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Towards a treatment for treatment: on communication between general practitioners and their deaf patients
Abstract
This study investigates the nature and extent of communication problems between hearing physicians and their deaf or hard-of-hearing patients. Thirty-two deaf and hard-of-hearing patients and their general practitioners were asked to fill in questionnaires regarding communication during the consultations. The authors were interested in (i) the physicians’ evaluation of their ability to explain the diagnosis and treatment to the patient; (ii) the patients’ evaluation of the degree to which they understand the information supplied by the physician; and (iii) the rating given by the physicians and patients regarding the quality of communication. They were also interested in factors that might influence the communication. In this context, the authors discuss linguistic and cultural issues and address the role of interpreting services. The results indicate that there are worrying problems in the communication between (general) practitioners and their deaf and hard-of-hearing patients. The nature of these communication problems is comparable to those previously described for the interaction between general practitioners and patients from an ethnic minority group.
... Depending on the degree and age of deafness onset, communication modalities and social integration, the hardof-hearing (HH) individuals evolve differently and encounter multiple types and levels of daily life challenges. For instance, even in developed countries, adherence to primary care by deaf people is still very challenging despite the growing number of Deaf health programs and research initiative [2,3]. ...
... Many of the Lebanese physicians are unaware of the Deaf culture and the health needs of deaf people as they may have a biologic basis for their hearing loss, leading to assumptions and misconceptions about deafness that undermine professional health care. For example, practitioners often believe that lip /speech reading and note writing provide effective health communication, whereas in reality, these are ineffective communication modalities for healthcare conversations [3,7]. The Deaf favor sign language and only a few can manage to fully understand lip or speech reading,: 30-45% of spoken English [26], 25% of spoken French [27], and only 14% of the LDP can manage to read lips. ...
People with disabling hearing disabilities face multiple levels of daily-life challenges where access to services and information remain difficult. In Lebanon, no data is available about the hard-of-hearing individuals. The aim of the study is to reflect the current situation of the Deaf community in Lebanon, to compare it with that of the general Lebanese population and propose practical ways to improve their national status and quality of care. A snowball sampling method was used to recruit hard-of-hearing individuals over the age of eighteen, via institutions and schools for the Deaf. Participants were asked to anonymously fill a qualitative questionnaire, individually or in groups in the presence of interpreters. The analysis was descriptive, and 95% binomial exact confidence intervals were constructed to compare parameters with those of the general population. Deaf adults in Lebanon have poorer socioeconomic conditions, lower literacy levels and limited access to information. However, they appear to be physically healthier than the general population while presenting frequent mental health problems and facing discrimination and poorer access to services. There still is no valid data available about the Deaf community in Lebanon. Hard-of-hearing people remain underserved by the current Lebanese healthcare, education, employment and public systems.
... That explains why the majority of the participants strongly agreed that the sign language interpretation cost has to be fully paid by the State (p=0.05). Smeijers and Pfau also reported this matter in their study [39], where the deaf avoided hiring interpreters for short consultations, given the limited funds made available by the government of the Netherlands. In order to achieve equity of access, it has been recommended in the literature that there should be a permanently available sign language interpreter in every hospital. ...
... Another reason for the inequalities in access to health services that the deaf are facing [27], is the lack of deaf awareness from health professionals [39,40]. When the preferred communication method for a patient with hearing loss is sign language, the presence of the interpreter is also useful for the physician himself, as effective communication is crucial for the explanation of the treatment he recommends, following an adequate clinical assessment and diagnosis [21,41]. ...
Background, aims and objectives: The present study aimed to investigate the perceived barriers in access to healthcare among the population with hearing loss in Greece (deaf and hard of hearing).
Methods: The sample consisted of 86 deaf and 54 hard of hearing adults that live in Attica. Core demographic data and information regarding participants’ access to health services was gathered using a self-completed structured questionnaire. Results: The 93% of deaf and the 77.8% of hard of hearing struggled to navigate the healthcare system and reported barriers in access to health services and unmet needs (p=0.009). There were difficulties in booking an appointment (p<0.001), lack of appropriate administrative means (e.g., booking via email) so as to book a visit without the mediation of another person (p<0.001), long waiting time (p=0.01) and intention to manage very consciously the limited benefits (regarding the free interpretation hours) that are entitlements (p<0.001). Regarding engagement with healthcare providers, poor adherence to medical instructions was revealed, as the 41.2% of deaf and the 60% of the hard of hearing did not adhere to the recommended medication, making a self-assessment that they did not need to do so (p=0.02). This minority population faces disproportionate difficulties in access to healthcare and therefore significant interventions to tackle these barriers need to be considered in order to create the person-centeredness of their care.
... The present results support previous evidence indicating the presence of many challenges in accessing healthcare for adults with HL (Smeijers andPfau, 2009, Kuenburg et al., 2016). The flexibility needed to facilitate access to audiology appointments for workers with HL and the hearing technologies offered were two key service aspects perceived to be affecting care. ...
Hearing loss (HL) among working-age adults in the UK is becoming more prevalent. Workers with HL face communication challenges that impact their career prospects, work performance, psychosocial wellbeing and financial security, leading to economic costs to wider society. Most of the available literature on workers with HL is focused on some aspects of the adversities they encounter. It is very deficient in examining the multidimensionality of the impact and the vital role of supportive audiology care in mitigating the impact of HL on work life. The available research concerning workers' experiences with HL and their healthcare is severely lacking in the United Kingdom (UK), and most of the international studies were conducted in previous decades, when work practices, disability legislation, and audiology services were rather different from today. This thesis gathers the experiences and views of audiologists and workers with HL to better understand the impact of HL on workers in the workplace. It explores the state of UK audiology care for workers with HL and identifies the factors that help or hinder effective support.
Three qualitative studies were conducted. Study 1 gathered interview data from 25 audiologists working either in the National Health Service (NHS) or independent health services, and Study 2 interviewed 24 workers with HL. The perspectives of both groups were then triangulated, and the issues around coping that came out strongly from Study 2 were further analysed in Study 3. The interviews were all thematically analysed for Studies 1-3. From the triangulated perspectives of audiologists and workers, supported by previous literature, a conceptual framework is developed, offering an unprecedented demonstration of the multidimensionality of the challenges affecting workers with HL and the issues that were perceived to be influencing workers’ experiences and wellbeing. HL can affect every aspect of a worker's working life, from career choices to day-to-day struggles and career progress. They experience stress, fatigue and difficulties adapting to different work situations, and a sense of being not sufficiently well supported by employers and colleagues and audiology services.
Key findings include the acknowledgement by audiologists in Study 1 that workers with HL have specific needs that often go unmet due to lack of resources, lack of funding, and lack of knowledge and training on how to support this demographic. The workers in Study 2 expressed uncertainty about who to approach for support and perceived a gap in audiological care for working adults, especially by the NHS. The triangulation of their perspectives showed that the audiologists and the workers mostly agreed that there were important issues in audiology care for the working population, such as better access to services, more effective patient-audiologist interaction, and more advanced technological support aside from hearing aid provision. However, the triangulation showed some misalignment of perspectives between the two groups. For example, the audiologists believed that workers were most in need of appointments outside of working hours, whereas the workers were much more concerned about inordinately long waits for appointments and overly-convoluted referral pathways and how these affected their jobs.
Study 3 identified the coping strategies used by workers’ with HL in the workplace, such as disclosure of HL, use of basic and advanced hearing technologies and withdrawal. Unlike previous research, this research found that factors related to coping In work life with HL include self management skills and better support from audiology services. Overall, this thesis shows that audiology services should make more effort to identify workers' needs and provide better support aside from standard hearing aid provision. Audiologists need to be supported by services and the health system to make effective improvements. Workers with HL need to take an active role in their care, while being supported by audiology services, healthcare provision and employers. This research can be used to develop higher standards of care for workers with HL and improve audiology services. Further research is needed to understand the factors influencing the quality of audiologic rehabilitation of workers with HL and how to implement timely, practical and effective positive changes to service delivery. <br/
... 29 The success of the consultation also relies on HCPs and patients understanding the role of the interpreter. 30,31 Even when health care interpreting services are available with professionally trained and qualified interpreters, deaf signers in various countries still report barriers to accessing health care information. 28,32,33 In this potentially highconsequence setting, "an incorrect explanation of symptoms to the practitioner or incomplete instructions to the patient can have serious ramifications: the wrong diagnosis or treatment can be life threatening." ...
There is a need for culturally competent health care providers (HCPs) to provide care to deaf signers, who are members of a linguistic and cultural minority group. Many deaf signers have lower health literacy levels due to deprivation of incidental learning opportunities and inaccessibility of health-related materials, increasing their risk for poorer health outcomes. Communication barriers arise because HCPs are ill-prepared to serve this population, with deaf signers reporting poor-quality interactions. This has translated to errors in diagnosis, patient nonadherence, and ineffective health information, resulting in mistrust of the health care system and reluctance to seek treatment. Sign language interpreters have often not received in-depth medical training, compounding the dynamic process of medical interpreting. HCPs should thus become more culturally competent, empowering them to provide cultural- and language-concordant services to deaf signers. HCPs who received training in cultural competency showed increased knowledge and confidence in interacting with deaf signers. Similarly, deaf signers reported more positive experiences when interacting with medically certified interpreters, HCPs with sign language skills, and practitioners who made an effort to improve communication. However, cultural competency programs within health care education remain inconsistent. Caring for deaf signers requires complex, integrated competencies that need explicit attention and practice repeatedly in realistic, authentic learning tasks ordered from simple to complex. Attention to the needs of deaf signers can start early in the curriculum, using examples of deaf signers in lectures and case discussions, followed by explicit discussions of Deaf cultural norms and the potential risks of low written and spoken language literacy. Students can subsequently engage in role plays with each other or representatives of the local signing deaf community. This would likely ensure that future HCPs are equipped with the knowledge and skills necessary to provide appropriate care and ensure equitable health care access for deaf signers.
... The research on access to health services for deaf people and health care interpreting indicates that a lack of interpreters or having no interpreter at all is apparently identified as a more acute problem than the lack of language-concordant health professionals (e.g., Höcker, Letzel, and Münster 2012;Henning et al. 2011;Smeijers and Pfau 2009). However, the research also indicates that, although interpreters are an essential solution to the problem of language barriers in health care, they are also an imperfect one, and that there is a need for languageconcordant health services (Feldman and Gum 2007;Middleton et al. 2010;Pollard et al. 2014;Steinberg, et al. 2006). ...
Sign language version of the abstract
This article rethinks the impact of sign language interpreting services (SLIS) as a social institution. It starts from the observation that “access” for deaf people is tantamount to availability of sign language interpreters, and the often uncritically proposed and largely accepted solution at the institutional level to lack of access seems to be increasing the number of interpreters. Using documented examples from education and health care settings, we raise concerns that arise when SLIS become a prerequisite for public service provision. In doing so, we problematize SLIS as replacing or concealing the need for language-concordant education and public services. We argue that like any social institution, SLIS should be studied and analyzed critically. This includes more scrutiny about how different kinds of “accesses” can be implemented without SLIS, and more awareness of the contextual languaging choices deaf people make beyond the use of interpreters.
... Deaf patients often feel that they have inadequate medication information and insecurities about whether the correct medication has been prescribed (Berry & Stewart, 2006). According to Smeijers and Pfau (2009), only 13% of interactions between doctors and Deaf patients were evaluated favorably, whereas 39% were rated "moderate" or "bad". Iezzoni et al (2004) concluded that inequities for the Deaf community centered around six main themes: ...
Although developmental stages and identity have been studied as part of aging, one category of both identity and biological difference that has received little attention in the medical and public health literature is that of older adults who were born deaf and/or who identify as part of the signing Deaf community. Research Method: Researchers conducted a systematic search of the literature for barriers to care access related to both aging and deafness. Results: Lack of cultural competence among providers, coupled with inconsistent access to interpreters in medical settings, puts deaf individuals at risk for treatment without adequate consent, or insufficient care due to communication barriers or misperceptions of expression or culture. Conclusions/Implications: Individuals may face unusual challenges, indicating a serious public health crisis on the horizon as the demographic of deaf older adults continues to grow. This paper will discuss what is known about the intersection of aging, Deaf culture, and health care access, and suggest policy and practice recommendations for the future.
Objective:
To investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students.
Methods:
The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students) and empathy (Interpersonal Reactivity Index), and disability-related questions, including self-reported disability, disability category, and program access. Associations between disability status, program access, empathy, and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related, and learning environment measures.
Results:
Overall, 23,898 (54.2%) provided disability data and were included. Of those, 2,438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1,215 [49.8%] or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared to students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95%CI, 1.34 - 1.69] and 2.59 [95%CI, 1.93 - 3.49], respectively) and lower odds of low empathy (.75 [95%CI, .67 - .85] and .68 [95%CI, .52 - .90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95%CI, 1.09 - 1.87], while SWD with program access did not (1.09 [95%CI, .97 - 1.22]).
Conclusions:
Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.
Worldwide public health authorities are taking action to contain Covid-19. While the bulk of research on the pandemic focuses on understanding the spread and seeking a cure for the virus from a virology perspective, research of the same magnitude should also focus on the risks of the pandemic for society, particularly among disadvantaged groups. This study adopted a community-centred approach to information and health rights and utilised the case study approach to investigate the quality and access to Covid-19 information, care and treatment by the Limited English Proficiency (LEP) and the Deaf communities in Zimbabwe. More than 60% of Covid-19 messages communicated in Zimbabwe's mainstream media do not cater for the needs of these disadvantaged groups. Brochures, videos and infographics, for instance, appear in English, yet there is a significant LEP population in Zimbabwe. As regards the Deaf community, videos, conversations and interviews with health specialists, which rarely appear in mainstream public media, include Zimbabwean Sign Language interpretation. In this case, the choice of language and medium used to communicate vital Covid-19 messages in mainstream public media may pose language barriers to effective and equitable health information for these vulnerable groups. What this reality hints at is that public communication that does not discriminate is a necessity to allow all members of the community to fight the spread of Covid-19 and hence, reduce its potential risks.
Effective and individualised antenatal care and parent education, safe expert care in labour, and competent care postnatally are the fundaments of contemporary midwifery practice. This chapter is designed to enable midwives, midwifery lecturers, student midwives, and other maternity healthcare practitioners to gain understanding of issues concerning deafness in order to improve the maternity care offered to deaf and hearing impaired women.
Background
Adults who are deaf or hard of hearing (D/HoH) have lower levels of health literacy compared to their counterparts who can hear. It is unclear, however, whether or not this inequality manifests in adolescence.
Objective or Hypothesis
This study aims to determine levels of health literacy among D/HoH adolescents and to identify barriers and misunderstandings they encounter as well as their expectations when applying for healthcare services.
Methods
This descriptive study was conducted with 88 D/HoH adolescents over the age of 15. The Health Sciences Faculty granted approval for the study.
Results
Of the adolescents, 70.5% had inadequate, 19.3% had limited, 2.3% had adequate and 8% had excellent health literacy levels. Those who had difficulty in communicating with the doctor (25%), those who misused the prescribed medication (13.6%) and those who could not use the medication without help (43.2%) had low THLS scores (<0.05). Those who stated that they did not understand what the nurses said (43.2%) or the health education materials (56.8%) and had significantly low THLS scores (<0.05). Of these adolescents, 55.7% expected their prescriptions or care procedures to be given to them in writing, and 87.5% expected that these would be explained to them in sign language. A significant relationship was observed between hearing disability and health literacy (R= 0.659, R2= 0.434) (p<0.01).
Conclusion
Most D/HoH adolescents have a significantly lower level of health literacy, which is more likely linked with poor communication and misunderstandings concerning medication instructions.
ResearchGate has not been able to resolve any references for this publication.