Health Care Needs of Deaf Signers: The Case for Culturally Competent Health Care Providers

Abstract

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.

New Pathways for Successfully Reducing Health Inequities Experienced by the Deaf and Hard of Hearing Community

“…Jacob et al provide a summary of the major barriers to providing high-quality care for culturally Deaf patients. 3 These include the lack of culturally competent health care professionals, low health literacy levels among Deaf patients due to the visual nature of signed languages, communication barriers with the health care community, and a lack of medically trained sign language interpreters. This highlights the importance of advocating for increased DHoH representation among health care professionals; developing cultural competency programs in medical education; and embracing the general bioethical principles of justice, autonomy, beneficence, and nonmaleficence for a very medically underrepresented population.…”

“…Jacob et al outline several clear and concise steps that the health care community can take to improve the quality of care for Deaf patients. 3 I agree that standardizing a Deaf cultural competency training program for health professions students creates a simple and efficient opportunity to improve Deaf patients' experiences and to bridge the health inequities they experience. In fact, the DHoH community is the second largest group in the country with an identified disability, and it will only increase with the aging baby boomer generation.…”

“…28 Oftentimes, patients who develop hearing loss do not seek out treatment and they are viewed as noncompliant in their health care. 29 While Jacob et al identify steps that can be taken to ensure cultural competency training for working with Deaf patients is embedded in health care education, 3 this should also be expanded to include those who identify as hard of hearing. For instance, hospital and medical clinic administrators should formulate communication access plans and language access teams.…”

“…2 Finally, Jacob et al's article argues for developing cultural competency for working with DHoH populations through educational channels, which should subsequently enhance general awareness and advocacy for DHoH patients in the health care system. 3 In this Invited Commentary, I briefly review each of these articles, connecting them to my own story and perspective as a DHoH family medicine physician in a rural community health center. Stories humanize conceptual ideas so that individuals can identify with the struggles faced by others, such as the challenges that many students with disabilities face in the pursuit of their career goals in the health professions.…”

“…Three articles in this issue of Academic Medicine [1][2][3] serve as a welcome addition to the literature in the quest to reduce the significant health inequities experienced by the Deaf and hard of hearing (DHoH) community. Historically, research involving DHoH representation in the health professions and health inequities in the DHoH community has focused primarily on identifying barriers.…”