Towards Health Equity: Deaf Adults' Engagement in Social e-Health Activities and e-Communication with Health Care Providers

Making virtual health care accessible to the deaf community: Findings from the telehealth survey

INTRODUCTION

To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits.

METHODS

A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches.

RESULTS

Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25).

CONCLUSION

Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs.

Social media and partnership jointly alleviate caregivers' psychological distress: exploring the effects of online and offline connectedness

BACKGROUND

The prevalence of caregiving in the United States has increased from 16.6% to 19.2% during the period between 2015 and 2020. Caregivers play a critical public health role post-pandemic and as the population ages. However, caregiving can be detrimental to the health of caregivers. Many studies have shown that communication and connectedness are effective forms of health intervention for caregivers, but how this can be achieved requires further investigation.

OBJECTIVE

This study aimed to investigate the indirect effect of caregiving on problems of alcohol drinking through psychological distress. Moreover, this study aimed to provide initial evidence of the distinct effects of online and offline communication and connectedness on caregivers' well-being.

METHODS

The predictions were evaluated by examining responses to the Health Information National Trends Survey 2020 (n = 3,865). A mediation analysis was conducted to test the mediating effect of psychological distress on the association between caregiving and alcohol drinking. A second-level moderation analysis was performed. The online communication and connectedness, social media use for health, and the offline type, marital or romantic partnership, were tested as moderators to lessen the psychological distress of caregiving.

RESULTS

A competitive mediation was identified. We found a positive indirect effect from caregiving to alcohol drinking mediated by psychological distress (bp = .0017, p < .05) but a negative direct effect from caregiving to alcohol drinking (bp = -.0340, p < .05). Furthermore, the study reported a strongly positive effect of moderated moderation on the linkage from caregiving to psychological distress. The negative impact of caregiving on mental distress was greater among those who used social media less, particularly those without a romantic or marital partner.

CONCLUSIONS

The findings indicate that caregivers experience more mental distress, which leads to risky behavior. This study highlights the crucial role of both online and offline connectedness in mitigating the adverse consequences of caregiving.

Medication-Related Experience of Deaf American Sign Language Users

BACKGROUND

Previous studies showed that deaf and hard-of-hearing (DHH) individuals have low health literacy related to prescription labels. This study examined the DHH's experience with understanding prescription labels and how technology can impact that experience.

OBJECTIVES

The purpose of this qualitative study was twofold: (1) gain a more enhanced understanding of DHH experiences in understanding prescription labels with a focus on language needs, expectations, and preferences, and (2) assess the potential role of technology in addressing the communication-related accessibility issues which emerge from the data.

METHODS

In this study, 25 Deaf American Sign Language users who picked up a prescription from a pharmacy within the past year were interviewed. A thematic analysis, which included a systematic coding process, was used to uncover themes about their experiences picking up and using prescription medications.

KEY RESULTS

Thematic analyses identified that medication-related experiences centered around themes: (1) medication information seeking; (2) comfort taking medication; (3) picking up medication; and (4) communication with the pharmacy team. A large contributor to the communication experience was the perception that the pharmacist was not being respectful. Regarding comfort taking medications, 12% of participants expressed a lack of understanding medications while taking medication. This led to participants largely using online resources when seeking medication information. This study also found that technology greatly aided the participants during this experience.

CONCLUSION

This study recorded the experiences within the context of limited health literacy and aversive audism found that the DHH individual repeatedly encountered communication barriers, which may contribute to their poor medication literacy. Thus, future studies should explore how to leverage the potential benefits of technology to improve the pharmacy experience of the DHH, thereby improving medication literacy. [HLRP: Health Literacy Research and Practice. 2023;7(4):e215-e224.].

Access to Effective Communication Aids and Services among American Sign Language Users across North Carolina: Disparities and Strategies to Address Them

OBJECTIVE

To examine the extent to which communication aids and services used by American Sign Language (ASL) users and their healthcare providers aligns with preferences, satisfaction, and unmet needs; and to elicit from stakeholders strategies to address disparities.

METHODS

A cross-sectional study was conducted of ASL users in North Carolina. Respondents completed an online survey presented in ASL and English (N = 189). McNemar's tests were used to compare rates of preferred and actual methods of communication. Logistic regression models explored relationships of accessible communication with dissatisfaction and unmet need. Qualitative interviews explored satisfaction with communication and reflections on what works, what does not, and outcomes (N = 54).

RESULTS

While 45% of respondents used a professional sign language interpreter, 65% of respondents preferred to do so. Accessible communication was associated with lower odds of dissatisfaction with communication (OR = .19, p < .05). Dissatisfaction with communication was associated with greater odds of unmet need for healthcare (OR = 8.95, p < .05). Interview respondents emphasized their preference for on-site interpreters, explaining how video remote interpreting was subject to technical difficulties while writing back-and-forth led to important gaps in understanding.

CONCLUSIONS

While ASL users prefer to use professional, on-site sign language interpreters to communicate with providers, most use some other form of communication instead. Findings emphasize the need for policy strategies to facilitate access to high quality, well-functioning professional interpreter services and to have those services delivered on-site to overcome disparities.

Application of Telemedicine in COVID-19: A Bibliometric Analysis

Background

Telemedicine as a tool that can reduce potential disease spread and fill a gap in healthcare has been increasingly applied during the COVID-19 pandemic. Many studies have summarized telemedicine's technologies or the diseases' applications. However, these studies were reviewed separately. There is a lack of a comprehensive overview of the telemedicine technologies, application areas, and medical service types.

Objective

We aimed to investigate the research direction of telemedicine at COVID-19 and to clarify what kind of telemedicine technology is used in what diseases, and what medical services are provided by telemedicine.

Methods

Publications addressing telemedicine in COVID-19 were retrieved from the PubMed database. To extract bibliographic information and do a bi-clustering analysis, we used Bicomb and gCLUTO. The co-occurrence networks of diseases, technology, and healthcare services were then constructed and shown using R-studio and the Gephi tool.

Results

We retrieved 5,224 research papers on telemedicine at COVID-19 distributed among 1460 journals. Most articles were published in the Journal of Medical Internet Research (166/5,224, 3.18%). The United States published the most articles on telemedicine. The research clusters comprised 6 clusters, which refer to mental health, mhealth, cross-infection control, and self-management of diseases. The network analysis revealed a triple relation with diseases, technologies, and health care services with 303 nodes and 5,664 edges. The entity “delivery of health care” was the node with the highest betweenness centrality at 6,787.79, followed by “remote consultation” (4,395.76) and “infection control” (3,700.50).

Conclusions

The results of this study highlight widely use of telemedicine during COVID-19. Most studies relate to the delivery of health care and mental health services. Technologies were primarily via mobile devices to deliver health care, remote consultation, control infection, and contact tracing. The study assists researchers in comprehending the knowledge structure in this sector, enabling them to discover critical topics and choose the best match for their survey work.

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

Many transgender and gender diverse (TGD) people use the internet to find ways out of isolation, network, and share information on health-related topics. Thus, e-health services could reduce the health burden of TGD people and facilitate access to health care. Following the PRISMA guidelines, we conducted a systematic review on e-health approaches that could improve trans health care (i.e., services directly for TGD people or training programs for health care professionals, HCPs) and their effectiveness, acceptability, and feasibility. We searched PubMed, Web of Science, and PubPsych databases for publications from January 2000 to June 2021 with final updates before publication. The systematic review identified e-health services across 27 studies from 8 different countries. Few studies evaluated e-health services exclusively for TGD people. However, use of an e-health service was found to be effective and beneficial: TGD people improved in health-related outcomes, and HCPs improved in professional expertise. Service users find e-health services helpful and easy to integrate into their daily lives. Recommendations for further development of e-health services in trans health care are provided. In the future, given the rapidly evolving e-health research and care field, new treatment approaches for TGD people should be subject to ongoing evaluation and development.

Deaf adults at higher risk for severe illness: COVID-19 information preference and perceived health consequences

OBJECTIVES

This study explores deaf and hard of hearing (DHH) individuals' preferred sources of information for COVID-19 and their perceptions of developing severe illness from COVID-19 given underlying medical conditions.

METHODS

A national online bilingual American Sign Language/English survey was conducted from April 17 to May 1, 2020. Weighted sample of 474 DHH adults living in the United States. Multivariate logistic regression analyses were conducted to examine independent associations of sociodemographic variables and health indicators with perceived COVID-19 health consequences.

RESULTS

About 44% of the medical condition sample used the Internet (English-based text) first for COVID-19 information, followed by TV (24%). Only 1% selected healthcare provider as the go-to source; the remainder got information from family or friends. Perceived health consequences increased with age (adjusted OR = 1.04; CI 95% = 1.02, 1.06). At-risk respondents who self-identified as persons of color were nearly three times more likely to believe that their health will be severely affected by COVID-19 compared to respondents who self-identified as white (adjusted OR = 2.94; CI 95% = 1.20, 7.18).

CONCLUSIONS

Perception of COVID-19 health consequences vary among DHH adults at higher risk for severe illness.

PRACTICE IMPLICATIONS

Information delivery methods must be flexible and comprehensive to meet the diverse community's needs, especially during the COVID-19 pandemic.

A Telemedicine Approach to Covid-19 Assessment and Triage

Covid-19 is a new highly contagious RNA viral disease that has caused a global pandemic. Human-to-human transmission occurs primarily through oral and nasal droplets and possibly through the airborne route. The disease may be asymptomatic or the course may be mild with upper respiratory symptoms, moderate with non-life-threatening pneumonia, or severe with pneumonia and acute respiratory distress syndrome. The severe form is associated with significant morbidity and mortality. While patients who are unstable and in acute distress need immediate in-person attention, many patients can be evaluated at home by telemedicine or videoconferencing. The more benign manifestations of Covid-19 may be managed from home to maintain quarantine, thus avoiding spread to other patients and health care workers. This document provides an overview of the clinical presentation of Covid-19, emphasizing telemedicine strategies for assessment and triage of patients. Advantages of the virtual visit during this time of social distancing are highlighted.

Social media health promotion in South Africa: Opportunities and challenges

BACKGROUND

Health promotion is an effective tool for public health. It goes beyond preventing the spread of diseases and reducing the disease burden. It includes interventions encompassing the creation of supportive environments, building public health policy, developing personal skills, reorienting health services and strengthening multisectoral community actions.

AIM

The aim of the review was conduct an analysis on the opportunities and challenges of the use of social media for health promotion in South Africa.

METHODS

A search of review articles on health promotion using social media conducted using Medline and Google Scholar. Secondary searches were conducted using references and citations from selected articles.

RESULTS

Social media has potential of being an effective health promotion tool in South Africa. It presents an opportunity for scaling health promotion programs because of its low cost, its ability to have virtual communities and the ease of access eliminating geographical barriers. It also allows real-time communication between various stakeholders. It allows information to spread far and fast and leaving irrespective of the credibility of the source of information. There is a need to take into account country specific socio-economic issues, which may perpetuate unintended consequences related to the digital divide, data costs and the varying levels of health literacy.

CONCLUSION

Considering the opportunities presented by social media, the National Department of Health needs to review its health promotion strategy and include the use of social media as an enabler. They also need to address to explore intersectoral measures to address issues which threatening equitable access to credible health promotion information.

Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study

Background

About 46% of US adults obtain recommended HIV screening at least once during their lifetime. There is little knowledge of screening rates among deaf and hard-of-hearing adults who primarily use American Sign Language (ASL), or of social media as a potentially efficacious route for HIV prevention outreach, despite lower HIV/AIDS-specific health literacy and potentially higher HIV seropositivity rates than hearing peers.

Objective

We investigated both the likelihood of HIV screening uptake among deaf adults in the past year and over one year ago, and the relationship between social media use and HIV screening uptake among deaf adult ASL users.

Methods

The Health Information National Trends Survey in ASL was administered to 1340 deaf US adults between 2015-2018. Modified Poisson with robust standard errors was used to assess the relationship between social media usage as a predictor and HIV screening as an outcome (screened more than one year ago, screened within the past year, and never been screened), after adjusting for sociodemographics and sexually transmitted disease (STD) covariates.

Results

The estimated lifetime prevalence of HIV screening uptake among our sample was 54% (719/1340), with 32% (429/1340) in the past year. Being of younger age, male gender, black, lesbian, gay, bisexual, or queer, or having some college education or a prior STD were associated with HIV screening uptake. Adjusting for correlates, social media use was significantly associated with HIV screening in the past year, compared to either lifetime or never.

Conclusions

Screening falls well short of universal screening targets, with gaps among heterosexual, female, Caucasian, or older deaf adults. HIV screening outreach may not be effective because of technological or linguistic inaccessibility, rendering ASL users an underrecognized minority group. However, social media is still a powerful tool, particularly among younger deaf adults at risk for HIV.

Deaf Women's Health: Adherence to Breast and Cervical Cancer Screening Recommendations

INTRODUCTION

No prevalence studies on cancer screening adherence among Deaf women have been conducted in the past decade. Current data on breast and cervical cancer screening are needed from Deaf women who adhered or did not adhere to the U.S. Preventative Services Task Force screening guidelines. The objectives of this study were to assess whether disparities for cancer screening adherence persist for Deaf women compared with the general population and whether racial and ethnic disparities for adherence exist among Deaf women.

METHODS

Data for adherence to Pap (n=529, Deaf women; n=1,119, hearing women) and mammogram screening (n=324, Deaf women; n=1,086, hearing women) were drawn from the Health Information National Trends Survey in American Sign Language (Deaf women; February-August 2017 and October 2017-May 2018) and the Health Information National Trends Survey 5, Cycle 1, data set (hearing women; January-May 2017). Data were analyzed in 2018. Propensity score model of the weighed samples estimated the probability of adherence among the entire sample and within the sample of Deaf women for each screening test.

RESULTS

About 78% (n=415) of age-eligible Deaf women and 85% (n=956) of age-eligible hearing women adhered to Pap screening recommendations (p<0.001). For breast cancer screening, the adherence rates for 245 Deaf women and 891 hearing women were 76% and 82%, respectively (p<0.01). After adjusting for correlates, for Deaf women, disparities remained for cervical cancer screening but not breast cancer screening. Race and ethnicity were not associated with cancer screening adherence.

CONCLUSIONS

This is a call to action for targeted, accessible health promotion interventions for age-eligible Deaf women to increase adherence to cervical cancer screening.