Critical health literacy in American deaf college students

Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients

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.

Exploring the health literacy status of people with hearing impairment: a systematic review

BACKGROUND

People with hearing impairment have many problems with healthcare use, which is associated with health literacy. Research on health literacy is less focused on people with hearing impairments. This research aimed to explore the levels of health literacy in people with hearing impairment, find the barriers to health literacy, and summarize methods for improving health literacy.

METHODS

A systematic review was conducted using three databases (PubMed, Cochrane, and Embase) to search the relevant articles and analyze them. The studies were selected using pre-defined inclusion/exclusion criteria in two steps: first, selection by examining the title and abstract; and second, after reading the study in full. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was used to assess the quality of the articles.

RESULTS

Twenty-nine studies were synthesized qualitatively. Individuals with hearing impairment were found to have lower health literacy, when compared to those without impairment, which can lead to a higher medical cost. Most of the people with hearing impairment faced barriers to obtaining health-related information and found it difficult to communicate with healthcare providers. To improve their health literacy, it is essential to explore new ways of accessing health information and improving the relationship between patients and healthcare providers.

CONCLUSIONS

Our findings show that people with hearing impairment have lower health literacy than those without. This suggests that developing new technology and policies for people with hearing impairment is necessary not to mention promoting provision of information via sign language.

TRIAL REGISTRATION

OSF: https://doi.org/10.17605/OSF.IO/V6UGW .

PROSPERO ID

CRD42023395556.

Medication-Related Experience of Deaf American Sign Language Users

BACKGROUND

Previous studies showed that deaf and hard-of-hearing (DHH) individuals have low health literacy related to prescription labels. This study examined the DHH's experience with understanding prescription labels and how technology can impact that experience.

OBJECTIVES

The purpose of this qualitative study was twofold: (1) gain a more enhanced understanding of DHH experiences in understanding prescription labels with a focus on language needs, expectations, and preferences, and (2) assess the potential role of technology in addressing the communication-related accessibility issues which emerge from the data.

METHODS

In this study, 25 Deaf American Sign Language users who picked up a prescription from a pharmacy within the past year were interviewed. A thematic analysis, which included a systematic coding process, was used to uncover themes about their experiences picking up and using prescription medications.

KEY RESULTS

Thematic analyses identified that medication-related experiences centered around themes: (1) medication information seeking; (2) comfort taking medication; (3) picking up medication; and (4) communication with the pharmacy team. A large contributor to the communication experience was the perception that the pharmacist was not being respectful. Regarding comfort taking medications, 12% of participants expressed a lack of understanding medications while taking medication. This led to participants largely using online resources when seeking medication information. This study also found that technology greatly aided the participants during this experience.

CONCLUSION

This study recorded the experiences within the context of limited health literacy and aversive audism found that the DHH individual repeatedly encountered communication barriers, which may contribute to their poor medication literacy. Thus, future studies should explore how to leverage the potential benefits of technology to improve the pharmacy experience of the DHH, thereby improving medication literacy. [HLRP: Health Literacy Research and Practice. 2023;7(4):e215-e224.].

Functional Health Literacy Among Chinese Populations and Associated Factors: Latent Class Analysis

BACKGROUND

Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one's health condition and its management, and higher use of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, the literature review shows that no studies of functional health literacy have been conducted among the Chinese population in China.

OBJECTIVE

This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy to provide some implications for health education, medical research, and public health policy making.

METHODS

We hypothesized that the participants' functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a four-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, the eHealth Literacy Scale, and the 6-item General Health Numeracy Test); and (4) health beliefs and self-confidence measured by the Multidimensional Health Locus of Control Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we used latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy.

RESULTS

All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. Applying latent class analysis, we classified Chinese populations into low (n=292, 36.5%), moderate-to-adequate (n=286, 35.7%), and low-to-moderate (n=222, 27.8%) functional health literacy groups and identified five factors associated with low communicative health literacy: (1) male gender (aged 40-49 years), (2) lower educational attainment (below diploma), (3) age between 38 and 68 years, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck.

CONCLUSIONS

We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy making.

Application of the truth and reconciliation model to meaningfully engage deaf sign language users in the research process

OBJECTIVES

One of the most underrepresented public health populations is the U.S. Deaf community-a minority group of 500,000 + individuals who communicate using American Sign Language (ASL). Research on Deaf health outcomes is significantly lacking due to inaccessible research procedures and mistrust of researchers that stems from historical mistreatment of Deaf people (i.e., Audism).

METHODS

Following the Truth and Reconciliation Model, we hosted three Deaf community forums between October and November 2016 across New England. We invited attendees to share their experiences in the research world and make recommendations about how researchers can better include Deaf people in their studies. A select group of hearing researchers served as representatives of the research community and to issue a formal apology on behalf of this community.

RESULTS

Forum attendees (n = 22; 5% racial/ethnic minority; 59% female) emphasized the following themes: Research conducted within general population samples is not an activity in which Deaf people can or will be included; a general mistrust of hearing people, including hearing researchers; researchers' frequent failure to communicate study results back to the Deaf community or the community-at-large; and a tendency of researchers to directly benefit from data provided by Deaf participants, without making any subsequent efforts to return to the community to give back or provide useful intervention.

CONCLUSIONS

Many injustices and forms of mistreatment are still ongoing; therefore, we recognize that our team's efforts to foster an open dialogue between the research community and the Deaf community must be an ongoing, iterative practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Turkish Sign Language Adaptation of the Turkish Health Literacy Scale-32

Sign language speakers are at a disadvantage in terms of health literacy due to the lack of health education materials in sign languages. Deaf and hard of hearing (DHH) individuals are excluded from health literacy research due to the lack of measurement tools in their language of excellent fluency. This study aims to provide the literature with a tool that allows the measurement of health literacy among DHH individuals. The Turkish Health Literacy Scale (THLS)-32 was translated into Turkish Sign Language (TSL). After the THLS-32 was translated into TSL in video format, it was tested for validity and reliability. The translated version of the scale was administered to participants from a DHH association in Turkey who are fluent in TSL. Subsequently, a study was conducted with 207 DHH individuals. The study group was assessed in terms of their mean index scores and evaluated to have "limited health literacy" according to the THLS-32 classification. We conclude that the THLS-32 in TSL is suitable to measure health literacy in DHH individuals and to assess the impact of the health education system.

Development of a Health Behavior Screening Tool for Deaf College Students

Young adults who are Deaf or Hard-of-Hearing (D/HH) face behavioral health risks similar to hearing adults. Despite the emphasis on health behavior screening in health care settings, a brief screening tool in American Sign Language (ASL) does not exist. This manuscript describes the development and pilot testing of an online survey in ASL called the Deaf Health Behavior Report. The Deaf Health Behavior Report includes standardized questions for general health, health behaviors, and psychosocial topics. We invited all D/HH students at a university in Southern California to complete the Deaf Health Behavior Report. A total of 31 D/HH students completed the survey. The most prevalent health risks were related to nutrition, stress, and binge drinking. The Deaf Health Behavior Report is a useful tool for health promotion efforts on college campuses and in general health settings.

Health Literacy Among University Students: A Systematic Review of Cross-Sectional Studies

OBJECTIVE

The aim of this systematic review was to provide an overview of cross-sectional studies that examined health literacy among university students and to identify possible determinants related to health literacy.

METHOD

The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three databases (PubMed, Scopus, and Web of Science) were systematically searched for cross-sectional studies that examined health literacy among university students. Results of included studies were narratively summarized.

RESULTS

The systematic review includes twenty-one research studies. The majority of studies report health literacy scores among university students that are lower compared to reference samples. The health literacy of students is influenced by different variables (age, gender, number of semesters, course of studies/curriculum, parental education, and socioeconomic background).

DISCUSSION

Health literacy activities should target all students. Universities should make use of their resources and offer health literacy courses for students in which content is used from disciplines available at the university (e.g., medicine, health, or psychology). To increase effectiveness, health literacy courses should be adapted according to the different needs and characteristics of the student subgroups.

Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review

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.

Deaf adults at higher risk for severe illness: COVID-19 information preference and perceived health consequences

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.

Developing Signs of Safety: A Deaf-accessible counselling toolkit for trauma and addiction

The U.S. Deaf community-more than half a million Americans who communicate using American Sign Language (ASL)-experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet there are no evidence-based treatments for any behavioural health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf-accessible trauma/SUD counselling approach. Here we describe our initial intervention development work and a single-arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of Signs of Safety-a Deaf-accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (Seeking Safety). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the Seeking Safety/Signs of Safety model. Frequency of drug use did not change significantly-likely attributable to the mid-study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of Signs of Safety based on pilot participant feedback, again using a Deaf-engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned.

Primary non-communicable disease prevention and communication barriers of deaf sign language users: a qualitative study

BACKGROUND

Deaf sign language users have lower health literacy and poorer access to non-communicable disease prevention information as compared to the general population. The aim was to explore disease concepts embedded in signs, primary non-communicable disease prevention behaviour and communication barriers among members of a deaf community.

METHODS

A qualitative study with a social constructivist approach was conducted to explore perspectives of deaf sign language users.15 individuals, two with and 13 without history of diabetes were recruited for semi-structured in-depth interviews in sign language at a deaf community center. The interviews were video-recorded, translated and analyzed using thematic content analysis.

RESULTS

Diabetes as one of the main non-communicable diseases is conceptualized differently in the manual component of signs depending on how deaf sign language users construct diabetes pathophysiologically. The disease conceptualization is not represented in the mouthing component. Health information seeking behavior varies among deaf sign language users and depends on their individual spoken and written language literacy. Overcoming communication barriers is key for developing an understanding of diabetes and other non-communicable disease prevention activities.

CONCLUSIONS

To develop barrier-free and inclusive non-communicable disease and diabetes prevention strategies for deaf sign language users, health professionals need to pay attention to sign language specific linguistic concepts. More studies are needed to better understand the specific needs of sign language users and effective strategies in health promotion contexts for sign language users.

Pre-Exposure Prophylaxis Knowledge and Perceived Effectiveness to Prevent HIV Among Deaf Gay, Bisexual, and Queer Men

Purpose: There have been recent advances to the adoption of pre-exposure prophylaxis (PrEP) as an effective human immunodeficiency virus (HIV) preventive treatment among men who have sex with men, but PrEP services and resources are often not accessible to those who are deaf and use American Sign Language (ASL). This article investigates PrEP knowledge among deaf gay, bisexual, and queer (GBQ) men and the contribution of social support to their perceptions regarding the effectiveness of PrEP at preventing HIV. Methods: An online health survey in ASL and English included questions about sexual orientation, HIV testing, PrEP knowledge and perceived effectiveness at preventing HIV, coming out to healthcare providers, and social support. We gathered data from 121 deaf GBQ men recruited from diverse cities in the United States, with 87% self-identifying as gay. Logistic regression analyses were used to examine the relationships between self-reported level of social support and perceived effectiveness of PrEP at preventing HIV after controlling for sociodemographic and health-related variables. Results: There was a significant relationship between meeting new lesbian, gay, bisexual, transgender, and queer (LGBTQ) friends online and PrEP knowledge (χ² = 14.93; p < 0.001). After controlling for sociodemographic and health-related variables, those who discussed LGBT-related issues online and/or on a social networking site regularly were threefold more likely to perceive PrEP as being effective at preventing HIV than those who did not engage in online discussions (odds ratio = 3.12; 95% confidence interval: 1.12-8.75). Conclusion: For deaf GBQ men, PrEP knowledge might be attained through meeting and making new LGBTQ friends online. Active engagement in online discussions about LGBT-related issues might enhance perceptions regarding the effectiveness of PrEP to prevent HIV.

Prevalence of Self-Reported Hypertension in Deaf Adults Who Use American Sign Language

BACKGROUND

In the United States, roughly one-third of adults have hypertension; another third have prehypertension. The prevalence of hypertension in deaf American Sign Language (ASL) users is unknown. We address this gap through a descriptive study for the prevalence of hypertension in the American Deaf community and discuss future directions to address this issue.

METHODS

Self-reported data for 1,388 ASL using deaf adults were compared with a secondary data of 2,830 English-speaking hearing adults. Frequency and percentages were used to describe the prevalence of hypertension in the deaf community. Age-weighted analysis was used to compare unmodifiable risk factors and hypertension rate between deaf and hearing adults.

RESULTS

Deaf and hearing samples' hypertension rates for gender and age were similar. Significant group differences between deaf and hearing samples emerged across race. Compared with the hearing controls, our deaf sample demonstrated a significantly decreased risk for hypertension with a prevalence of 37% (compared with 45% in the hearing sample).

CONCLUSIONS

Although the hypertension rate for gender and age was similar across deaf and hearing samples, between-group disparities exist for race. The lower rate of hypertension in our deaf sample is likely a consequence of underdiagnoses due to lower health literacy and poor patient-physician communication. Furthermore, deaf black Americans' lower rates compared with hearing black Americans may be due to poor patient-physician communication, not having regular providers or social stressors. It is recommended that modifiable risk factors and social determinants be investigated to determine their effect on hypertension within the deaf community.

Towards Health Equity: Deaf Adults' Engagement in Social e-Health Activities and e-Communication with Health Care Providers

Deaf people face significant barriers with accessing health information, health care services, and communication with their health care provider and as a result, show poorer health outcomes compared to the general population. Studies on the general population found that those who use social network sites (SNS) for health-related activities were more likely to communicate with their health care provider via the Internet or email. For deaf individuals who use American Sign Language (ASL), using eHealth platforms to communicate with health care providers has the potential to navigate around communication barriers and create greater opportunity to discuss screening and treatment plans. Using national data from the HINTS-ASL survey, we explored whether engagement in social eHealth activities on SNS is linked to electronic communication with health care providers after controlling for deaf patient characteristics. Our sample for this study consisted of 515 deaf participants who reported using (social media/SNS) to read and share health information. Controlling for sociodemographic variables, participants who engaged in social eHealth activity were threefold more likely to communicate with their healthcare provider electronically. Using eHealth platforms for social health engagement demonstrates potential to reduce health inequality among deaf people.