Impact of Communication on Preventive Services Among Deaf American Sign Language Users

doi:10.1016/j.amepre.2011.03.004

American Journal of Preventive Medicine

Volume 41, Issue 1, July 2011, Pages 75-79

https://doi.org/10.1016/j.amepre.2011.03.004 Get rights and content

Background

Deaf American Sign Language (ASL) users face communication and language barriers that limit healthcare communication with their providers. Prior research has not examined preventive services with ASL-skilled clinicians.

Purpose

The goal of this study was to determine whether provider language concordance is associated with improved receipt of preventive services among deaf respondents.

Methods

This cross-sectional study included 89 deaf respondents aged 50–75 years from the Deaf Health Survey (2008), a Behavioral Risk Factor Surveillance System survey adapted for use with deaf ASL users. Association between the respondent's communication method with the provider (i.e., categorized as either concordant–doctor signs or discordant–other) and preventive services use was assessed using logistic regression adjusting for race, gender, income, health status, health insurance, and education. Analyses were conducted in 2010.

Results

Deaf respondents who reported having a concordant provider were more likely to report a greater number of preventive services (OR=3.42, 95% CI=1.31, 8.93, p=0.0122) when compared to deaf respondents who reported having a discordant provider even after adjusting for race, gender, income, health status, health insurance, and education. In unadjusted analyses, deaf respondents who reported having a concordant provider were more likely to receive an influenza vaccination in the past year (OR=4.55, p=0.016) when compared to respondents who had a discordant provider.

Conclusions

Language-concordant patient–provider communication is associated with higher appropriate use of preventive services by deaf ASL 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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High levels of patient satisfaction are critical in health care and allow patients to feel more satisfied with their care and be more compliant overall. This idea is even more important in traditionally disenfranchised groups of people, such as Deaf patients, because satisfaction with medical encounters can translate into better health outcomes. This community possesses its own traditions, language, and culture, and health disparities here are apparent and often significant. Clearer communication in clinical encounters allows for more accessible health care. Barriers to effective communication are a major factor accounting for poorer health outcomes for Deaf individuals.
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Prior studies on severe maternal morbidity (SMM) have often excluded women who are deaf or hard of hearing (DHH), even though they are at increased risk of pregnancy complications and adverse birth outcomes. This study compared rates of SMM during delivery and postpartum among DHH and non-DHH women.
This nationally representative retrospective cohort study used hospital discharge data from the 2004–2020 Health Care and Cost Utilization Project Nationwide Inpatient Sample. The risk of SMM with and without blood transfusion during delivery and postpartum among DHH and non-DHH women were compared using modified Poisson regression analysis. The study was conducted in the United States in 2022–2023.
The cohort included 9351 births to DHH women for the study period, and 13,574,382 age-matched and delivery year-matched births to non-DHH women in a 1:3 case-control ratio. The main outcomes were SMM and non-transfusion SMM during delivery and postpartum. Relative risks were sequentially adjusted for sociodemographic characteristics, hospital-level characteristics, and clinical characteristics. In unadjusted analyses, DHH women were at 80% higher risk for SMM (RR = 1.81, 95% CI 1.63–2.02, p < 0.001) during delivery and postpartum compared to non-DHH women. Adjustment for socio-demographic and hospital characteristics attenuated risk for SMM (RR = 1.54, 95% CI 1.38–1.72, p < 0.001). Adjustment for the Elixhauser comorbidity score further attenuated the risk of SMM among DHH women (RR = 1.13, 95% CI 1.01–1.26, p < 0.05).
The findings of this study demonstrate a critical need for inclusive preconception, prenatal, and postpartum care that address conditions that increase the risk for SMM among DHH people.
Exploring healthcare barriers and satisfaction levels among deaf individuals in Ecuador: A video-based survey approach
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Approximately 80% of Deaf individuals live in low- and middle-income countries, where health systems often overlook their specific needs. This communication gap can result in misdiagnosis and inappropriate treatment, impacting their overall satisfaction with healthcare services.
This study aims to uncover barriers to healthcare access and preferences among the Deaf population in Ecuador, and the role of communication barriers in shaping satisfaction levels with healthcare services.
The study gathered data from 386 participants through online surveys, focusing on demographic characteristics, healthcare experiences, communication methods, and levels of satisfaction. Descriptive statistics and association analyses were employed to analyze the data.
The study reveals that nearly all participants possessed an officially recognized disability (95.9%) and 53.9% reported hereditary deafness. Ecuadorian sign language was predominant (60.9%). Communication barriers were evident, with 65.0% having trouble understanding medical instructions, and 66.6% identifying a deficiency of tools for Deaf individuals in healthcare settings. Satisfaction levels were associated with the presence of interpreters during medical care, with 46.6% expressing a preference for interpreters over other communication methods. Additionally, private healthcare facilities were perceived as providing better services, despite being less frequently accessed (38.9%). Dissatisfaction was evident, particularly in aspects of communication and physician courtesy.
This study underscores the importance of tailoring healthcare services to address the unique needs of the Deaf population. Communication barriers emerged as a central obstacle, necessitating the inclusion of sign language interpreters and improvement of resources. The study's implications extend to healthcare equity in developing nations, emphasizing the significance of patient-centered care and inclusive healthcare practices.
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Empathy of clinical providers is necessary for patient-centered care. Virtual reality, such as 360-videos, may enable empathy development with thoughtful design. We describe our process and outcomes developing an educational innovation for clinical providers to work with the challenges experienced by the deaf and hard-of-hearing population using 360-videos.
A user-centered design-informed process was used to (a) empathize with our patient population using a focus group and stakeholder input, (b) design content for videos with iterative feedback from stakeholders, and (c) feasibility and usability test the innovation.
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Deaf individuals who communicate using American Sign Language (ASL) seem to experience a range of disparities in health care, but there are few empirical data.
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ED visits in 2018 at a U.S. academic medical center were assessed retrospectively in Deaf adults who primarily use ASL (n = 257) and hearing individuals who primarily use English, selected at random (n = 429). Logistic regression analyses adjusted for confounders compared the groups on the provision or nonprovision of four routine ED care practices (i.e., laboratories ordered, medications ordered, images ordered, placement of peripheral intravenous line [PIV]) and on ED disposition (admitted to hospital or not admitted).
The ED encounters with Deaf ASL users were less likely to include laboratory tests being ordered: adjusted odds ratio 0.68 and 95% confidence interval 0.47–0.97. ED encounters with Deaf individuals were also less likely to include PIV placement, less likely to result in images being ordered in the ED care of ASL users of high acuity compared with English users of high acuity (but not low acuity), and less likely to result in hospital admission.
Results suggest disparate provision of several types of routine ED care for adult Deaf ASL users. Limitations include the observational study design at a single site and reliance on the medical record, underscoring the need for further research and potential reasons for disparate ED care with Deaf individuals.
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Deaf and hard-of-hearing (DHH) people report ineffective healthcare communication. Limited research has been conducted on healthcare communication during pregnancy. This study’s aim was to assess communication accommodations and experiences during pregnancy for DHH people.
An accessible web-based survey was administered to a non-probability sample of DHH people through national organizations, social media, and snowball sampling. Eligibility criteria included being 21 years or older; given birth in the U.S. within the past 10 years, report hearing loss prior to the most recent birth. Questions focused on healthcare experiences and information access during their last pregnancy. The sample included 583 respondents for the present analysis. We describe the communication accommodations requested and received during pregnancy, segmented by preferred language.
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Brief reportImpact of Communication on Preventive Services Among Deaf American Sign Language Users

Background

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

J Emerg Med

Soc Sci Med

Prev Med

J Midwifery Womens Health

Cancer prevention information-seeking among Hispanic and non-Hispanic users of the National Cancer Institute's Cancer Information Service: trends in telephone and LiveHelp use

J Health Commun

Language barriers in medicine in the U.S.

JAMA

Impact of language barriers on patient satisfaction in an emergency department

J Gen Intern Med

Barriers to health care access for Latino children: a review

Fam Med

The pervading role of language on health

J Health Care Poor Underserved

Effective physician–patient communication and health outcomes: a review

CMAJ

Health services by low-income limited English proficiency adults

J Immigr Minor Health

Physician language ability and cultural competence

J Gen Intern Med

Effects of limited English proficiency and physician language on health care comprehension

J Gen Intern Med

Improvements in preventive care and communication for deaf patients: results of a novel primary health care program

J Gen Intern Med

Inside deaf culture

Clinical and cultural issues in caring for deaf people

Fam Med

Brief report
Impact of Communication on Preventive Services Among Deaf American Sign Language Users