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Weerapol N, Leelakanok N. Communication between healthcare professionals and patients with hearing loss: A systematic review and meta-analysis. Am J Health Syst Pharm 2024; 81:521-530. [PMID: 38430534 DOI: 10.1093/ajhp/zxae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Indexed: 03/04/2024] Open
Abstract
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.
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Affiliation(s)
- Neeranun Weerapol
- Department of Pharmacy, Sawaengha Hospital, Ang Thong, Thailand
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Nattawut Leelakanok
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
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Hamadah K, Velagapudi M, Navarro JJ, Pirotte A, Obersteadt C. Best Practices for Treating Blind and Visually Impaired Patients in the Emergency Department: A Scoping Review. West J Emerg Med 2024; 25:350-357. [PMID: 38801041 PMCID: PMC11112656 DOI: 10.5811/westjem.61686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Blind and visually impaired individuals, an under-represented population of the emergency department (ED), possess comorbidities and have a higher chance of in-hospital sequelae, including falls. This potentially vulnerable population, if not treated mindfully, can be subject to decreased quality of care, recurrent and/or longer hospitalizations, persistence of health issues, increased incidence of falls, and higher healthcare costs. For these reasons, it is crucial to implement holistic practices and train clinicians to treat blind and visually impaired patients in the ED setting. Methods We identified and used a comprehensive article describing best practices for the care of blind and visually impaired patients to establish the ED-specific recommendations presented in this paper. A scoping review of the literature was then performed using PubMed to identify additional articles to support each recommendation. To ensure that recommendations could be implemented in a representative, scalable, and sustainable manner, we consulted an advocate for the blind to help refine and provide additional suggestions. Results We identified 14 recommendations that focus on communication strategies, ED resource access, and continuity of care. The main recommendation is for the clinician to support the unique healthcare needs of the visually impaired individual and maintain the patient's autonomy. Another recommendation is the consistent use of assistive devices (eg, canes, guide dogs) to aid patients to safely ambulate in the ED. Also identified as best practices were discharge education with the use of a screen reader and timely follow-up with a primary care physician. Conclusion While we summarize a variety of recommendations in this article, it is important to implement only the strategies that work best for the patients, personnel, and environment specific to your ED. After implementation, it is vital to refine (as frequently as needed) the interventions to optimize the strategies. This will enable the provision of exceptional and equal care to blind and visually impaired patients in the ED.
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Affiliation(s)
- Kareem Hamadah
- University of Kansas School of Medicine, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
| | - Mary Velagapudi
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
| | - Juliana J. Navarro
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew Pirotte
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Medical Center, Department of Emergency Medicine, Kansas City, Kansas
- University of Kansas Medical Center, Office of Student Affairs, Kansas City, Kansas
| | - Chris Obersteadt
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
- Rockhurst University, Kansas City, Kansas
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McKee MM, Zhang J, Akobirshoev I, McKee K, Mitra M. Antenatal Hospital Use among Deaf and Hard of Hearing Women. Am J Perinatol 2024; 41:e1560-e1569. [PMID: 36918163 DOI: 10.1055/a-2053-7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications, and adverse birth outcomes compared with hearing women. Health care utilization patterns during the perinatal period remain not well understood. The objective of this study was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women. STUDY DESIGN We conducted a retrospective cohort study design to analyze 2002 to 2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N = 925) and hearing (N = 2,895) women with singleton deliveries. Matching was done based on delivery year, age at delivery, and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical, and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for sociodemographic and clinical characteristics. RESULTS Among DHH women (N = 925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a nondelivery hospital stay compared with 26, 14, and 6%, respectively, among hearing women (N = 28,95) during the antenatal period (all ps < 0.001). The risk of nondelivery emergency department visits (risk ratio [RR] 1.58; p < 0.001) and inpatient stays (RR = 1.89; p < 0.001) remained higher among DHH women compared with hearing women even after adjustment. Having four or more antenatal emergency department visits (7 vs. 2%) and two or more nondelivery hospital stays (4 vs. 0.4%) were more common among pregnant DHH women compared with their controls (all p-values < 0.001). CONCLUSION The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed. KEY POINTS · Antenatal emergency department use is significantly higher among deaf and hard of hearing women.. · Antenatal hospitalizations are significantly higher among deaf and hard of hearing women.. · Hearing loss screening may identify those at risk for adverse pregnancy and birth outcomes..
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jianying Zhang
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Hulme C, Young A, Rogers K, Munro KJ. Cultural competence in NHS hearing aid clinics: a mixed-methods case study of services for Deaf British sign language users in the UK. BMC Health Serv Res 2023; 23:1440. [PMID: 38114981 PMCID: PMC10731837 DOI: 10.1186/s12913-023-10339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers. METHODS This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels. RESULTS Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness. CONCLUSION This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS.
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Affiliation(s)
- Celia Hulme
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK.
| | - Alys Young
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
- Centre for Deaf Studies, University of the Witwatersrand, Johannesberg, South Africa
| | - Katherine Rogers
- Social Research with Deaf People (SORD), School of Health Sciences, University of Manchester, Manchester, UK
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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James TG, Sullivan MK, McKee MM, Rotoli J, Maruca D, Stachowiak R, Cheong J, Varnes JR. Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients. Health Expect 2023; 26:2374-2386. [PMID: 37555478 PMCID: PMC10632638 DOI: 10.1111/hex.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients. METHODS This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach. RESULTS Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes. CONCLUSIONS This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine. PATIENT OR PUBLIC CONTRIBUTION This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | | | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - JeeWon Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - Julia R. Varnes
- Department of Health Services Research, Management, and PolicyUniversity of FloridaGainesvilleFloridaUSA
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Conner KR, Jones CM, Wood N, Aldalur A, Paracha M, Powell SJ, Nie Y, Dillon KM, Rotoli J. Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users. J Emerg Med 2023; 65:e163-e171. [PMID: 37640633 PMCID: PMC10653031 DOI: 10.1016/j.jemermed.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND 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. OBJECTIVE To examine the provision of common care practices in the emergency department (ED) to this population. METHODS 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). RESULTS 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. CONCLUSION 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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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Courtney M Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Nancy Wood
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Mariam Paracha
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York; Department of Science and Mathematics, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Stephen J Powell
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Yunbo Nie
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Kevin M Dillon
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jason Rotoli
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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Alharthy N, Almotairy R, Aldulhum R, Alghamdi A, Aquil R, Alkharaan G, Alsuwais S, Alshibani A. Knowledge and experience of paramedics concerning patients with hearing and visual disability. BMC Emerg Med 2023; 23:91. [PMID: 37592234 PMCID: PMC10433550 DOI: 10.1186/s12873-023-00866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND A 2017 nationwide disability survey conducted by the General Authority of Statistics in Saudi Arabia, a sample representing the whole population living in Saudi Arabia, reported that approximately 5% and 2% of the Saudi population suffers from visual or hearing impairments, respectively. Patients with these disabilities find it difficult to convey their medical history and chief complaints to paramedics, causing communication breakdowns that can lead to misinterpretation of patient history, leave medical problems unaddressed, and reduce patient engagement and autonomy. We aimed to assess paramedics' knowledge, attitude, and level of confidence when managing patients with visual or hearing problems. METHODS Descriptive cross-sectional design was used to report the knowledge and experience of paramedics towards patients with hearing/vision disabilities in Saudi Arabia. A validated questionnaire was distributed to our study sample of paramedics in Riyadh, Saudi Arabia between 01, July 2020 and 31, December 2020. Ethical approval was obtained from King Abdullah International Medical Research Center. RESULTS Ninety-seven participants completed the survey. Male paramedics accounted for 77% of the study participants; 24% were Saudi Red Crescent employees, and 57% were 20-25 years old. Most participants encountered 1-5 cases of patients with hearing disability (55%) as well as patients with visual disability (48%) during their career. Taking medical history was a challenge indicated by 42% of the participants, and 30% reported difficulties in explaining procedures. Of the participants, 44% were confident in handling patients with hearing or visual impairment. There was a strong association between participants who indicated higher confidence levels and those who had obtained specific training for patients with hearing or visual impairments. CONCLUSION Assisting patients with hearing or visual impairments is challenging, especially during an emergency. We recommend programs that provide specific training in handling hearing or visually impaired patients to close the communication gap in emergent medical situations handled by paramedics or other emergency medicine doctors and nurses.
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Affiliation(s)
- Nesrin Alharthy
- Pediatrics Emergency Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Raghad Almotairy
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rahaf Aldulhum
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Albatool Alghamdi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reem Aquil
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghada Alkharaan
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sara Alsuwais
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alshibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Hall WC, Dye TDV, Siddiqi S. Associations of childhood hearing loss and adverse childhood experiences in deaf adults. PLoS One 2023; 18:e0287024. [PMID: 37343003 PMCID: PMC10284385 DOI: 10.1371/journal.pone.0287024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
Childhood trauma and adverse childhood experiences have a strong relationship with health disparities across the lifespan. Despite experiencing approximately doubled rates of trauma, Adverse Childhood Experiences (ACEs) are poorly characterized in deaf populations. We sought to characterize deaf-specific demographic factors and their association with multiple experiences of ACEs before the age of 18 years old. An analytical cross-sectional approach was used to ascertain associations of deaf-specific demographic factors and experiences with ACEs. The complete dataset included 520 participants for a total response rate of 56%. After adjusting for confounding effects, less severe hearing loss of 16-55 dB (2+ OR: 5.2, 4+ OR: 4.7), having a cochlear implant (2+ OR: 2.1, 4+ OR: 2.6), and not attending at least one school with signing access (2+ OR: 2.4, 4+ OR: 3.7) were significantly and independently associated with reported experiences of multiple ACEs. We conclude that factors associated with childhood hearing loss and language experiences increase risk of experiencing ACEs. Given the strong relationship between ACEs and poor social outcomes, early intervention clinical practice and health policies should consider interventions to support healthy home environments for deaf children.
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Affiliation(s)
- Wyatte C. Hall
- Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
- Pediatrics, University of Rochester Medical Center, Rochester, New York, United States of America
- Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York, United States of America
- Neurology, University of Rochester Medical Center, Rochester, New York, United States of America
- Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Timothy D. V. Dye
- Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
- Pediatrics, University of Rochester Medical Center, Rochester, New York, United States of America
- Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Shazia Siddiqi
- Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York, United States of America
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Epstein S, Johnson LM, Sie KCY, Norton SJ, Ou HC, Horn DL. Sensitivity to Deaf Culture Among Otolaryngology and Audiology Trainees. Ann Otol Rhinol Laryngol 2023; 132:648-656. [PMID: 35822616 PMCID: PMC10164444 DOI: 10.1177/00034894221111248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- Sherise Epstein
- Department of Otolaryngology Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Luke M Johnson
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
- Division of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Susan J Norton
- Department of Otolaryngology Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
- Division of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Henry C Ou
- Department of Otolaryngology Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
- Division of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David L Horn
- Department of Otolaryngology Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
- Division of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
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Xie Z, Tanner R, Striley CL, Sheffield SW, Marlow NM. Hearing Impairment, Mental Health Services Use, and Perceived Unmet Needs Among Adults With Serious Mental Illness: A Cross-Sectional Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-11. [PMID: 37257284 DOI: 10.1044/2023_jslhr-22-00385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Individuals with hearing impairment have higher risks of mental illnesses. We sought to develop a richer understanding of how the presence of any hearing impairment affects three types (prescription medication, outpatient services, and inpatient services) of mental health services utilization (MHSU) and perceived unmet needs for mental health care; also, we aimed to identify sociodemographic factors associated with outpatient mental health services use among those with hearing impairment and discuss potential implications under the U.S. health care system. METHOD Using secondary data from the 2015-2019 National Survey on Drug Use and Health, our study included U.S. adults aged ≥ 18 years who reported serious mental illnesses (SMIs) in the past year. Multivariable logistic regression was used to examine associations of hearing impairment with MHSU and perceived unmet mental health care needs. RESULTS The study sample comprised 12,541 adults with SMIs. Prevalence of MHSU (medication: 55.5% vs. 57.5%; outpatient: 37.1% vs. 44.2%; inpatient: 6.6% vs.7.1%) and unmet needs for mental health care (47.5% vs. 43.3%) were estimated among survey respondents who reported hearing impairment and those who did not, respectively. Those with hearing impairment were significantly less likely to report outpatient MHSU (OR = 0.73, 95% CI [0.60, 0.90]). CONCLUSIONS MHSU was low while perceived unmet needs for mental health care were high among individuals with SMIs, regardless of hearing status. In addition, patients with hearing impairment were significantly less likely to report outpatient MHSU than their counterparts. Enhancing communication is essential to improve access to mental health care for those with hearing impairment.
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Affiliation(s)
- Zhigang Xie
- Department of Public Health, University of North Florida, Jacksonville
| | - Rebecca Tanner
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
| | | | - Sterling W Sheffield
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Nicole M Marlow
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
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Heitz C, Challen K, Milne WK. Hot off the press: SGEM#383: Tommy can you hear me-Deaf and hard-of-hearing patients in the ED. Acad Emerg Med 2023; 30:216-218. [PMID: 36587391 DOI: 10.1111/acem.14652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023]
Abstract
Patients who are deaf and hard of hearing may have difficulty accessing healthcare resources when compared with non-deaf or hard of hearing patients. Little research has been performed investigating in what ways these difficulties manifest. This article summarizes the podcast and blog discussing the manuscript by James et al. in which deaf and hard of hearing patients are compared to non-deaf and hard of hearing patients when it comes to acuity, length of stay, and emergency department revisits. Social media commentary is included.
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Affiliation(s)
- Corey Heitz
- LewisGale Medical Center, Salem, Virginia, USA
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Narayan N, Schecter A, McKee M, Rotoli J. Deaf Health Pathway - Immersing Medical Students in the Cultural and Language Aspects of Deaf Health. MEDICAL SCIENCE EDUCATOR 2023; 33:11-13. [PMID: 36713277 PMCID: PMC9862222 DOI: 10.1007/s40670-023-01738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Language and cultural-concordant healthcare providers improve health outcomes for deaf patients, yet training opportunities are lacking. The Deaf Health Pathway was developed to train medical students on cultural humility and communication in American Sign Language to better connect with deaf community members and bridge the gap in their healthcare.
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Affiliation(s)
- Neha Narayan
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Arielle Schecter
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI USA
| | - Jason Rotoli
- Department of Emergency Medicine, University of Rochester Medical Center, Box 655, 601 Elmwood Ave, Rochester, NY 14642 USA
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13
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Accommodating hearing loss in outpatient physician offices in the U.S. Disabil Health J 2023; 16:101397. [PMID: 36376146 DOI: 10.1016/j.dhjo.2022.101397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Approximately 16.2 million Americans ages 18 and older (5.7%) report being deaf or having serious difficulty hearing. Hearing loss impedes effective communication during clinical encounters putting patients' safety at risk. A large fraction of Americans with Disabilities Act lawsuits addresses whether providers offered auxiliary aids and services required to ensure effective communication. OBJECTIVE Examine use of different hearing accommodations for deaf or hard of hearing patients by U.S. physicians. METHODS We surveyed randomly selected physicians nationwide representing 7 specialties about their reported use of 8 types of accommodations when communicating with adult outpatients who are deaf or have significant difficulty hearing, even with hearing aids (overall weighted response rate = 61.0%). We performed a descriptive analysis of responses, using survey sampling weights. RESULTS Among the 526 physicians in this analysis, most were male, white, urban, and practiced in community-based practices. Overall, 81.5% (SE = 1.9) reported that patients with significant hearing limitations get worse quality health care than others. Among participants, 49.8% (2.4) reported never using an in-person sign language interpreter hired by the practice, and 63.2% (2.4) never use video remote interpreting. In contrast, 30.7% (2.1) always and 29.8% (2.2) usually speak louder and slower to patients with significant hearing limitations. None of the 8 accommodations were always or usually used by 8.9% (1.3) of participants. CONCLUSIONS More than 32 years after the Americans with Disabilities Act, most physicians do not offer accommodations sufficient to ensure effective communication with adult outpatients with significant hearing limitations.
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14
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James TG, Miller MD, McKee MM, Sullivan MK, Rotoli J, Pearson TA, Mahmoudi E, Varnes JR, Cheong JW. Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: A retrospective chart review. Acad Emerg Med 2022; 29:1290-1300. [PMID: 35904003 PMCID: PMC9671827 DOI: 10.1111/acem.14573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Deaf and hard-of-hearing (DHH) patients are understudied in emergency medicine health services research. Theory and limited evidence suggest that DHH patients are at higher risk of emergency department (ED) utilization and poorer quality of care. This study assessed ED condition acuity, length of stay (LOS), and acute ED revisits among DHH patients. We hypothesized that DHH patients would experience poorer ED care outcomes. METHODS We conducted a retrospective chart review of a single health care system using data from a large academic medical center in the southeast United States. Data were received from the medical center's data office, and we sampled patients and encounters from between June 2011 and April 2020. We compared DHH American Sign Language (ASL) users (n = 108), DHH English speakers (n = 358), and non-DHH English speakers (n = 302). We used multilevel modeling to assess the differences among patient segments in outcomes related to ED use and care. RESULTS As hypothesized, DHH ASL users had longer ED LOS than non-DHH English speakers, on average 30 min longer. Differences in ED condition acuity, measured through Emergency Severity Index and triage pain scale, were not statistically significant. DHH English speakers represented a majority (61%) of acute ED revisit encounters. CONCLUSIONS Our study identified that DHH ASL users have longer ED LOS than non-DHH English speakers. Additional research is needed to further explain the association between DHH status and ED care outcomes (including ED LOS and acute revisit), which may be used to identify intervention targets to improve health equity.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - M. David Miller
- School of Human Development and Organizational Studies in EducationUniversity of FloridaGainesvilleFloridaUSA
| | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Thomas A. Pearson
- Department of EpidemiologyUniversity of FloridaGainesvilleFloridaUSA
| | - Elham Mahmoudi
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Julia R. Varnes
- Department of Health Services Research Management and PolicyUniversity of FloridaGainesvilleFloridaUSA
| | - Jee Won Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
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15
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McKee M, James TG, Helm KVT, Marzolf B, Chung DH, Williams J, Zazove P. Reframing Our Health Care System for Patients With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3633-3645. [PMID: 35969852 PMCID: PMC9802570 DOI: 10.1044/2022_jslhr-22-00052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. METHOD A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. RESULTS These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. CONCLUSIONS The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.
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Affiliation(s)
- Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Tyler G. James
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Kaila V. T. Helm
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Brianna Marzolf
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Dana H. Chung
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - John Williams
- Department of Population Health Science, University of Mississippi Medical Center, Jackson
| | - Philip Zazove
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
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16
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Yet AXJ, Hapuhinne V, Eu W, Chong EYC, Palanisamy UD. Communication methods between physicians and Deaf patients: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2841-2849. [PMID: 35577636 DOI: 10.1016/j.pec.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Deaf individuals often face communication challenges within healthcare settings. Given the importance of the role played by physicians in shaping patients' health outcomes, it is paramount to explore Deaf patient-physician interactions. This research aims to explore (1) the existing communication support and (2) the factors influencing its usage in medical consultations with Deaf patients. METHODS A scoping review was carried out and adhered to the Preferred Reporting System for Meta-Analysis. A comprehensive search strategy of four databases; PubMed, Medline, CINAHL Plus and Scopus, from January 2011 to June 2021 was applied. Thematic analysis was used to analyse the data. RESULTS Ten journal articles were included, and four themes were identified; patient experiences using communication methods, practitioners' cultural competence in Deaf culture, inherent challenges of communication methods, and extrinsic factors. Professional interpreters are often regarded as the preferred modality of communication but writing and lip-reading were commonly used in healthcare settings, with video remote interpreting the least common. CONCLUSION Healthcare professionals need to appreciate the heterogeneity of Deaf patients and their communication methods and adopt a more person-centred approach. PRACTICE IMPLICATIONS This review provides up-to-date insight on Deaf patient-physician interactions and provisional recommendations for practice, education and policy.
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Affiliation(s)
- Andrea Xue Jin Yet
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Sunway, Selangor, Malaysia
| | - Vinuri Hapuhinne
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Sunway, Selangor, Malaysia
| | - Weilyn Eu
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Sunway, Selangor, Malaysia
| | - Elizabeth Yie-Chuen Chong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Sunway, Selangor, Malaysia
| | - Uma Devi Palanisamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Sunway, Selangor, Malaysia.
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17
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Myers MJ, Annis IE, Withers J, Williamson L, Thomas KC. Access to Effective Communication Aids and Services among American Sign Language Users across North Carolina: Disparities and Strategies to Address Them. HEALTH COMMUNICATION 2022; 37:962-971. [PMID: 33541113 DOI: 10.1080/10410236.2021.1878594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the extent to which communication aids and services used by American Sign Language (ASL) users and their healthcare providers aligns with preferences, satisfaction, and unmet needs; and to elicit from stakeholders strategies to address disparities. METHODS A cross-sectional study was conducted of ASL users in North Carolina. Respondents completed an online survey presented in ASL and English (N = 189). McNemar's tests were used to compare rates of preferred and actual methods of communication. Logistic regression models explored relationships of accessible communication with dissatisfaction and unmet need. Qualitative interviews explored satisfaction with communication and reflections on what works, what does not, and outcomes (N = 54). RESULTS While 45% of respondents used a professional sign language interpreter, 65% of respondents preferred to do so. Accessible communication was associated with lower odds of dissatisfaction with communication (OR = .19, p < .05). Dissatisfaction with communication was associated with greater odds of unmet need for healthcare (OR = 8.95, p < .05). Interview respondents emphasized their preference for on-site interpreters, explaining how video remote interpreting was subject to technical difficulties while writing back-and-forth led to important gaps in understanding. CONCLUSIONS While ASL users prefer to use professional, on-site sign language interpreters to communicate with providers, most use some other form of communication instead. Findings emphasize the need for policy strategies to facilitate access to high quality, well-functioning professional interpreter services and to have those services delivered on-site to overcome disparities.
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Affiliation(s)
- Mark J Myers
- Department of Government and Public Affairs, Gallaudet University
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy
| | - Jan Withers
- Division of Services for the Deaf and Hard of Hearing, NCDHHS
| | - Lee Williamson
- Division of Services for the Deaf and Hard of Hearing, NCDHHS
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy
- Division of Research, Mountain Area Health Education Center; Mental Health Services Research Program, UNC Cecil G. Sheps Center for Health Services Research
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18
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Roman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. The Occupational Health and Safety of Sign Language Interpreters Working Remotely During the COVID-19 Pandemic. Prev Chronic Dis 2022; 19:E30. [PMID: 35679479 PMCID: PMC9258443 DOI: 10.5888/pcd19.210462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The COVID-19 pandemic has caused a dramatic shift in work conditions, bringing increased attention to the occupational health of remote workers. We aimed to investigate the physical and mental health of sign language interpreters working remotely from home because of the pandemic. Methods We measured the physical and mental health of certified interpreters who worked remotely 10 or more hours per week. We evaluated associations within the overall sample and compared separate generalized linear models across primary interpreting settings and platforms. We hypothesized that physical health would be correlated with mental health and that differences across settings would exist. Results We recruited 120 interpreters to participate. We calculated scores for disability (mean score, 13.93 [standard error of the mean (SEM), 1.43] of 100), work disability (mean score, 10.86 [SEM, 1.59] of 100), and pain (mean score, 3.53 [SEM, 0.29] of 10). Shoulder pain was most prevalent (27.5%). Respondents had scores that were not within normal limits for depression (22.5%), anxiety (16.7%), and stress (24.2%). Although disability was not associated with depression, all other outcomes for physical health were correlated with mental health (r ≥ 0.223, P ≤ .02). Educational and community/freelance interpreters trended toward greater adverse physical health, whereas educational and video remote interpreters trended toward more mental health concerns. Conclusion Maintaining the occupational health of sign language interpreters is critical for addressing the language barriers that have resulted in health inequities for deaf communities. Associations of disability, work disability, and pain with mental health warrant a holistic approach in the clinical treatment and research of these essential workers.
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Affiliation(s)
- Gretchen Roman
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York.,Clinical and Translational Science Institute and Department of Public Health Sciences, 265 Crittenden Blvd, Rochester, NY 14642.
| | - Vincent Samar
- Department of Liberal Studies, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Deborah Ossip
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Steven Barnett
- Department of Family Medicine, University of Rochester, Rochester, New York
| | - Reza Yousefi-Nooraie
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York
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19
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Moreland CJ, Meeks LM, Nahid M, Panzer K, Fancher TL. Exploring accommodations along the education to employment pathway for deaf and hard of hearing healthcare professionals. BMC MEDICAL EDUCATION 2022; 22:345. [PMID: 35524331 PMCID: PMC9073820 DOI: 10.1186/s12909-022-03403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Deaf and hard of hearing (DHH) people are an underserved population and underrepresented among healthcare professionals. A major barrier to success for DHH healthcare professionals is obtaining effective accommodations during education and employment. Our objective: describe DHH individuals' experiences with accommodations in healthcare education. METHODS We used an online survey and multipronged snowball sampling to recruit participants who identify as DHH and who had applied to a U.S. health professional school (regardless of acceptance status). One hundred forty-eight individuals representing multiple professions responded; 51 had completed their training. Over 80% had been accepted to, were currently enrolled, or had completed health professions schools or residency programs, and/or were employed. The survey included questions addressing experiences applying to health professions programs and employment; satisfaction with accommodations in school and training; having worked with a disability resource professional (DRP); and depression screening. RESULTS Use and type of accommodation varied widely. While in school, respondents reported spending a mean of 2.1 h weekly managing their accommodations. Only 50% were highly satisfied with the accommodations provided by their programs. Use of disability resource providers (DRPs) for accommodations was highest during school (56%) and less frequent during post-graduate training (20%) and employment (14%). Respondents who transitioned directly from school to employment (versus via additional training) were more satisfied with their accommodations during school and were more likely to find employment (p = 0.02). Seventeen respondents screened positive for risk of depression; a positive screen was statistically associated with lower school accommodation satisfaction. CONCLUSIONS DHH people study and practice across many health professions. While respondents were mostly successful in entering health professions programs, accommodation experiences and satisfaction varied. Satisfaction with accommodations was related to successful employment and wellness. Low satisfaction was associated with higher likelihood of depression symptoms. To increase representation in the workforce, healthcare professional schools, training programs, and employers should enhance support for the learning and working climates for people with disabilities.
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Affiliation(s)
- C. J. Moreland
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, 1601 Trinity St, Bldg B, Austin, TX 78712 USA
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA USA
| | - L. M. Meeks
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA USA
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48104-1213 USA
| | - M. Nahid
- General & Internal Medicine, Weil Cornell Medicine, 420 E 70th St., New York, NY 10021 USA
| | - K. Panzer
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48104-1213 USA
| | - T. L. Fancher
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA USA
- Department of Internal Medicine, UC Davis School of Medicine, 4610 X Street, #4101, Sacramento, CA 95817 USA
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20
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Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients: A Retrospective Chart Review. Disabil Health J 2022; 15:101327. [DOI: 10.1016/j.dhjo.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
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21
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Akobirshoev I, McKee MM, Reif S, Adams RS, Li FS, Mitra M. Opioid Use Disorder-Related Emergency Department Visits Among Deaf or Hard of Hearing Adults in the United States. Disabil Health J 2022; 15:101291. [DOI: 10.1016/j.dhjo.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
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22
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James TG, Coady KA, Stacciarini JMR, McKee MM, Phillips DG, Maruca D, Cheong J. "They're Not Willing To Accommodate Deaf patients": Communication Experiences of Deaf American Sign Language Users in the Emergency Department. QUALITATIVE HEALTH RESEARCH 2022; 32:48-63. [PMID: 34823402 DOI: 10.1177/10497323211046238] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Deaf people who use American Sign Language (ASL) are more likely to use the emergency department (ED) than their hearing English-speaking counterparts and are also at higher risk of receiving inaccessible communication. The purpose of this study is to explore the ED communication experience of Deaf patients. A descriptive qualitative study was performed by interviewing 11 Deaf people who had used the ED in the past 2 years. Applying a descriptive thematic analysis, we developed five themes: (1) requesting communication access can be stressful, frustrating, and time-consuming; (2) perspectives and experiences with Video Remote Interpreting (VRI); (3) expectations, benefits, and drawbacks of using on-site ASL interpreters; (4) written and oral communication provides insufficient information to Deaf patients; and (5) ED staff and providers lack cultural sensitivity and awareness towards Deaf patients. Findings are discussed with respect to medical and interpreting ethics to improve ED communication for Deaf patients.
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Affiliation(s)
- Tyler G James
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
| | - Kyle A Coady
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
| | - Jeanne-Marie R Stacciarini
- Department of Family, Community and Health System Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | - Michael M McKee
- Department of Family Medicine, 12266University of Michigan, Ann Arbor, MI, USA
| | | | | | - JeeWon Cheong
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
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23
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James TG, Varnes JR, Sullivan MK, Cheong J, Pearson TA, Yurasek AM, Miller MD, McKee MM. Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412901. [PMID: 34948509 PMCID: PMC8701061 DOI: 10.3390/ijerph182412901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Tyler G. James
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
- Correspondence:
| | - Julia R. Varnes
- Department of Health Services Research, Management, and Policy, University of Florida, P.O. Box 100185, Gainesville, FL 32610, USA;
| | | | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - Thomas A. Pearson
- Department of Epidemiology, University of Florida, P.O. Box 100231, Gainesville, FL 32610, USA;
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - M. David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, P.O. Box 117047, Gainesville, FL 32611, USA;
| | - Michael M. McKee
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
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24
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Moreland CJ, Paludneviciene R, Park JH, McKee M, Kushalnagar P. Deaf adults at higher risk for severe illness: COVID-19 information preference and perceived health consequences. PATIENT EDUCATION AND COUNSELING 2021; 104:2830-2833. [PMID: 33824053 PMCID: PMC8446077 DOI: 10.1016/j.pec.2021.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This study explores deaf and hard of hearing (DHH) individuals' preferred sources of information for COVID-19 and their perceptions of developing severe illness from COVID-19 given underlying medical conditions. METHODS A national online bilingual American Sign Language/English survey was conducted from April 17 to May 1, 2020. Weighted sample of 474 DHH adults living in the United States. Multivariate logistic regression analyses were conducted to examine independent associations of sociodemographic variables and health indicators with perceived COVID-19 health consequences. RESULTS About 44% of the medical condition sample used the Internet (English-based text) first for COVID-19 information, followed by TV (24%). Only 1% selected healthcare provider as the go-to source; the remainder got information from family or friends. Perceived health consequences increased with age (adjusted OR = 1.04; CI 95% = 1.02, 1.06). At-risk respondents who self-identified as persons of color were nearly three times more likely to believe that their health will be severely affected by COVID-19 compared to respondents who self-identified as white (adjusted OR = 2.94; CI 95% = 1.20, 7.18). CONCLUSIONS Perception of COVID-19 health consequences vary among DHH adults at higher risk for severe illness. PRACTICE IMPLICATIONS Information delivery methods must be flexible and comprehensive to meet the diverse community's needs, especially during the COVID-19 pandemic.
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Affiliation(s)
- Christopher J Moreland
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, TX, USA.
| | | | - Jung Hyun Park
- New York University, Silver School of Social Work, New York City, NY, USA
| | - Michael McKee
- University of Michigan at Ann Arbor, Department of Family Medicine, Ann Arbor, MI, USA
| | - Poorna Kushalnagar
- Gallaudet University, Department of Psychology, Washington, DC, USA; Gallaudet University, Center for Deaf Health Equity, Washington, DC, USA
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25
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Lee PH, Spooner C, Harris MF. Access and communication for deaf individuals in Australian primary care. Health Expect 2021; 24:1971-1978. [PMID: 34378292 PMCID: PMC8628593 DOI: 10.1111/hex.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aims The Australian Deaf Community face barriers that impede their access to, and communication within, primary health care settings. This study aimed to identify barriers and facilitators to access and communication for deaf individuals and Auslan interpreters in Australian general practice settings. Methods Semi‐structured interviews were conducted with eight Auslan interpreters and four deaf participants recruited from interpreter organisations and social media. Transcripts of interviews were coded inductively and deductively based on a model of access to health care. Results Patient, provider and contextual factors were reported. Patient barriers included English and Auslan fluency levels within the Australian Deaf Community. GP clinics varied in the degree of accommodation to the needs of deaf people. There were barriers related to the communication methods used by health care providers and their use of interpreters. Visual aids and flexibility in terms of the GP clinics' appointment systems facilitated access. Contextual barriers included the shortage of Auslan interpreters and the complexity of the National Disability Insurance Scheme. Conclusion The main barriers identified concerned the availability of interpreters, accommodation by health providers, cultural sensitivity and the adequacy of communication methods. Research is needed to explore the limitations of the National Disability Insurance Scheme and interventions to improve GPs' skills in communicating with Deaf individuals. Patient or Public Contribution A researcher with a hearing impairment and experience in working with people with hearing impairments was consulted on study design and interview questions. Recruitment was assisted by Auslan interpreter agencies and a Deaf Community Facebook group.
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Affiliation(s)
- Phoebe H Lee
- Faculty of Medicine and Health, Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, New South Wales, Australia
| | - Catherine Spooner
- Faculty of Medicine and Health, Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mark F Harris
- Faculty of Medicine and Health, Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, New South Wales, Australia
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James TG, McKee MM, Sullivan MK, Ashton G, Hardy SJ, Santiago Y, Phillips DG, Cheong J. Community-Engaged Needs Assessment of Deaf American Sign Language Users in Florida, 2018. Public Health Rep 2021; 137:730-738. [PMID: 34161191 DOI: 10.1177/00333549211026782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Deaf American Sign Language (ASL) users comprise a linguistic and cultural minority group that is understudied and underserved in health education and health care research. We examined differences in health risk behaviors, concerns, and access to health care among Deaf ASL users and hearing English speakers living in Florida. METHODS We applied community-engaged research methods to develop and administer the first linguistically accessible and contextually tailored community health needs assessment to Deaf ASL users living in Florida. Deaf ASL users (n = 92) were recruited during a 3-month period in summer 2018 and compared with a subset of data on hearing English speakers from the 2018 Florida Behavioral Risk Factor Surveillance System (n = 12 589). We explored prevalence and adjusted odds of health behavior, including substance use and health care use. RESULTS Mental health was the top health concern among Deaf participants; 15.5% of participants screened as likely having a depressive disorder. Deaf people were 1.8 times more likely than hearing people to engage in binge drinking during the past month. In addition, 37.2% of participants reported being denied an interpreter in a medical facility in the past 12 months. CONCLUSION This study highlights the need to work with Deaf ASL users to develop context-specific health education and health promotion activities tailored to their linguistic and cultural needs and ensure that they receive accessible health care and health education.
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Affiliation(s)
- Tyler G James
- 3463 Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Michael M McKee
- 21614 Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Meagan K Sullivan
- 12234 Florida Disability and Health Program, Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL, USA
| | - Glenna Ashton
- Deaf Community Advisory Workgroup, Gainesville, FL, USA
| | - Stephen J Hardy
- Deaf Community Advisory Workgroup, Gainesville, FL, USA.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Yary Santiago
- Deaf Community Advisory Workgroup, Gainesville, FL, USA.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | | | - JeeWon Cheong
- 3463 Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
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Rotoli JM, Hancock S, Park C, Demers-Mcletchie S, Panko TL, Halle T, Wills J, Scarpino J, Merrill J, Cushman J, Jones C. Emergency Medical Services Communication Barriers and the Deaf American Sign Language User. PREHOSP EMERG CARE 2021; 26:437-445. [PMID: 34060987 DOI: 10.1080/10903127.2021.1936314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: We sought to identify current Emergency Medical Services (EMS) practitioner comfort levels and communication strategies when caring for the Deaf American Sign Language (ASL) user. Additionally, we created and evaluated the effect of an educational intervention and visual communication tool on EMS practitioner comfort levels and communication. Methods: This was a descriptive study assessing communication barriers at baseline and after the implementation of a novel educational intervention with cross-sectional surveys conducted at three time points (pre-, immediate-post, and three months post-intervention). Descriptive statistics characterized the study sample and we quantified responses from the baseline survey and both post-intervention surveys. Results: There were 148 EMS practitioners who responded to the baseline survey. The majority of participants (74%; 109/148) previously responded to a 9-1-1 call for a Deaf patient and 24% (35/148) reported previous training regarding the Deaf community. The majority felt that important details were lost during communication (83%; 90/109), reported that the Deaf patient appeared frustrated during an encounter (72%; 78/109), and felt that communication limited patient care (67%; 73/109). When interacting with a Deaf person, the most common communication strategies included written text (90%; 98/109), friend/family member (90%; 98/109), lip reading (55%; 60/109), and spoken English (50%; 55/109). Immediately after the training, most participants reported that the educational training expanded their knowledge of Deaf culture (93%; 126/135), communication strategies to use (93%; 125/135), and common pitfalls to avoid (96%; 129/135) when caring for Deaf patients. At 3 months, all participants (100%, 79/79) reported that the educational module was helpful. Some participants (19%, 15/79) also reported using the communication tool with other non-English speaking patients. Conclusions: The majority of EMS practitioners reported difficulty communicating with Deaf ASL users and acknowledged a sense of patient frustration. Nearly all participants felt the educational training was beneficial and clinically relevant; three months later, all participants found it to still be helpful. Additionally, the communication tool may be applicable to other populations that use English as a second language.
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Affiliation(s)
- Jason M Rotoli
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Sarah Hancock
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Chanjun Park
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Susan Demers-Mcletchie
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Tiffany L Panko
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Trevor Halle
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Jennifer Wills
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Julie Scarpino
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Johannah Merrill
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Jeremy Cushman
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Courtney Jones
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
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Harris CM, Kotwal S, Wright SM. A Nationwide Study Examining Deafness Among Hospitalized Adults. Am J Audiol 2021; 30:275-280. [PMID: 33823115 DOI: 10.1044/2021_aja-20-00156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background It is unknown whether hospital outcomes differ among nonspeaking deaf patients compared to those without this disability. Objective This article aims to compare clinical outcomes and utilization data among patients with and without deafness. Design This study used a retrospective cohort study. Setting and Participants The participants included Nationwide Inpatient Sample, year 2017, hospitalized adults with and without diagnostic codes related to deafness and inability to speak. Method Multiple logistic and linear regression were used to compare in-hospital outcomes. Results Thirty million four hundred one thousand one hundred seventeen adults were hospitalized, and 7,180 had deafness and inability to speak related coding. Patients with deafness were older (mean age ± SEM: 59.2 ± 0.51 vs. 57.9 ± 0.09 years, p = .01), and less likely female (47.0% vs. 57.7%, p < .01) compared to controls. Those with deafness had more comorbidities compared to the controls (Charlson comorbidity score ≥ 3: 31.2% vs. 27.8%, p < .01). Mortality was higher among deaf versus controls (3.6% vs. 2.2%; p < .01); this translated into higher adjusted odds of mortality (adjusted odds ratio = 1.7. [confidence interval (CI) 1.3-2.4]; p = .01). Deaf patients had lower odds of being discharged home compared to controls {aOR} = 0.6, (CI) 0.55-0.73]; p < .01. Length of stay was longer (adjusted mean difference = 1.5 days CI [0.7-2.3]; p < .01) and hospital charges were higher, but not significantly so (adjusted mean difference = $4,193 CI [-$1,935-$10,322]; p = .18) in patients with deafness. Conclusions Hospitalized nonspeaking deaf patients had higher mortality and longer hospital stays compared to those without this condition. These results suggest that specialized attention may be warranted when deaf patients are admitted to our hospitals in hopes of reducing disparities in outcomes. Supplemental Material https://doi.org/10.23641/asha.14336663.
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Affiliation(s)
- Ché Matthew Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Susrutha Kotwal
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Scott Mitchell Wright
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Affiliation(s)
- Helen Grote
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
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Mitra M, McKee MM, Akobirshoev I, Ritter GA, Valentine AM. Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data. Womens Health Issues 2021; 31:470-477. [PMID: 33888398 DOI: 10.1016/j.whi.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/05/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States. OBJECTIVE To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data. STUDY DESIGN We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics. RESULTS DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained. CONCLUSIONS DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453.
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
| | - Grant A Ritter
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
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Panko TL, Contreras J, Postl D, Mussallem A, Champlin S, Paasche-Orlow MK, Hill J, Plegue MA, Hauser PC, McKee M. The Deaf Community's Experiences Navigating COVID-19 Pandemic Information. Health Lit Res Pract 2021; 5:e162-e170. [PMID: 34213997 PMCID: PMC8241230 DOI: 10.3928/24748307-20210503-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Users of American Sign Language (ASL) who are deaf often face barriers receiving health information, contributing to significant gaps in health knowledge and health literacy. To reduce the spread of coronavirus disease 2019 (COVID-19) and its risk to the public, the government and health care providers have encouraged social distancing, use of face masks, hand hygiene, and quarantines. Unfortunately, COVID-19 information has rarely been available in ASL, which puts the deaf community at a disadvantage for accessing reliable COVID-19 information. OBJECTIVE This study's primary objective was to compare COVID-19-related information access between participants who are deaf and participants who are hearing. METHODS The study included 104 adults who are deaf and 74 adults who are hearing who had participated in a prior health literacy study. Surveys were conducted between April and July 2020 via video conference, smartphone apps, or phone calls. COVID-19 data were linked with preexisting data on demographic and health literacy data as measured by the Newest Vital Sign (NVS) and the ASL-NVS. KEY RESULTS Neither group of participants differed in their ability to identify COVID-19 symptoms. Adults who are deaf were 4.7 times more likely to report difficulty accessing COVID-19 information (p = .011), yet reported using more preventive strategies overall. Simultaneously, adults who are deaf had 60% lower odds of staying home and calling their doctor versus seeking health care immediately or doing something else compared with participants who are hearing if they suspected that they had COVID-19 (p = .020). CONCLUSIONS Additional education on recommended COVID-19 management and guidance on accessible health care navigation strategies are needed for the deaf community and health care providers. Public health officials should ensure that public service announcements are accessible to all audiences and should connect with trusted agents within the deaf community to help disseminate health information online in ASL through their social media channels. [HLRP: Health Literacy Research and Practice. 2021;5(2):e162-e170.] Plain Language Summary: Compared to participants who are hearing, a higher portion of participants who are deaf reported challenges with accessing, understanding, and trusting COVID-19 information. Although respondents who are deaf had similar knowledge of symptoms compared to participants who are hearing, they used more prevention strategies and were more likely to plan immediate care for suspected symptoms. Improved guidance on COVID-19 management and health care navigation accessible to the deaf community is needed.
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Affiliation(s)
- Tiffany L. Panko
- Address correspondence to Tiffany L. Panko, MD, MBA, NTID Research Center on Culture and Language, Rochester Institute of Technology, 52 Lomb Memorial Drive, Rochester, NY 14623;
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Communicating With the American Sign Language User in the Emergency Department. J Emerg Nurs 2020; 47:16-17. [PMID: 33183771 DOI: 10.1016/j.jen.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
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Giegerich V, Hall AK, Cureton JL, McCartney J, Geething K. Teaching Interpreted Counseling Practice: A Step Toward Multicultural Competence. COUNSELOR EDUCATION AND SUPERVISION 2020. [DOI: 10.1002/ceas.12182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Victoria Giegerich
- School of Lifespan Development and Educational Sciences Kent State University
- Now at Department of Counseling and Human Development Malone University
| | - Alicia K. Hall
- School of Lifespan Development and Educational Sciences Kent State University
| | - Jenny L. Cureton
- School of Lifespan Development and Educational Sciences Kent State University
| | - Jamie McCartney
- School of Lifespan Development and Educational Sciences Kent State University
| | - Kathy Geething
- School of Lifespan Development and Educational Sciences Kent State University
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Meeks LM, Poullos P, Swenor BK. Creative Approaches to the Inclusion of Medical Students With Disabilities. AEM EDUCATION AND TRAINING 2020; 4:292-297. [PMID: 32704601 PMCID: PMC7369494 DOI: 10.1002/aet2.10425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 05/29/2023]
Affiliation(s)
- Lisa M. Meeks
- Department of Family MedicineThe University of Michigan Medical SchoolAnn ArborMI
| | - Peter Poullos
- Departments of Radiology and Gastroenterology and HepatologyStanford University Medical CenterPalo AltoCA
| | - Bonnielin K. Swenor
- Wilmer Eye InstituteJohns Hopkins School of Medicine and Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Fuentes-López E, Fuente A. Access to healthcare for deaf people: a model from a middle-income country in Latin America. Rev Saude Publica 2020; 54:13. [PMID: 32022141 PMCID: PMC6986863 DOI: 10.11606/s1518-8787.2020054001864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if there are existing healthcare access inequities among the deaf Chilean population when compared to the general Chilean population. METHODS Data were obtained from a population-based national survey in Chile. In total, 745 prelingually deaf individuals were identified. The number of times the person used the healthcare system was dichotomized and analyzed using a multivariate logistic regression model. RESULTS Prelingually deaf people had lower incomes, fewer years of education, and greater rates of unemployment and poverty when compared with the general population. Moreover, they visited more general practitioners, mental health specialists, and other medical specialists. On average, they attended more appointments for depression but had fewer general checkups and gynecological appointments than the general population. CONCLUSIONS Deaf people in Chile have a lower socioeconomic status than the rest of the Chilean population. The results from this study are similar to the findings reported for high-income countries, despite differences in the magnitude of the associations between being deaf and healthcare access. Further studies should be conducted to determine the health status of deaf people in Chile and other Latin American countries and what factors are associated with a significantly lower prevalence of gynecological appointments among deaf women when compared with non-deaf women.
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Affiliation(s)
- Eduardo Fuentes-López
- Pontificia Universidad Católica de ChileFacultad de MedicinaDepartamento de Ciencias de la SaludSantiagoChilePontificia Universidad Católica de Chile. Facultad de Medicina. Departamento de Ciencias de la Salud. Santiago, Chile
| | - Adrian Fuente
- Université de MontréalFaculté de médecineÉcole d’orthophonie et d’audiologieMontréalQuébecCanadaUniversité de Montréal. Faculté de médecine. École d’orthophonie et d’audiologie. Montréal, Québec, Canada,Centre de recherchel’Institut universitaire de gériatrie de MontréalMontréalQuébecCanadaCentre de recherche de l’Institut universitaire de gériatrie de Montréal. Montréal, Québec, Canada
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Romero RL, Kates F, Hart M, Ojeda A, Meirom I, Hardy S. Quality of Deaf and Hard-of-Hearing Mobile Apps: Evaluation Using the Mobile App Rating Scale (MARS) With Additional Criteria From a Content Expert. JMIR Mhealth Uhealth 2019; 7:e14198. [PMID: 31670695 PMCID: PMC6913732 DOI: 10.2196/14198] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The spread of technology and dissemination of knowledge across the World Wide Web has prompted the development of apps for American Sign Language (ASL) translation, interpretation, and syntax recognition. There is limited literature regarding the quality, effectiveness, and appropriateness of mobile health (mHealth) apps for the deaf and hard-of-hearing (DHOH) that pose to aid the DHOH in their everyday communication and activities. Other than the star-rating system with minimal comments regarding quality, the evaluation metrics used to rate mobile apps are commonly subjective. OBJECTIVE This study aimed to evaluate the quality and effectiveness of DHOH apps using a standardized scale. In addition, it also aimed to identify content-specific criteria to improve the evaluation process by using a content expert, and to use the content expert to more accurately evaluate apps and features supporting the DHOH. METHODS A list of potential apps for evaluation was generated after a preliminary screening for apps related to the DHOH. Inclusion and exclusion criteria were developed to refine the master list of apps. The study modified a standardized rating scale with additional content-specific criteria applicable to the DHOH population for app evaluation. This was accomplished by including a DHOH content expert in the design of content-specific criteria. RESULTS The results indicate a clear distinction in Mobile App Rating Scale (MARS) scores among apps within the study's three app categories: ASL translators (highest score=3.72), speech-to-text (highest score=3.6), and hard-of-hearing assistants (highest score=3.90). Of the 217 apps obtained from the search criteria, 21 apps met the inclusion and exclusion criteria. Furthermore, the limited consideration for measures specific to the target population along with a high app turnover rate suggests opportunities for improved app effectiveness and evaluation. CONCLUSIONS As more mHealth apps enter the market for the DHOH population, more criteria-based evaluation is needed to ensure the safety and appropriateness of the apps for the intended users. Evaluation of population-specific mHealth apps can benefit from content-specific measurement criteria developed by a content expert in the field.
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Affiliation(s)
- Ryan Lee Romero
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Frederick Kates
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Mark Hart
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Amanda Ojeda
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Itai Meirom
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Stephen Hardy
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
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Wells TS, Nickels LD, Rush SR, Musich SA, Wu L, Bhattarai GR, Yeh CS. Characteristics and Health Outcomes Associated With Hearing Loss and Hearing Aid Use Among Older Adults. J Aging Health 2019; 32:724-734. [PMID: 31092107 PMCID: PMC7586498 DOI: 10.1177/0898264319848866] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: This study recruited older adults to explore physical and
psychosocial conditions and other health outcomes associated with hearing loss (HL) and
hearing aid use. Method: Survey data were used to categorize 20,244
participants into five groups: no HL, unaided mild HL, aided mild HL, unaided severe HL,
and aided severe HL. Results: Individuals with unaided severe HL were more
likely to report poor-fair self-rated health and were less likely to leave the home, or
exercise 4 to 7 days per week, while there were no such associations for those with aided
mild or severe HL. In addition, those with aided hearing were less likely to report
depression, low social support, or mobility limitations. Discussion: In
several instances, hearing aid use reduced associations between HL and negative
psychosocial and physical characteristics, and health outcomes. More research using
longitudinal study designs is needed to better understand the true implications of these
findings.
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Affiliation(s)
- Timothy S. Wells
- Optum, Ann Arbor, MI, USA
- Timothy S. Wells, Associate Director, Research for
Aging Populations, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, USA.
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Meeks LM, Engelman A, Booth A, Argenyi M. Deaf and Hard-of-Hearing Learners in Emergency Medicine. West J Emerg Med 2018; 19:1014-1018. [PMID: 30429935 PMCID: PMC6225942 DOI: 10.5811/westjem.2018.8.38550] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/11/2022] Open
Abstract
Approximately 23% of Americans over age 12 have some level of hearing loss.1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities' commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice. In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication.
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Affiliation(s)
- Lisa M. Meeks
- University of Michigan, Department of Family Medicine, Ann Arbor, Michigan
| | - Alina Engelman
- California State University, East Bay, Department of Health Sciences, Hayward, California
| | | | - Michael Argenyi
- University of Massachusetts Medical School, Department of Family Medicine and Community Health, Worcester, Massachusetts
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Hall WC, Smith SR, Sutter EJ, DeWindt LA, Dye TDV. Considering parental hearing status as a social determinant of deaf population health: Insights from experiences of the "dinner table syndrome". PLoS One 2018; 13:e0202169. [PMID: 30183711 PMCID: PMC6124705 DOI: 10.1371/journal.pone.0202169] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
The influence of early language and communication experiences on lifelong health outcomes is receiving increased public health attention. Most deaf children have non-signing hearing parents, and are at risk for not experiencing fully accessible language environments, a possible factor underlying known deaf population health disparities. Childhood indirect family communication–such as spontaneous conversations and listening in the routine family environment (e.g. family meals, recreation, car rides)–is an important source of health-related contextual learning opportunities. The goal of this study was to assess the influence of parental hearing status on deaf people’s recalled access to childhood indirect family communication. We analyzed data from the Rochester Deaf Health Survey–2013 (n = 211 deaf adults) for associations between sociodemographic factors including parental hearing status, and recalled access to childhood indirect family communication. Parental hearing status predicted deaf adults’ recalled access to childhood indirect family communication (χ2 = 31.939, p < .001). The likelihood of deaf adults reporting “sometimes to never” for recalled comprehension of childhood family indirect communication increased by 17.6 times for those with hearing parents. No other sociodemographic or deaf-specific factors in this study predicted deaf adults’ access to childhood indirect family communication. This study finds that deaf people who have hearing parents were more likely to report limited access to contextual learning opportunities during childhood. Parental hearing status and early childhood language experiences, therefore, require further investigation as possible social determinants of health to develop interventions that improve lifelong health and social outcomes of the underserved deaf population.
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Affiliation(s)
- Wyatte C. Hall
- Obstetrics & Gynecology and Clinical & Translational Science Institute, University of Rochester Medical Center, Rochester, New York, United States of America
- * E-mail:
| | - Scott R. Smith
- Office of the Associate Dean of Research, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York, United States of America
| | - Erika J. Sutter
- National Center for Deaf Health Research, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Lori A. DeWindt
- National Center for Deaf Health Research, University of Rochester Medical Center, Rochester, New York, United States of America
- Deaf Wellness Center, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Timothy D. V. Dye
- Obstetrics & Gynecology and Clinical & Translational Science Institute, University of Rochester Medical Center, Rochester, New York, United States of America
- Pediatrics and Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
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Pertz L, Plegue M, Diehl K, Zazove P, McKee M. Addressing Mental Health Needs for Deaf Patients Through an Integrated Health Care Model. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2018; 23:240-248. [PMID: 29562357 DOI: 10.1093/deafed/eny002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
Deaf individuals struggle with accessing mental health services because of language and cultural discordance. Our project's purpose was to design and pilot an accessible, integrated mental health program for the Deaf population, scalable for other health centers interested in serving these individuals. Our team addressed several identified barriers to care. The addition of a language-concordant mental health clinician and telemental health appointments helped us better manage Deaf patients' mental health needs. Individual and clinic level data were collected and analyzed. Results demonstrated a significant improvement in the patients' depression and anxiety scores from their baseline to their last documented visit. Patient satisfaction overall was high. Telemental health appears to be a feasible tool to address some of the mental health gaps in the Deaf community. Further studies are needed to demonstrate how this program can be effective within a larger geographical area.
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Barriers and Facilitators of Health Literacy among D/deaf Individuals: A Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:1465-1474. [PMID: 29167764 PMCID: PMC5696685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The implication of health literacy is the ability of individuals to find, understand, and use their required health information from reliable sources. It is an indicator of the individuals' participation in their own medical decision-making. Deaf individuals have limited health literacy and poor health status due to low literacy. Hence, this review was conducted to understand barriers and facilitators influencing health literacy among deaf community. METHODS We searched the ISI Web of Sciences, Scopus, and Medline from 1987 to 2016. Seventy-three papers were analyzed thematically. RESULTS We found three primary themes, including inadequate health literacy, barriers, and facilitators to accessing health information and health care services among deaf individuals. Facilitators were composed of four sub-theme including legal activities protecting the right of deaf patients to accessing health services, training health professionals about effective communication with deaf patients, providing sign language interpreter services, and developing deaf-tailored educational health programs and materials. CONCLUSION Closing the deaf cultural gap and their limited access to health information are achievable through the removal of the communication barriers, allowing deaf individuals with more access to health learning opportunities, and informing the hearing community about the communicative skills of deaf individuals.
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Pendergrass KM, Nemeth L, Newman SD, Jenkins CM, Jones EG. Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users. J Am Assoc Nurse Pract 2017; 29:316-323. [DOI: 10.1002/2327-6924.12461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/07/2022]
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Birth Outcomes Among U.S. Women With Hearing Loss. Am J Prev Med 2016; 51:865-873. [PMID: 27687529 PMCID: PMC9397576 DOI: 10.1016/j.amepre.2016.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/09/2016] [Accepted: 08/02/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The purpose of this study is to estimate the national occurrence of deliveries in women with hearing loss and to compare their birth outcomes to women without hearing loss. METHODS This study examined the 2008-2011 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project in 2015 to compare birth outcomes in women with hearing loss and without. Birth outcomes included preterm birth and low birth weight. Multivariate regression analyses compared birth outcomes between women with and without hearing loss, controlling for maternal age, racial and ethnic identity, type of health insurance, comorbidity, region of hospital, location and teaching status of the hospital, ownership of the hospital, and median household income for mother's ZIP code. RESULTS Of an estimated 17.9 million deliveries, 10,462 occurred in women with hearing loss. In adjusted regression analyses controlling for demographic characteristics, women with hearing loss were significantly more likely than those without hearing loss to have preterm birth (OR=1.28, 95% CI=1.08, 1.52, p<0.001) and low birth weight (OR=1.43, 95% CI=1.09, 1.90, p<0.05). CONCLUSIONS This study provides a first examination of the pregnancy outcomes among women with hearing loss in the U.S. This analysis demonstrates significant disparities in birth outcomes between women with and without hearing loss. Understanding and addressing the causes of these disparities is critical to improving pregnancy outcomes among women with hearing loss.
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Smith SR, Samar VJ. Dimensions of Deaf/Hard-of-Hearing and Hearing Adolescents' Health Literacy and Health Knowledge. JOURNAL OF HEALTH COMMUNICATION 2016; 21:141-154. [PMID: 27548284 PMCID: PMC5073377 DOI: 10.1080/10810730.2016.1179368] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Deaf and hard-of-hearing (D/HH) adults have lower health literacy compared to hearing adults, but it is unclear whether this disparity also occurs in adolescence. We used the Health Literacy Skills Instrument-Short Form (HLSI-SF), Short Form of the Test of Functional Health Literacy in Adults (S-TOFHLA), Comprehensive Heart Disease Knowledge Questionnaire (CHDKQ), and newly constructed interactive and critical health literacy survey items to quantify D/HH and hearing adolescents' health literacy. We adapted and translated survey materials into sign language and spoken English to reduce testing bias due to variable English language skills. Participants were 187 D/HH and 94 hearing college-bound high school students. When we adjusted for age, gender, race/ethnicity, school grade, and socioeconomic status, D/HH adolescents demonstrated weaker general and functional health literacy and cardiovascular health knowledge than hearing adolescents on the HLSI, S-TOFHLA, and CHDKQ (all ps < .0001). Standard health literacy or knowledge scores were associated with several interactive and critical health literacy skills (all ps < .05). D/HH adolescents who reported greater hearing-culture identity, having hearing aids, experiencing better hearing with assistive devices, having good quality of communication with parents, and attending hearing schools at least half of the time had higher functional health literacy (all ps < .025). Those who reported English as their best language and attending hearing schools at least half of the time had higher cardiovascular health knowledge scores (all ps < .03). Results suggest that interventions to improve D/HH adolescents' health literacy should target their health-related conversations with their families; access to printed health information; and access to health information from other people, especially health care providers and educators.
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Affiliation(s)
- Scott R. Smith
- National Technical Institute for the Deaf at Rochester Institute of Technology
| | - Vincent J. Samar
- National Technical Institute for the Deaf at Rochester Institute of Technology
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