Deaf And Hard Of Hearing Participants Research Articles

Communication barriers to optimal access to emergency rooms according to deaf and hard-of-hearing patients and health care workers: A mixed-methods study.

This study aimed to identify communication barriers between health care workers (HCWs) and deaf and hard-of-hearing (DHH) patients. Both perspectives are offered to provide a comprehensive understanding. Two consecutive studies were conducted from 2018 to 2021. Study 1 comprised mixed methods, employing a cross-sectional survey (n = 288) and in-depth interviews (n = 9) with DHH participants, utilizing accessible tools including sign language. Study 2 involved a cross-sectional survey of health care emergency workers without hearing loss (N = 391). The perceived self-efficacy of DHH patients, and not their hearing loss, was linked with their ability to communicate independently with HCWs. No significant differences in successful communication with these providers were found vis-à-vis mode of communication utilized (sign language, writing, interpreter, etc.). In the qualitative findings, DHH patients noted two urgent care barriers: HCWs' communication unfamiliarity and patients' communication accessibility issues. Quantitative findings indicated a main barrier: difficulties in communicating with HCWs in general (57%) and specifically in the emergency room (ER; 65%). Only 28.8% reported being able to independently communicate with ER staff. Health care providers were not familiar with effective communication strategies when treating these patients. Respondents indicating that communication was not a barrier to care were mainly administrative staff (54.55%), compared to nurses (32.74%) and physicians (22.58%). Communication solutions are needed to improve access to health services, especially in emergencies. Providing medical staff training on effective communication strategies with these patients could simplify interactions and reduce the reliance on hearing family members, potentially improving medical care. Implementing a communication policy for frontline staff, along with the use of visual aids, is crucial. Health care professionals may not realize that small changes can greatly improve communication with DHH patients.

Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign.

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. Qualitative study using thematic analysis. Semi-structured, individual remote, or in-person interviews in the United States. Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. The barriers and facilitators related to a positive perinatal care experience among DHH women. Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey.

This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English. DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity. The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use. DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.

Deaf and hard-of-hearing patients are unsatisfied with and avoid German health care: Results from an online survey in German Sign Language

BackgroundApproximately 235,000 deaf and hard of hearing (DHH) people live in Germany. Due to communication barriers, medical care for this group is difficult in many respects. Especially in the case of acute illnesses, the possibilities of communication, e.g., through sign language interpreters, are limited. This study investigates the satisfaction of DHH patients with medical care in Germany in unplanned medical consultations. The aim of this study is to provide insights into DHH patient's perception of medical care, to identify barriers and avoidance behaviours that stem from fears, miscommunication, and prior experiences.MethodsWe obtained data from adult DHH participants between February and April 2022 throughout Germany via an online survey in German Sign Language. The responses of N = 383 participants (65% female, M = 44 years, SD = 12.70 years) were included in statistical analyses. Outcomes were convictions of receiving help, satisfaction with healthcare provision, and avoiding healthcare visits; further variables were concerns during healthcare visits, incidences of miscommunication, and a communication score. We calculated t-tests, ANOVAs, correlations, and linear and logistic regression analyses.ResultsOur main findings show that (1) DHH patients were unsatisfied with provided healthcare (M = 3.88; SD = 2.34; range 0–10); (2) DHH patients reported many concerns primarily about communication and treatment aspects when visiting a doctor; and (3) 57% of participants deliberately avoided doctor visits even though they experienced symptoms. Factors such as concerns during doctor’s visits (B = -0.18; 95%CI: -0.34--0.02; p = .027) or miscommunication with medical staff (B = -0.19; 95%CI: -0.33–0.06; p = .006) were associated with satisfaction with medical care, while we found almost no associations with gender and location, and only few with age and education.ConclusionsOverall, our findings suggest that DHH patients are unsatisfied with provided healthcare, they deliberately avoid doctor visits, and they face various communication barriers. This study revealed several communication-related determinants of satisfaction with healthcare in DHH patients, such as incidences of miscommunication and the communication score. Communication-related barriers have high potential to be addressed in collaboration with the DHH community. To improve the medical care and the satisfaction with healthcare in DHH patients, training healthcare professionals, digital technologies, and other communication-enhancing interventions should be explored in future intervention studies.

Exploratory study of spoken and sign language comprehension among Deaf and Hard-of-hearing adults in Slovenia

The aim of this study was to explore spoken and sign language comprehension among Deaf and Hard-of-Hearing (DHH) adults in Slovenia. A sample of 116 DHH participants from eleven Slovenian DHH associations completed a series of tasks that were used to measure their comprehension abilities related to spoken and sign language. The instructions were stratified into three groups according to the complexity of the language. Positive correlations were established between the comprehension ability of spoken and sign language. Slovenian DDH participants differed significantly with respect to the following predictors of spoken and sign language comprehension: age at onset of hearing loss, degree of hearing loss, and age of sign language exposure. The findings of this study provide a starting point for further research on the comprehension of spoken and sign language.

Whole-food plant-based Jumpstart for a Deaf and Hard of Hearing cohort.

Deaf and Hard of Hearing (DHH) patients are at high risk of developing chronic illness, and when they do, are at higher risk of poor outcomes than in a hearing community. Rochester Lifestyle Medicine Institute adapted its online, Zoom-based, medically-facilitated 15 Day Whole-Food Plant-Based (WFPB) Jumpstart program, to give DHH participants knowledge, skills, and support to make dietary changes to improve their health. Adaptations included having a medical provider present who is fluent in American Sign Language (ASL), is board-certified in Lifestyle Medicine, and has a Master of Science in Deaf Education; spotlighting participants when asking a question during the Q&A session; using ASL interpreters; utilizing closed captioning/automatic transcription during all Zoom meetings; and employing a Success Specialist to provide outreach via text and email throughout the program. Participants had significant positive changes in their eating pattern. They reported improvements in biometric measures as well as in how they were feeling. They all reported that they planned to continue to eat a more WFPB diet than they did prior to Jumpstart. All either agreed or strongly agreed that they learned important information, were confident that they knew the best eating pattern for health, and gained the skills they needed to make changes. Although this was a small pilot program, it suggests that this model can be used to provide education and support for behavior change that will lead to improved health in a DHH community.

Interactive description to enhance accessibility and experience of deaf and hard-of-hearing individuals in museums.

Text descriptions in museums provide detailed and rich information about artifacts that broadens museum visitors' knowledge and enriches their experience. However, since deaf and hard-of-hearing (DHH) individuals have low literacy compared to hearing people and communicate through sign language, museum descriptions are considerably limited in delivering a stimulating and informative environment for understanding and enjoying exhibits. To improve DHH individuals' museum experience, we investigated the potential of three interactive description prototypes: active-linked, graph-based, and chatbot-based. A comparative study with 20 DHH participants confirmed that our interaction-based prototypes improve information accessibility and provide an enhanced experience compared to conventional museum descriptions. Most participants preferred the graph-based prototype, while post-interviews suggested that each prototype has potential benefits and limitations according to DHH individuals' particular literacy skills and preferences. Text descriptions can be enlivened for DHH visitors by adding a simple interaction functionality, e.g., clicking, which can lead to a better museum experience.

Exploring deaf students’ disaster awareness and preparedness in U.S. higher education settings: Implications for university-level DRR policy and programming

Deaf and hard of hearing (DHH) communities in the US are underserved during climate and human-caused disasters. While it is necessary for first responders, who are often hearing, to receive additional training, it is important to recognize that DHH individuals themselves are critical leaders in disaster preparedness and response in their communities. This paper examines DHH college students’ disaster awareness and knowledge through a cross-sectional survey protocol adapted from the Disaster Knowledge Instrument (Catedral Mamon, 2017). The survey pertains to disaster awareness, and was administered via a written English online survey platform, from October 1 to November 1, 2019, to DHH students attending a university in the Mid-Atlantic United States that is specifically designed for educating DHH students. Results consisted of 205 DHH participants with 58.5% (n = 120) identifying as white and 59.5% (n = 122) as female. Findings indicated significant differences in disaster experiences and awareness with respect to reported gender identities and racial and ethnic identities. Gender, in particular, had an extremely high correlation with disaster experiences, with 93.7% of the survey sample (n = 205) having experienced one or more disasters in their lifetime. Gender also significantly predicted knowledge about disaster preparedness and readiness, disaster awareness, and disaster risk perception. The analysis developed in this article demonstrates that while DHH college students may be aware of disaster and emergency related phenomena, students do not appear to possess an actionable foundation of knowledge to prepare for and mitigate disaster impacts. Moreover, it is not clear where students received the information they are reporting, as there is an extreme scarcity of data on disaster and emergency training for DHH serving primary, secondary, and higher education settings–including at the university where this study was conducted. Ultimately, the article identifies that a robust research program is needed to ascertain the current status of disaster education and training initiatives for DHH students. Such research is necessary for understanding the kinds of disaster preparedness activities taking place with DHH students, how effective they are, and to identify recommendations for policy and programmatic inputs. These activities could serve as a foundation for quality and equitable disability inclusive emergency planning and training of DHH community members, including those working and studying in educational institutions.

Theory of Mind and Alexithymia in Deaf and Hard-of-Hearing Young Adults

The aim of the current study was to examine theory of mind (ToM), the ability to infer the mental states of others, in young adults who are deaf and hard-of-hearing (DHH), and to explore the influence of alexithymia, an inability to understand emotions of the self and others, on ToM performance in this group. Compared to participants with typical hearing, DHH participants displayed significantly lower affective ToM skills and greater alexithymia. After accounting for verbal intelligence quotient, hearing status and alexithymia significantly contributed to poorer ToM performance, accounting for over 14% of the variance. Having a parent who is deaf and being part of the Deaf community were associated with better emotion processing and appear to be important protective factors. Findings provide support that ToM difficulties may linger into young adulthood among DHH individuals and that alexithymia may be a contributing factor. Early intervention programs emphasizing emotional understanding, perspective-taking, and communication skills are warranted for DHH children as well as their caregivers.

Miranda Warning Comprehension: The Influence of Verbal Aptitude and Hearing Status.

The Miranda warning was drafted in order to inform people of their rights upon arrest in an easy to understand manner. However, to understand the warning a person needs a high school level reading comprehension (which is above the level of most offenders). Among these offenders, deaf and hard-of-hearing (DHH) individuals are particularly prone to misinterpreting the Miranda warning due to language barriers with law enforcement and below average English literacy compared to hearing individuals. Two studies were performed. The first compared Miranda warning comprehension between hearing and DHH participants, and it was found that DHH participants showed overall lower comprehension. The second study, consisting only of DHH participants, compared the effectiveness of four different presentations of the Miranda warning: signed in American Sign Language (ASL), signed in Signed Exact English (SEE), oral presentation, and written presentation. The written presentation demonstrated the lowest comprehension scores while the other three methods showed no significant difference in comprehension. The results suggest that the Miranda warning is best administered to DHH individuals with the assistance of a certified sign language interpreter. Limitations of the sample and directions for future research are discussed.

Deaf and Hard of Hearing Students' Configurational and Phonological Processing in Chinese One- and Two-Character Word Recognition.

To examine deaf and hard of hearing (DHH) students' configurational and phonological processing in Chinese one- and two-character word recognition, two experiments were conducted in a primed semantic categorization task. Configurational priming was observed in DHH participants' reaction times (RTs) at the SOA (stimulus onset asynchrony) of 47 ms and in their probability of making erroneous responses at SOAs of 47 and 187 ms in Experiment 1. Phonological priming was revealed in hearing and DHH participants' probability of making erroneous responses in Experiment 2. Hearing participants' RTs indicated facilitation and inhibition at the SOAs of 47 and 187 ms, respectively; DHH participants' RTs showed priming at the SOA of 187 ms. It is concluded that DHH college students are more likely to use the configurational information but less likely to use the phonological information than hearing college students in one- and two-character word recognition.

Speech perception in deaf and hard of hearing Arabic-speaking children

The rate of Deaf and Hard of Hearing (DHH) people is relatively large in native Arabic speakers in Israel. However, Arabic assessment tools are scarce. The present study reports the procedure of developing two speech perception assessment tools, which are used for hearing loss diagnosis, hearing aids fitting, cochlear implant mapping, and evaluation of progress following rehabilitation intervention. Our closed set test “Arabic Picture Speech Pattern Contrast” (ArPiSPAC), and word perception open-set test, “Arabic AB” (ArAB), were administered to 34 children with moderate to profound sensorineural hearing loss, hearing aids users, aged between 4;5—8;11. In addition, the ArPiSPaC was administered to 38 hearing children, aged between 2;6-5;5 in order to obtain a developmental hierarchy. For DHH participants, the findings showed that vowel contrasts were better perceived than consonants, and articulation manner was better perceived than articulation place. The hearing participants' phonological perception hierarchy differed in some interesting features from that of the DHH children. The mean percent of phoneme perception by DHH was M = 60.53%, (SD = 23.87), and the mean percent of word perception was M = 18.5%, (SD = 15.68). Voicing and pharyngealization contrasts revealed the largest Pearson correlation for phoneme and word perception.

DHH Students' Phoneme Repetition Awareness in Sentence Reading.

To examine deaf and hard-of-hearing (DHH) students' awareness of phoneme repetition in Chinese sentence reading, two experiments were conducted in the self-paced, moving-window reading paradigm. The materials comprised sentences in which Chinese characters that sequentially followed each other shared similar spelling initials and finals in Experiments 1 and 2, respectively. In comparison to hearing participants, DHH participants were more likely to find it more time-consuming to read sentences with, as opposed to without, phoneme repetitions. However, their difficulty in phonological processing seemed to be linked to their weakness at syntactic skilfulness, thus having a negative influence on their reading performance. It is concluded that Chinese DHH college students have developed a phoneme repetition awareness which is different from how hearing college students are aware of phoneme repetitions in Chinese sentence reading. It is implicated that DHH students are able to develop their own skills of phonological information processing in sentence reading as a result of many practices.

EarVR: Using Ear Haptics in Virtual Reality for Deaf and Hard-of-Hearing People.

Virtual Reality (VR) has a great potential to improve skills of Deaf and Hard-of-Hearing (DHH) people. Most VR applications and devices are designed for persons without hearing problems. Therefore, DHH persons have many limitations when using VR. Adding special features in a VR environment, such as subtitles, or haptic devices will help them. Previously, it was necessary to design a special VR environment for DHH persons. We introduce and evaluate a new prototype called "EarVR" that can be mounted on any desktop or mobile VR Head-Mounted Display (HMD). EarVR analyzes 3D sounds in a VR environment and locates the direction of the sound source that is closest to a user. It notifies the user about the sound direction using two vibro-motors placed on the user's ears. EarVR helps DHH persons to complete sound-based VR tasks in any VR application with 3D audio and a mute option for background music. Therefore, DHH persons can use all VR applications with 3D audio, not only those applications designed for them. Our user study shows that DHH participants were able to complete a simple VR task significantly faster with EarVR than without. The completion time of DHH participants was very close to participants without hearing problems. Also, it shows that DHH participants were able to finish a complex VR task with EarVR, while without it, they could not finish the task even once. Finally, our qualitative and quantitative evaluation among DHH participants indicates that they preferred to use EarVR and it encouraged them to use VR technology more.

Fairness decisions in children and early adolescents with and without hearing loss

AbstractAlthough having universal aspects, development of a sense of fairness, a milestone in children's social development, is influenced by social and cultural forces. Yet, it scarcely has been studied in children who are at risk for their social development, let alone in deaf and hard‐of‐hearing (DHH) children, who have limited access to linguistic and social input. This study examined for the first time equity preferences in DHH children compared with hearing counterparts. About 179 children (8–11 years) and early adolescents (12–14 years) played four economic allocation games where they distributed coins between themselves and another child. Participants with and without hearing loss were similar in conditions that entailed non‐costly prosociality or self‐maximization. However, DHH participants showed weaker inequity aversion in more complex conditions: DHH children were more willing to allow other players to receive more coins than themselves, compared with hearing children and to DHH or hearing adolescents, and DHH adolescents were less willing to share resources when it was self‐costly, compared with all other groups. Findings are discussed in light of the tension between norms of social comparison and norms of prosociality, and how they are reflected in developmental trajectories for inequity aversion when access to these norms is limited.

Are French Fries a Vegetable? Lexical Typicality Judgement Differences in Deaf and Hearing Learners

Deaf and hard-of-hearing (DHH) learners are known to have vocabulary knowledge and language outcomes more heterogeneous than their hearing peers, with a greater incidence of difficulties presumably related (both as cause and effect) to documented challenges in academic domains. In particular, there is increasing evidence that differences may exist in the ways that semantic networks are structured and accessed in DHH and hearing learners. Individuals' judgments of word typicality offers a window into their semantic networks, revealing internal relationships in the mental lexicon. In the present study, 90 DHH and hearing college-aged learners provided typicality ratings at two points in time for 120 words common words considered to be central, borderline, or non-members of six categories. DHH and hearing participants differed in terms of their word knowledge, rating consistency, and rating magnitudes. Relative to hearing peers, DHH participants reported not knowing more of the words, but rated all words as being more typical than did hearing participants and rated the typicality of items more consistently over time. Implications of these findings for understanding mental lexicon structure for DHH and hearing learners, interpreting previous research, and constructing stimuli for future research are discussed.

Design and Psychometric Evaluation of American Sign Language Translations of Usability Questionnaires

To promote greater inclusion of people who are Deaf and Hard of Hearing (DHH) in studies conducted by Human-Computer Interaction (HCI) researchers or professionals, we have undertaken a project to formally translate several standardized usability questionnaires from English to ASL. Many deaf adults in the U.S. have lower levels of English reading literacy, but there are currently no standardized usability questionnaires available in American Sign Language (ASL) for these users. A critical concern in conducting such a translation is to ensure that the meaning of the original question items has been preserved during translation, as well as other key psychometric properties of the instrument, including internal reliability, criterion validity, and construct validity. After identifying best-practices for such a translation and evaluation project, a bilingual team of domain experts (including native ASL signers who are members of the Deaf community) translated the System Usability Scale (SUS) and Net Promoter Score (NPS) instruments into ASL and then conducted back-translation evaluations to assess the faithfulness of the translation. The new ASL instruments were employed in usability tests with DHH participants, to assemble a dataset of response scores, in support of the psychometric validation. We are disseminating these translated instruments, as well as collected response values from DHH participants, to encourage greater participation in HCI studies among DHH users.

Reading Comprehension and Phonics Research: Review of Correlational Analyses with Deaf and Hard-of-Hearing Students.

This manuscript reviews 28 studies of reading research on deaf and hard-of-hearing (DHH) students published since 2000 that used correlational analyses. The examination focused on assessment issues affecting measurement and analysis of relationships between early phonological or orthographic skills and reading comprehension. Mixed outcomes complicate efforts to determine evidence-based practices, and to develop an accurate model of reading. Across the 28 studies, DHH participants represented a wide age range with potential floor and ceiling effects that reduce score variability for valid correlations. Many studies assessed readers beyond the optimal ages during which early skills develop and are most useful for reading. Reading skills also were assessed using a diverse array of measures and skill definitions. Particularly for reading comprehension, word-level and text-level abilities appear to be different constructs. Suggestions include more consistent skill definitions and differential timing for early- versus later-developing skill assessments to ensure more robust correlational relationships.

Comprehension of Written Grammar Test: Reliability and Known-Groups Validity Study With Hearing and Deaf and Hard-of-Hearing Students.

The aim of the current study was to gather validation evidence for the Comprehension of Written Grammar (CWG; Easterbrooks, 2010) receptive test of 26 grammatical structures of English print for use with children who are deaf and hard of hearing (DHH). Reliability and validity data were collected for 98 participants (49 DHH and 49 hearing) in Grades 2-6. The objectives were to: (a) examine 4-week test-retest reliability data; and (b) provide evidence of known-groups validity by examining expected differences between the groups on the CWG vocabulary pretest and main test, as well as selected structures. Results indicated excellent test-retest reliability estimates for CWG test scores. DHH participants performed statistically significantly lower on the CWG vocabulary pretest and main test than the hearing participants. Significantly lower performance by DHH participants on most expected grammatical structures (e.g., basic sentence patterns, auxiliary "be" singular/plural forms, tense, comparatives, and complementation) also provided known groups evidence. Overall, the findings of this study showed strong evidence of the reliability of scores and known group-based validity of inferences made from the CWG.

Accessibility Evaluation of Classroom Captions

Real-time captioning enables deaf and hard of hearing (DHH) people to follow classroom lectures and other aural speech by converting it into visual text with less than a five second delay. Keeping the delay short allows end-users to follow and participate in conversations. This article focuses on the fundamental problem that makes real-time captioning difficult: sequential keyboard typing is much slower than speaking. We first surveyed the audio characteristics of 240 one-hour-long captioned lectures on YouTube, such as speed and duration of speaking bursts. We then analyzed how these characteristics impact caption generation and readability, considering specifically our human-powered collaborative captioning approach. We note that most of these characteristics are also present in more general domains. For our caption comparison evaluation, we transcribed a classroom lecture in real-time using all three captioning approaches. We recruited 48 participants (24 DHH) to watch these classroom transcripts in an eye-tracking laboratory. We presented these captions in a randomized, balanced order. We show that both hearing and DHH participants preferred and followed collaborative captions better than those generated by automatic speech recognition (ASR) or professionals due to the more consistent flow of the resulting captions. These results show the potential to reliably capture speech even during sudden bursts of speed, as well as for generating “enhanced” captions, unlike other human-powered captioning approaches.