Deaf American Sign Language Users Research Articles

Medication-Related Experience of Deaf American Sign Language Users.

Previous studies showed that deaf and hard-of-hearing (DHH) individuals have low health literacy related to prescription labels. This study examined the DHH's experience with understanding prescription labels and how technology can impact that experience. The purpose of this qualitative study was twofold: (1) gain a more enhanced understanding of DHH experiences in understanding prescription labels with a focus on language needs, expectations, and preferences, and (2) assess the potential role of technology in addressing the communication-related accessibility issues which emerge from the data. In this study, 25 Deaf American Sign Language users who picked up a prescription from a pharmacy within the past year were interviewed. A thematic analysis, which included a systematic coding process, was used to uncover themes about their experiences picking up and using prescription medications. Thematic analyses identified that medication-related experiences centered around themes: (1) medication information seeking; (2) comfort taking medication; (3) picking up medication; and (4) communication with the pharmacy team. A large contributor to the communication experience was the perception that the pharmacist was not being respectful. Regarding comfort taking medications, 12% of participants expressed a lack of understanding medications while taking medication. This led to participants largely using online resources when seeking medication information. This study also found that technology greatly aided the participants during this experience. This study recorded the experiences within the context of limited health literacy and aversive audism found that the DHH individual repeatedly encountered communication barriers, which may contribute to their poor medication literacy. Thus, future studies should explore how to leverage the potential benefits of technology to improve the pharmacy experience of the DHH, thereby improving medication literacy. [HLRP: Health Literacy Research and Practice. 2023;7(4):e215-e224.].

Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users

BackgroundDeaf individuals who communicate using American Sign Language (ASL) seem to experience a range of disparities in health care, but there are few empirical data. ObjectiveTo examine the provision of common care practices in the emergency department (ED) to this population. MethodsED visits in 2018 at a U.S. academic medical center were assessed retrospectively in Deaf adults who primarily use ASL (n = 257) and hearing individuals who primarily use English, selected at random (n = 429). Logistic regression analyses adjusted for confounders compared the groups on the provision or nonprovision of four routine ED care practices (i.e., laboratories ordered, medications ordered, images ordered, placement of peripheral intravenous line [PIV]) and on ED disposition (admitted to hospital or not admitted). ResultsThe ED encounters with Deaf ASL users were less likely to include laboratory tests being ordered: adjusted odds ratio 0.68 and 95% confidence interval 0.47–0.97. ED encounters with Deaf individuals were also less likely to include PIV placement, less likely to result in images being ordered in the ED care of ASL users of high acuity compared with English users of high acuity (but not low acuity), and less likely to result in hospital admission. ConclusionResults suggest disparate provision of several types of routine ED care for adult Deaf ASL users. Limitations include the observational study design at a single site and reliance on the medical record, underscoring the need for further research and potential reasons for disparate ED care with Deaf individuals.

"There is No Communication": A Qualitative Examination of Deaf Signers' Experiences With Advance Care Planning.

Objective(s): Deaf American Sign Language (ASL) users are subject to health care disparities resulting from communication and language barriers. Currently, few resources on advance care planning and end-of-life care exist in ASL. This study explores Deaf ASL users' perceptions and experiences with end-of-life care and advance care planning. Methods: Semi-structured 1:1 interviews with Deaf signers were translated, and transcribed into English by a bilingual researcher. Investigators inductively coded transcripts and identified themes of barriers, facilitators, knowledge, and sources of information regarding end-of-life care. Participants' knowledge of advance care planning and completion of advance care planning documents were evaluated using a brief assessment. Results: Eleven Deaf ASL users participated in the study with two deaf interviewers. Participants reported barriers to end-of-life care including poor provider communication, inaccessible sources, and inadequate provision of accommodations, leading to patient distrust. Participants' understanding of advance care planning was facilitated by accessible forms of communication and their social networks, such as family, friends, and Deaf peers. Participants primarily gained information on end-of-life care from first-hand familial experience, peers, and media. Participants' mean advance care planning knowledge was 4.6 out of 15 (SD  =  2.6). Conclusions: Deaf ASL users face scarce accessible resources around end-of-life care, lowering their ability to understand and proceed with advance care planning. Implementation of ASL accessible advance care planning educational tools in health care settings is needed.

Equitable Access to Telehealth and Other Services for Deaf People During the COVID-19 Pandemic.

Deaf people who use American Sign Language (ASL) with low self-perceived ability to understand spoken information face inequitable access to health care due to systemic barriers. We conducted interviews with 266 deaf ASL users at baseline (May-Aug 2020) and 244 deaf ASL users at follow-up (3 months). Questions addressed (1) access to interpretation during in-person visits; (2) whether they visited clinics (3) or emergency departments (EDs); and (4) telehealth use. Analyses involved univariate and multivariable logistic regressions across levels of perceived ability to understand spoken language. Less than a third were aged >65 (22.8%); Black, Indigenous, People of Color (28.6%), or LGBTQ+ (31.1%); and had no college degree (30.6%). More respondents reported outpatient visits at follow-up (63.9%) than at baseline (42.3%). Ten more respondents reported going to urgent care or an ED at follow-up than at baseline. At follow-up interviews, 57% of deaf ASL respondents with high perceived ability to understand spoken language reported receiving interpretation at clinic visits compared to 32% of ASL respondents with low perceived ability to understand spoken language (p<0.01). Telehealth and ED visits showed no between-group differences for low versus high perceived ability to understand spoken language. Our study is the first to explore deaf ASL users' access to telehealth and outpatient encounters over time during the pandemic. The U.S. health care system is designed for people who have high perceived ability to understand spoken information. Systemic access to health care, including telehealth and clinics, must be made consistently equitable for deaf people who require accessible communication.

Communication Access In Mental Health And Substance Use Treatment Facilities For Deaf American Sign Language Users.

Deaf and hard of hearing (DHH) American Sign Language users experience significant mental health-related disparities compared with non-DHH English speakers. Yet there is little empirical evidence documenting this priority population's communication access in mental health and substance use treatment facilities. This study measured mental health and substance use treatment facilities' noncompliance to Section 1557 of the Affordable Care Act (ACA), which requires health care facilities receiving government funds to provide effective communication access, such as a sign language interpreter, to DHH patients. Using nationally representative data from the Substance Abuse and Mental Health Services Administration, we found that 41percent of mental health facilities and 59percent of substance use treatment facilities receiving public funds reported not providing services in sign language in 2019 and were thus noncompliant with the ACA's mandate to provide accessible communication to DHH patients. We mapped these data to display state-level noncompliance, and we make detailed recommendations at the policy, facility, and provider levels. These include monitoring noncompliance among government-funded facilities, expanding state-by-state mental health licensure reciprocity and telehealth policies to improve access to American Sign Language-fluent mental health professionals and addiction counselors, establishing systematic processes to collect information on disability-related accommodation needs, and increasing the workforce of DHH American Sign Language-fluent providers.

Perceiving fingerspelling via point-light displays: The stimulus and the perceiver both matter.

Signed languages such as American Sign Language (ASL) rely on visuospatial information that combines hand and bodily movements, facial expressions, and fingerspelling. Signers communicate in a wide array of sub-optimal environments, such as in dim lighting or from a distance. While fingerspelling is a common and essential part of signed languages, the perception of fingerspelling in difficult visual environments is not well understood. The movement and spatial patterns of ASL are well-suited to representation by dynamic Point Light Display (PLD) stimuli in which human movement is shown as an array of moving dots affixed to joints on the body. We created PLD videos of fingerspelled location names. The location names were either Real (e.g., KUWAIT) or Pseudo-names (e.g., CLARTAND), and the PLDs showed either a High or a Low number of markers. In an online study, Deaf and Hearing ASL users (total N = 283) watched 27 PLD stimulus videos that varied by Word Type and Number of Markers. Participants watched the videos and typed the names they saw, along with how confident they were in their response. We predicted that when signers see ASL fingerspelling PLDs, language experience in ASL will be positively correlated with accuracy and self-rated confidence scores. We also predicted that Real location names would be understood better than Pseudo names. Our findings supported those predictions. We also discovered a significant interaction between Age and Word Type, which suggests that as people age, they use outside world knowledge to inform their fingerspelling success. Finally, we examined the accuracy and confidence in fingerspelling perception in early ASL users. Studying the relationship between language experience with PLD fingerspelling perception allows us to explore how hearing status, ASL fluency levels, and age of language acquisition affect the core abilities of understanding fingerspelling.

"They're Not Willing To Accommodate Deaf patients": Communication Experiences of Deaf American Sign Language Users in the Emergency Department.

Deaf people who use American Sign Language (ASL) are more likely to use the emergency department (ED) than their hearing English-speaking counterparts and are also at higher risk of receiving inaccessible communication. The purpose of this study is to explore the ED communication experience of Deaf patients. A descriptive qualitative study was performed by interviewing 11 Deaf people who had used the ED in the past 2years. Applying a descriptive thematic analysis, we developed five themes: (1) requesting communication access can be stressful, frustrating, and time-consuming; (2) perspectives and experiences with Video Remote Interpreting (VRI); (3) expectations, benefits, and drawbacks of using on-site ASL interpreters; (4) written and oral communication provides insufficient information to Deaf patients; and (5) ED staff and providers lack cultural sensitivity and awareness towards Deaf patients. Findings are discussed with respect to medical and interpreting ethics to improve ED communication for Deaf patients.

Community-Engaged Needs Assessment of Deaf American Sign Language Users in Florida, 2018.

Deaf American Sign Language (ASL) users comprise a linguistic and cultural minority group that is understudied and underserved in health education and health care research. We examined differences in health risk behaviors, concerns, and access to health care among Deaf ASL users and hearing English speakers living in Florida. We applied community-engaged research methods to develop and administer the first linguistically accessible and contextually tailored community health needs assessment to Deaf ASL users living in Florida. Deaf ASL users (n = 92) were recruited during a 3-month period in summer 2018 and compared with a subset of data on hearing English speakers from the 2018 Florida Behavioral Risk Factor Surveillance System (n = 12 589). We explored prevalence and adjusted odds of health behavior, including substance use and health care use. Mental health was the top health concern among Deaf participants; 15.5% of participants screened as likely having a depressive disorder. Deaf people were 1.8 times more likely than hearing people to engage in binge drinking during the past month. In addition, 37.2% of participants reported being denied an interpreter in a medical facility in the past 12 months. This study highlights the need to work with Deaf ASL users to develop context-specific health education and health promotion activities tailored to their linguistic and cultural needs and ensure that they receive accessible health care and health education.

Emergency Medical Services Communication Barriers and the Deaf American Sign Language User

Objective: We sought to identify current Emergency Medical Services (EMS) practitioner comfort levels and communication strategies when caring for the Deaf American Sign Language (ASL) user. Additionally, we created and evaluated the effect of an educational intervention and visual communication tool on EMS practitioner comfort levels and communication. Methods: This was a descriptive study assessing communication barriers at baseline and after the implementation of a novel educational intervention with cross-sectional surveys conducted at three time points (pre-, immediate-post, and three months post-intervention). Descriptive statistics characterized the study sample and we quantified responses from the baseline survey and both post-intervention surveys. Results: There were 148 EMS practitioners who responded to the baseline survey. The majority of participants (74%; 109/148) previously responded to a 9-1-1 call for a Deaf patient and 24% (35/148) reported previous training regarding the Deaf community. The majority felt that important details were lost during communication (83%; 90/109), reported that the Deaf patient appeared frustrated during an encounter (72%; 78/109), and felt that communication limited patient care (67%; 73/109). When interacting with a Deaf person, the most common communication strategies included written text (90%; 98/109), friend/family member (90%; 98/109), lip reading (55%; 60/109), and spoken English (50%; 55/109). Immediately after the training, most participants reported that the educational training expanded their knowledge of Deaf culture (93%; 126/135), communication strategies to use (93%; 125/135), and common pitfalls to avoid (96%; 129/135) when caring for Deaf patients. At 3 months, all participants (100%, 79/79) reported that the educational module was helpful. Some participants (19%, 15/79) also reported using the communication tool with other non-English speaking patients. Conclusions: The majority of EMS practitioners reported difficulty communicating with Deaf ASL users and acknowledged a sense of patient frustration. Nearly all participants felt the educational training was beneficial and clinically relevant; three months later, all participants found it to still be helpful. Additionally, the communication tool may be applicable to other populations that use English as a second language.

Effects of age on American Sign Language sentence repetition.

The study of deaf users of signed languages, who often experience delays in primary language (L1) acquisition, permits a unique opportunity to examine the effects of aging on the processing of an L1 acquired under delayed or protracted development. A cohort of 107 congenitally deaf adult signers ages 45-85 years who were exposed to American Sign Language (ASL) either in infancy, early childhood, or late childhood were tested using an ASL sentence repetition test. Participants repeated 20 sentences that gradually increased in length and complexity. Logistic mixed-effects regression with the variables of chronological age (CA) and age of acquisition (AoA) was used to assess sentence repetition accuracy. Results showed that CA was a significant predictor, with increased age being associated with decreased likelihood to reproduce a sentence correctly (odds ratio [OR] = 0.56, p = .010). In addition, effects of AoA were observed. Relative to native deaf signers, those who acquired ASL in early childhood were less likely to successfully reproduce a sentence (OR = 0.42, p = .003), as were subjects who learned ASL in late childhood (OR = 0.27, p < .001). These data show that aging affects verbatim recall in deaf users of ASL and that the age of sign language acquisition has a significant and lasting effect on repetition ability, even after decades of sign language use. These data show evidence for life-span continuity of early life effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Ask and ye shall not receive: Interpreter-related access barriers reported by Deaf users of American sign language

BackgroundHealthcare providers are mandated to provide reasonable accommodations for Deaf users of American Sign Language (ASL) accessing healthcare services, including ASL interpreters. Provision of accommodations improves access and provider/patient communication. ObjectiveDescribe the types, frequency, severity, and trends in healthcare access complications experienced by Deaf patients. MethodsA six-year retrospective review of complaints (n = 108) filed regarding interpreter provision in healthcare settings with the Idaho Council for the Deaf and Hard of Hearing by Deaf users of ASL was conducted and summarized. An analysis of demographic and language factors associated with interpreter-related barriers and whether the complaint was resolved was performed using multivariate logistic regression. ResultsReasons for complaints of interpreter-related barriers to care included: 48.2% were “told an interpreter was not available”; 28.7% received an unqualified interpreter; interpreter was promised but not provided (18.5%). Factors independently associated with having been promised an interpreter were: medical clinics (vs. dental) (OR 3.92 95%CI 1.18–12.98), and complaints filed later in the study period (OR 1.55 per year 95%CI 1.19–2.01). For each additional year during the study period, complaints were 1.6 times (95%CI 1.15–2.22) more likely to have an interpreter promised but not provided. Patients from rural areas were less likely to have their complaints satisfactorily resolved (OR 0.18 95%CI 0.06–0.55). ConclusionDeaf patients experience various interpreter-related barriers throughout the process of accessing healthcare and communicating with providers/staff, though further regional and nationwide documentation is warranted.

Deaf Adults' Health Literacy and Access to Health Information: Protocol for a Multicenter Mixed Methods Study.

BackgroundDeaf American Sign Language (ASL) users often struggle with limited health literacy compared with their hearing peers. However, the mechanisms driving limited health literacy and how this may impact access to and understanding of health information for Deaf individuals have not been determined. Deaf individuals are more likely than hearing individuals to use the internet, yet they continue to report significant barriers to health information. This study presents an opportunity to identify key targets that impact information access for a largely marginalized population.ObjectiveThis study aims to elucidate the role of information marginalization on health literacy in Deaf ASL users and to better understand the mechanisms of health literacy in this population for the purpose of identifying viable targets for future health literacy interventions.MethodsThis is an exploratory mixed methods study to identify predictors and moderators of health literacy in the Deaf population. These predictors of health literacy will be used to inform the second step that qualitatively explains the findings, including how Deaf individuals access and understand Web-based health information. Multiple interviewer- and computer-based instruments underwent translation and adaptation, from English to ASL, to make them accessible for the Deaf participants in our study. A planned sample of 450 Deaf ASL users and 450 hearing native English speakers, aged 18 to 70 years, will be recruited from 3 partnering sites: Rochester, NY; Flint, MI; and Chicago, IL. These individuals will participate in a single data collection visit. A subset of participants (approximately 30) with key characteristics of interest will be invited for a second data collection visit to observe and inquire more about their ability to directly access, navigate, and comprehend Web-based health information. The study will help assess how the ways health literacy and information are visualized may differ between Deaf individuals and hearing individuals. The study will also survey participants’ ownership and use of computer and mobile devices and their level of Web-based information use, including health information.ResultsAdaptation and translation of protocols and instruments have been completed and are now in use for the study. Recruitment is underway and will continue until late 2020. Results from this study will be used to provide a guide on how to structure Web-based health information in a way that maximizes accessibility and improves health literacy for Deaf individuals.ConclusionsThe results from this mixed methods proposal will advance what is known about health literacy and health information accessibility for Deaf individuals. This innovative study will generate rich data on how to formulate health information and health literacy interventions more accurately to take advantage of visual learning skills.International Registered Report Identifier (IRRID)PRR1-10.2196/14889

Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study.

BackgroundAbout 46% of US adults obtain recommended HIV screening at least once during their lifetime. There is little knowledge of screening rates among deaf and hard-of-hearing adults who primarily use American Sign Language (ASL), or of social media as a potentially efficacious route for HIV prevention outreach, despite lower HIV/AIDS-specific health literacy and potentially higher HIV seropositivity rates than hearing peers.ObjectiveWe investigated both the likelihood of HIV screening uptake among deaf adults in the past year and over one year ago, and the relationship between social media use and HIV screening uptake among deaf adult ASL users.MethodsThe Health Information National Trends Survey in ASL was administered to 1340 deaf US adults between 2015-2018. Modified Poisson with robust standard errors was used to assess the relationship between social media usage as a predictor and HIV screening as an outcome (screened more than one year ago, screened within the past year, and never been screened), after adjusting for sociodemographics and sexually transmitted disease (STD) covariates.ResultsThe estimated lifetime prevalence of HIV screening uptake among our sample was 54% (719/1340), with 32% (429/1340) in the past year. Being of younger age, male gender, black, lesbian, gay, bisexual, or queer, or having some college education or a prior STD were associated with HIV screening uptake. Adjusting for correlates, social media use was significantly associated with HIV screening in the past year, compared to either lifetime or never.ConclusionsScreening falls well short of universal screening targets, with gaps among heterosexual, female, Caucasian, or older deaf adults. HIV screening outreach may not be effective because of technological or linguistic inaccessibility, rendering ASL users an underrecognized minority group. However, social media is still a powerful tool, particularly among younger deaf adults at risk for HIV.

Young Deaf Adults' Knowledge of Human Papillomavirus and Human Papillomavirus Vaccine's Effectiveness in Preventing Cervical, Anal, Penile, and Oral Cancer.

To describe knowledge and risk perception of human papillomavirus (HPV) among deaf adults who use American sign language (ASL) comparison with hearing adults in the United States. Secondary HPV knowledge data for the deaf subset sample were drawn from the Health Information National Trends survey in ASL that was administered between 2015 and 2018. HPV knowledge data for the hearing subset sample were drawn from cycle 5 of the Health Information National Trends survey in English that was administered in2017. Surveys are a nationally based survey of deaf ASL users in the United States and a nationally based survey of hearing non-ASL users in the United States. The age of the deaf and hearing subset samples was determined on the basis of catchup vaccine eligibility criteria as outlined by the Centers for Disease Control and Prevention that recommends catchup vaccination in women, men who have sex with men, immunocompromised individuals, and those who identify as transgender. We examined HPV, HPV vaccine, and HPV-related cancer knowledge in deaf and hearing subsets. Our sample consisted of 235 deaf and 115 hearing adults aged 18-26years. Of the deaf participants 58% (136/235)reported knowledge of HPV compared with 84% (97/115) of hearing participants (P<.001). Hearing participants showed higher accuracy in risk perception of HPV relation to cervical cancer compared with deaf participants (P<.001). Hearing participants were more likely to have heard of the HPV vaccine as well as believe it is successful in preventing cervical cancer compared with deaf participants (P<.001). Deaf ASL users are less likely to have knowledge of HPV, virus-related cancer risk, and preventative vaccination compared with hearing peers.

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users

Pendergrass, Kathy M. PhD, FNP‐BC; (Assistant Professor)*,1; Nemeth, Lynne PhD, RN, FAAN; (Professor)2; Newman, Susan D. PhD, RN, CRRN; (Associate Professor)2; Jenkins, Carolyn M. DrPH, MSN, RD, LD, FAAN; (Research Professor)2; Jones, Elaine G. PhD, RN; (Associate Professor)3 Author Information

Bilingual approach to online cancer genetics education for Deaf American Sign Language users produces greater knowledge and confidence than English text only: A randomized study

IntroductionDeaf American Sign Language-users (ASL) have limited access to cancer genetics information they can readily understand, increasing risk for health disparities. We compared effectiveness of online cancer genetics information presented using a bilingual approach (ASL with English closed captioning) and a monolingual approach (English text). HypothesisBilingual modality would increase cancer genetics knowledge and confidence to create a family tree; education would interact with modality. MethodsWe used a parallel 2:1 randomized pre-post study design stratified on education. 150 Deaf ASL-users ≥18 years old with computer and internet access participated online; 100 (70 high, 30 low education) and 50 (35 high, 15 low education) were randomized to the bilingual and monolingual modalities. Modalities provide virtually identical content on creating a family tree, using the family tree to identify inherited cancer risk factors, understanding how cancer predisposition can be inherited, and the role of genetic counseling and testing for prevention or treatment. 25 true/false items assessed knowledge; a Likert scale item assessed confidence. Data were collected within 2 weeks before and after viewing the information. ResultsSignificant interaction of language modality, education, and change in knowledge scores was observed (p = .01). High education group increased knowledge regardless of modality (Bilingual: p < .001; d = .56; Monolingual: p < .001; d = 1.08). Low education group increased knowledge with bilingual (p < .001; d = .85), but not monolingual (p = .79; d = .08) modality. Bilingual modality yielded greater confidence creating a family tree (p = .03). ConclusionsBilingual approach provides a better opportunity for lower educated Deaf ASL-users to access cancer genetics information than a monolingual approach.

Assessing Health Literacy in Deaf American Sign Language Users

Communication and language barriers isolate Deaf American Sign Language (ASL) users from mass media, health care messages, and health care communication, which, when coupled with social marginalization, places them at a high risk for inadequate health literacy. Our objectives were to translate, adapt, and develop an accessible health literacy instrument in ASL and to assess the prevalence and correlates of inadequate health literacy among Deaf ASL users and hearing English speakers using a cross-sectional design. A total of 405 participants (166 Deaf and 239 hearing) were enrolled in the study. The Newest Vital Sign was adapted, translated, and developed into an ASL version (ASL-NVS). We found that 48% of Deaf participants had inadequate health literacy, and Deaf individuals were 6.9 times more likely than hearing participants to have inadequate health literacy. The new ASL-NVS, available on a self-administered computer platform, demonstrated good correlation with reading literacy. The prevalence of Deaf ASL users with inadequate health literacy is substantial, warranting further interventions and research.

Emergency Department utilization among Deaf American Sign Language users

BackgroundDeaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. ObjectiveTo compare ED use between deaf and non-deaf patients. MethodA retrospective cohort from medical records. The sample was derived from 400 randomly selected charts (200 deaf ASL users and 200 hearing English speakers) from an outpatient primary care health center with a high volume of deaf patients. Abstracted data included patient demographics, insurance, health behavior, and ED use in the past 36 months. ResultsDeaf patients were more likely to be never smokers and be insured through Medicaid. In an adjusted analysis, deaf individuals were significantly more likely to use the ED (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.11–3.51) over the prior 36 months. ConclusionDeaf American Sign Language users appear to be at greater odds for elevated ED utilization when compared to the general hearing population. Efforts to further understand the drivers for increased ED utilization among deaf ASL users are much needed.

Abstract MP33: The Deaf Weight Wise Study: A Unique Clinical Trial of Health Behavior Modification with Deaf Adults

Introduction: Deaf people who use American Sign Language (ASL) comprise linguistic and cultural minority populations without access to language-concordant health information and healthcare. Deaf ASL users are rarely included in health research or public health surveillance. Recent research with Deaf ASL users found a higher prevalence of obesity than in the general population. No randomized trials of lifestyle modification or weight reduction have ever been attempted with Deaf ASL users. Methods: We worked with the Rochester (NY) Deaf community to adapt a 16-week healthy lifestyle program previously shown to be effective with hearing people. We adapted the curriculum and research measures to be culturally and linguistically appropriate. We used a group intervention format recommended by our Deaf partners, and trained group leaders who were Deaf, ASL fluent and had backgrounds in counseling, public health, or healthcare. For this Deaf Weight Wise (DWW) trial, we recruited Deaf adults aged 40-70 with a BMI of 25-45 from community settings, and randomized participants to immediate intervention or intervention delayed 1 year. We will collect data from DWW trial participants over two years. We present analyses of data after 6 months here. Primary outcomes were changes in weight, BMI and scores on two standard measures: Dietary Risk Assessment (DRA) and Physical Activity Assessment (PAA). We used group by time repeated measures ANOVA to examine changes from baseline to 6 months for the immediate group and delayed group (no intervention yet). Hypothesis: The immediate intervention group would have greater reduction in weight and BMI as well as improvement in DRA and PAA scores six months after baseline compared with the delayed intervention group. Results: At baseline, the 104 participants’ mean age was 53.5 years; 68.3% (71 of 104) were female and 91.3% (95/104) were White. Randomization was successful based on baseline data. At 6 months, the immediate group weight changed -3.35kg (1.0 s.e.; p=.002) and BMI changed -1.35 (0.4 s.e.; p≤.0001) compared with the delayed group. Most of the immediate group (58.3%, 28/48) lost ≥ 5% of baseline weight versus 14.3% (8/56) of the delayed group (p≤.0001). Changes in mean DRA (p=.055) and moderate PAA (p=.054) scores numerically favored the immediate group. Conclusions: Deaf Weight Wise is the first randomized controlled trial of a healthy lifestyle program with Deaf ASL users. This culturally appropriate and language accessible behavioral intervention was feasible and highly effective with this underserved and rarely studied population.

Higher educational attainment but not higher income is protective for cardiovascular risk in Deaf American Sign Language (ASL) users

BackgroundHigher educational attainment and income provide cardiovascular protection in the general population. It is unknown if the same effect is seen among Deaf American Sign Language (ASL) users who face communication barriers in health care settings. ObjectiveWe sought to examine whether educational attainment and/or annual household income were inversely associated with cardiovascular risk in a sample of Deaf ASL users. MethodsThis cross-sectional study included 302 Deaf respondents aged 18–88 years from the Deaf Health Survey (2008), an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) administered in sign language. Associations between the self-reported cardiovascular disease equivalents (CVDE; any of the following: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) with educational attainment (≤high school [low education], some college, and ≥4 year college degree [referent]), and annual household income (<$25,000, $25,000–<$50,000, or ≥$50,000 [referent]) were assessed using a multivariate logistic regression adjusting for age, sex, race/ethnicity, and smoking history. ResultsDeaf respondents who reported ≤high school education were more likely to report the presence of a CVDE (OR = 5.76; 95% CI = 2.04–16.31) compared to Deaf respondents who reported having ≥4 year college degree after adjustment. However, low-income Deaf individuals (i.e., household incomes <$25,000) were not more likely to report the presence of a CVDE (OR = 2.24; 95% CI = 0.76–6.68) compared to high-income Deaf respondents after adjustment. ConclusionLow educational attainment was associated with higher likelihood of reported cardiovascular equivalents among Deaf individuals. Higher income did not appear to provide a cardiovascular protective effect for Deaf respondents.