Elsevier

Preventive Medicine

Volume 42, Issue 3, March 2006, Pages 235-239
Preventive Medicine

Cardiovascular disease knowledge among culturally Deaf patients in Chicago

https://doi.org/10.1016/j.ypmed.2005.12.012Get rights and content

Abstract

Background

Deaf persons experience communication barriers that may impact on their knowledge of cardiovascular disease (CVD); however, data measuring this deficit are limited. A comprehensive health survey of Deaf adults included questions on CVD knowledge.

Methods

Between November 2002 and March 2003, 203 Deaf adults participated in the survey, which was conducted via face-to-face interviews in American Sign Language. Questions assessed knowledge of heart attack and stroke symptoms, risk factors, and emergency response.

Results

Forty percent of respondents could not list any symptoms of a heart attack, while over 60% could not list any symptoms of a stroke. Less than half of respondents identified chest pain/pressure as a symptom of a heart attack. Only 61% reported that they would call 911 in response to cardiovascular disease symptoms. The median number of risk factors correctly identified by respondents was 3 of 6.

Conclusions

Knowledge of cardiovascular disease among Deaf respondents is low, and considerably lower than that of the general hearing population. The need to develop health education materials and programs for Deaf individuals is evident. Health care providers should be educated on Deaf culture and barriers in communication. Finally, efforts need to be made to assure that 911 is deaf-accessible.

Introduction

Deaf individuals face barriers in communication with the majority culture that may lead to significant deficits in their health knowledge. An estimated 20 million people in the U.S. are deaf or hard of hearing, with approximately 1.2 million reporting profound hearing loss (Ries, 1994). The number of culturally Deaf (Deaf with a capital “D”) is more difficult to define. Culturally Deaf individuals are frequently deaf from birth or prelingually (generally defined as before the age of 3), and prefer sign language for communication. Most Deaf Americans identify American Sign Language (ASL) as their native language. ASL is a unique language, with its own grammar and syntax; it is not a gestured representation of the English language (Valli and Lucas, 1995). Many Deaf people are therefore not fluent in English. In fact, the average Deaf high school graduate has English language skills equivalent to those of a fourth grade hearing student (Allen, 1986, Holt, 1993). Consequently, many Deaf individuals do not fully comprehend written health information. Most also face the additional barrier of not being able to communicate directly with their health care provider. Finally, as over 90% of Deaf individuals grow up in hearing families (Schein, 1989, Mitchell and Karchmer, 2004), they miss out on a significant source of incidental learning, overheard conversations, further decreasing what has been referred to as their “fund of information” (Pollard, 1998).

Heart disease and stroke are the number 1 and 3 killers of Americans, respectively (Kochanek et al., 2004). An estimated 1.2 million Americans per year experience heart attack, while 700,000 experience stroke (American Heart Association, 2004). Recent improvements in our understanding of the pathophysiology of both heart disease and stroke have led to significant advances in both prevention and treatment. However, in order for preventive and treatment methods to be effective, the general public must be knowledgeable about cardiovascular disease (CVD), including its risk factors, warning signs, and emergency response.

Little data exist regarding heart attack and stroke knowledge among Deaf individuals. Deaf persons are missed by national and local surveys that rely on phones, are not included in face-to-face interviews administered in spoken English, and only participate in written surveys if they are proficient in English. A comprehensive review of the literature revealed no prior surveys conducted with Deaf persons focusing on CVD knowledge. However, as a marginalized population with compromised access to health information, it seems likely that Deaf individuals would be less knowledgeable about CVD risk factors, symptoms, and proper emergency response than the general population.

Thus, we sought to describe the knowledge of heart attack and stroke symptoms, risk factors, and emergency response among a sample of Deaf patients from Chicago.

Section snippets

Methods

A sample of 203 Deaf patients from either of Chicago's two largest Deaf-serving health care systems (Sinai Health System (SHS) and Advocate Health Care (AHC)) participated in a comprehensive, face-to-face health survey conducted between November 2002 and March 2003 in ASL by Deaf interviewers. Participants were generally recruited during a clinic visit. In some instances, appointments were set-up in advance for persons to come in and complete the interview. In order to be eligible, participants

Results

The sociodemographic characteristics of respondents and the prevalence of self-reported risk factors for CVD are presented in Table 1. In terms of race/ethnicity and socioeconomic status, respondents from the two sites were very different. Whereas the SHS respondents were primarily non-Hispanic Black (51.0%), AHC respondents were predominantly non-Hispanic White (82.2%). Also, respondents from SHS were less likely to have an education beyond high school, more likely to report a household income

Discussion

To our knowledge, this is the most comprehensive health survey ever conducted with Deaf adults. While we expected to find deficits in knowledge of CVD among this population, the results were more sobering than anticipated. The survey reveals that knowledge of CVD symptoms, risk factors, and emergency response in our population is generally poor and is considerably lower than that of the majority, the hearing population. For example, while 90% of respondents in a U.S. population-based survey

Acknowledgments

The authors would like to thank the entire Project Team for their efforts in designing and implementing the survey, and in interpreting its findings. Specifically, we would like to thank: Carroll Cradock, Dorothea DeGutis, Barbara Giloth, Teri Hedding, Lisa Kivland, Lewis Lummer, Linda Miller, Melvin Patterson, Toby Perlman, Raymond Rodgers, Crystal Schwartz, and Steve Whitman.

This research was funded by the Michael Reese Health Trust.

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