Looking beyond discussions of medical and social models: A critical qualitative examination of deaf health disparities

Abstract

There is strong empirical evidence, from Australia and internationally, that people living with hearing loss or deafness experience substantial challenges to accessing health services, resulting in poor health. Despite evidence demonstrating the success of hearing technology for correcting hearing losses and deafness, health disparities between hearing people and people living with hearing loss or deafness continue. Empirical work in the area of deafness is contextualised by ongoing theoretical discussions of the medical and social models of disability and, by extension, deafness. Despite consensus among theorists, even among those who are living with a disability themselves, that the medical model is restrictive, it is clear that this model continues to shape research priorities and dominant practices and ideology in society. While social models of disability/deafness tend to be favoured among theorists and discussed as preferable to the medical model and inclusive of the lived experiences of deafness, academics continue to debate and refine the social models of deafness. These debates largely remain theoretical as there is limited empirical work that has explored how these models, and related discourses, operate within society. Located within a social constructionist framework, this thesis provides a reflexive account of how I explored ways that deafness is constructed within Australian society and how these constructions contribute to the health disparities between hearing people and people living in Australia with hearing loss or deafness. The aims of this thesis are two-fold, (1) to explore how people living with hearing loss or deafness construct experiences of deafness and how these constructs relate (if at all) to theoretical discussions of disability or deafness; (2) to examine how health professionals construct experiences of treating clients living with hearing loss or deafness. These aims are achieved in two separate studies. The first is a mixed methods study of an online forum with people living with hearing loss or deafness and the second, interviews with health professionals who have treated clients living with hearing loss or deafness. Chapter 1 is an outline the structure of the thesis, describing both the research problem and my position as the author. In Chapter 2, I introduce social constructionism and the tensions that exist between this framework and positivism, and how these frameworks have shaped the thesis. Building on this, I provide an overview of the research methods implemented in the thesis. In order to contextualise the research presented in this thesis, information relevant to deafness and the Australian context is discussed at length in Chapter 3. Chapter 4 and 5 are a review of the literature relevant to how deafness has been studied in the past. This review covers deafness as a socially constructed phenomenon and critiques the empirical evidence pertaining to the health-related quality of life, health knowledge and barriers to accessing health that people living with hearing loss or deafness experience. Chapter 5 then provides a short discussion of why not everyone wants their deafness or hearing loss cured. In combination, these chapters provide the necessary information and theoretical positioning for the reader to understand the impetus of the research presented in this thesis and the context within which it was conducted. Chapter 6 presents a reflective explanation of how and why I developed an online survey and forum for people to discuss their experiences of living in Australia with hearing loss or deafness. As an innovative method of enquiry, this chapter includes an in-depth discussion of the challenges I negotiated as the researcher for this study. Following this, I present a discursive analysis of the 24 forum users’ posts, whereby a discourse of deafness as abnormal was identified. Building these findings, Chapter 7 presents an inductive thematic analysis of 18 interviews with health professionals who have provided health services to clients living with hearing loss or deafness. In response to the identification of an overarching theme of hearingness as privileged, I provide a brief review of the literature on privilege and oppression, along with a reflexive account of how this analysis represented a shift and clarification in my knowledge and understanding of the research problem described in Chapter 1. In closing, Chapter 8 provides a summary of the empirical, methodological, theoretical and practical contributions of this thesis. I present the argument that while health systems in our society continue to value and assume hearingness the health disadvantages experienced by this population will remain, regardless of the successes of hearing technology. I discuss the role and importance of reflexivity as it relates to the production of knowledge in this thesis, particularly as a hearing researcher, and consider future empirical directions for work in this area.