The current health of the signing Deaf community in the UK compared with the general population: a cross-sectional study

Exploring the Interplay of Diabetes, Deaf Patient Reported Outcomes, and Cancer Screening in Deaf and Hard of Hearing Women

Purpose

Some deaf and hard-of-hearing (DHH) individuals face health information barriers, increasing their risk of diabetes mellitus (DM) and subsequent cancer development. This study examines if health-related quality of life (HRQoL) and deaf patient-reported outcomes (DHH-QoL) mediate the relationship between DM diagnosis and cancer screening adherence among DHH individuals.

Patients and Methods

In a cross-sectional study, US DHH adults assigned female at birth answered questions on cervical and breast cancer screenings from the ASL-English bilingual Health Information National Trends Survey (HINTS-ASL) and the PROMIS (Patient Reported Outcome Measurement Information System) Deaf Profile measure's Communication Health and Global Health domains. Odds ratios (OR) and 95% confidence intervals (CI) were obtained from multivariable logistic and linear regression models, examining the association between DM, DHH-QoL, and cancer screening adherence, adjusting for other covariates and HRQoL. A Baron and Kenny causal mediation analysis was used. A two-sided p < 0.05 indicated significance.

Results

Most respondents were White (66.4%), heterosexual (66.2%), did not have DM (83.9%), had health insurance (95.5%), and adhered to pap smears (75.7%) and mammograms (76.9%). The average (standard deviation) DHH-QoL score was 50.9 (8.6). Those with DM had lower HRQoL scores (46.2 (9.5) vs 50.2 (8.8); p < 0.0001) than those without. Non-significant multivariable models indicate that those with DM were more adherent to pap testing (OR: 1.48; 95% CI: 0.72, 3.03; p = 0.285) and mammograms (2.18; 95% CI: 0.81, 5.88; p = 0.122), with DHH-QoL scores slightly increasing them to 1.53 (0.74, 3.16; p = 0.250) for pap testing and 2.55 (0.91, 7.13; p = 0.076) for mammograms. DHH-QoL was significantly associated with mammograms (p = 0.027), with 6% increased adherence per unit increase in the score. Overall, HRQoL and DHH-QoL were not significant mediators.

Conclusion

While HRQoL/DHH-QoL in DHH individuals with DM does not mediate cancer screening adherence, higher DHH-QoL scores are associated with it. DHH-focused health literacy and communication training can improve cancer-related outcomes.

Health outcomes in Deaf signing populations: A systematic review

OBJECTIVES

(i) To identify peer reviewed publications reporting the mental and/or physical health outcomes of Deaf adults who are sign language users and to synthesise evidence; (ii) If data available, to analyse how the health of the adult Deaf population compares to that of the general population; (iii) to evaluate the quality of evidence in the identified publications; (iv) to identify limitations of the current evidence base and suggest directions for future research.

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase, PsychINFO, and Web of Science.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The inclusion criteria were Deaf adult populations who used a signed language, all study types, including methods-focused papers which also contain results in relation to health outcomes of Deaf signing populations. Full-text articles, published in peer-review journals were searched up to 13th June 2023, published in English or a signed language such as ASL (American Sign Language).

DATA EXTRACTION

Supported by the Rayyan systematic review software, two authors independently reviewed identified publications at each screening stage (primary and secondary). A third reviewer was consulted to settle any disagreements. Comprehensive data extraction included research design, study sample, methodology, findings, and a quality assessment.

RESULTS

Of the 35 included studies, the majority (25 out of 35) concerned mental health outcomes. The findings from this review highlighted the inequalities in health and mental health outcomes for Deaf signing populations in comparison with the general population, gaps in the range of conditions studied in relation to Deaf people, and the poor quality of available data.

CONCLUSIONS

Population sample definition and consistency of standards of reporting of health outcomes for Deaf people who use sign language should be improved. Further research on health outcomes not previously reported is needed to gain better understanding of Deaf people's state of health.

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

BACKGROUND

Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals' experiences in healthcare and improve their capacity to communicate with these populations.

METHODS

This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention.

RESULTS

Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients.

CONCLUSIONS

Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs' perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

Silent struggles to self-manage high blood pressure among deaf sign language users: a qualitative study

AIMS

Tailored self-management support of hypertension, considering language and communication, is important for minorities, specifically in the deaf community. However, little is known about the experiences of hypertension self-management in deaf individuals who use sign language. This study aimed to explore the factors and processes of self-management in deaf sign language users with hypertension.

METHODS AND RESULTS

Ten men and women who used sign language participated in this study. Data were collected using in-depth personal interviews conducted in the presence of a sign language interpreter between November 2022 and February 2023. All interviews were recorded and transcribed for conventional content analysis. Qualitative analyses identified four categories related to the self-management of hypertension among participants: personal factors (chronic hand pain, unique language and communication, and efforts to turn crisis into opportunities), family and socioeconomic factors (family support and financial burden of living), challenges (limited health literacy and alienation from health education), and desire for health education considering the deaf community.

CONCLUSION

The results of this study suggest that family support, socioeconomic status, hand pain, and health literacy should be considered for the planning and development of health education on self-management of hypertension in deaf individuals. In addition, this health education requires cooperation with qualified sign language interpreters in healthcare settings.

Enablers and barriers for hearing parents with deaf children: Experiences of parents and workers in Wales, UK

BACKGROUND

More than 90% of deaf children are born to hearing families who know little about deafness. Benefits from hearing screening at birth are often lost, as families find little information about pathways for deaf children but are key to ensuring deaf children receive relevant language and communication support. Systems surrounding deaf children and family members are crucial for children's health and social development. Experiences of hearing parents raising deaf children and understanding factors that influence families' experience of navigating pathways for deaf children through health and education services are currently underreported.

METHODS

An exploratory study was conducted in Wales, UK. Twenty participants were interviewed, including 10 hearing parents of deaf children and 10 people who work with deaf children using semistructured interviews. Bronfenbrenner's ecological systems theory was used as a lens to explore the micro-, meso-, exo-, macro- and chronosystems that surround children and families. This study explores potential supports and barriers in those systems.

FINDINGS

Findings are reported under two broad headings: enablers and barriers. Under enablers, it was found that provision of resources, supporting people and knowledge were key factors. Under barriers, a lack of knowledge, lack of provision and battling services and attitudes were key issues that need addressing.

CONCLUSION

Hearing parents of deaf children in Wales, UK reported experiencing a range of enablers and barriers that impact upon their experiences of raising a deaf child. Further provision is needed by policymakers and governments to recognise support needs to improve the outcomes for deaf children.

PATIENT OR PUBLIC CONTRIBUTION

This project was developed from initial discussions with the stakeholder reference group and progressed with the group's deaf panel and hearing parents with deaf children. The project's steering group was involved in study design, recruitment and continuous feedback on all stages of the research process.

Whole-food plant-based Jumpstart for a Deaf and Hard of Hearing cohort

Deaf and Hard of Hearing (DHH) patients are at high risk of developing chronic illness, and when they do, are at higher risk of poor outcomes than in a hearing community. Rochester Lifestyle Medicine Institute adapted its online, Zoom-based, medically-facilitated 15 Day Whole-Food Plant-Based (WFPB) Jumpstart program, to give DHH participants knowledge, skills, and support to make dietary changes to improve their health. Adaptations included having a medical provider present who is fluent in American Sign Language (ASL), is board-certified in Lifestyle Medicine, and has a Master of Science in Deaf Education; spotlighting participants when asking a question during the Q&amp;A session; using ASL interpreters; utilizing closed captioning/automatic transcription during all Zoom meetings; and employing a Success Specialist to provide outreach via text and email throughout the program. Participants had significant positive changes in their eating pattern. They reported improvements in biometric measures as well as in how they were feeling. They all reported that they planned to continue to eat a more WFPB diet than they did prior to Jumpstart. All either agreed or strongly agreed that they learned important information, were confident that they knew the best eating pattern for health, and gained the skills they needed to make changes. Although this was a small pilot program, it suggests that this model can be used to provide education and support for behavior change that will lead to improved health in a DHH community.

Staff experiences of diabetes care in residential care facilities for people with severe disabilities in Denmark: a mixed-methods assessment of access to screening for diabetes complications

OBJECTIVES

To identify the prevalence of diabetes among adults (>18 years) living in residential care facilities in Denmark and to identify the structural, practical, and individual barriers and drivers related to their participation in screening programmes.

DESIGN

SETTING: The register-based study included all residents living in residential care facilities in Denmark. The survey and qualitative analysis were carried out exclusively in the Capital Region of Denmark.

PARTICIPANTS

For the register-based study, we identified 11 620 residents of care facilities in Denmark (>18 years) and identified the number of residents with diagnosis codes of type 1 or type 2 diabetes or dispensed prescriptions of blood glucose-lowering medication. Staff from 102 psychiatric facilities housing adults with severe psychiatric disabilities were invited to participate in the survey. Of these, 56 facilities participated with one responder each, of which n=16 also participated in follow-up qualitative interviews.

RESULTS

Register-based study: of the residents at the facilities, 954 (8%) were diagnosed with diabetes. Descriptive statistics of responses and results from content analysis of interviews were summarised in five themes that illuminated how a screening programme could be tailored to the care facilities: (1) characteristics of residents and care facilities, (2) the care needs of residents, (3) the way care was organised, (4) the specific barriers and drivers for participating in programmes, (5) number of hours and settings for screening programmes.

CONCLUSION

To increase the participation of people living in psychiatric care facilities in screening programmes, future programmes should be tailored to the identified needs and barriers experienced by the residential care staff.

Prevalence of non-communicable chronic diseases and associated factors in deaf people

OBJECTIVE

To analyze the prevalence and factors associated with non-communicable chronic diseases in deaf people.

METHODS

Cross-sectional study with 110 deaf people in Maringá-Paraná, selected using the snowball sampling technique. Data were collected from February to August 2019, using a structured instrument; and, in the analysis, multiple logistic regression was used.

RESULTS

The self-reported prevalence of chronic diseases was 43.6%, the most frequent being: arterial hypertension (12.7%), depression (6.4%), diabetes mellitus (5.4%), respiratory disease (5.4%) and hypothyroidism (4.5%). Using health services for routine consultations was significantly associated with being bimodal bilingual. The only risk behavior significantly associated with chronic disease was excessive consumption of sweet foods.

CONCLUSION

The prevalence of chronic diseases in this population may be higher than that found, as there is a possibility of underdiagnosis due to the low demand for routine consultations and the difficulty of communication with health professionals.

Video Relay Interpretation and Overcoming Barriers in Health Care for Deaf Users: Scoping Review

BACKGROUND

Persons who are deaf are more likely to avoid health care providers than those who can hear, partially because of the lack of means of communication with these providers and the dearth of available interpreters. The use of video remote interpretation, namely the video camera on an electronic device, to connect deaf patients and health providers has rapidly expanded owing to its flexibility and advantageous cost compared with in-person sign language interpretation. Thus, we need to learn more about how this technology could effectively engage with and respond to the priorities of its users.

OBJECTIVE

We aimed to identify existing evidence regarding the use of video remote interpretation (VRI) in health care settings and to assess whether VRI technology can enable deaf users to overcome barriers to interpretation and improve communication outcomes between them and health care personnel.

METHODS

We conducted a search in 7 medical research databases (including MEDLINE, Web of Science, Embase, and Google Scholar) from 2006 including bibliographies and citations of relevant papers. The searches included articles in English, Spanish, and French. The eligibility criteria for study selection included original articles on the use of VRI for deaf or hard of hearing (DHH) sign language users for, or within, health care.

RESULTS

From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. In total, 15 articles were included in this study: 4 studies were literature reviews, 4 were surveys, 3 were qualitative studies, and 1 was a mixed methods study that combined qualitative and quantitative data, 1 brief communication, 1 quality improvement report, and 1 secondary analysis. In this scoping review, we identified a knowledge gap regarding the quality of interpretation and training in sign language interpretation for health care. It also shows that this area is underresearched, and evidence is scant. All evidence came from high-income countries, which is particularly problematic given that most DHH persons live in low- and middle-income countries.

CONCLUSIONS

Furthering our understanding of the use of VRI technology is pertinent and relevant. The available literature shows that VRI may enable deaf users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within health care services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screens and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review

Background

d/Deaf people suffer from inequitable access to healthcare and health information. This results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people have been documented but not systematically analyzed. The purpose of this systematic review is to obtain a global overview of what we know about interventions aimed at improving health equity for d/Deaf people.

Methods

Medline Ovid SP, Embase, CINAHL EBSCO, PsycINFO Ovid SP, Central—Cochrane Library Wiley and Web of Science were searched for relevant studies on access to healthcare and health-related interventions for d/Deaf people following the PRISMA-equity guidelines. We focused on interventions aimed at achieving equitable care and equitable access to health information for d/Deaf people.

Results

Forty-six studies were identified and analyzed. Seven categories of interventions facing healthcare or health education inequities emerged: use of Sign Language (1), translation, validation and identification of clinical tools and scales (2), healthcare provider training program (3), development of adapted healthcare facilities (4), online interventions (5), education programs (6) and videos (7). Despite some methodological limitations or lack of data, these interventions seem relevant to improve equity of care and health education for d/Deaf people.

Conclusion

Interventions that promote healthcare equity, health education amongst d/Deaf patients and healthcare provider awareness of communication barriers and cultural sensitivity show promise in achieving more equitable care for d/Deaf patients. Meaningful engagement of d/Deaf individuals in the conceptualization, implementation and evaluation of health-related interventions is imperative.

Evaluation of a specialist cognitive clinic for the Deaf community

There are significant health inequalities between Deaf and hearing people, including barriers to accessing care and communication difficulties in consultations. Such problems have particularly affected Deaf people with acquired cognitive deficits, leading to late and missed diagnoses. We therefore established a specialist cognitive clinic for the Deaf community in 2011 at the National Hospital for Neurology and Neurosurgery, which to our knowledge is the first of its kind in the world. In this study, we retrospectively analysed electronic patient records to evaluate the service and its impact since inception. We found that Deaf patients who use British sign language had difficulty obtaining an accurate diagnosis before attending our specialist clinic, highlighting the importance of tailored services for Deaf people. Our results show that the clinic improved communication for patients and accessibility to specialist investigations, ensuring diagnostic accuracy and overall reducing health inequality for this population.

Prevalência de doenças crônicas não transmissíveis e fatores associados em pessoas surdas

RESUMO Objetivo: Analisar a prevalência e os fatores associados às doenças crônicas não transmissíveis em pessoas surdas. Métodos: Estudo transversal com 110 pessoas surdas, em Maringá-Paraná, selecionadas com a técnica snowball sampling. Coletaram-se dados de fevereiro a agosto de 2019, mediante aplicação de instrumento estruturado; e, na análise, utilizou-se regressão logística múltipla. Resultados: A prevalência autorreferida de doenças crônicas foi de 43,6%, sendo as mais frequentes: hipertensão arterial (12,7%), depressão (6,4%), diabetes mellitus (5,4%), doença respiratória (5,4%) e hipotireoidismo (4,5%). Utilizar os serviços de saúde para consulta de rotina apresentou associação significante com ser bilíngue bimodal. O único comportamento de risco associado significantemente com doenças crônicas foi consumo excessivo de alimentos doces Conclusão: A prevalência de doenças crônicas nessa população pode ser maior do que o encontrado, pois há a possibilidade do subdiagnóstico decorrente da pouca procura por consultas de rotina e da dificuldade de comunicação com os profissionais de saúde.

Disparities in health literacy during the COVID-19 pandemic between the hearing and deaf communities

BACKGROUND

Barriers to communication for those with hearing loss are not only associated with social, emotional, educational and occupational difficulties, but also with reduced access to essential healthcare services, health information, and poorer health outcomes (Emond et al., 2015). These concerns are amplified with mandates such as physical distancing and the use of masks, which although needed to prevent respiratory transmission of SARS-Cov-2, obscure access to facial features needed for lipreading and sign language.

OBJECTIVES

To compare the disparities of health knowledge and practice surrounding COVID-19, if any, among hearing and Deaf or Hard of Hearing (DHH) individuals.

METHODS

A total of 110 (70 hearing and 40 DHH) participants were recruited in the unique linguistic context of Kuwait and Saudi Arabia utilising a cross-sectional electronic survey. Participants were differentiated according to status of hearing loss, communication mode, as well as country, age, sex, occupation, education level and satisfaction with available information. Various aspects of knowledge relating to COVID-19 and associated public health measures were tested by means of a questionnaire.

RESULTS

A multivariate regression analysis showed that both the degree of hearing loss, and use of sign language as the primary means of communication were associated with lower scores. In addition, disparities exist in the use of health information sources, where DHH participants relied mostly on social media compared to the hearing group who relied predominantly on official government sources.

CONCLUSIONS

In light of the pandemic, bridging the gap in health literacy for DHH individuals is essential in both policy and practice, in order to ensure equal access to healthcare and universal compliance with health directives at the population level.

Deaf women's experiences of maternity and primary care: An integrative review

BACKGROUND

An estimated 24,000 people in the UK report using British Sign Language (BSL) as their first language. Misconceptions about deaf culture and language mean that deaf people have less access to health information and their health literacy is lower. Deaf people's health needs go under the radar in primary care with ensuing poorer health outcomes. Deaf women's experiences of maternity care are poorly understood.

METHODS

Using Whittemore and Knafl's method for an integrative review, the following databases were searched: EMBASE, MedLine, CINAHL and Maternity and Infant Care. After reviewing 430 journal article titles and abstracts against the inclusion/exclusion criteria, 11 articles were included for final review. Selected studies were conducted internationally and were available in English. 10 were qualitative studies, 1 used survey design. They were reviewed using the Caldwell Framework.

FINDINGS

These show that deaf women avoid seeking care, have a lack of access to health information and healthcare providers, including midwives, have a lack of deaf awareness. For deaf women, during pregnancy, birth and postnatal periods, this can mean having longer hospital stays and more complex postnatal care needs in both the hospital and community setting.

CONCLUSIONS

Current care provisions do not always meet the needs of the deaf BSL using women who use maternity services. Midwives should be aware of deafness as a culture and how to best meet the needs of the community to improve health outcomes for women and their babies.

Developing and Evaluating a Capacity-Building Intervention for Healthcare Providers to Improve Communication Skills and Awareness of Hard of Hearing and D/deaf Populations: Protocol for a Participative Action Research-Based Study

Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population. Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up. Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.

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.

Health State Values of Deaf British Sign Language (BSL) Users in the UK: An Application of the BSL Version of the EQ-5D-5L

BACKGROUND

Deaf people experience health inequalities compared to hearing populations. The EQ-5D, a widely used, standardised, generic measure of health status, which is available in over 100 languages, was recently translated into British Sign Language (BSL) and initial validation conducted. Using data from this previous study of the EQ-5D-5L BSL we aimed to assess (1) whether responses to the EQ-5D differed between a sample of Deaf BSL users and the general population (2) whether socio-demographic characteristics and clinical measures were associated with EQ-5D index scores in Deaf BSL users and (3) the impact of psychological distress and depression on health status in Deaf BSL users.

METHODS

Published population tariffs were applied to the EQ-5D-5L BSL, using the crosswalk methodology, to estimate health state values. Descriptive statistics (mean, SD, 95% CIs) compared Deaf BSL signer participants' (n = 92) responses to data from the general population. Descriptive statistics and linear regression analyses were used to identify associations between Deaf participants' EQ-5D index scores, socio-demographic characteristics, physical health and depression. Descriptive statistics compared the BSL index scores for people with psychological distress/depression to those from two cross-sectional, population-based surveys.

RESULTS

Using the EQ-5D, Deaf participants had lower mean health-state values (0.78; 95% CI 0.72-0.83; n = 89) than people participating in the 2017 Health Survey for England (0.84; 95% CI 0.83-0.84; n = 7169). Unlike larger studies, such as the Health Survey for England sample, there was insufficient evidence to assess whether Deaf participants' EQ-5D health state values were associated with their demographic characteristics. Nevertheless, analysis of the BSL study data indicated long-standing physical illness was associated with lower health-state values (ordinary least squares coefficient = - 0.354; 95% CI - 0.484, - 0.224; p < 0.01; n = 82). Forty-three percent of our Deaf participants had depression. Participants with depression had reduced health status (0.67; 95% CI 0.58-0.77; n = 36) compared to those with no psychological distress or depression (0.87; 95% CI 0.61-0.67; n = 36).

CONCLUSIONS

The study highlights reduced health in the Deaf signing population, compared to the general population. Public health initiatives focused on BSL users, aiming to increase physical and mental health, are needed to address this gap.

Ask and ye shall not receive: Interpreter-related access barriers reported by Deaf users of American sign language

BACKGROUND

Healthcare providers are mandated to provide reasonable accommodations for Deaf users of American Sign Language (ASL) accessing healthcare services, including ASL interpreters. Provision of accommodations improves access and provider/patient communication.

OBJECTIVE

Describe the types, frequency, severity, and trends in healthcare access complications experienced by Deaf patients.

METHODS

A six-year retrospective review of complaints (n = 108) filed regarding interpreter provision in healthcare settings with the Idaho Council for the Deaf and Hard of Hearing by Deaf users of ASL was conducted and summarized. An analysis of demographic and language factors associated with interpreter-related barriers and whether the complaint was resolved was performed using multivariate logistic regression.

RESULTS

Reasons for complaints of interpreter-related barriers to care included: 48.2% were "told an interpreter was not available"; 28.7% received an unqualified interpreter; interpreter was promised but not provided (18.5%). Factors independently associated with having been promised an interpreter were: medical clinics (vs. dental) (OR 3.92 95%CI 1.18-12.98), and complaints filed later in the study period (OR 1.55 per year 95%CI 1.19-2.01). For each additional year during the study period, complaints were 1.6 times (95%CI 1.15-2.22) more likely to have an interpreter promised but not provided. Patients from rural areas were less likely to have their complaints satisfactorily resolved (OR 0.18 95%CI 0.06-0.55).

CONCLUSION

Deaf patients experience various interpreter-related barriers throughout the process of accessing healthcare and communicating with providers/staff, though further regional and nationwide documentation is warranted.

Assessing Deaf patients in the neurology clinic

There are over 87 000 Deaf people in the UK with British Sign Language (BSL) as their first language.1 Few healthcare professionals receive training in Deaf awareness or in BSL, and missed diagnoses and inadequate treatment of Deaf patients are estimated to cost the National Health Service £30 million per year.2 Neurologists are likely to encounter Deaf BSL users in their practice, but without prior experience may find consultations challenging, especially within the time constraints and pressure of a standard clinic. In this article, we provide guidance on consulting with Deaf people in a neurology clinic, drawing on experience from our cognitive clinic for Deaf BSL users where effective communication is essential.

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.

Food Insecurity, Chronic Disease and Quality of Life among Deaf Adults who use American Sign Language

This study examined the relationships of food insecurity, chronic diseases, and QoL in a U.S. sample of 630 deaf adults (18 to 89 years old; 55% female) who used American Sign Language (ASL). Measures of USDA Food Security Module, self-reported diagnoses of chronic diseases, and QoL were administered in ASL and English. Approximately 22% reported facing food insecurity, with low food security (11%) and very low food security (11.4%). QoL, but not the presence of chronic diseases, was significantly associated with food insecurity. Higher income and absence of depression acted as protective factors, reducing the risk for food insecurity.

[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.

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.

Prevalence of Self-Reported Hypertension in Deaf Adults Who Use American Sign Language

BACKGROUND

In the United States, roughly one-third of adults have hypertension; another third have prehypertension. The prevalence of hypertension in deaf American Sign Language (ASL) users is unknown. We address this gap through a descriptive study for the prevalence of hypertension in the American Deaf community and discuss future directions to address this issue.

METHODS

Self-reported data for 1,388 ASL using deaf adults were compared with a secondary data of 2,830 English-speaking hearing adults. Frequency and percentages were used to describe the prevalence of hypertension in the deaf community. Age-weighted analysis was used to compare unmodifiable risk factors and hypertension rate between deaf and hearing adults.

RESULTS

Deaf and hearing samples' hypertension rates for gender and age were similar. Significant group differences between deaf and hearing samples emerged across race. Compared with the hearing controls, our deaf sample demonstrated a significantly decreased risk for hypertension with a prevalence of 37% (compared with 45% in the hearing sample).

CONCLUSIONS

Although the hypertension rate for gender and age was similar across deaf and hearing samples, between-group disparities exist for race. The lower rate of hypertension in our deaf sample is likely a consequence of underdiagnoses due to lower health literacy and poor patient-physician communication. Furthermore, deaf black Americans' lower rates compared with hearing black Americans may be due to poor patient-physician communication, not having regular providers or social stressors. It is recommended that modifiable risk factors and social determinants be investigated to determine their effect on hypertension within the deaf community.

Determinants of health- related quality of life (HRQoL) among deaf and hard of hearing adults in Greece: a cross-sectional study

Background

Hearing loss is an important public health issue, since it has a very negative impact on peoples' lives, irrespective of the age at which it develops. However, globally there is a noticeable lack of epidemiological data for health outcomes for people who are deaf and hard of hearing. In Greece, people with hearing disabilities are systematically not included in health policy and planning processes, despite there being a marked tendency for global efforts aimed at improving their quality of life.

Methods

The sample consisted of 140 adults with hearing loss (86 d/Deaf and 54 hard of hearing) and 97 normal hearing as the control group. We run data collection from April to June 2015, using the Greek version of the 36-Item Short Form Health Survey (SF-36v2). Socio-demographic and characteristics about non-medical determinants of health (tobacco and alcohol consumption levels, BMI and physical activity).were also collected and were analysed as possible determinants. Data analysis included bivariate and multivariate analyses such as linear regression models.

Results

Multivariate analyses identified that in all the SF-36v2 dimensions, the scores among deaf people were lower than those with normal hearing. Determinants included the hearing loss degree, educational level, body mass index, levels of physical activity, and alcohol consumption levels, while the variable "number of family members per household" was inversely associated with physical health summary scale score.

Conclusions

Improving knowledge of the health-related determinants that affect quality of life for the population with hearing loss is an important step in designing targeted services and interventions. In light of these findings, a special effort must be made to ensure the wellbeing of this population.

How do we know what we don't know? Exploring Deaf people's experiences of supporting their Deaf family member living with dementia

Deaf sign language users living with dementia and their carers, some of whom are Deaf, routinely face everyday barriers in accessing information, support (both formal and informal) and services. The familial care situation is further complicated given that most Deaf people will choose a life partner who is Deaf and most Deaf couples will have hearing children. This study focussed specifically on the everyday experiences of Deaf carers and the impact of caring for a loved one with dementia. Drawing on data from a wider consultation about dementia care, three Deaf carers were directly interviewed in British Sign Language by a Deaf researcher about their everyday experiences of care, support, and services. Thematic analysis focussed on: access is more than the provision of interpreters; effective care for the carers; and unknowing risk taking. Findings demonstrate the multifaceted effects of barriers to knowledge and information when the care partner is also Deaf, the urgent need for effective support for Deaf carers and unrecognised safeguarding concerns that are a result of lack of access to forms of basic knowledge about living with someone with dementia and potential coping strategies. Nonetheless, the participants demonstrated novel solutions and resilience in the face of these multiple challenges. Implications are drawn for future targeted services to supported Deaf carers of people affected by dementia.

The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa

BACKGROUND

The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care.

METHODS

The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects' registry from 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs.

RESULTS

Average Sign Language Interpreter services' utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008-2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013.

CONCLUSIONS

In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf.

The pedagogical effect of a health education application for deaf and hard of hearing students in elementary schools

Background

Deaf or hard-of-hearing children experience difficulties in learning health principles. But technology has significantly improved their ability to learn. The challenge in e-learning is to design attractive applications while having an educational aspect.

Objective

The aims of this study were to determine the pedagogical effectiveness of a health education application for deaf and hard of hearing students in elementary schools, and to investigate the student’s perceptions in different educational grades about the educational effectiveness of the text, graphics, video clips, and animation in the application.

Methods

The study design was quasi experimental and was conducted in Mashhad in 2016. Study population were deaf or hard-of-hearing students in elementary schools. The intervention included health application training to deaf and hard-of-hearing students in Mashhad. A questionnaire was used for data gathering. The pedagogical effectiveness was determined by measuring the modified Adapted Pedagogical Index. This index was created based on the characteristics of the application and study population. Statistical analysis was performed using the Kruskal-Wallis and Mann–Whitney tests with Bonferroni adjustment by SPSS 22.

Results

Eighty-two students participated in the intervention. The value of modified Adapted Pedagogical Index was 0.669, indicating that the application was effective. The results of Kruskal-Wallis H and Mann–Whitney U test showed significant differences in different educational grades. (p<0.008)

Conclusion

Using information technology can improve the education of deaf and hard-of-hearing students. Modified Adapted Pedagogical Index can be used for evaluation of non-interactive applications for elementary school children who are deaf or hard of hearing.

Health promotion via SMS improves hypertension knowledge for deaf South Africans

Background

Signing Deaf South Africans have limited access to health information. As a result, their knowledge about health is limited. Cell phone usage in South Africa is high. This study aimed to assess whether a short message service (SMS)-based health promotion campaign could improve Deaf people’s knowledge of hypertension and healthy living. Additionally, the study aimed to assess the acceptability of using SMSs for health promotion targeting Deaf people.

Methods

A baseline questionnaire assessed participants’ knowledge about hypertension before an SMS-based information campaign was conducted. After the campaign, an exit questionnaire was conducted, containing the same questions as the baseline questionnaire with additional questions about general acceptability and communication preferences. Results were compared between baseline and exit, using McNemar’s test, paired t-test and Wilcoxon signed-rank test. Focus groups aimed to get further information on the impact and acceptability of SMSs. The focus groups were analysed using inductive thematic analysis.

Results

The campaign recruited 82 participants for the baseline survey, but due to significant loss-to-follow-up and exclusions only 41 participants were included in the analysis of the survey. The majority (60%) were men. Eighty percent were employed, while 98% had not finished high school. The campaign showed a statistically significant improvement in overall knowledge about hypertension and healthy living amongst participants. Six individual questions out of 19 also showed a statistically significant improvement. Despite this, participants in focus groups found the medical terminology difficult to understand. Several ways of improving SMS campaigns for the Deaf were identified. These included using using pictures, using ‘signed’ SMSs, combining SMSs with signed drama and linking SMS-campaigns to an interactive communication service that would enable the Deaf to pose questions for clarification. Focus groups suggested that participants who were hypertensive during the campaign adopted a healthier lifestyle.

Conclusion

SMSs were effective in improving Deaf people’s knowledge of hypertension and healthy living. However, SMS-campaigns should be cognizant of Deaf people’s unique needs and communication preference and explore how to accommodate these.

Trial registration

The research was registered with the Pan African Clinical Trial Registry on December 1, 2015. Identification number: PACTR201512001353476.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4619-7) contains supplementary material, which is available to authorized users.

Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

Background

Improving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme.

Objectives

(1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design.

Design

A mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results.

Settings

IAPT service providers (NHS and private); the Deaf community.

Participants

Deaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118).

Interventions

IAPT at steps 2 and 3.

Main outcome measures

Reliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios.

Data sources

IAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature.

Results

Randomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.

Limitations

The small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.

Conclusions

There is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established.

Future work

A prospective observational study for definitive results is justified.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Retrospective Basic Parent-Child Communication Difficulties and Risk of Depression in Deaf Adults

This paper describes the relationship between retrospective communication difficulties and current depressive symptomatology. A total of 143 deaf/hard-of-hearing late adolescents and adults (64 % White; 55 % female) completed questionnaires related to parent communication, language history and current psychological functioning. Logistic regression models were used to estimate the likelihood of having depression that is associated with understanding parents' communication after controlling for gender, hearing level, and language history. Significant odds ratio indicated that the difficulties in understanding basic communication with parents increased the odds of depression symptomatology. The odds ratio indicates that when holding all other variables constant, the odds of reporting depression were at least 8 times higher for those who reported being able to understand some to none of what the same-sex parent said. For the different-gender parent, only the mother's communication with the male individual was associated with depression. Although our study findings suggest that DHH men and women with history of communication difficulties at home are at risk for depression in adulthood, they do not provide information on the causal mechanisms linking communication difficulties early in life and depression later in life. Greater attention should be given to promoting healthy communication between DHH girls and their mothers as well as DHH boys and their fathers, which might reduce the impact on later emergence of depression in the DHH individual.

Deaf Adolescents' Learning of Cardiovascular Health Information: Sources and Access Challenges

Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents' informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media.