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IMPORTANCE Primary medical and dental clinics may accept fewer people who are deaf as patients than persons who can hear, and clinics may deny requests by patients who are deaf for American Sign Language (ASL) interpretation at appointments when necessary, creating diminished access to primary medical and dental care. OBJECTIVE To compare the rate at which patients who are deaf are offered primary care medical or dental appointments with the rate at which appointments are offered to patients who can hear in a real-world context. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used a simulated patient (SP) call audit method. Simulated patients (4 who could hear and 4 who were deaf) followed a call script in which an adult sought to establish care, requesting new patient appointments from a statewide stratified random sample of clinicians listed in the Idaho Medical and Dental Associations member databases at 445 clinics (334 primary care and 111 general dentistry) throughout Idaho. Simulated patients who were deaf also requested interpreting services at the appointment. Calls were made between June 7 and December 6, 2018. Data analysis was conducted from December 2019 to April 2020. EXPOSURES Simulated patients who were deaf or could hear called primary care medical or dental clinics from the sampling frame and requested an appointment, supplying the same basic information. In addition, SPs who were deaf requested that an ASL interpreter be provided by the clinic for the appointment. MAIN OUTCOMES AND MEASURESRates of new appointments offered and, for SPs who were deaf, whether ASL interpreter services were confirmed for the appointment.RESULTS Two male and 2 female SPs who could hear were successful on 210 occasions (64.4%) when requesting a new patient appointment compared with 2 male and 2 female SPs who were deaf who were successful on 161 occasions (49.1%) (P < .001). Simulated patients who could hear were nearly 2 times more likely to secure appointments than were SPs who were deaf (adjusted odds ratio, 1.88; 95% CI, 1.27-2.79). For SPs who were deaf, 80 unsuccessful appointment requests (48.2%) were associated with a request for interpretation. CONCLUSIONS AND RELEVANCEThe findings suggest that in a statewide representative sample, access to primary medical and dental care for patients who are deaf is significantly reduced. Patients who are deaf may not receive an appointment if they request interpreter services, even when such services are required to provide effective communication.

Deaf persons who use American Sign Language (ASL) as their primary form of communication are members of a cultural and linguistic minority that experiences significant health disparities yet are not recognized as a health disparity population by the National Institutes of Health. Studies have reported ineffective communication in healthcare interactions and reduced access to care experienced by Deaf patients. Requests for sign language interpreters in healthcare encounters are frequently denied, despite federal mandates to provide effective communication. Comprised of three articles, this dissertation investigates the diminished access to communication in healthcare settings experienced by Deaf patients and qualitative research methods when working with Deaf communities. Chapter One provides an overview of the dissertation purpose along with authorship and statement contributions for each article. Chapter Two features an autoethnographic study which recommends specific research methods and paradigms researchers who can hear should consider when conducting research with Deaf people. Reflections on the process of qualitative data analysis in this context is provided. Chapter Three reports the results in article form from a mixed-method, bilingual, and online survey which received 170 responses from Deaf respondents in 42 states. The survey provides a deeper understanding of the communication barriers experienced by Deaf patients than has been available or documented previously. Chapter Four documents the diminished access to care experienced by Deaf patients as documented in a "secret shopper" study. Appointment success rates of Deaf simulated patients compared to success rates of simulated patients who can hear, and reasons associated with denials are reported from a field-experiment audit study of a stratified random sample of primary care and general dentistry clinics throughout Idaho. Chapter Five provides a summary of the dissertation findings, action and policy recommendations, planned and completed dissemination of the research results, and areas of future research.