Deaf Qualitative Health Research: Leveraging Technology to Conduct Linguistically and Sociopolitically Appropriate Methods of Inquiry

Application of the truth and reconciliation model to meaningfully engage deaf sign language users in the research process

OBJECTIVES

One of the most underrepresented public health populations is the U.S. Deaf community-a minority group of 500,000 + individuals who communicate using American Sign Language (ASL). Research on Deaf health outcomes is significantly lacking due to inaccessible research procedures and mistrust of researchers that stems from historical mistreatment of Deaf people (i.e., Audism).

METHODS

Following the Truth and Reconciliation Model, we hosted three Deaf community forums between October and November 2016 across New England. We invited attendees to share their experiences in the research world and make recommendations about how researchers can better include Deaf people in their studies. A select group of hearing researchers served as representatives of the research community and to issue a formal apology on behalf of this community.

RESULTS

Forum attendees (n = 22; 5% racial/ethnic minority; 59% female) emphasized the following themes: Research conducted within general population samples is not an activity in which Deaf people can or will be included; a general mistrust of hearing people, including hearing researchers; researchers' frequent failure to communicate study results back to the Deaf community or the community-at-large; and a tendency of researchers to directly benefit from data provided by Deaf participants, without making any subsequent efforts to return to the community to give back or provide useful intervention.

CONCLUSIONS

Many injustices and forms of mistreatment are still ongoing; therefore, we recognize that our team's efforts to foster an open dialogue between the research community and the Deaf community must be an ongoing, iterative practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Scoping Review of Approaches to Improving Quality of Data Relating to Health Inequalities

Identifying and monitoring of health inequalities requires good-quality data. The aim of this work is to systematically review the evidence base on approaches taken within the healthcare context to improve the quality of data for the identification and monitoring of health inequalities and describe the evidence base on the effectiveness of such approaches or recommendations. Peer-reviewed scientific journal publications, as well as grey literature, were included in this review if they described approaches and/or made recommendations to improve data quality relating to the identification and monitoring of health inequalities. A thematic analysis was undertaken of included papers to identify themes, and a narrative synthesis approach was used to summarise findings. Fifty-seven papers were included describing a variety of approaches. These approaches were grouped under four themes: policy and legislation, wider actions that enable implementation of policies, data collection instruments and systems, and methodological approaches. Our findings indicate that a variety of mechanisms can be used to improve the quality of data on health inequalities at different stages (prior to, during, and after data collection). These findings can inform us of actions that can be taken by those working in local health and care services on approaches to improving the quality of data on health inequalities.

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.

"They're Not Willing To Accommodate Deaf patients": Communication Experiences of Deaf American Sign Language Users in the Emergency Department

Deaf people who use American Sign Language (ASL) are more likely to use the emergency department (ED) than their hearing English-speaking counterparts and are also at higher risk of receiving inaccessible communication. The purpose of this study is to explore the ED communication experience of Deaf patients. A descriptive qualitative study was performed by interviewing 11 Deaf people who had used the ED in the past 2 years. Applying a descriptive thematic analysis, we developed five themes: (1) requesting communication access can be stressful, frustrating, and time-consuming; (2) perspectives and experiences with Video Remote Interpreting (VRI); (3) expectations, benefits, and drawbacks of using on-site ASL interpreters; (4) written and oral communication provides insufficient information to Deaf patients; and (5) ED staff and providers lack cultural sensitivity and awareness towards Deaf patients. Findings are discussed with respect to medical and interpreting ethics to improve ED communication for Deaf patients.

Deaf ACCESS: Adapting Consent Through Community Engagement and State-of-the-Art Simulation

One of the most understudied health disparity populations in the United States is the Deaf community, a sociolinguistic minority group of more than 500,000 individuals who communicate via American Sign Language. Research on Deaf health disparities is lacking due to inaccessible recruitment, sampling, and data collection procedures, as well as the fundamental disconnect between medical and cultural views of Deaf people. A potential starting place for addressing inaccessible research methods and mistrust of the biomedical research community is the careful reconsideration of the traditional informed consent process, often a Deaf individual's first point of contact with the research world. Yet, most Deaf individuals experience obstacles to engaging in informed consent due to differences in language and development compared to hearing individuals. In response to these issues, our team led a three-phase, formative, community-engaged approach to adapt the informed consent process and train research staff in the updated method so that all required components are properly communicated and understood. The goals of our work were to promote Deaf engagement in research about the Deaf community, increase the number of Deaf individuals who participate in general population biomedical research, and generalize our findings to improve research accessibility for the general population.

Recruiting people with disabilities as research participants: challenges and strategies to address them

There are 56.7 million people with disabilities (PWD) living in the United States; yet, PWD are significantly underrepresented in health research. Even when researchers purposively seek to include PWD in studies, challenges emerge related to recruitment and retention, leading to inadequate representation and surface understandings of this population. This in turn contributes to the perpetuation of implicit and explicit health disparities that are already experienced by this population. Grounded within a qualitative, community-based participatory health research framework, we highlight challenges associated with recruiting and retaining PWD in health research, including a critical analysis of the research enterprise structure, how this disables accessible research practices for PWD, and leads to continued skepticism among PWD regarding the value of participating in research. Finally, we propose solutions to create and maintain a culture of access and inclusion as well as long-term collaborative and equity-focused partnerships.