Deaf Hard Of Hearing Research Articles

Augmentative and alternative communication and deaf children with disabilities

ABSTRACT With recent data reporting approximately 40–50% of Deaf or hard of hearing (DHH) individuals as having a diability, complex communication needs are not uncommon within this population and can present unique communicative challenges. Implementing augmentative and alternative communication (AAC) systems can provide this population with an effective means of communication, assist them in developing specific language skills, and support them in effectively accessing their social environment. The purpose of this scoping review was to (a) identify the facilitators and barriers to AAC provision for this group of individuals, (b) discuss observable trends throughout studies, and (c) highlight areas for further research in AAC for this group of learners. This review compiles the results from seven studies within the last 10 years and focuses on the facilitators and barriers when implementing AAC systems for DHH individuals with a disability (DWD) and complex communication needs. The facilitators and barriers are categorised as interpersonal, intervention and assessment related. The trends that were identified included (a) the overall success of AAC, (b) the prevalence of speech-generating devices (SGD) use, (c) the lack of communication within interdisciplinary teams, (d) the lack of DHH-specific research, and (e) the lack of standardised methods for AAC selection.

535 - Exploring the Intersectionality of Being Deaf and Black while Accessing Dermatological Care

Abstract In 2021, Deaf or hard of hearing (DHH) persons made up ∼3.4% of the United States population however, there was no sub-categorical data about race. This dearth of data makes it challenging to quantify the health disparities amongst Black DHH individuals. This paper aims to identify trends and disparities to improve health outcomes for DHH and Black patients seeking dermatologic care. Black patients utilize less preventative service, have lower post-trauma survival, and a 3-fold higher risk of maternal mortality than White patients. DHH patients experience delayed cancer treatment, more emergency department visits, and higher intimate partner violence than hearing patients. Black DHH patients have a higher likelihood of cancer, diabetes, hypertension, and lung disease than Black-hearing patients. Black patients have lower survival rates with certain cutaneous neoplasms and poorer disease control than White counterparts. The literature lacks dermatologic care outcomes for Black DHH patients. Shared themes impacting Black and DHH patients’ care include audism and racism, medical mistrust, and poor communication with clinicians. Unfortunately, the dermatological experiences of Black DHH patients are poorly documented. To minimize disparities for this population, clinicians must acknowledge them and partner with the community to investigate them.

Sign language usage of deaf or hard of hearing Sri Lankans.

In Sri Lanka, about 300,000 Sinhala speaking people are either deaf or hard of hearing (DHH) and would benefit from a common Sinhala sign language, technological resources such as captioning, and educational and social support. There is no fully developed common sign language for members of the Sinhalese community, a severe shortage of sign language interpreters, and few resources for teachers. This exploratory study was undertaken in all nine provinces of Sri Lanka into the use of sign language, access to education for people with disabilities, and the availability of trained or qualified educators to work with the DHH people. Data were gathered via interviews and focus groups with Special Education Assistant Directors, Principals and Teachers in Deaf Schools, and Teachers of Special Education Deaf Units in mainstream schools. The DHH members of Sri Lankan society are marginalized, under-supported, and require urgent attention to their educational and social needs. This study provides a basis for much needed attention and reform.

SignIt! An Android game for sign bilingual play that collects labelled sign language data

The Deaf or Hard-of-Hearing (DHH) community constitutes over 430 million people globally, with about 70 million of them using sign language as their primary means of communication. India has around 63 million DHH individuals. The DHH community in India faces several challenges, particularly in learning sign language and English, due to delayed diagnosis, stigma, oralism, and a diversity of languages. Digital games for spoken and sign language learning have gained popularity due to their advantages over traditional language learning methods, such as enhanced engagement and socialization, driving increased research and adoption over traditional methods. Moreover, the development of robust machine learning models for sign language recognition, which could significantly improve access for signers, is currently impeded by the scarcity of labelled sign language data. To address these challenges, we collaborated with NISH, an academic institution for the DHH community and developed SignIt!, an accessible and inclusive quiz platform that facilitates the learning of English and Indian Sign Language (ISL) with a secondary goal of data collection. To assess the game's usability, we conducted a study with 20 members of the DHH community, followed by interviewing 15 participants. Overall, our participants answered 2160 quiz questions and created 210 questions. The quiz creation resulted in the collection of three hours of labelled real-world sign language data. The interviews revealed novel insights, such as a preference for playing competitively with friends, empowerment by their agency to be content creators, and early signs of learning English, sign language, and quiz content by playing and creating quizzes. We plan to open-source and release SignIt! to increase its adoption among diverse DHH communities.

Development of Teleaudiology Service in Special Education Service Centre in Malaysia: Lessons Learned

Teleaudiology has been implemented in several settings, including hospitals, nursing homes, community-based programmes, and educational institutions. Despite its numerous advantages, teleaudiology is still relatively new in Malaysia and is gaining popularity among audiologists. Additionally, the majority of studies have been conducted on normal-hearing individuals. Thus, as a pioneer in Malaysia, this study established teleaudiology services for students who are deaf or hard of hearing (DHH) at the Special Education Service Centre. The researchers examined two critical factors that contribute to the service's proper operation: internet speed and the audio-visual quality of the ICT applications employed. This study documented the details of the service's implementation, which included 25 sessions of synchronous teleaudiology with DHH school children. Additionally, this study revealed that upload and download speeds exceed prior research-recommended minimums. Meanwhile, most teleaudiology service sessions are done in high-quality audio and video, except for the Skype programme, which has a moderate visual quality. To summarise, teleaudiology services have been effectively deployed amongst institutions and have the potential to be expanded to another location in Malaysia.

A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts.

Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the "Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.

EHDI Services should be accessible! caregivers’ expectations of EHDI services in South Africa

ABSTRACT Progress of Early Hearing Detection and Intervention (EHDI) services within the South African context lags behind that made by high-income countries internationally. Implementation of EHDI services in this context faces many challenges that underscore the need to ensure contextualized intervention approaches that meet the needs of South Africa’s linguistically and culturally diverse population. The aim of the current study was to describe caregivers’ expectations of EHDI services, and to evaluate the success and/or failure of the EHDI services in relation to these expectations. To achieve this aim, in-person, telephonic and videoconferencing narrative interviews were conducted with nine caregivers of children who are Deaf-or-Hard-of-Hearing (DHH), and analysed through reflexive thematic analysis. The following themes and sub-themes emerged from the narrative interviews: (1) expectations of the EHDI process (‘early detection of hearing loss and ‘EHDI should be accessible’), and (2) expectations for the outcomes of EHDI services (‘age-appropriate acquisition of spoken language’, ‘mainstream education’, and ‘further education and independence’). These themes speak to concerns with the entire EHDI process from detection to intervention, including continuity of care. In order to ensure effective and sustainable EHDI services within the South African context; caregivers’ expectations should be used to inform service provision and to guide best practice. Furthermore, these findings suggest a need to implement wide spread, integrated, and inter-disciplinary EHDI services that are linguistically and culturally responsive and relevant; with caregivers and families forming a crucial part of the programmes.

Emotion recognition and false belief in deaf or hard-of-hearing preschool children.

This study aims to examine emotion recognition and false belief performances of 4-5-year-old (48-71months) deaf or hard-of-hearing (DHH) children. The performances have been assessed using the Turkish Version of the Theory of Mind Task Battery for Children. The DHH children have been continuing schooling in inclusive settings with an auditory-oral approach. The emotion recognition performances of hearing children (n = 100) and DHH (n = 100) children have appeared to be similar. The ANOVA analysis has revealed that the groups do not differ concerning false belief performances between the ages of 4 and 5.5. However, from the age of 5.5, hearing children have performed better than DHH children. According to correlation analysis, parental education has been determined as a remarkable factor in DHH children's false belief development. The findings point to the need for research across a wide range of ages to better understand the developmental course of false belief in DHH children.

Cochlear Implantation in Children with Additional Disabilities: A Systematic Review.

This study examines the last 10 years of medical literature on the benefits of cochlear implantation in children who are deaf or hard of hearing (DHH) with additional disabilities. The most recent literature concerning cochlear implants (CIs) in DHH children with additional disabilities was systematically explored through PubMed, Embase, Scopus, PsycINFO, and Web of Science from January 2012 to July 2023. Our two-stage search strategy selected a total of 61 articles concerning CI implantation in children with several forms of additional disabilities: autism spectrum disorder, cerebral palsy, visual impairment, motor disorders, developmental delay, genetic syndromes, and intellectual disability. Overall, many children with additional disabilities benefit from CIs by acquiring greater environmental sound awareness. This, in turn, improves non-verbal communication and adaptive skills, with greater possibilities to relate to others and to be connected with the environment. Instead, despite some improvement, expressive language tends to develop more slowly and to a lesser extent compared to children affected by hearing loss only. Further studies are needed to better appreciate the specificities of each single disability and to personalize interventions, not restricting the analysis to auditory and language skills, but rather applying or developing cross-culturally validated instruments able to reliably assess the developmental trajectory and the quality of life of DHH children with additional disabilities before and after CI.

Hearing Impairment and School Engagement Outcomes in US Children

Ensuring appropriate school engagement for deaf or hard of hearing (DHH) children in the US is important for improving their long-term outcomes as they grow into adults. To examine the associations between hearing loss (HL), its sequelae (speech and/or language disorders, behavioral and/or conduct problems, and neuropsychiatric and/or learning disorders), and various school engagement measures among school-aged children in the US. This cross-sectional study combined data from the nationally representative 2016-2021 National Survey of Children's Health. A total of 155 178 randomly selected children (weighted, approximately 49 340 700 children) aged 6 to 17 years with a parent or caregiver who responded to an address-based survey by mail or online were included. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population-based estimates representative of all noninstitutionalized school-aged US children and adolescents residing in housing units. Diverse school engagement measures, including extracurricular participation in sports, clubs, paid work, volunteer work, and organized lessons, as well as educational performance variables, including missed school days, not caring about doing well in school, not doing required homework, grade repetition, and parent or guardian contacted by school. Of the estimated 49 340 700 children aged 6 to 17 years (41.1% aged 6-10 years; 51.1% male; 54.7% without underrepresented minority status), an estimated 1.4% (95% CI, 1.2%-1.5%) were reported by their parent or guardian to have deafness or hearing problems. Having DHH status was associated with significantly worse outcomes on 8 of 10 school engagement measures (eg, participation in sports: adjusted odds ratio [AOR], 0.75 [95% CI, 0.60-0.93]; missed school days: AOR, 2.98 [95% CI, 2.21-4.00]), even after adjustment for age, sex, underrepresented minority status, highest educational level of parent or guardian, federal poverty level of the household, and primary language in the household. Moreover, although subgroup analyses of DHH children with and without HL sequelae revealed significant differences (speech and/or language disorder: AOR, 5.83 [95% CI, 4.31-7.89]; behavioral and/or conduct problem: AOR, 2.75 [95% CI, 2.10-3.60]; neuropsychiatric and/or learning disorder: AOR, 3.06 [95% CI, 2.39-3.91]), HL sequelae only partially mediated the associations between these disparities. In this cross-sectional study, DHH status itself may have been the primary factor directly associated with school engagement disparities. These findings suggest the need for greater emphasis on educational accommodations and support for hearing status itself, independent of the presence or absence of HL sequelae.

Diagnostic Utility of Parent Ratings on the Behavior Assessment System for Children-Third Edition in Children who are Deaf and Hard of Hearing and Diagnosed with Autism Spectrum Disorder.

Between 1 to 2 of every 1,000 children are born deaf or hard of hearing (DHH) and, of those, 30-50% have additional disabilities, including Autism Spectrum Disorder (ASD). Most measures assessing ASD characteristics rely on some degree of behavioral response to sound (e.g., responding to name, listening response), and may not be appropriate for use with children who are DHH. Further, ASD specific measures do not provide information on a child's functional abilities across developmental domains. We conducted a cross-sectional analysis comparing mean T-scores on a standardized multidimensional measure, the Behavior Assessment System for Children, Third Edition, Parent Rating Scale (BASC-3 PRS), across three groups matched for age and sex: children who are DHH and diagnosed with ASD (DHH + ASD; n = 16); children who are DHH without ASD (DHH-ASD; n = 16); and children who are typically hearing with ASD (H + ASD; n = 16). Analyses revealed statistically significant differences across scales of Attention Problems, Atypicality, Withdrawal, Behavioral Symptoms Index, Social Skills, Leadership, Functional Communication, Activities of Daily Living, Adaptive Skills, Autism Probability Indices, and Developmental Social Disorders. Pairwise comparisons showed DHH + ASD and H + ASD mean T-scores were statistically similar and distinct from DHH-ASD mean T-scores on all these scales except for Withdrawal, Leadership, Functional Communication, and Activities of Daily Living, where pairwise comparisons varied. The findings add to the literature on ASD and DHH childrenand call for further exploration of the BASC-3 as a tool for both evaluation of ASD and the development of individualized treatment plans in this unique population.

Parenting stress and needs for social support in mothers and fathers of deaf or hard of hearing children.

Hearing parents of deaf or hard of hearing (DHH) children may experience parenting stress and social support could be a buffer to this stress. Differences in levels of these two indicators may exist between mothers and fathers. This study focuses on the parenting stress and social support needs of mothers and fathers of DHH children. Twenty-seven French parental couples of DHH children completed the Parenting Stress Index and the Family Needs Survey, a questionnaire on social support needs. Their overall stress scores showed no difference, but subdomain scores show that mothers and fathers are more stressed by the child's hyperactivity, and fathers by the child's adaptability, than parents of children with normal hearing. Mothers are more stressed than fathers by role restriction; they feel less free because of their parenting role. Fathers have a lower quality of attachment to their child than mothers. Parents have a high social support need, especially for obtaining information about their child's individual characteristics and health situation. The ranking of mothers and fathers in the top 10 needs reveals different needs profiles. Parenting stress profiles show that mothers and fathers with higher-than-normal stress levels have a greater overall need for social support than mothers and fathers with lower than normal stress levels. This study highlights the value of assessing parenting stress and social support needs in parents of DHH children for a better understanding of their situation in research and its clinical implications, as well as the importance of differentiating outcomes for mothers and fathers.

The Utility of the Dynamic Indicators of Basic Early Literacy Skills as a Literacy Screener for Children Who Are Deaf or Hard of Hearing.

The purpose of this study was to (a) compare outcomes between children who are deaf or hard of hearing (DHH) and children with typical hearing (CTH) on the DIBELS Eighth Edition assessment and (b) compare outcomes of children who are DHH on the DIBELS to other standardized literacy assessments. Participants included 19 children who are DHH and 19 CTH in kindergarten or first grade. All participants who are DHH had bilateral hearing loss and used listening technology. The participants completed timed and untimed standardized literacy assessments. Data were analyzed using independent samples t-test, chi-square analysis, and Pearson correlation analysis. Only one of five subtests on the DIBELS, the Oral Reading Fluency subtest, revealed a significant difference in scores between children who are DHH and CTH. Despite this difference, there were no differences in the distribution of risk between the groups. The DIBELS scores of children who are DHH strongly correlated to their scores on other standardized literacy assessments. The results indicate that the DIBELS is an adequate measure to screen early literacy skills for children who are DHH. The DHH and CTH groups differ in reading comprehension using a standardized measure, however, the DIBELS does not measure this skill. Further assessments of reading comprehension along with the DIBELs are recommended when assessing these skills in children who are DHH.

Social media use and mental health in deaf or hard-of-hearing adults—Results of an online survey

This paper presents the results of an online survey on digital participation through the use of social media of n = 38 German deaf or hard-of-hearing (DHH) adults. In addition, information about the respondents' mental health is collected with four different scales: the Rosenberg Self-Esteem Scale (RSES), the Fear of Missing Out Scale (FoMoS), the Patient-Reported Outcomes Measurement Information System Social Isolation Scale (PRO-MIS SI-S) and the Social Media Disorder Scale (SMDS). Correlation analyses using Pearson correlation and Spearman rank correlation tests were conducted to identify relationships between mental health and use of social media. The results indicate that the DHH adults have 4.13 social media accounts on average and use social media 3.78 h per day. This is consistent with other research findings, so that the DHH individuals in this study do not differ from other DHH adults or hearing adults in the number of their social media accounts and in their media usage time. However, there are differences in usage of social media that concern, for example, the social media platforms that are used and time of usage due to communication modality (spoken language, sign language, bimodal bilingualism, and mixed forms). DHH individuals who use sign language use social media less overall compared to DHH people who use spoken language. In terms of mental health, it was found that, as expected, addictive social media behavior and high usage time are interrelated. Addictive behavior, in turn, is often associated with low self-esteem, a sense of social isolation, and a fear of missing out. In general, many participants in the study score high in scales for self-perception of social isolation and loneliness. Nevertheless, there are also positive effects and opportunities of using social media, especially in terms of digital participation, for DHH people, which are also discussed in the article.

Implementing Caregiver Coaching in Early Intervention With Families of Children Who Are Deaf or Hard of Hearing

Caregiver coaching is a common component of early intervention services, but providers may be unfamiliar with methods of coaching for families of children who are Deaf or hard of hearing (DHH). This article provides guidance for early interventionists to implement caregiver coaching to facilitate language development in their children who are DHH. While the paper is written mainly for general interventionists who may be less familiar with the special needs of families with children who are DHH, the coaching guidance provided here may also be of value to early intervention providers who routinely serve this population as a model for coaching.

Why Are Causal and Temporal Connectives Difficult to Understand? A Comparison Between Italian Hearing Good and Poor Comprehenders and Deaf Poor Comprehenders.

Both hearing poor comprehenders (PCs) and deaf or hard-of-hearing (DHH) PCs have problems in understanding causal and temporal coherence relations signaled by connectives. The study examined whether hearing and DHH PCs' problems with connective understanding are similar and mainly related to their limited vocabulary, including knowledge of connective words, or to their poor reading comprehension abilities more generally. Three groups of 7- to 10-year-old readers, matched on grade level (hearing PCs, DHH PCs, and hearing good comprehenders [GCs]) performed a reading comprehension task, a vocabulary task, and causal and temporal connective understanding tasks. Hearing and DHH PCs were also matched on reading comprehension and decoding abilities. The DHH PCs performed significantly worse than both the hearing GCs and PCs in temporal and causal connective understanding. Significant differences between hearing PCs and GCs were found only in causal connective understanding. DHH readers' difficulties in causal connective understanding were significantly associated with poorer vocabulary knowledge. In contrast, vocabulary knowledge did not uniquely contribute to hearing PCs' difficulties with causal connective understanding, once their reading comprehension skills were controlled for. The results suggest that despite a similar reading profile, DHH PCs' difficulties with causal connective understanding are more closely related to their vocabulary delay, whereas hearing PCs' difficulties are more strongly influenced by their poor text integration processes (as indexed by their reading comprehension skills). Neither vocabulary knowledge nor reading comprehension skills contributed to the explanation of DHH readers and hearing PCs' temporal connective understanding.

A Systematic Review and Meta-Analysis of Vocabulary Interventions for Deaf/Hard of Hearing Children and Adolescents.

The development of vocabulary size in deaf/hard of hearing (DHH) children and adolescents can be delayed compared to their peers due to lack of access to early language input. Complementary vocabulary interventions are reported in the literature. Our aim is to evaluate the effectiveness of intervention methods for their vocabulary improvement. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched five databases for peer-reviewed journal articles in English, published between 2000 and 2022 (inclusive), reporting vocabulary interventions for 2- to 18-year-old DHH children and adolescents without comorbidities. We conducted separate meta-analyses using a random-effects model on receptive oral vocabulary, expressive oral vocabulary, and signed vocabulary. We assessed the methodological quality of each paper. This review is preregistered in PROSPERO (International Prospective Register of Systematic Reviews) with ID CRD42021243479. We included 25 group studies in this review out of 1,724 identified records. The quality assessment of the studies revealed risk of bias ranging from some concerns to high risk. Experimental vocabulary instruction produced improvement in receptive oral vocabulary (Hedges's g = 1.08, 95% CI [0.25, 1.90], I2 = 93.46, p = .01), expressive oral vocabulary (Hedges's g = 1.00, 95% CI [0.18, 1.83], I2 = 96.37, p = .02), and signed vocabulary (Hedges's g = 1.88, 95% CI [1.09, 2.66], I2 = 96.01, p < .001) in the experimental groups. Written vocabulary and general vocabulary skills are also reported as a synthesis of results. Multisensory and multimodal explicit vocabulary instruction for DHH children and adolescents is helpful in improving vocabulary acquisition with respect to baseline levels. However, its effectiveness must be carefully interpreted due to the lack of proper control groups and details on treatment as usual reported in the studies. https://doi.org/10.23641/asha.23646357.

Retrospective assessment of the impact of an education specialist on the care of children with hearing loss

ObjectiveTo assess the impact of an education specialist in a multidisciplinary pediatric hearing loss clinic. Study designRetrospective review and cross-sectional survey. SettingSingle tertiary care center. MethodsConsultations held between an education specialist and families of pediatric deaf or hard of hearing (DHH) children within a two-year period were reviewed. Reasons for referral and services provided to each patient and family who subsequently worked with the educational specialist were assessed. Parents of patients who had previously worked with the education specialist were invited to complete a survey evaluating their experience. Results102 patients were referred to the educational specialist in a two-year period. Most common reasons for referral included need for special education plans to accommodate their hearing deficit (32) or family request to support for revisions to such plans (37). 14 patient families completed our survey. 76.9 % of respondents confirmed that the education specialist recommended resources they had not been introduced to before. Given a scale of 1 (“completely dissatisfied”) and 10 being “completely satisfied,” the average rating of the 14 respondents was 9.0. ConclusionThe role of an education specialist in a pediatric hearing loss clinic is to optimize patient and family access to resources that could benefit their DHH child's academic development over time. Future studies should prospectively investigate the impact of education specialist services on the educational progress of DHH patients compared to outcomes without these supports.

The Linguistic Input of Fathers of Children Who Are Deaf or Hard of Hearing

Purpose: This study presents an exploration of facilitative language techniques (FLTs) used by fathers of children who are deaf or hard of hearing (DHH) in the natural environment. Method: This investigation utilized the Language ENvironment Analysis (LENA) to collect full-day audio samples from three families with children who were DHH and between 22 and 27 months of age. A total of 6 hr of audio recordings per participant was manually coded for the presence of 10 FLTs used by fathers in the natural environment. These data were compared with FLT use by mothers from the same samples. Results: Fathers of children who are DHH used fewer overall FLTs, fewer responsive FLTs, and more directives compared with mothers. Conclusions: Results of this analysis indicate that fathers provide less linguistic input to their children who are DHH in the natural environment. Furthermore, their input tends to be directive in nature rather than responsive to the child. Implications for clinical practice are discussed. Supplemental Material: https://doi.org/10.23641/asha.23511948

Disparities in Health Care Utilization Among Deaf and Hard of Hearing Adults

Purpose: A substantial literature exists, documenting differences in access to quality health care among individuals of different racial/ethnic, residence, income, and disability groups. However, little attention has been given to disparate utilization among those who are deaf or hard of hearing (DHH). The purpose of this study was to evaluate differences between individuals with and without hearing-related issues using a nationally representative survey of health care access outcomes to quantify the magnitude of these differences. Method: Using data from the 2021 Centers for Disease Control Behavioral Risk Factor Surveillance System survey, we compared health care utilization between individuals who reported being DHH and those without hearing-related issues. Logistic regression models were used to explore differences in access to care between DHH and non-DHH individuals controlling for sociodemographic characteristics. Results: The total Behavioral Risk Factor Surveillance System survey sample consisted of 412,427 respondents. Among those were 36,532 (6.85%) who identified as DHH. Logistic models indicated that DHH adults were less likely to have a personal health care provider (odds ratio [ OR ] = 0.91, 95% CI [0.83–2.03]) and less likely to have received a routine checkup within the last 2 years ( OR = 0.91, 95% CI [0.82–1.02]) but more likely to have forgone health care due to difficulty paying ( OR = 1.90, 95% CI [1.71–2.06]) compared to those without hearing difficulties. Differences were robust to race, sex, and other demographic factors. Conclusions: Significant differences in health care utilization were observed between DHH and non-DHH individuals. This is concerning given that DHH adults have a higher prevalence of many chronic conditions that require clinical management. These results indicate that health care providers and systems must offer greater communication options to facilitate better health-related outcomes.