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Hulme C, Young A, Rogers K, Munro KJ. Deaf signers and hearing aids: motivations, access, competency and service effectiveness. Int J Audiol 2024; 63:136-145. [PMID: 36382888 DOI: 10.1080/14992027.2022.2143431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study concerns culturally Deaf signers in the UK who use hearing aids and (i) explores motivations for hearing aid use (ii) identifies barriers and facilitators to accessing NHS hearing aid services, (iii) examines cultural competency of hearing aid clinics and (iv) identifies factors influencing effective adult hearing aid service provision. DESIGN Online survey in British Sign Language and English that was informed by Deaf service users. STUDY SAMPLE 75 Deaf adult BSL users who wear hearing aids and use NHS hearing aid clinics. RESULTS No specific reason emerged as outstandingly important for hearing aid use; however, assisting with lipreading (57%) and listening to music (52%) were rated as very/extremely important. Access issues reported were contacting clinics, poor communication with staff and lack of Deaf awareness. To be an effective and culturally competent hearing aid clinic for Deaf signers, a good understanding of Deaf culture and language was most rated as important (87%). CONCLUSION The study is the first that explores hearing aid use and experiences of accessing hearing aid clinics from Deaf signers' perspectives. Enhancements to clinical practice are required to consider culturally Deaf people's motivations for hearing aid use and make services more BSL-friendly.
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Affiliation(s)
- Celia Hulme
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
| | - Alys Young
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
- Centre for Deaf Studies, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine Rogers
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Hulme C, Young A, Rogers K, Munro KJ. Cultural competence in NHS hearing aid clinics: a mixed-methods case study of services for Deaf British sign language users in the UK. BMC Health Serv Res 2023; 23:1440. [PMID: 38114981 PMCID: PMC10731837 DOI: 10.1186/s12913-023-10339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers. METHODS This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels. RESULTS Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness. CONCLUSION This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS.
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Affiliation(s)
- Celia Hulme
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK.
| | - Alys Young
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
- Centre for Deaf Studies, University of the Witwatersrand, Johannesberg, South Africa
| | - Katherine Rogers
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Rogers K, Lovell K, Young A. What is the efficacy and effectiveness of telemedicine intervention for deaf signing populations in comparison to face-to-face interventions? A systematic review. BMC Health Serv Res 2023; 23:678. [PMID: 37349811 DOI: 10.1186/s12913-023-09509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Deaf signing populations face inequality in both access to health services and health outcomes. Telemedicine intervention might offer a potential solution to address these inequalities in mental health and health related services, therefore a systematic review was carried out. The review question was: "What is the efficacy and effectiveness of telemedicine intervention for Deaf signing populations in comparison to face-to-face interventions?". METHODS The PICO framework was applied to identify the components of the review question for this study. The inclusion criteria were: Deaf signing populations; any intervention that includes the delivery of telemedicine therapy and/or the delivery of assessment (e.g. psychological assessments) using telemedicine; and any evidence for the benefits, efficacy and effectiveness of telemedicine intervention with Deaf people whether in health and/or mental health services. The databases PsycINFO, PubMed, Web of Science, CINAHL, and Medline were searched up to August 2021. RESULTS Following the search strategy, and after the duplicates were removed, 247 records were identified. Following screening, 232 were removed as they did not meet the inclusion criteria. The remaining 15 full-text articles were assessed for eligibility. Only two met the criteria to be included in the review (both concerned telemedicine and mental health interventions). However, they did not fully answer the review's research question. Therefore, the evidence gap remains regarding the effectiveness of telemedicine intervention for Deaf people. CONCLUSIONS The review has identified a gap in the knowledge on the efficacy and effectiveness of telemedicine intervention for Deaf people when compared with face-to-face interventions.
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Affiliation(s)
| | | | - Alys Young
- The University of Manchester, Manchester, England
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Vissapragada R, Bulamu NB, Brumfitt C, Karnon J, Yazbeck R, Watson DI. Improving cost-effectiveness of endoscopic surveillance for Barrett's esophagus by reducing low-value care: a review of economic evaluations. Surg Endosc 2021; 35:5905-5917. [PMID: 34312726 DOI: 10.1007/s00464-021-08646-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with Barrett's esophagus are believed to be at 30-120× risk of developing esophageal adenocarcinoma (EAC). Early detection and endoscopic treatment of dysplasia/early cancer confers a significant advantage to patients under surveillance; however, most do not progress past the non-dysplastic state of Barrett's esophagus (NDBE), which is potentially an inefficient distribution of health care resources. OBJECTIVES This article aimed to review the outcomes of cost-effectiveness studies reducing low-value care in the context of endoscopic surveillance for non-dysplastic Barrett's esophagus (NDBE). METHODS A systematic search was conducted by two reviewers in accordance with PRISMA guidelines. INCLUSION CRITERIA cost-utility analyses of endoscopic surveillance of NDBE patients with at least one treatment strategy focused on reduction of surveillance. A narrative synthesis of economic evaluations was undertaken, along with an in-depth analysis of input parameters contributing to stated Incremental cost-effectiveness ratios (ICER). Study appraisal was performed using the consolidated health economic evaluation reporting standards (CHEERS) tool. RESULTS 10 Studies met inclusion criteria. There was significant variation in cost-model structures, input parameters, ICER values, and willingness-to-pay thresholds between studies. All studies except one concluded guideline-specified endoscopic surveillance for NDBE patients was not cost-effective. Studies that explored a modified surveillance by deselection of low-risk NDBE patients found it to be a cost-effective strategy. CONCLUSION Guideline specified endoscopic surveillance for NDBE was not found to be cost-effective in the studies examined. A modified endoscopic surveillance strategy removing individuals with the lowest risk for progression from NDBE to adenocarcinoma is likely to be cost-effective but is dependent on risk profile of patients excluded from surveillance.
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Affiliation(s)
- Ravi Vissapragada
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.,Department of Surgery, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia
| | - Norma B Bulamu
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Christine Brumfitt
- Department of Surgery, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Roger Yazbeck
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia. .,Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia. .,Department of Surgery, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, SA, 5042, Australia.
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Shields GE, Rogers KD, Young A, Dedotsi S, Davies LM. Health State Values of Deaf British Sign Language (BSL) Users in the UK: An Application of the BSL Version of the EQ-5D-5L. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:547-556. [PMID: 31942693 DOI: 10.1007/s40258-019-00546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Gemma E Shields
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Centre for Health Economics, Oxford Road, Manchester, M13 9PL, UK.
| | - Katherine D Rogers
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Social Research with Deaf People (SORD), University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Alys Young
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Social Research with Deaf People (SORD), University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Sofia Dedotsi
- Department of Social Work, Education and Community Wellbeing, University of Northumbria, Room C115, Coach Lane Campus West, Benton, Newcastle upon Tyne, NE7 7XA, UK
| | - Linda M Davies
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Centre for Health Economics, Oxford Road, Manchester, M13 9PL, UK
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Wakefield S, Kellett S, Simmonds‐Buckley M, Stockton D, Bradbury A, Delgadillo J. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:1-37. [DOI: 10.1111/bjc.12259] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/14/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Sarah Wakefield
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Stephen Kellett
- University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust UK
| | | | | | - Abigail Bradbury
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Jaime Delgadillo
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
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Schmidt S, Metzner F. [Interpreter-Aided Psychotherapy for Deaf and Hearing-Impaired Patients - a Systematic Review of Research and Recommendations for Psychotherapists with Normal Hearing and Sign Language Interpreters]. DAS GESUNDHEITSWESEN 2019; 82:180-187. [PMID: 31810109 DOI: 10.1055/a-1033-7449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Germany, deaf patients undergoing psychotherapy have the right to have the costs of a sign language interpreter covered by the insurance since 2001. The effectiveness of interpreter-aided psychotherapy worldwide is disputed. A systematic literature review was conducted on sign language interpreter-aided psychotherapy. Six scientific databases were searched. Two independent raters conducted a 2-step rating process. Out of 1,184 identified publications, 10 studies in German and English language were included. These 10 studies examined between 1 and 85 deaf patients (7-60 years) in different psychotherapeutic settings (8 ambulatory, 4 family therapy). Nine studies reported therapy success. Relevant knowledge (e. g. about culture of deaf people), attitudes (e. g. openness), abilities (e. g. sign language) and general conditions (e. g. declaration for professional secrecy, light conditions) were recommended for psychotherapists with normal hearing and sign language interpreters. Empirical data on psychotherapy with sign language interpreters is low and methodologically limited. The present study can be considered as a starting point for further research.
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Affiliation(s)
- Steffi Schmidt
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Franka Metzner
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Young A, Ferguson-Coleman E, Keady J. Authentic public and patient involvement with Deaf sign language users: It is not just about language access. DEMENTIA 2018; 17:1001-1010. [PMID: 30373465 DOI: 10.1177/1471301218789567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
This article concerns Public and Patient Involvement practice with Deaf people who are sign language users. It draws on the experience of public and patient involvement in a project concerning Deaf people's lived experience of dementia and focusses on: (i) creating the conditions of trust in circumstances of unrecorded knowledge; (ii) being a community insider as a necessary but not sufficient condition without public and patient involvement and (iii) community consultation as influencing positive public and patient involvement practice. It sets out a series of recommendations for authentic public and patient involvement practice with Deaf sign language users linked to each of these themes before considering more generally barriers to Deaf people's involvement in public and patient involvement in health and social care research.
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Ferguson-Coleman E, Johnston A, Young A, Brown F, de Sainte Croix R, Redfern P. How do we know what we don't know? Exploring Deaf people's experiences of supporting their Deaf family member living with dementia. DEMENTIA 2018; 19:1381-1396. [PMID: 30223678 DOI: 10.1177/1471301218798993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | | | - Alys Young
- Social Research with Deaf People Group, University of Manchester, UK
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Rogers KD, Dodds C, Campbell M, Young A. The validation of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) with deaf British sign language users in the UK. Health Qual Life Outcomes 2018; 16:145. [PMID: 30041627 PMCID: PMC6056943 DOI: 10.1186/s12955-018-0976-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background There is no validated measure of positive mental well-being that is suitable for Deaf people who use a signed language such as British Sign Language (BSL). This impedes inclusion of this population in a range of research designed to evaluate effectiveness of interventions. The study aims were: (i) to translate the original English version of SWEMWBS into BSL and to test the SWEMWBS BSL with the Deaf population in the UK who use BSL; (ii) to examine its psychometric properties; and (iii) to establish the validity and reliability of the SWEMWBS BSL. Methods The SWEMWBS was translated into BSL following a six stage translation procedure and in consultation with the originators. The draft version was piloted with Deaf BSL users (n = 96) who also completed the CORE-OM BSL well-being subscale and the EQ-5D VAS BSL. Reliability was explored using Cronbach’s alpha for internal consistency and ICC for test-retest reliability. Validity was explored by using Kendall’s tau correction for convergent validity and an exploratory factor analysis for construct validity. Results The internal consistency for the reliability of the SWEMWBS BSL was found to be good and the test-retest one week apart showed an acceptable reliability. There was good convergent validity of the SWEMWBS BSL with the well-being subscale of the CORE-OM BSL and the EQ-5D VAS BSL. Conclusions The SWEMWBS BSL can be used with a Deaf population of BSL users. This is the first validated version of a BSL instrument that focuses solely on positively phrased questions for measuring mental well-being.
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Affiliation(s)
- Katherine D Rogers
- Division of Nursing, Midwifery, & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Claire Dodds
- Division of Nursing, Midwifery, & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Malcolm Campbell
- Division of Nursing, Midwifery, & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alys Young
- Division of Nursing, Midwifery, & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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