with Deaf culture can impair the quality and accessibility of healthcare for the Deaf. This essay analyses the scope of this issue in Singapore: a state party to the CRPD which has a vibrant Deaf community, and yet no legislative or constitutional guarantees of the rights of persons with disabilities. In addition to exploring the communication barriers faced by Deaf patients in Singapore, this essay highlights ways in which healthcare providers and the state can support community-based initiatives to overcome these barriers.

Healthcare providers' and deaf patients' interpreting preferences for critical care and non-critical care: Video remote interpreting

BACKGROUND

While Video Remote Interpreting services provides prompt services for emergency care and is cheaper than in-person interpreting services, there have been several issues, such as poor connection and limited flexibility to maneuver.

OBJECTIVES

This study proposes three research questions and four hypotheses to identify healthcare providers and deaf/hard of hearing (DHH) patients' preferences for VRI and in-person interpreting on critical care and non-critical care.

METHODS

The study utilizes a mixed methods design incorporating both an online survey and qualitative interviews. A total of 103 participants responded to the online survey. This included 36 healthcare providers who worked with limited English proficiency (LEP) patients, 26 healthcare providers who worked with DHH patients, and 41 DHH patients. Qualitative interviews were also conducted with eight healthcare providers and eight DHH patients to explore the online survey findings.

RESULTS

In the Part I study, healthcare providers (n = 62) included 16 males and 45 females; most professions were dentists, nurse practitioners, and students. DHH patients (n = 41) included 17 males and 22 females; most education was graduate or professional degrees. There was no statistical difference in their preference uses for critical care (p = 1.000), but there was a statistical difference for non-critical care (p = .035). In the Part II study, both healthcare providers and DHH patients preferred in-person interpreting for critical care to obtain effective communication, translation accuracy, and better treatment.

CONCLUSIONS

Recommendation to improve VRI equipment and training with healthcare providers, hospital administrators, VRI companies, VRI interpreters, and DHH patients to improve healthcare communication.

[Accessibility of deaf women to the public health system of the Basque Country (Spain)]

OBJECTIVE

To explore what are the perceptions and experiences of deaf women in relation to accessibility to the Basque Public Health System (Osakidetza). As a secondary objective, explore the experience of these women about gender violence.

METHOD

A qualitative study with exploratory design is developed. The selection of the informants was carried out through intentional sampling. Deaf women were invited to participate through the Federation of Deaf People of the Basque Country. Four discussion groups were developed between October 2013 and July 2014, with duration of 90-120minutes. The discussion groups were recorded in video for their later literal transcription in which the service of interpreters of sign language of Euskadi participated. Thematic analyses carried out.

RESULTS

Three main categories arise: 1) feelings of discrimination and limitation of the principle of autonomy; 2) barriers and facilitators in the accessibility to the health system; and 3) vulnerability of deaf women as a result of the lack of communication.

CONCLUSIONS

Nowadays, deaf women continue having difficulties in accessing to the health system in our context. The results of this study can be the starting point for the development of health policies and institutional protocols.

Disability Rights in Botswana: Perspectives of Individuals With Disabilities

Even though the United Nations Convention on the Rights of Persons With Disabilities (UN-CRPD) 2006 has been in existence for the last 10 years, the Government of Botswana has not ratified the convention. As a result, individuals with disabilities (IWDs) fail to access services and are at the mercy of the service providers. This qualitative study involved in-depth interviews with 30 IWDs about their experiences related to disability rights. Analysis of the data indicated that IWDs face several challenges in exercising their basic rights; these challenges being (a) stigmatization, (b) infrastructural barriers, (c) transport barriers, and (d) information barriers. Findings suggested that awareness of disability rights among IWDs, caregivers, and the general public was generally low. As a result, many IWDs were not aware of their rights and therefore could not exercise their rights fully.

Mobile app communication aid for Cypriot deaf people

Purpose

People with severe or profound hearing loss face daily communication problems mainly due to the language barrier between themselves and the hearing community. Their hearing deficiency, as well as their use of sign language, often makes it difficult for them to use and understand spoken language. Cyprus is amongst the top 5 European countries with a relatively high proportion of registered deaf people (0.12 per cent of the population: GUL, 2010). However, lack of technological and financial support to the Deaf Community of Cyprus leaves the Cypriot deaf people unsupported and marginalised. The paper aims to discuss this issue.

Design/methodology/approach

This study implemented user-centred design methods to explore the communication needs and requirements of Cypriot deaf people and develop a functional prototype of a mobile app to help them to communicate more effectively with hearing people. A total of 76 deaf adults were involved in various stages of the research. This paper presents the participatory design activities (N=8) and results of usability testing (N=8).

Findings

The study found that users were completely satisfied with the mobile app and, in particular, they liked the use of Cypriot Sign Language (CSL) videos of a real person interpreting hearing people’s speech in real time and the custom onscreen keyboard to allow faster selection of text input.

Originality/value

Despite advances in communication aid technologies, there is currently no technology available that supports CSL or real-time speech to sign language conversion for the deaf people of Cyprus.

Deaf LGBTQ Patients' Disclosure of Sexual Orientation and Gender Identity to Health Care Providers

INTRODUCTION

Even with accessible communication, deaf patients who self-identify as LGBTQ might or might not feel comfortable disclosing their sexual orientation/gender identity to a health care provider based on social stigma concerns and previous negative experiences with healthcare providers. The current study examined whether deaf LGBTQ individuals' patient centered communication and level of comfort in sharing health information in the presence of an interpreter contributed to coming out to providers.

METHODS

Using an online health survey in American Sign Language (ASL) and English, data was gathered from 313 (32% persons of color) self-identified LGBTQ deaf adults across diverse cities in the U.S.A. Binary logistic regression was used to examine the relationships between sexual orientation, gender identity, patient centered communication, and sharing health information with healthcare providers in front of an interpreter, and disclosing orientation/identity to healthcare providers.

RESULTS

After controlling for sociodemographic and patient-related variables, cisgender women were significantly less likely to disclose their LGBTQ identities to healthcare providers compared with cisgender men. Being accepted as LGBTQ by loved ones and high perceived patient centered communication significantly increased the likelihood of coming out to providers. The presence of an ASL interpreter did not prevent or promote the deaf LGBTQ patients' decision to share health information with their healthcare provider.

CONCLUSION

Implications for future research and recommendations for providers seeking to develop greater intersectional cultural competencies are discussed, with emphasis on the need for providers to be familiar with health access challenges and inequities facing deaf bisexual and queer women.

Assistive communication devices for patients with hearing loss: a cross-sectional survey of availability and staff awareness in outpatient clinics in England

Purpose: Fair and equal access to health care for all is a fundamental principle of the National Health Service (NHS) in England. However, findings from a previous national survey examining the experiences of hearing-impaired patients when accessing services within the primary care setting have revealed that significant barriers continue to exist. The aim of this study was to examine the availability of assistive communication devices for patients with hearing loss at reception desks and in patient waiting areas in hospital outpatient settings.Methods: We conducted a cross-sectional telephone survey involving Audiology and Ear, Nose and Throat (ENT) clinics in NHS hospitals in England. Questionnaires were administered to members of staff at clinic reception desks.Results: All NHS hospital trusts in England providing Audiology and ENT services were included in the survey. Information was obtained from a total of 208 individual clinic reception desks. Assistive communication devices were reported to be available at 64 per cent of Audiology (49/76), 42 per cent of ENT (32/76) and 71 per cent of shared Audiology and ENT reception areas (40/56). The most common type of device was an induction loop system. A substantial proportion of survey respondents were not aware of existing facilities.Conclusions: There is a shortage of assistive communication devices in Audiology and ENT clinic reception areas in England. The range of technology currently in place is insufficient. We have identified a significant lack of "deaf awareness" among frontline staff.Implications for rehabilitationProviders of health care services must recognize their legal obligation to ensure that their services are made more accessible to patients with hearing loss.The use of multimodal assistive technology ensures that more patients can benefit.Staff awareness and training is essential in improving the quality of service provision.

Promotion of Healthy Humor Cancer Education Messages for the Deaf Community

The Deaf community members of this community-campus partnership identified the lack of health information in American Sign Language (ASL) as a significant barrier to increasing the Deaf community's health knowledge. Studies have shown that the delivery of health messages in ASL increased Deaf study participants' cancer knowledge. Once health messages are available on the Internet, strategies are needed to attract viewers to the website and to make repeat visits in order to promote widespread knowledge gains. This feasibility study used the entertainment-education strategy of coupling cancer information with jokes in ASL to increase the appeal and impact of the health messages. ASL-delivered cancer control messages coupled with Deaf-friendly jokes were shown to 62 Deaf participants. Participants completed knowledge questionnaires before, immediately after, and 1 week after viewing the paired videos. Participants' health knowledge statistically significantly increased after viewing the paired videos and the gain was retained 1 week later. Participants also reported sharing the newly acquired information with others. Statistically significant results were demonstrated across nearly all measures, including a sustained increase in cancer-information-seeking behavior and intent to improve health habits. Most participants reported that they would be motivated to return to such a website and refer others to it, provided that it was regularly updated with new jokes.

Perceptions of deaf subjects about communication in Primary Health Care

Objective:

to analyze the perceptions of deaf individuals about the communication process with health professionals of the state of Rio de Janeiro.

Methods:

cross-sectional observational study. Data were collected through the application of a questionnaire with quantitative and qualitative questions to 121 deaf adults. Objective responses were studied descriptively through frequency tables and analyzed by inferential statistics and logistic regression. The data from the open questions were analyzed through content analysis.

Results:

the lack of interpreters and the lack of use of the Brazilian Sign Language by professionals were perceived as the main communication barriers. In turn, the presence of companions who are listeners (73%) and the use of mime/gestures (68%) were among the strategies most used by the deaf. The majority of deaf people reported insecurity in consultations, and those who best understood their diagnosis and treatment were the bilingual deaf (p = 0.0347) and the deaf who used oral communication (p = 0.0056).

Conclusion:

communication with the professionals was facilitated when the deaf people had a companion or when they used mimics and gestures. Sign language was neglected, despite the fact that the provision of care to the deaf by professionals trained to use this language is guaranteed in the legislation.

A qualitative study on the design and development of an mHealth app to facilitate communication with the Deaf community: perspective of community pharmacists

PURPOSE

This study prepares the groundwork on the potential design and development of a mobile health (mHealth) app that will be able to bridge the communication gap between pharmacists and patients who are Deaf and Hard of Hearing (DHoH).

PATIENTS AND METHODS

A focus group discussion was conducted with 12 community pharmacists. Participants were recruited using snowball sampling. Audio-recordings were transcribed verbatim, and analyzed using a thematic approach.

RESULTS

Three themes were apparent: 1) suggestions for app design and content, 2) perceived benefits of the app, and 3) potential challenges related to the app. Participants believed the app would be able to facilitate and improve communication, and hence relationship, between pharmacists and the DHoH. Potential challenges of the app were highlighted, such as the need for manpower to manage the app, and its cost to this group of economically disadvantaged people. There were also concerns about privacy and security.

CONCLUSIONS

This study allowed community pharmacists, one of the end-users of the app, to provide feedback on the contents and design of the app, which would allow them to provide pharmaceutical care services to patients who are DHoH, and better serve them. Potential benefits and challenges of the app were also identified. Undoubtedly, through the mHealth app, community pharmacists will be better equipped to serve and communicate with the DHoH, and this will hopefully translate to improved health outcomes in these patients.

Factors affecting access to primary health care services for persons with disabilities in rural areas: a "best-fit" framework synthesis

Background

Access to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings.

Methods

We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis.

Results

We identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost.

Conclusion

Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings.

Electronic supplementary material

The online version of this article (10.1186/s41256-018-0091-x) contains supplementary material, which is available to authorized users.

Models of service delivery for ear and hearing care in remote or resource-constrained environments

Background

There is poor availability of ear and hearing services globally, because of a lack of infrastructure, funding, equipment and appropriately trained personnel. When deciding upon delivery of ear and hearing services, an approach based upon community assessment is advocated, with subsequent asset mapping and acquisition.

Objectives

Some of the challenges to delivery of care in resource-constrained or remote environments are acknowledged, with discussion of several existing models of service delivery, and their advantages and disadvantages. Public health and telehealth are also mentioned. This article may assist those trying to set up new programmes in ear and hearing health.

Hearing loss, family status and mortality - Findings from the HUNT study, Norway

Hearing loss as well as being single has been associated with an increased risk of all-cause mortality. The purpose of the study is to assess whether being single or childless moderates the elevated risk of mortality in hearing impaired. The Nord-Trøndelag hearing Loss Study examined 50,462 persons above 20 years of age during 1996-1998. The Norwegian Cause of Death Registry was used to identify deaths until 2016. Data on marital status was obtained from the Norwegian Population Registry. Hearing loss was defined as the pure-tone average (0.5-4 kHz) of hearing thresholds greater than 25 dB hearing level (dB HL) in the better ear. Associations between hearing loss and mortality risk were estimated using Cox regression after an average follow-up of 17.6 years. Hearing loss was associated with increased risk of all-cause mortality before 75 years of age (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.4) and cardiovascular mortality (HR 1.8, 95% CI 1.5-2.1) but not with cancer mortality (HR 1.1, 95% CI 0.9-1.3) or mortality due to injuries (HR 1.4, 95% CI 0.9-2.3). Adjusting for socio-economic characteristics, cardiovascular risk-factors, diseases, and family status, reduced the associations for all-cause mortality (HR 1.1, 95% CI 1.0-1.2) and cardiovascular mortality (HR 1.4, 95% CI 1.2-1.6). The adjusted mortality risk was found to be significantly related to family status. Being divorced raised the mortality risk associated with hearing loss among those below 75 years of age. There was a similar tendency also for being childless, although this was only significant for females. There was also a trend for a lower mortality related to hearing loss in subjects with a well-hearing partner. More focus should be given to those who lack a family when having functional limitations such as hearing impairment.

Profound Hearing Loss: Addressing Barriers to Hearing Healthcare

The impact of profound hearing loss on infants and adults is variable and greatly influenced by improved audition derived from hearing aids and cochlear implants. However, barriers to healthcare, hearing healthcare in particular, can offset the benefits provided by these sensory devices. Common barriers include cost, location, availability of trained professionals, acceptance of the hearing loss, language and cultural differences, secondary disabilities, and mental health issues. These barriers and their distinct presentations vary somewhat by age, language, and where people live (urban vs. rural), and can interfere with receiving testing and devices in a timely manner. They also can limit auditory, speech and language therapies, and interfere with acceptance of the hearing loss and devices. Rehabilitation should focus on eliminating or reducing the adverse impact of these barriers on patients and their families. Some of which can be done through professional training and multidisciplinary activities, counseling, and community outreach.

Improving Cancer Literacy for the Deaf Using Deaf-Tailored Educational Interventions: a Review of the Literature

To date, there have been many strategies, including educational interventions, for cancer prevention and control, but most of them are not deaf-tailored ones. This narrative review aimed to examine cancer educational programs to improve the deaf individuals' knowledge and attitude toward cancer. The design of this study is a narrative review. We searched ISI Web of Science, Scopus, Science Direct, and MEDLINE/PubMed using the following search strategy: ("cancer education" AND "deaf") OR ("cancer" AND "deaf" AND literacy). Publication years ranged from 1983 to 2016 for studies on cancer educational interventions for the deaf. Included studies were analyzed regarding research methodologies, types of intervention, and major findings. In total, 12 included studies were classified into three research methodologies. Although short-term and long-term knowledge improvement has been reported, since there is limited evidence on the types of cancer-related educational interventions and there are insufficient studies, longterm effectiveness of educations in improving cancer knowledge of the deaf has to be reported cautiously. Current deaf-tailored education interventions are limited, but included functional features which facilitate communicating cancer health information to the deaf community. In fact, cancer literacy might improve considering deaf community preferences such as using a short open caption, sign language, and plain language in educational interventions, but further research is recommended.

Deaf patient-provider communication and lung cancer screening: Health Information National Trends survey in American Sign Language (HINTS-ASL)

OBJECTIVE

To assess whether mode of communication and patient centered communication (PCC) with physicians were associated with the likelihood of deaf smokers inquiring about lung cancer screening.

METHODS

An accessible health survey including questions about PCC, modes of communication, smoking status and lung cancer screening was administered in American Sign Language (HINTS-ASL) to a nationwide sample of deaf adults from February to August 2017. Of 703 deaf adults who answered the lung screening question, 188 were 55-80 years old.

RESULTS

The odds ratio of asking about a lung cancer screening test was higher for people with lung disease or used ASL (directly or through an interpreter) to communicate with their physicians. PCC was not associated with asking about a lung cancer screening test.

CONCLUSION

Current or former smokers who are deaf and use ASL are at greater risk for poorer health outcomes if they do not have accessible communication with their physicians.

PRACTICE IMPLICATIONS

Optimal language access through interpreters or directly in ASL is critical when discussing smoking cessation or lung cancer screening tests. Counseling and shared decision-making will help improve high-risk deaf patients' understanding and decision-making about lung cancer screening.

Exploring misinformation of family planning practices and methods among deaf people in Ghana

Having a good knowledge of family planning methods is vital for reducing maternal morbidity and mortality resulting from unintended pregnancies and unsafe abortions. In this paper, we highlight deaf people's ability to discern various misconceptions about pregnancy, with the aim of assessing their level of knowledge on pregnancy prevention methods. The article is derived from a sexual and reproductive health (SRH) needs assessment involving participants residing in two cities and a senior high school in Ghana. The needs assessment involved three focus groups with 26 participants, a survey with 152 respondents, and an interview with one health professional. Apart from the health professional, all the remaining participants were deaf people. Findings from the study indicated that more than half the participants lacked familiarity with pregnancy prevention methods. The findings of this study confirm other studies that there is a general lack of knowledge on SRH issues among deaf people in Ghana. Thus, although this study focused on prevention of unwanted pregnancy, which is just one component of SRH issues, the study provides insights into the broader SRH needs of the deaf community and calls for making these issues visible for policy-making.

Ethnographic analysis of communication and the deaf community's rights in the clinical context

BACKGROUND

Communication is a key factor in the health system. In the case of Deaf Community healthcare interactions could be affected by communication and it can also have a negative impact on health and jeopardise some of their health rights.

OBJECTIVES

Aims (i) know the communication access difficulties of deaf people in healthcare context (ii) determine how these difficulties violate their rights.

METHODS

Ethnographical study.

RESULTS

Subjects were 25 deaf adults (7 men; 18 women). Two themes were identified (1) barriers to information access - right to information; (2) communication barriers - right to privacy and to decide.

CONCLUSIONS

Communication difficulties and access to information have an impact on the health of deaf people, and violate health rights. In addition, their language rights like a community are also violate. Impact statement: Research could have a positive impact on improvement to access, communication and safe in the Deaf Community, in a clinical context.

Making Cancer Health Text on the Internet Easier to Read for Deaf People Who Use American Sign Language

People with relatively limited English language proficiency find the Internet's cancer and health information difficult to access and understand. The presence of unfamiliar words and complex grammar make this particularly difficult for Deaf people. Unfortunately, current technology does not support low-cost, accurate translations of online materials into American Sign Language. However, current technology is relatively more advanced in allowing text simplification, while retaining content. This research team developed a two-step approach for simplifying cancer and other health text. They then tested the approach, using a crossover design with a sample of 36 deaf and 38 hearing college students. Results indicated that hearing college students did well on both the original and simplified text versions. Deaf college students' comprehension, in contrast, significantly benefitted from the simplified text. This two-step translation process offers a strategy that may improve the accessibility of Internet information for Deaf, as well as other low-literacy individuals.