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Health Care and the Deaf:


 

Jennifer Savino
5/28/2013


 

Barriers to Health Care for the Deaf


Health care is important to everyone and every one should have equal access to quality health care. More than 20 million people in the United States have a hearing loss (Harmer, 1999). Approximately 10% of Americans have some level of hearing loss and this number is expected to increase as Baby Boomers age (Scheier, 2009). The number of people with hearing loss is also expected to increase due to noise exposure and with an increase in the number of premature babies surviving (Msall, 2008). There are several barriers to quality health care for the Deaf, but there are also things that can be done to help the problem.
 

A primary reason that the Deaf have difficulty accessing health care is communication. American Sign Language (ASL) is the primary language of the Deaf. Few health care providers are fluent in ASL. The Americans with Disabilities Act (ADA) of 1990 mandates communication services for the Deaf or hard of hearing when they receive health care (Scheier, 2009). However, many people choose not to use interpreters because of privacy concerns (Glickman, 2003). Deaf communities can be very close knit and it is likely that a Deaf patient knows or will eventually know the interpreter outside of the medical appointment. Another problem that can lead to dangerous miscommunications during medical appointments is that some interpreters are not knowledgeable in medical terminology (Scheier, 2009).
 

Choosing to understand a health care provider through lip reading instead of an interpreter can be very difficult. The best lip reader can see only about 30% of English on the speaker's lips (Lieu, 2007). Many sounds look the same. For example, a 'P' and a 'B' look identical on the lips. A mustache or accent complicates lip reading. Other factors, also add to the difficulty the Deaf experience when communicating through lip reading, including multiple speakers, improper lighting, speakers placing their hands near their mouth or not directly facing the Deaf listener. (Scheier, 2009).
 

Literacy is another factor adversely affecting health care for the Deaf. Since English is a second language for many Deaf individuals and since they are not able to hear the language, reading can be difficult. A study of the literacy level of 17 -18 year old Deaf students found that their median reading level corresponded to a fourth grade reading level for hearing students (Gallaudet Research Institute, 1996). Many Deaf individuals have limited access to health related information since it is provided through written or sound communication, such as the television, radio, computers, newspapers and health professionals (Jones, 2007).
 

Communication difficulties between Deaf patients and healthcare providers can lead to misunderstandings. An English phrase can seem similar to a phrase in ASL but have the opposite meaning. For example, if a doctor says or writes to a signer without proficient English skills that one may need surgery, the Deaf person may think that he or she needs surgery in the month of May (Meador, 2005). Misunderstandings about the expression of pain are also possible because many healthcare providers know little to nothing about the major role that facial expressions play in Deaf communication. There are over 250 facial expressions in ASL that express different emotions (Allen, 2002). Facial expressions are important because they are used to demonstrate where or how much pain is occurring. It is also crucial for healthcare providers to be cautious when using facial expressions to minimize miscommunication (Scheier, 2009).
 

Characteristics of Deaf culture can also lead to difficulties in the delivery of healthcare. Interpersonal interactions between hearing healthcare providers and Deaf patients may be awkward if the healthcare provider does not understand the rules and behaviors of Deaf culture. For example, the provider may be perceived as impolite if they do not maintain eye contact when speaking to a Deaf person. They may be considered rude if they exclude a Deaf person from a conversation or fail to convey information that a hearing person would have, such as a knock on the door. It may not be understood that many Deaf people have a special bond with each other that in many cases is stronger than that with their hearing family members. Many healthcare providers also do not understand that many Deaf people are proud to be Deaf and do not wish to be able to hear. Historically, Deaf people had been viewed negatively and were thought to be inadequate and inferior to hearing persons (Scheier, 2009). This can increase the likelihood that a patient does not ask that information be clarified so that they do not appear stupid. Deaf communities are relatively small and they are geographically diverse, which makes health education through in-person interventions logistically impracticable (Jones, 2010).
 

Technology can be used to help improve healthcare for Deaf and hard of hearing people. Telemedicine can increase the opportunities for healthcare. Patients can have increased access to an interpreter and a physician through the use of webcams. Patients in waiting or emergency rooms should be given pagers or vibrators so that they know when it is their turn. Text telephones (TTY) allow Deaf or hard of hearing people to participate in phone conversation because TTY allows messages to be typed back and forth instead of talking and listening (Scheier, 2009).
 

A Deaf-friendly Stop-smoking (Df-SS) website is an example of technology being used to improve health education for the Deaf. This website provided smoking cessation information in ASL, used webcams to create real-time video chat rooms for support groups that communicated in sign language and included an ask the expert feature to answer questions. Deaf people were included as experts and moderators. A program like this overcomes language and literacy barriers by providing information in ASL. Geographic barriers are overcome because it is an online program. Cultural issues are addressed by including Deaf instructors (Jones, 2010).
 

The Deaf Heart Health Intervention (DHHI) is an example of a program that does not use technology but is specifically designed to provide health information to the Deaf. Classes were highly interactive and were taught entirely in sign language by a trained Deaf lay heart-health teacher. A study of the program showed that the DHHI was effective in increasing Deaf adults self-efficacy (confidence) to engage in health behaviors to improve their risk factors for heart disease (Jones, 2007).
 

The primary barrier to providing healthcare to the Deaf is communication. There are few health care providers fluent in sign language. The use of sign interpreters is costly and takes away from the privacy of the patient. Sign interpreters, especially ones knowledgeable in medical terminology, are not always available. Since English is a second language to many ASL users, written communication between healthcare providers and Deaf patients or as a means of health education is also limited in its effectiveness. Deaf communities tend to be small and geographically diverse, creating another barrier to healthcare delivery. Technology can be used to overcome some of these barriers, such as the use of telemedicine or online health education programs, such as the Deaf-friendly Stop-smoking web site intervention program. The Deaf Heart Health Intervention is an example of a program that effectively provided health education to Deaf people because it was specifically designed for Deaf people. It is possible to overcome barriers and provide quality healthcare to the Deaf.


 

References

Gallaudet Research Institute. (1996) Stanford Achievement Test, 9th Edition, Form S, Norms booklet for Deaf and hard-of-hearing students. Washington DC: Gallaudet University.
 

Glickman, N. (2003). Mental healthcare of Deaf people. Mahwah, New Jersey: Lawrence Erlbaum.


Harmer, L (1999). Health care delivery and Deaf people: Practice, problems and recommendations for change. Journal of Deaf Studies and Deaf Education, 4(2), 73.


Jones, E. (2007). Self-efficacy for health-related behaviors among Deaf adults.
Research in Nursing & Health, 30, 185-191.


Jones, E. (2010). Creating and testing a Deaf-friedly, stop-smoking web site intervention.
American Annals of the Deaf, 155(1), 96-102.


Lieu, C (2007). Communication strategies for nurses interacting with Deaf patients. MedSurg Nursing, 16(4), 239-244.


Meador, H. (2005) Healthcare interactions with Deaf culture. Journal of the American Board of Family Practice, 18(3), 218-222.


Msall, M. (2008). The spectrum of behavioral outcomes after extreme prematurity: Regulatory, attention, social and adaptive dimensions. Seminars in Perinatology, 32(4), 42-50.


Scheier, D. (2009). Barriers to health care for people with hearing loss: A review of the literature.
Journal of the New York State Nurses Association, 4-9.

 


Editor's note: The term "Deaf" has been capitalized by the editor of this paper (me) as per the emerging style preference of many leaders in the Deaf Community.  I recognize this is not the norm for many typical publications. On the other hand, social change has to start somewhere.
- Bill  (William G. Vicars, EdD)


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