Deaf persons' english reading levels and associations with epidemiological, educational, and cultural factors

One hundred six Michigan d/Deaf persons, part of a study evaluating how to improve d/Deaf persons' understanding of cancer prevention recommendations, had reading levels determined using the Test of Reading Comprehension, Syntactic Sentences. Respondents averaged 52 years old, 59% female, 84% Caucasian, 58% married, and 75% Deaf community members. The mean Test of Reading Comprehension, Syntactic Sentences score was 6.1 (women: 6.2, men: 6.0). Higher scores were associated with greater income (p = .02), employment (p = .01), education (high school p = .002, some college p < .001), English use (child at home, teacher in school, at home now: all p < .001), a hearing spouse (p = .003), hard of hearing/d/Deaf father (p = .02), losing hearing after age 20 years, believing smoking is bad (p < .001), speaking with and satisfaction with physicians and nurses (p < .001), good communication with (p = .01), and comfort discussing cancer with doctors (p < .001). Lower scores were associated with using American Sign Language with physicians and nurses (.019) and Deaf community membership (p = .02). In multivariate analysis, higher scores were associated with higher income, college degree, and teacher using English. Reading levels of a predominantly Deaf population were low. Higher income, college degree, and teacher using English were associated with higher reading levels.

Effectiveness of videos improving cancer prevention knowledge in people with profound hearing loss

Deaf persons have a poorer understanding of cancer prevention, which is felt to be partly due to communication barriers. One hundred ninety-seven d/Deaf persons completed a survey and video on cancer prevention. Half viewed a spoken English program designed for hearing persons (control group); the other half viewed an amended program that had American Sign Language, captions, and printed English options added (experimental group). Knowledge was measured before and after the video, including 1 and 6 months later. Respondents were primarily Caucasian, had low incomes, lost hearing at young ages, and had d/Deaf spouses. Although overall knowledge improved after viewing the video, the presence of culture-specific communications (American Sign Language, captions) did not improve scores compared to the control group, either immediately after the intervention or over time. Moreover, percentage correct on all pretest, and almost all post-test, questions was <50% for both experimental and control groups. For all subjects, regardless of which group they were in, a hearing spouse (p  < 0.001) and more healthcare information sources (p = 0.001) improved knowledge, while African-Americans showed a trend to lesser improvement (p = 0.06). Using culture-specific language did not improve cancer prevention knowledge in this d/Deaf population, and overall knowledge remained low. More study is needed to determine the best way to increase cancer prevention knowledge in this population.

Cancer prevention knowledge of people with profound hearing loss

BACKGROUND

Deaf persons, a documented minority population, have low reading levels and difficulty communicating with physicians. The effect of these on their knowledge of cancer prevention recommendations is unknown.

METHODS

A cross-sectional study of 222 d/Deaf persons in Michigan, age 18 and older, chose one of four ways (voice, video of a certified American Sign Language interpreter, captions, or printed English) to complete a self-administered computer video questionnaire about demographics, hearing loss, language history, health-care utilization, and health-care information sources, as well as family and social variables. Twelve questions tested their knowledge of cancer prevention recommendations. The outcome measures were the percentage of correct answers to the questions and the association of multiple variables with these responses.

RESULTS

Participants averaged 22.9% correct answers with no gender difference. Univariate analysis revealed that smoking history, types of medical problems, last physician visit, and women having previous cancer preventive tests did not affect scores. Improved scores occurred with computer use (p = 0.05), higher education (p < 0.01) and income (p = 0.01), hearing spouses (p < 0.01), speaking English in multiple situations (p < 0.001), and in men with previous prostate cancer testing (p = 0.04). Obtaining health information from books (p = 0.05), physicians (p = 0.008), nurses (p = 0.03) or the internet (p = 0.02), and believing that smoking is bad (p < 0.001) also improved scores. Multivariate analysis revealed that English use (p = 0.01) and believing that smoking was bad (p = 0.05) were associated with improved scores.

CONCLUSION

Persons with profound hearing loss have poor knowledge of recommended cancer prevention interventions. English use in multiple settings was strongly associated with increased knowledge.

Assessment of depressive symptoms in deaf persons

BACKGROUND

Evidence suggests that Deaf people may have a greater prevalence of depressive symptoms. However, it is unclear whether commonly used written screening instruments are accurate with this population because of their unique cultural and linguistic factors.

SETTING

Deaf persons (n = 71) residing in southeastern Michigan.

METHODS

Subjects completed the Zung Self-Rated Depression Scale in both the written (ZSDS-W) and American Sign Language (ZSDS-S) formats and the Hamilton Depression Scale (HAM-D) in American Sign Language in counterbalanced order, followed by a Test Of Reading Comprehension (TORC). They also provided extensive data on demographic, hearing loss, language use, social and health care use variables.

RESULTS

Mean subject age was 52 years, 63% of subjects were women, 95% were Caucasian, and 47% were married (87% to another deaf/hard of hearing person). Thirty percent had a college degree and 20% had less than a 10th grade education. The ZSDS-W and ZSDS-S scores were highly correlated (r = +0.79), although the mean ZSDS-W score was 2.8 points higher (P = .001). The ZSDS-S correlated more highly (r = 0.80) with the HAM-D than the ZSDS-W (r = 0.71). There was a significant interaction effect (P < .001) such that the ZSDS-W and HAM-D were significantly associated among higher literacy subjects (beta = 0.80, P < .001) but not lower literacy subjects (beta = 0.20, P = .183). There were no other significant associations between depression scores and numerous demographic, educational, hearing loss, social or language variables.

CONCLUSIONS

Compared with the conventional ZSDS-W, the ZSDS-S more accurately assesses depression severity among deaf persons with lower English literacy. However, given the greater sensitivity of the ZSDS-W and the practical barriers to ZSDS-S in physician practices, further research should determine which modality is best for routine depression screening.

Health care system accessibility. Experiences and perceptions of deaf people

BACKGROUND

People who are deaf use health care services differently than the general population; little research has been carried out to understand the reasons.

OBJECTIVE

To better understand the health care experiences of deaf people who communicate in American Sign Language.

DESIGN

Qualitative analyses of focus group discussions in 3 U.S. cities.

PARTICIPANTS

Ninety-one deaf adults who communicate primarily in American Sign Language.

MEASUREMENTS

We collected information about health care communication and perceptions of clinicians' attitudes. We elicited stories of both positive and negative encounters, as well as recommendations for improving health care.

RESULTS

Communication difficulties were ubiquitous. Fear, mistrust, and frustration were prominent in participants' descriptions of health care encounters. Positive experiences were characterized by the presence of medically experienced certified interpreters, health care practitioners with sign language skills, and practitioners who made an effort to improve communication. Many participants acknowledged limited knowledge of their legal rights and did not advocate for themselves. Some participants believed that health care practitioners should learn more about sociocultural aspects of deafness.

CONCLUSIONS

Deaf people report difficulties using health care services. Physicians can facilitate change to improve this. Future research should explore the perspective of clinicians when working with deaf people, ways to improve communication, and the impact of programs that teach deaf people self-advocacy skills and about their legal rights.

Deaf persons and computer use

Deaf person's computer use was studied (N = 227). Respondents self-administered a survey in their preferred language (voice, American Sign Language, captions, or printed English). A small nonparticipant sample was also recruited. Demographics were consistent with those in other studies of deaf people: 63% of respondents reported computer use, mostly at home; 50% of nonparticipants reported computer use. Subjects with hearing loss due to meningitis were less likely to use computers (p = .0004). Computer use was associated with English usage at home (p = .008), with hearing persons (p = .002), and with physicians and nurses (p = .00001). It was also associated with the use of Signed English as a child to communicate (p = .02), teacher use of Signed English (p = .04), and teacher use of ASL (p = .03). Two thirds of respondents reported using computers, though nonresponder data suggested less use among all deaf persons. Computer use was associated with English use and inversely associated with hearing loss due to meningitis.

Knowledge and attitudes about AIDS among deaf and hard of hearing persons

We investigated whether the public information being dispensed about Acquired Immunodeficiency Syndrome (AIDS) reaches Deaf and Hard of Hearing (D&HH) persons to the same extent as the rest of the American population. Using a self-administered written survey, modified so that D&HH persons whose primary language is American Sign Language (ASL) could understand the questions, we studied 40 D&HH and 37 hearing persons in southeast Michigan. There were no significant demographic differences between the two populations, but there were differences regarding attitudes towards and knowledge about AIDS. D&HH persons were less likely to associate sexual contact with drug users and number of sexual partners as high risk sexual behaviours, were more likely to believe that storing blood for future personal use lowers their chances of contracting AIDS, and believed that using public restrooms, kisses on the cheek and visiting an AIDS patients increased their chance of contracting AIDS. Furthermore, they were more likely to believe they did not need to change their sexual behaviour as a result of the AIDS epidemic. D&HH persons also reported different attitudes towards AIDS patients, such as they were not important to their community, dentists with AIDS should not be allowed to continue working, and landlords should be able to evict people with AIDS. Our findings suggest differences in receiving, trusting, and/or being exposed to current information about AIDS by the Deaf community, consistent with the fact that they are a minority population with distinct knowledge and cultural traditions.

Communication mode use of two hearing-impaired adolescents in conversation

Communication mode use in the dyadic conversational speech of adolescent simultaneous communication (SC)-trained hearing-impaired twin boys was investigated. Proportional frequencies of modes and the English structural characteristics of the spoken components of utterances produced in each mode were examined. The results indicated that these adolescents were using an integrated bimodal form of English with a grammatical base that did not vary as a function of the presence or absence of simultaneous signs either in their speech or their partner's speech. Implications of the results are discussed.