Research

Below is a summary of the research we did at the beginning of our project to get a better understanding of the context of the project and the realities of deaf patient’s care, struggles and needs in healthcare.

This initial research made us realize how big the problem of unequal healthcare accessibility, quality, and experience for deaf patients is. It was definitely very eye-opening and made us feel even more motivated about doing our project well.

A Guide to Working with Deaf People in a Health Setting – Best Practice Guide (BID Services)

  [Internet]. Bid.org.uk. 2019 [cited 10 January 2019]. Available from: https://www.bid.org.uk/downloads/resources/a5-guide-to-working-with-deaf-people-in-a-health-setting.pdf

  • Missed diagnosis and poor treatment is costing the NHS £50 million a year.
  • Deaf patients may need to take more breaks than the average hearing person in the conversation as understanding requires constant focus and eye contact, it is also advised to try and use the same interpreter consistently to maintain a good working relationship.

Healthcare access for deaf patients – the legal and ethical perspectives

Laur A. Healthcare access for deaf patients – The legal and ethical perspectives. Medico-Legal Journal [Internet]. 2017 [cited 15 January 2019];86(1):36-41. Available from: https://journals-sagepub-com.ezproxy.is.ed.ac.uk/doi/pdf/10.1177/0025817217743416

  • Recent census indicate that there are 50 000 deaf people living in the UK and 8.3million have hearing difficulties.
  • “Some feel ‘trapped’ and ‘treated like second-class citizens’, unable to participate in their healthcare”
  • Inadequate communication with these patients can cause misdiagnosis, mistreatment and medical errors due to the incomplete or inaccurate history.
  • In UK, USA and France, the medical centres bear the costs of providing sign language interpreters (compulsory under the Equality Act in the UK). Can be a cost burden on the hospitals, so often medical professionals tend to rely on patients’ relatives or friends to interpret, as well as lip-reading and written notes.

Communication With Deaf Patients. Knowledge, Beliefs, and Practices of Physicians

Ebert D. Communication With Deaf Patients. JAMA [Internet]. 1995 [cited 15 January 2019];273(3):227. Available from: https://jamanetwork-com.ezproxy.is.ed.ac.uk/journals/jama/fullarticle/386177

  • 63% of physicians knew that sign language should be the initial method of communicating with deaf patients who sign, only 22% used sign language interpreters more frequently than other methods in their practice.
  • When surveyed, physicians and deaf patients both recorded that writing is the most common communication between them.  However, deaf patients’ reading and writing skills may be seriously impaired and may fail to comprehend what physicians are attempting to tell them.  Writing back and forth can be tiresome for both parties. As a result of this, doctors may try to abbreviate messages, causing incomplete communication.

Communication with Deaf and Hard-of-hearing people: A guide for medical Education

Barnett S. Communication with Deaf and Hard-of-hearing People. Academic Medicine. 2002;77(7):694-700.

  • Hearing loss is more prevalent than that of heart disease, asthma, or diabetes (conditions that are well covered in medical school). “Just as diabetes is an impairment that affects glucose metabolism, hearing loss is an impairment that affects communication.” And communication is essential for physicians to diagnose a patient’s illness.
  • Hard-of-hearing = these people can still derive some linguistically useful information from the speach
  • Deaf = receive no useful linguistic information from sound.
  • For many deaf patients, especially those who went deaf before the age of 3, when they were prelingual, sign language is their primary way to communicate
  • The average reading level of the deaf population is lower than that of the general population, additionally many deaf patients do not use English as their primary language and instead use BSL or equivalent, which has different grammar and vocab from English.

Access to primary care affects the health of Deaf people

Emond A, Ridd M, Sutherland H, Allsop L, Alexander A, Kyle J. Access to primary care affects the health of Deaf people. British Journal of General Practice. 2015;65(631):95-96.

  • Compared to the hearing population, a greater prevalence of obesity and higher levels of hypertension, high levels of self-reported depression, but low levels of reported smoking and alcohol consumption. Of particular concern were the underdiagnosis of raised blood pressure and the under-treatment of hypertension, diabetes, hyperlipidaemia, and cardiovascular disease.
  • A recent study found that adult deaf patients used primary care services more than GPPS, however many (44%) found the last interaction with GP to be difficult or very difficult.  40% found the receptionist to be unhelpful (compared to 8% of GPPS finding receptionist unhelpful).
  • Vast majority of deaf patients want to use BSL.
  • 53% had to rely on lip-reading
  • 15% had to rely on written notes
  • Neither of these allow adequate 2-way conversation between the physician and the patient
  • 67% of general population indicate trust in their doctor, while only 25% deaf patients indicated the same trust.

Sick of it Report (2014)

  • 45% of Deaf people still have to walk into their surgery to make an appointment, because of the lack of other ways to do it.
  • 8 in 10 Deaf people want to use sign language, 3 in 10 are given the chance.
  • Deaf people are twice as likely as everyone else to have high blood pressure and not know it.
  • One in twelve Deaf people had higher than normal blood sugar levels, a warning sign for diabetes. That is nearly four times the rate of pre-diabetic cases in the rest of the population.
  • Deaf people who’ve been told they have high blood pressure are three times more likely than everyone else to still not have it under control, 62% of Deaf people compared with 20% generally. They are also less likely to be on medication for the condition (only 36% compared with 57% in the wider population).
  • Our research also shows that many Deaf people are unsure why they are taking their medication. It seems doctors aren’t making sure their Deaf patients understand what is wrong, or what their treatment and medication is for.
  • Most surgeries make no note of the way Deaf patients would like to communicate.
  • 70% of Deaf people who hadn’t been to their GP recently had wanted to go, but didn’t, mainly because there was no interpreter.
  • Audiology departments and Ear, Nose & Throat specialists treat a high number of Deaf patients, so you might expect them to be far more aware and accessible, however, this is not the case.