Communication between healthcare professionals and patients with hearing loss: A systematic review and meta-analysis

DISCLAIMER

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PURPOSE

We aimed to systematically review and meta-analyze published evidence on modes of communication between healthcare professionals and patients with hearing loss.

METHODS

MEDLINE/PubMed, Scopus, CINAHL, ScienceDirect, and Thai Journals Online Complete databases were searched. A meta-analysis was performed using a random-effects model. Data on the prevalence and types of communication between healthcare professionals and patients with any extent of hearing loss were extracted.

RESULTS

Twenty studies were included. Using a hearing aid (pooled prevalence, 57.4%; 95% CI, 11.4%-103.4%, N = 3, I2 = 99.33) and gestures (pooled prevalence = 54.8%, 95%CI: 17.4% to 92.1%, N = 7, I2 = 99.68) were the most commonly reported modes of communication. Few healthcare professionals could use sign language, and limited access to qualified interpreters was common.

CONCLUSION

Communication barriers exist. Qualified sign language interpreters and assistive technology should be used to improve communication.

Dentists' considerations concerning treating patients from the Deaf and Hard of Hearing community: A national survey

OBJECTIVES

Research shows that adults who were Deaf or Hard of Hearing (HoH) had poorer oral health than adults who did not belong to this community. The objectives were to assess dentists' education, knowledge, attitudes, and professional behavior related to treating patients from the Deaf or HoH community and the relationships between these constructs.

METHODS

A total of 207 members of the American Dental Association and the Michigan Dental Association responded to a mailed or web-based survey concerning their education, knowledge, attitudes, and professional behavior related to treating patients from the Deaf or HoH community.

RESULTS

On average, the respondents disagreed that they were well educated in classroom-based, clinical, or community-based dental school settings (five-point answer scale with 1 = disagree strongly; mean = 2.29/2.27/2.35) or by their professional organization (mean = 2.00) about treating Deaf or HoH patients. However, the more recently the respondents had graduated from dental school, the better they described their education about this topic (r = 0.29; p < 0.001). Additionally, 45.9% agreed/strongly agreed that they would like to attend a continuing education course about this topic; 68.9% agreed/agreed strongly that negative consequences for patients' general health can occur; and 61.1% that patients cannot be well educated about oral hygiene if Deaf or HoH patients do not have appropriate interpretive support in dental offices. The better dentists were educated about this topic, the more knowledge they had (r = 0.50; p < 0.001). On average, the respondents agreed more strongly that they were comfortable treating adult patients who communicated orally than patients using American Sign Language (4.02 vs. 3.25; p < 0.001).

CONCLUSIONS

These findings show that efforts are needed to improve dental school and continuing education curricula about dental treatment for Deaf and HoH patients. The more recently the respondents had graduated, the more positively they described their education. Increased dental school and continuing education efforts are still urgently needed.

In search of language development for students who are hard of hearing: measuring the effectiveness of assistive technologies through teaching practices

This study evaluated the effectiveness of assistive technologies (ATs) through e-books in teaching practices aimed at enhancing language development among hard-of-hearing (HH) students. The study implemented an intervention consisting of four language aspects (phonemic awareness, writing, vocabulary, and reading comprehension) wherein the ATs' impacts on language development were assessed. Eighty HH students were divided into control and treatment groups and evaluated through pre- and post-tests. The results showed that the intervention led to significant changes in all four language aspects in both groups. Interestingly, the effect sizes were moderate in the control group but large in the treatment group, thus showing the efficiency and effectiveness of the developed intervention. These findings constitute useful evidence-based guidelines for implementing ATs to enhance teaching practices in the HH language setting.

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.

Barriers and facilitators to the inclusion of deaf people in clinical trials

BACKGROUND/AIMS

This article discusses the barriers that prevent deaf people from participating in clinical trials and offers recommendations to overcome these barriers and ensure equal access to study participation.

METHODS

Between April and May 2022, we conducted six focus groups with 20 deaf adults who use American Sign Language, all of whom had previous experience as research study participants. Focus group prompts queried community awareness of clinical trial opportunities, barriers and facilitators to deaf people's participation in clinical trials, and recommended resources to improve clinical trial access. This qualitative focus group data is supplemented by survey data gathered from 40 principal investigators and clinical research coordinators between November 2021 and December 2021. The survey queried researchers' prior experiences with enrolling deaf participants in clinical trials and strategies they endorse for enrollment of deaf participants in future clinical trials.

RESULTS

Focus group participants unanimously agreed that, compared to the general hearing population, deaf sign language users lack equivalent access to clinical trial participation. Reported barriers included lack of awareness of clinical trial opportunities, mistrust of hearing researchers, and refusal by clinical trial staff to provide accessible communication (e.g. denial of requests for sign language interpreters). Survey data from 40 principal investigators and clinical research coordinators corroborated these barriers. For example, only 2 out of 40 survey respondents had ever enrolled a deaf person in a clinical trial. Respondents indicated that the most helpful strategies for including deaf sign language users in future clinical trials would be assistance with making recruitment information accessible to deaf sign language users and assistance in identifying qualified interpreters to hire to help facilitate the informed consent process.

CONCLUSION

The lack of communication accessibility is the most common factor preventing deaf sign language users from participating in clinical trials. This article provides recommendations for hearing researchers to improve deaf people's access to clinical trials moving forward, drawing from mixed-methods data.

Socio-Emotional Experiences and Wellbeing of Deaf and Hard of Hearing Children and Their Parents before and during the COVID-19 Pandemic

Deaf and hard of hearing (DHH) children in Victoria, Australia, were exposed to strict public health restrictions, including sustained lockdowns, during the COVID-19 pandemic. DHH children have higher health and socio-emotional needs than their hearing peers. We aimed to (1) describe the socio-emotional experiences of DHH children and their parents and (2) compare child and parent socio-emotional wellbeing, before and during the COVID-19 pandemic. Between May and September 2020, 497 (62%) parents of DHH children from the Victorian Childhood Hearing Longitudinal Databank completed an online survey. Measures were drawn from the CoRonavIruS Health Impact Survey (CRISIS) v3.0. Data were summarized using descriptive statistics to compare outcomes before and during the pandemic. Parents reported their children to have more negative socio-emotional wellbeing (mean emotions/worries score, EWS, changed from 0.76 pre-pandemic to 1.10 during the pandemic, mean difference 0.34, 95% CI: 0.28 to 0.39), regardless of the type or severity of hearing loss. Parents also had more negative socio-emotional wellbeing (mean EWS changed from 1.05 pre-pandemic to 1.43 during the pandemic, mean difference 0.38, 95% CI: 0.31 to 0.44). Negative socio-emotional experiences co-occurred with large social changes during the pandemic. Additional services should support the socio-emotional wellbeing of DHH children during significant adverse childhood experiences.

Feasibility and Reliability of Health-Related Physical Fitness Tests in Children and Adolescents with Hearing Impairment

Although research supports the feasibility and reliability of health-related physical fitness (HRPF) tests in typically developing children and adolescents, little is known regarding the feasibility and reliability of these tests for those with hearing impairments (HI). The aim of this study was to evaluate the feasibility and reliability of a HRPF test battery for children and adolescents with HI. A test-retest design with a one-week interval was conducted with 26 participants with HI (mean age: 12.7 ± 2.8 years; 9 male). The feasibility and reliability of seven field-based HRPF tests (i.e., body mass index, grip strength, standing long jump, vital capacity, long distance run, sit-and-reach, one leg stand) were evaluated. All the tests showed high feasibility (completion rate > 90%). Six tests indicated good to excellent test-retest reliability (all intraclass correlation coefficient [ICC] > 0.75) while the one leg stand test showed poor reliability (ICC = 0.36). Relatively large percentages of standard error of measurement (SEM%) and minimal detectable change (MDC%) were observed in the sit-and-reach test (SEM% = 52.4%, MDC% = 145.2%) and one leg stand test (SEM% = 107.9%, MDC% = 299.2%), whereas the rest of the tests demonstrated reasonable SEM% and MDC% values. Collectively, most of the tests can be feasibly and reliably used to assess HRPF for children and adolescents with HI.

Quantifying Access to Speech in Children with Hearing Loss: The Influence of the Work of Pat Stelmachowicz on Measures of Audibility

This article reviews the research of Pat Stelmachowicz on traditional and novel measures for quantifying speech audibility (i.e., pure-tone average [PTA], the articulation/audibility index [AI], the speech intelligibility index, and auditory dosage) as predictors of speech perception and language outcomes in children. We discuss the limitations of using audiometric PTA as a predictor of perceptual outcomes in children and how Pat's research shed light on the importance of measures that characterize high-frequency audibility. We also discuss the AI, Pat's work on the calculation of the AI as a hearing aid outcome measure, and how this work led to the application of the speech intelligibility index as a clinically utilized measure of unaided and aided audibility. Finally, we describe a novel measure of audibility-auditory dosage-that was developed based on Pat's work on audibility and hearing aid use for children who are hard of hearing.

Sensitivity to Deaf Culture Among Otolaryngology and Audiology Trainees

OBJECTIVE

The Deaf community is an ethnolinguistic minority group. Low sensitivity to Deaf culture contributes to health disparities among Deaf patients. This study determines the level of sensitivity to Deaf culture among otolaryngology-head and neck surgery (OHNS) and audiology trainees.

METHODS

Cross-sectional survey study of OHNS and audiology trainees from 10 large US institutions. Trainees were queried on their exposure to and comfort with Deaf patients and their education on, attitude toward, and awareness and knowledge of Deaf culture. Sensitivity to Deaf culture was operationalized as awareness and knowledge of Deaf culture. These were assessed using a 35-item instrument that was previously developed using a d/Deaf community-based participatory approach to research. We used T-tests to compare the sample to previous samples of medical students with training in Deaf culture (MS-TDCs) and general practitioners (GPs).

RESULTS

There were 91 completed surveys (response rate 44.5%). Almost all were aware of Deaf culture (97.8%). The mean knowledge score was 55.0% (standard deviation (SD) 13.4%), which was significantly higher than that for GPs at 43.0% (SD 15.0%) (95% confidence interval 8.1%, 15.8%, P < .0001) but significantly lower than that for MS-TDCs at 69.0% (SD 13.0%)(CI -20.3%, -7.6%, P < .0001). Knowledge scores were comparable for OHNS and audiology trainees (P = .09).

CONCLUSION

This sample of OHNS and audiology trainees was more sensitive to Deaf culture than GPs but less sensitive than MS-TDCs. Developing specialty-specific education may be warranted.

LEVEL OF EVIDENCE

4.

What can a national patient registry tell us about psychiatric disorders and reasons for referral to outpatient services in youth with hearing loss?

BACKGROUND

Studies of reasons for referral to the Child and Adolescent Mental Health Services (CAMHS) and subsequent psychiatric disorders are missing in youth with Hearing loss (HL).

AIMS

To examine the referral reasons to CAMHS and the clinically diagnosed psychiatric disorders in youth with HL among the nationally representative population.

METHODS

The study population was a youth with HL referred to CAMHS and registered in the national Norwegian Patient Registry (NPR) during the years 2011-2016. The results were also compared with some data published from CAMHS for the General Youth Population (GenPop).

RESULTS

Among youth with HL, 18.1% had also been referred to CAMHS compared to about 5% in GenPop, at mean age 9.1 years, >70% before age 13 years vs. 46% in the GenPop. Boys with HL comprised 57% and were referred about two years earlier than girls with HL. Compared to the GenPop, youth with HL were referred more frequently for suspected neurodevelopmental- and disruptive disorders, and less frequently for suspected emotional disorders. Girls with HL were referred for suspected Attention-Deficit/Hyperactivity Disorder (ADHD) at about the same rate as boys with HL in the 7-12 year age group. The most frequently registered psychiatric disorders were ADHD: 29.8%, anxiety disorders: 20.4%, and autism spectrum disorders: 11.0%, while disruptive disorders constituted about 5.0%.

CONCLUSIONS

Youth with HL were referred to CAMHS more often, but earlier than the GenPop, mostly due to ADHD disorders. Although more rarely referred for suspected anxiety disorders, these were frequently diagnosed, suggesting that anxiety was not recognized at referral in youth with HL.

Systematic Review of Research on Barriers to Access to Veterinary and Medical Care for Deaf and Hard of Hearing Persons

The Deaf and hard of hearing (DHH) population suffers disproportionately from barriers to health care access. Progress has been made toward improving access to medical care in the human health field; however, the veterinary field has not yet implemented similar standards. More research is needed to improve access to veterinary care for disabled individuals. This systematic review aimed to evaluate all primary research articles pertaining to medical and veterinary health care access for DHH adults in the United States. Its purpose was to assess gaps in knowledge regarding DHH persons' access to veterinary care. The review includes 39 articles related to DHH access to medical care and 6 articles related to general access to veterinary care. The authors found no articles related specifically to DHH access to veterinary care nor any articles on disability accessibility to veterinary care that met the inclusion criteria. Results outline significant barriers to DHH persons' access to health care, unique needs specific for this population of patients, and recommendations to improve access to medical care for individuals who identify as DHH. The results also suggest that further research is needed to investigate barriers to veterinary care experienced by DHH pet owners, the unique needs of this population of pet owners, and how the field of veterinary medicine can better accommodate those needs.

Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review

Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.

Mild matters: parental insights into the conundrums of managing mild congenital hearing loss

OBJECTIVE

To explore and describe parental experiences related to the management of mild bilateral congenital hearing loss in children.

DESIGN

Using qualitative methods, we conducted semi-structured interviews with parents/caregivers until saturation of themes was achieved. We analysed transcripts using inductive content analysis.

STUDY SAMPLE

Caregivers of children under 3-years-old with mild bilateral sensorineural hearing loss.

RESULTS

We interviewed 12 parents. Parental perception of advice regarding hearing aid fitting was varied; almost all children were offered hearing aids. Perceived positives related to hearing aids: feeling empowered that action has been taken; improvements in the child's hearing perception and; facilitation of behavioural management. Perceived negatives of hearing aid use: difficulties with compliance resulting in parental frustration and guilt, damage/loss of equipment, discomfort, parental discord, altered quality of natural sound and potential bullying/stigma. Some parents were ambivalent about the effect of the hearing aids. Where hearing aids were offered and not fitted, there was significant ongoing uncertainty, and the family carried the burden of their decision.

CONCLUSIONS

There was a wide variation in perceived advice regarding early hearing aid fitting in children with mild bilateral hearing loss. We identified parental perceptions of positive/negative impacts of hearing aid fitting and potential perceived harms from not fitting.

Impact of communication modality on caregiver ratings for deaf and hard of hearing children

PURPOSE

Literature on children who are deaf or hard of hearing (DHH) suggests overall increased rates of difficulties in emotional/behavioral and adaptive functioning. However, limitations of this literature include the failure to integrate issues unique to the experience of children who are DHH, such as home and school communication modalities and the consistency of modalities across settings.

METHOD

This study examined de-identified data from a clinical database. Data included caregiver ratings of emotional/behavioral and adaptive functioning in a diverse sample of clinically referred children who are DHH (N = 177). Caregivers also reported home and school communication modalities (e.g., match, partial match, different modalities). We examined mean score differences between our sample and normative samples and compared functioning across subgroups of children with various home-school communication modality combinations.

RESULTS

Consistent with the literature, we found overall increased rates of emotional/behavioral and adaptive functioning concerns on parent rating scales. Emotional/behavioral concerns did not differ among children with spoken language match, sign language match, or partial match communication modalities combinations. Within adaptive functioning, communication and functional academics were significantly lower among children with partial match home-school communication modalities. Adaptive functioning did not differ between spoken language match and sign language match groups.

CONCLUSIONS

Our findings suggest possible benefits to adaptive functioning among children who are DHH when home and school communication modalities match, regardless of which modality is used.

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.

Perception of COVID-19 Physical Distancing Effectiveness and Contagiousness of Asymptomatic Individuals: Cross-sectional Survey of Deaf and Hard of Hearing Adults in the United States

Background

During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency.

Objective

The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person.

Methods

This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform.

Results

The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors.

Conclusions

This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics.

Specialized outpatient clinic for deaf and hard-of-hearing patients in the Netherlands: Lessons learned in an attempt to improve health care

RATIONALE, AIMS, AND OBJECTIVE

A group of organizations and individuals in the Netherlands collaborated to attempt to improve access to health care and health education for deaf and hard of hearing (DHH) patients in the country. The outcome was the start of a specialized outpatient clinic named PoliDOSH. An independent research group was set up to evaluate the effect of this specialized clinic. Even though the initiative did not succeed and was closed after 2 years, an extensive analysis of the start-up and functioning of the whole process was made.

METHODS

Structured and nonstructured questionnaires and structured interviews.

RESULTS

Only a small group of DHH patients indicated that they felt a need for consultations at the PoliDOSH. It became clear that to ensure successful functioning of a specialized facility the team members should include a representative group of DHH members. All key functions should be filled by top experts in the relevant fields as well as an expert in communication and needs of the target group.

CONCLUSIONS

There is a great need for facilities to collect and disseminate information to and about DHH patients. The information should be aimed at providing psycho-education for the DHH persons themselves and health care professionals, concerning the specific needs and problems of this patient group. If a similar facility is set up in the future, thorough market research prior to start up is needed to enable the facility to connect with the needs of patients. The start-up period should allow sufficient time for the project to become known and for patients to become familiar with it and trust it.

Development and Validation of an Instrument to Measure Nurses' Beliefs Toward Deaf and Hard of Hearing Interaction

BACKGROUND AND PURPOSE

Nurse-patient communication has a significant effect on health outcomes and quality of care. The purpose of this research was to develop and validate an instrument to measure nurses' beliefs toward interacting with Deaf signers, non-signing deaf, and hard of hearing (DdHH) patients.

METHODS

Initial pool items created based on literature review. Content validated by DdHH and hearing registered nurses (RNs) and certified interpreters working in healthcare. Resulting D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) administered to two groups of RNs. Two validation studies conducted.

RESULTS

Analyses demonstrated high inter-item reliability, internal consistency reliability, and stability reliability of a 25-item DdHH-IBS/RN. Confirmatory factor analysis supported hypothesized structure of the scale.

CONCLUSION

The DdHH-IBS/RN is a reliable and valid scale to measure nurses' beliefs towards DdHH interaction.

Oral Health and Dental Care in Deaf and Hard of Hearing Population: A Scoping Review

PURPOSE

To compile the literature available about the oral health and dental care of the deaf and hard of hearing (DHH) population.

MATERIALS AND METHODS

The study question of this scoping review was 'What are the main findings reported in the literature about oral health and dental care of the DHH population?' The following databases were included: Web of Science, LILACS, SciELO, MEDLINE, Scopus, EMBASE, GoogleScholar and Redalyc. Full-text articles published in peer-reviewed journals, in Spanish, Portuguese, and English, from the January 2000 to January 2018 were selected with qualitative and quantitative methods. All study designs were included in the review with the exception of letters to the editor and case reports.

RESULTS

A total of fifty articles were selected for analysis. DHH population has poorer oral hygiene and a higher prevalence of caries than their non DHH peers. DHH also report significant struggles with oral health and dental access. Most dentists experienced difficulties communicating with their DHH patients.

CONCLUSIONS

This scoping review is the first known that centers on DHH oral health and their dental care. Efforts to develop accessible dental health programmes are needed to address apparent oral health inequities in the DHH population.

Physical Activity of Children and Adolescents with Hearing Impairments: A Systematic Review

Physical activity (PA) is important for the development of children and adolescents with hearing impairments (HI). This systematic review aims to summarise the existing literature pertaining to the PA of children and adolescents with HI. A systematic search was conducted on eight major electronic databases. Two reviewers independently screened and selected the returned articles, performed data extraction, assessed methodological quality and synthesised the data using an inductive approach. A total of 15 articles consisting of 14 survey studies and one single-subject intervention study met the inclusion criteria. These studies had good to excellent methodological quality. Participants with HI showed lower levels of participation in PA than participants without disabilities, but they were more physically active than those with other types of disabilities. Amongst the 12 PA correlates identified (i.e., gender, age, mother's education and social cognitive constructs), only gender was a relatively consistent determinant, and boys are significantly more physically active than girls. Additional studies are needed to confirm the determinants of the PA in children and adolescents with HI to provide strong evidence for the development and implementation of PA interventions for this target group.

Spelling in Deaf, Hard of Hearing and Hearing Children With Sign Language Knowledge

What do spelling errors look like in children with sign language knowledge but with variation in hearing background, and what strategies do these children rely on when they learn how to spell in written language? Earlier research suggests that the spelling of children with hearing loss is different, because of their lack of hearing, which requires them to rely on other strategies. In this study, we examine whether, and how, different variables such as hearing degree, sign language knowledge and bilingualism may affect the spelling strategies of children with Swedish sign language, Svenskt teckenspråk, (STS) knowledge, and whether these variables can be mirrored in these children's spelling. The spelling process of nineteen children with STS knowledge (mean age: 10.9) with different hearing degrees, born into deaf families, is described and compared with a group of fourteen hearing children without STS knowledge (mean age: 10.9). Keystroke logging was used to investigate the participants' writing process. The spelling behavior of the children was further analyzed and categorized into different spelling error categories. The results indicate that many children showed exceptionally few spelling errors compared to earlier studies, that may derive from their early exposure of STS, enabling them to use the fingerspelling strategy. All of the children also demonstrated similar typing skills. The deaf children showed a tendency to rely on a visual strategy during spelling, which may result in incorrect, but visually similar, words, i.e., a type of spelling errors not found in texts by hearing children with STS knowledge. The deaf children also showed direct transfer from STS in their spelling. It was found that hard-of-hearing children together with hearing children of deaf adults (CODAs), both with STS knowledge, used a sounding strategy, rather than a visual strategy. Overall, this study suggests that the ability to hear and to use sign language, together and respectively, play a significant role for the spelling patterns and spelling strategies used by the children with and without hearing loss.

Use of the LENA Autism Screen with Children who are Deaf or Hard of Hearing

Background and Objectives: This systematic review reports the evidence from the literature concerning the potential for using an automated vocal analysis, the Language ENvironment Analysis (LENA, LENA Research Foundation, Boulder, CO, USA) in the screening process for children at risk for autism spectrum disorder (ASD) and deaf or hard of hearing (D/HH). ASD and D/HH have increased comorbidity, but current behavioral diagnostic and screening tools have limitations. The LENA Language Autism Screen (LLAS) may offer an additional tool to disambiguate ASD from D/HH in young children. Materials and Methods: We examine empirical reports that use automatic vocal analysis methods to differentiate disordered from typically developing children. Results: Consensus across the sampled scientific literature shows support for use of automatic methods for screening and disambiguation of children with ASD and D/HH. There is some evidence of vocal differentiation between ASD, D/HH, and typically-developing children warranting use of the LLAS, but additional empirical evidence is needed to better understand the strengths and weaknesses of the tool. Conclusions: The findings reported here warrant further, more substantive, methodologically-sound research that is fully powered to show a reliable difference. Findings may be useful for both clinicians and researchers in better identification and understanding of communication disorders.

Communicating with Patients with Disability: Perspectives of Practicing Physicians

BACKGROUND

Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA).

OBJECTIVE

To understand physicians' perspectives on communication experiences with people with disability.

DESIGN

Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis.

SETTING

Massachusetts, October 2017-January 2018.

PARTICIPANTS

Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties.

MEASUREMENTS

Commonly expressed themes around communication with people with disability.

RESULTS

Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients.

CONCLUSIONS

Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.

Preparedness Training Programs for Working With Deaf and Hard of Hearing Communities and Older Adults: Lessons Learned From Key Informants and Literature Assessments

OBJECTIVES

The objectives of this study were to (1) identify available training programs for emergency response personnel and public health professionals on addressing the needs of Deaf and hard of hearing individuals and older adults, (2) identify strategies to improve these training programs, and (3) identify gaps in available training programs and make recommendations for addressing these gaps.

METHODS

A literature review was conducted to identify relevant training programs and identify lessons learned. Interviews were conducted by telephone or email with key informants who were subject matter experts who worked with Deaf and hard of hearing persons (n=11) and older adults (n=11).

RESULTS

From the literature, 11 training programs targeting public health professionals and emergency response personnel serving Deaf and hard of hearing individuals (n=7) and older adults (n=4) were identified. The 4 training programs focused on older adults had corresponding evaluations published in the literature. Three (43%) of the 7 training programs focused on Deaf and hard of hearing persons included individuals from the affected communities in the development and implementation of the training. Key informant interviews identified common recommendations for improving training programs: (1) training should involve collaboration across different emergency, state, federal, and advocacy agencies; (2) training should involve members of affected communities; (3) training should be more widely accessible and affordable; and (4) training should teach response personnel varied communication techniques relevant to the Deaf and hard of hearing and older adult communities.

CONCLUSIONS

Developing effective, accessible, and affordable training programs for emergency response personnel working with Deaf and hard of hearing persons, some of whom belong to the older adult population, will require a collaborative effort among emergency response agencies, public health organizations, and members of the affected communities. (Disaster Med Public Health Preparedness. 2018;12:606-614).

You're Deaf? Breaking through Myths for Effective Therapeutic Practice

Most mental health practitioners provide services to hearing clients and might be unprepared when a deaf individual requests services. The purpose of this article is to explore commonly held stereotypes and myths about deaf people and to provide guidance to clinicians who encounter deaf clients in their practices. Myths and stereotypes can affect the way clinicians perceive their clients' needs. This can lead to miscommunication, misunderstanding, and misinformation, which can harm the therapeutic relationship, thus making effective therapy unattainable. Clinicians should reframe these beliefs and overcome barriers to make way for the therapeutic process to begin.

The Relationship Between Child Maltreatment and Partner Violence Victimization and Perpetration Among College Students: Focus on Auditory Status and Gender

Partner violence is a pervasive public health concern that has received significant attention over the past three decades. Although a number of studies have reported that college students who are Deaf or hard of hearing are at an increased risk of experiencing partner violence compared with their hearing counterparts, little is known about partner violence perpetration among college students who are Deaf or hard of hearing. Furthermore, beyond disability, studies examining partner violence among students with disabilities tend to ignore other potential risk factors that may increase the risk of partner violence as a victim and/or a perpetrator. This exploratory study examines the extent of partner violence among male and female college students by auditory status and the relationship between experiencing and perpetrating partner abuse (i.e., physical abuse and psychological abuse) and child maltreatment (i.e., witnessing abuse and experiencing child physical abuse). The study also examines gender differences in the relationship between child maltreatment and physical and psychological abuse victimization and perpetration. Data were collected from a sample of approximately 680 college students at a northeastern university. Findings indicate that having witnessed interparental abuse as a child was only significant for being an adult victim of physical abuse. Having been a child victim of parental abuse was not significant for any of the abuse measures. Gender was only significant for being an adult victim of physical abuse. Deaf students were significantly more likely to report all abuse measures. Implications and directions for further research are discussed.

Provider Perspectives on Telepractice for Serving Families of Children Who are Deaf or Hard of Hearing

Telepractice to deliver remote Part C early intervention (EI) services to families in their home is a rapidly-growing strategy under the Individuals with Disabilities Education Act (IDEA) to meet the needs of infants and toddlers who are deaf or hard of hearing. A survey was completed within a “learning community” comprised of staff from EI programs that were implementing telepractice to learn about their specific implementation strategies and challenges they faced. Twenty-seven individuals representing 11 programs responded. The results showed great variability in hardware and software, with many raising concerns regarding security. Primary challenges reported were internet connectivity and training in skills required to deliver telepractice services. The findings from this survey were valuable in guiding future areas of investigation for the learning community and ultimately improving telepractice in the field.

Clinical practice: The approach to the deaf or hard-of-hearing paediatric patient

Approximately 1 child in 1,000 is deaf or severely hard of hearing from birth, and the prevalence rises to about 1.6 per 1,000 in adolescents. Providing medical care for this group of children poses special challenges for professionals. To allow a medical consultation to proceed successfully and to the satisfaction of the patient, it is essential that physicians are aware of the different linguistic and cultural background of these patients. Healthcare workers should be aware of the possible higher incidence of comorbidities, sexual abuse and (psycho)social problems, of the possible pitfalls in obtaining informed consent and higher frequency of medical mistakes. This review describes the communication challenges and medical, ethical and legal issues a physician can experience when faced with these patients.