Brief reportImpact of Communication on Preventive Services Among Deaf American Sign Language Users
Introduction
Individuals with limited English proficiency or communication abilities are at high risk for health disparities and adverse health effects.1, 2 Poor health communication can lead to lower patient satisfaction, adherence, use of health services, and education regarding healthy behaviors.2, 3, 4, 5, 6 Linguistic concordance between patients and providers is an important determinant of whether patients seek, understand, and adhere to providers' preventive services recommendations, which has been associated with improved healthcare utilization.7, 8, 9, 10, 11
Deaf linguistic minority refers to deaf American Sign Language (ASL) users, a group of individuals who identify themselves as a minority community, with their own unique language and culture.12, 13 Deaf ASL users struggle to understand spoken English and may lack proficiency in written English. Historically health-related research and education programs have excluded deaf ASL users. Communication and language barriers isolate this group from mass media and healthcare messages.14, 15, 16 Documented health disparities experienced by deaf ASL users include sexual health,17, 18, 19 cancer,20 preventive health,16, 21 and cardiovascular disease.22 Cultural and linguistic differences pose a challenge for many clinicians who care for deaf ASL users. Results from an ASL-accessible survey were used to test the hypothesis that deaf ASL users who report language-concordant healthcare communication are more likely to receive preventive services.
Section snippets
Methods
The data source is the National Center for Deaf Health Research's (NCDHR's) Deaf Health Survey (DHS), adapted from the Behavioral Risk Factor Surveillance System (BRFSS)23 survey for deaf individuals. The DHS is self-administered on a touch-screen computer. Deaf respondents chose the survey language—ASL, signed English, and written English. The Rochester NY metropolitan statistical area (MSA) was selected to administer the survey because of its high per capita population of deaf ASL users. The
Results
Demographics and most healthcare variables were similar for respondents who reported concordant and discordant healthcare communication (Table 1). Ages between the two groups were comparable (mean age was 57.9 for the concordant group and 57.2 for the discordant group). Only one respondent with provider language concordance reported receiving none or only one preventive service (influenza, colonoscopy, and cholesterol screening), whereas 17% of the respondents in the provider language
Discussion
The findings support the hypothesis that deaf ASL users with language-concordant healthcare communication are more likely to receive preventive services than deaf ASL users with language-discordant healthcare communication. These findings are consistent with research showing an association between language-concordant healthcare communication and appropriate healthcare services, including preventive services.7, 10 With poor communication, preventive services may be relegated to a low priority or
Conclusion
This study demonstrated for the first time with deaf ASL users the relationship between preventive services use and having a language-concordant clinician. Increasing the number of ASL-fluent clinicians (hearing or deaf themselves), and expanding their geographic reach through the use of tele-health technology, would likely improve healthcare services use and health in this underserved language minority population.
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