Access to primary care affects the health of Deaf people

A scoping review of Deaf awareness programs in Health professional education

Deaf awareness aims to promote understanding about Deaf and hard of hearing people, with the goal of reducing barriers between Deaf and hearing populations; and is particularly pertinent for health professional students as they need to learn to communicate effectively with a range of population groups. This scoping review aims to provide an overview of literature examining Deaf awareness programs provided to health professional students during their initial training. We searched four medical and public health databases and registers using terms related to Deaf awareness. We used the PRISMA-ScR reporting standards checklist for scoping reviews. We identified 10,198 citations, with 15 studies included in the final review. Searches were performed during August to September 2022, and April 2023. Studies were included provided they examined Deaf awareness content or programs within health professional education. Data were extracted by two independent reviewers who screened all abstracts using Rayyan software, followed by discussion to achieve knowledge synthesis and agreement. In all, a total of 15 articles from six countries were identified across health professional student disciplines including pharmacy, nursing, audiology, inter-professional and medical programs. The review found sparse evidence of research into Deaf awareness programs delivered to health professional students, with delivery often solely to small groups of students, indicating why so few students can access information about how to communicate effectively with Deaf and hard of hearing patients during their initial training programs. This scoping reviewed showed evidence of promising benefits for health professional students undertaking Deaf awareness programs during their undergraduate education. The importance of communicating with Deaf and hard of hearing patients and attaining Deaf cultural competencies for health professional students should be investigated in future research.

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.

Deaf signers and hearing aids: motivations, access, competency and service effectiveness

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.

Knowledge, Attitudes, and Practices Toward Deaf Patients Among Healthcare Workers in Saudi Arabia: 2020-2021

Introduction The literature informs us that people who are Deaf frequently struggle with health services, which contributes to lower health literacy due to communication and language barriers. Few health professionals understand sign language, so communication between a Deaf person and a health professional may rely on a mediator, usually a family member or an interpreter, to provide communication assistance. Aim This study aimed to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) at King Saud University Medical City (KSUMC) toward Deaf adult patients. Subjects and methods This cross-sectional study was conducted among HCWs at KSUMC, Saudi Arabia. A self-administered questionnaire was sent to the HCWs using an online survey. The questionnaire includes socio-demographic data (i.e., age, gender, marital status, etc.), previous interaction with Deaf patients, and KAP items. Results Of the 351 HCWs, 63.8% were females, and 41.6% were aged between 28 and 37 years old. The overall mean knowledge score was 1.14 out of 7 points. The overall mean attitude score was 46.2 out of 90 points, and the mean practice score was 19.1 out of 35 points. Significant factors of increased attitude include being a non-Saudi, being married, having children, increasing years of working experience, and being a nurse, while being a male, having previous interaction with a Deaf patient, and having skills in any type of sign language were the significant predictors of increased practice. Working in the surgery department was the only predictor associated with increased knowledge. Conclusion There was a significant deficiency, particularly with regard to knowledge and attitude toward Deaf patients. Increasing knowledge was associated with increasing practices but not with attitude. HCWs who had previous interactions with Deaf patients and had knowledge of any sign language tended to demonstrate better practice in dealing with Deaf patients. Further, longitudinal studies are needed to determine the level of KAP among HCWs in our region.

Introducing the READY Study: DHH Young people's Well-Being and Self-Determination

READY is a self-report prospective longitudinal study of deaf and hard of hearing (DHH) young people aged 16 to 19 years on entry. Its overarching aim is to explore the risk and protective factors for successful transition to adulthood. This article introduces the cohort of 163 DHH young people, background characteristics and study design. Focusing on self-determination and subjective well-being only, those who completed the assessments in written English (n = 133) score significantly lower than general population comparators. Sociodemographic variables explain very little of the variance in well-being scores; higher levels of self-determination are a predictor of higher levels of well-being, outweighing the influence of any background characteristics. Although women and those who are LGBTQ+ have statistically significantly lower well-being scores, these aspects of their identity are not predictive risk factors. These results add to the case for self-determination interventions to support better well-being amongst DHH young people.

Perception of the Impact of COVID-19 on a Sample of Spaniards with Hearing Disabilities

This paper describes an empirical study carried out with 40 Spanish deaf people, users of sign language, between 19 and 45 years of age, which gathers their perceptions of aspects related to the incidence of the COVID-19 pandemic and its repercussions. During the pandemic, people with hearing disabilities, among other groups, were forgotten. They suffered from accessibility problems to the information issued by the authorities, violating their right to be informed and exposing their health to COVID-19. In this work, we identify the problems they suffered and what effects COVID-19 had on their lives. This will help to take the appropriate measures to restore their rights and design policies and strategies to deal with any new future health emergency. For this, an ad hoc questionnaire was designed, adapted to easy reading and sign language. This was publicized via email and WhatsApp through the Association of Deaf People of Granada and Province (Spain) and was responded to online and by video call with the collaboration of sign language interpreters using the LimeSurvey platform. The results discover (1) the difficulties of communication barriers in the relationship with health professionals and institutions, as well as in the spheres of work and education, (2) similarities with the rest of the population in the negative effects of confinement, and (3) presence of positive effects, such as the development of positive activities and emotions. The study highlights the need to increase economic and institutional support aimed at improving coping resources, access to information, and the reduction of social and institutional barriers that would allow people with hearing disabilities to successfully face future health problems of a global nature such as that experienced with COVID-19.

Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.

Communication methods between physicians and Deaf patients: A scoping review

OBJECTIVE

Deaf individuals often face communication challenges within healthcare settings. Given the importance of the role played by physicians in shaping patients' health outcomes, it is paramount to explore Deaf patient-physician interactions. This research aims to explore (1) the existing communication support and (2) the factors influencing its usage in medical consultations with Deaf patients.

METHODS

A scoping review was carried out and adhered to the Preferred Reporting System for Meta-Analysis. A comprehensive search strategy of four databases; PubMed, Medline, CINAHL Plus and Scopus, from January 2011 to June 2021 was applied. Thematic analysis was used to analyse the data.

RESULTS

Ten journal articles were included, and four themes were identified; patient experiences using communication methods, practitioners' cultural competence in Deaf culture, inherent challenges of communication methods, and extrinsic factors. Professional interpreters are often regarded as the preferred modality of communication but writing and lip-reading were commonly used in healthcare settings, with video remote interpreting the least common.

CONCLUSION

Healthcare professionals need to appreciate the heterogeneity of Deaf patients and their communication methods and adopt a more person-centred approach.

PRACTICE IMPLICATIONS

This review provides up-to-date insight on Deaf patient-physician interactions and provisional recommendations for practice, education and policy.

The Struggle to Fit in: A Qualitative Study on the Sense of Belonging and Well-being of Deaf People in Ipoh, Perak, Malaysia

The sense of belonging plays an important role in a person's well-being. It also acts as a protective factor against mental distress. Deaf people struggle to fit into the dominant hearing society due to communication barriers. The multi-languages used in Malaysian families add to this communication challenge. Communication breakdown leaves the deaf person socially excluded while a poor sense of belonging also increases their vulnerability to mental health issues. Hence, this study explored the deaf person's sense of belonging and well-being through their social experiences in Malaysia. Baumeister's need-to-belong theory served as the theoretical framework of this study. An Ethnographic approach with in-depth interviews and participant observation was used to explore the social experiences of six Chinese deaf adults, aged 20-37, residing in Ipoh. Their hearing parents were interviewed as well to obtain parents' perspective of the child's well-being in the earlier years. Participants were selected using the purposive and snowballing sampling method. Upon data saturation, thematic analysis was used to identify themes, patterns, and interpret its meanings. The main themes that emerged from the data was the "struggle to fit in", "emotional effect", and "quality social connections". Findings of this study can be used in the formation of policies and strategies to ensure that deaf individuals are not excluded from their communities. Cultivating an inclusive community and developing the deaf community offers a better sense of belonging, which would help increase well-being of deaf people. Future research may focus on deaf identity and well-being of deaf youth in Malaysia.

Exploring the lived experiences of British Sign Language (BSL) users who access NHS adult hearing aid clinics: an interpretative phenomenological analysis

OBJECTIVE

To explore the lived experiences of culturally Deaf British Sign Language (BSL) users who access adult hearing aid services.

DESIGN

Semi-structured qualitative interviews were conducted in BSL by the Deaf researcher and analysed using an Interpretative Phenomenological Analysis (IPA) approach.

STUDY SAMPLE

Eight Deaf BSL expert informants who were experienced users of NHS adult hearing aid clinics.

RESULTS

Participants expressed dissatisfaction about audiology staff's lack of Deaf awareness and did not feel valued as Deaf signers. Participants' motivations for hearing aid use primarily concerned audibility rather than speech. Mismatch of perspectives on 'hearing' between audiologists and Deaf patients are discussed in the context of culturally sensitive services. Inadequate or uncertain linguistic access during appointments is considered in light of patient agency.

CONCLUSION

This is the first study to explore culturally Deaf signers' specific experiences of adult hearing aid services in the UK and their experiences of hearing aids. There are numerous reasons why Deaf signers wear hearing aids, but access to spoken language is not a priority. Limited Deaf awareness and cultural competence in adult hearing aid services can result in patient frustration and disempowerment. Suggestions for improvement in the Deaf signing patient experience are offered.

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Changing medical students' attitudes to and knowledge of deafness: a mixed methods study

BACKGROUND AND AIM

Communication with healthcare professionals is challenging for those with hearing loss. This study aimed to determine the impact dedicated deaf awareness training could have on medical student's attitudes to and knowledge of deafness, and to explore ways of incorporating deaf awareness training into the core undergraduate medical curriculum.

METHODS

A validated questionnaire was used to measure attitudes to and knowledge of deafness in those taking an optional deaf awareness and basic sign language module for second year medical students compared to students who took another module. Previous students on this module were also contacted and asked to complete the same questionnaire. Focus groups with these students explored ways to incorporate deaf awareness training into the core undergraduate medical curriculum.

RESULTS

After completing the module, students had a more positive attitude to deaf individuals (p < 0.001), and higher knowledge scores (p = 0.027) in comparison to the control group. Examination of data revealed a significant negative association between years since undertaking the module and attitudes score (r = - 0.29, p = 0.04, n = 51), with no significant association for knowledge score (r = 0.22, p = 0.11, n = 52). Focus groups suggested integrating deaf awareness training into existing undergraduate communication skills teaching, with the inclusion of deaf tutors.

CONCLUSIONS

This study indicates that incorporating a specialist module on deafness can improve attitudes to and knowledge of deafness. Importantly, this effect decreases over time, demonstrating the need for refresher training amongst junior doctors.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Knowledge and experience of Family Health Team professionals in providing healthcare for deaf people

ABSTRACT Objective: to explore the communication of family health team professionals in providing healthcare for deaf people. Methods: this cross-sectional study was comprised of 39 Family Health teams located in urban and rural areas. A census was conducted and some questionnaires were applied to the Family Health Professionals (31 doctors, 30 nurses, 27 dental surgeons and 4 pharmacists) from the Family Health Support Centers. Results: the great majority of the personnel (60.8%) reported being aware of the existence of Brazilian Sign Language, but none of the interviewees had used it to communicate. Most of the Family Health Team personnel (68.5%) had provided care to a deaf person at some time. However, none of them had taken a complementary course or received any specialized training. Conclusion: the relational dimension is fundamental in developing individual therapy plans. From this perspective, the communication barriers that deaf people face can compromise the necessary bonding for healthcare, which may adversely affect early diagnosis, timely treatment, and adherence to required treatment.

The theoretical and practical determination of clinical cut-offs for the British Sign Language versions of PHQ-9 and GAD-7

BACKGROUND

The PHQ-9 and the GAD-7 assess depression and anxiety respectively. There are standardised, reliability-tested versions in BSL (British Sign Language) that are used with Deaf users of the IAPT service. The aim of this study is to determine their appropriate clinical cut-offs when used with Deaf people who sign and to examine the operating characteristics for PHQ-9 BSL and GAD-7 BSL with a clinical Deaf population.

METHODS

Two datasets were compared: (i) dataset (n = 502) from a specialist IAPT service for Deaf people; and (ii) dataset (n = 85) from our existing study of Deaf people who self-reported having no mental health difficulties. Parameter estimates, with the precision of AUC value, sensitivity, specificity, positive predicted value (ppv) and negative predicted value (npv), were carried out to provide the details of the clinical cut-offs. Three statistical choices were included: Maximising (Youden: maximising sensitivity + specificity), Equalising (Sensitivity = Specificity) and Prioritising treatment (False Negative twice as bad as False Positive). Standard measures (as defined by IAPT) were applied to examine caseness, recovery, reliable change and reliable recovery for the first dataset.

RESULTS

The clinical cut-offs for PHQ-9 BSL and GAD-7 BSL are 8 and 6 respectively. This compares with the original English version cut-offs in the hearing population of 10 and 8 respectively. The three different statistical choices for calculating clinical cut-offs all showed a lower clinical cut-off for the Deaf population with respect to the PHQ-9 BSL and GAD-7 BSL with the exception of the Maximising criteria when used with the PHQ-9 BSL. Applying the new clinical cut-offs, the percentage of Deaf BSL IAPT service users showing reliable recovery is 54.0 % compared to 63.7 % using the cut-off scores used for English speaking hearing people. These compare favourably with national IAPT data for the general population.

CONCLUSIONS

The correct clinical cut-offs for the PHQ-9 BSL and GAD-7 BSL enable meaningful measures of clinical effectiveness and facilitate appropriate access to treatment when required.

Health Care Access Among Deaf People

Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health.

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

OBJECTIVES

To assess the current health of the Deaf community in the UK and compare with the general population.

DESIGN

A quota sample of adult Deaf British Sign Language (BSL) users underwent a health assessment and interview in 2012-2013. Comparative data were obtained from the Health Survey for England (HSE) 2011 and the Quality Outcomes Framework (QOF) 2012.

SETTING

Participants completed a structured interview and health assessment at seven Bupa centres across the UK, supported in BSL by Deaf advisers and interpreters.

PARTICIPANTS

298 Deaf people, 20-82 years old, 47% male, with 12% from ethnic minorities.

MAIN OUTCOME MEASURES

Self-reported health conditions, medication usage, tobacco and alcohol consumption; measured blood pressure (BP), body mass index, fasting blood sugar and lipid profile.

RESULTS

Rates of obesity in the Deaf sample were high, especially in those over 65 years, and 48% were in a high risk group for serious illness. High BP readings were obtained in 37% of Deaf people (21% in HSE): 29% were unaware of this (6% in HSE). Only 42% of Deaf people being treated for hypertension had adequate control, compared with 62% of the general population. Deaf people with self-reported cardiovascular disease (CVD) were significantly less than the general population. One-third of Deaf participants had total cholesterol >5 mmol/L but although control rates were high compared with HSE, treatment rates for self-reported CVD were half the general population rate. Eleven per cent of Deaf participants had blood sugar at prediabetic or diabetic levels, and 77% of those at prediabetic levels were unaware of it. Deaf respondents self-reported more depression (31% of women, 14% of men), but less smoking (8%) and alcohol intake (2-8 units/week).

CONCLUSIONS

Deaf people's health is poorer than that of the general population, with probable underdiagnosis and undertreatment of chronic conditions putting them at risk of preventable ill health.