Deaf Sign Language Users Research Articles

Deaf Qualitative Health Research: Leveraging Technology to Conduct Linguistically and Sociopolitically Appropriate Methods of Inquiry.

One of the most understudied health disparity populations in the United States is the Deaf community-a sociolinguistic minority group of at least 500,000 individuals who communicate using American Sign Language. Research within this population is lacking, in part, due to researchers' use of methodologies that are inaccessible to Deaf sign language users. Traditional qualitative methods were developed to collect and analyze participants' spoken language. There is, therefore, a paradigm shift that must occur to move from an auditory data schema to one that prioritizes the collection and analysis of visual data. To effectively navigate this shift when working with Deaf sign language users, there are unique linguistic and sociopolitical considerations that should be taken into account. The current article explores these considerations and outlines an emerging method of conducting qualitative analysis that, we argue, has the potential to enhance qualitative researchers' work regardless of the population of focus.

The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa

BackgroundThe World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care.MethodsThe ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects’ registry from 2008–2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs.ResultsAverage Sign Language Interpreter services’ utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008–2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013.ConclusionsIn the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf.

Task-response times, facilitating and inhibiting factors in cross-signing

AbstractThis paper reports on data from the “cross-signing” strand of a research project on Sign Multilingualism. Cross-signing investigates the ad-hoc improvised conversations of small groups of deaf sign language users who do not have fluency in any shared language. Participants were filmed in pairs when they met for the very first time, and after a contact period of 4–6 weeks together as a group. The deaf signers involved in this study are from the UK, Jordan, Indonesia, Japan, India, and Nepal. All signers are highly fluent in their own sign language, with varying competence in a language of literacy from their home country, but minimal or no overlapping competence in International Sign, English, or any other shared language between them. The participants used a wide range of multilingual and multimodal communicative resources, including their own and invented signs, fingerspelling, pointing, mouthing, gesture/mime, and various representations of writing. The article considers quantitative data from signed interactions during a picture-based elicitation game. While the overall response times taken by participants for completing the elicitation game are reduced at the end of the contact period compared to the initial contact, differentiating factors are at work that lead to different degrees of response time reduction in the individual signers. As a step towards explaining these patterns, the article explores insights into factors that may inhibit or facilitate communication between cross-signers, such as extent of contact between signers, typological distance between sign languages, or the use of literacy. Moreover, the data suggest a cumulative impact of these factors.

Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

BackgroundImproving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme.Objectives(1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design.DesignA mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results.SettingsIAPT service providers (NHS and private); the Deaf community.ParticipantsDeaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118).InterventionsIAPT at steps 2 and 3.Main outcome measuresReliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios.Data sourcesIAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature.ResultsRandomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.LimitationsThe small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.ConclusionsThere is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established.Future workA prospective observational study for definitive results is justified.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

“It’s good for them but not so for me”: Inside the sign language interpreting call centre

This paper reports on findings from an international survey of sign language interpreters who have experience of working remotely via video link, either in a video relay service or as a video remote interpreter. The objective of the study was to identify the common issues that confront interpreters when working in these remote environments and ascertain what aspects of interpreting remotely via a video link are working successfully. The international reach of this survey demonstrates how working remotely via video link can be an integral part of bringing about social equality for deaf sign language users; yet according to interpreters who work in these services, ineffective video interpreting policies, poor public awareness and lack of training are identified as areas needing improvement.

Expert Listening beyond the Limits of Hearing: Music and Deafness

Attitudes to the relationship between music and deafness suffer from two related misconceptions: the enduring assumption that hearing is central to musical experience in conjunction with an extreme impression of deafness as total aural loss; and, more recently, the tendency to reduce deaf listening to tactility, as narratives about inborn sensory acuities among the deaf proliferate in the popular imaginary. Increasingly, deafness symbolizes a set of sensory polarities that obscure an intrinsic diversity of musical experiences from which musicology stands to gain, a diversity that encompasses members of Deaf culture and non-culturally deaf people alike, and that is signaled through the person-centered compound “d/Deaf.” My article builds on recent music scholarship on disability to offer a pluralistic understanding of music and deafness. Beginning with Scottish deaf percussionist Evelyn Glennie, I investigate a range of d/Deaf accounts of music, including those of Deaf sign language users, hearing aid wearers, and cochlear implant recipients, and of people with music-induced hearing loss. Deafness resists automatic entry points into music, unsettling any straightforward hierarchy of the senses. Deaf people reflect on the musical status of aurality in markedly different ways, just as they offer a complex understanding of vision and touch. For instance, vision is a highly versatile listening strategy and is often more reliable than vibration; touch is feasible because of its contextual dependence on visual cues, and is further tied to a set of material and environmental variables. Ultimately, I argue that d/Deaf listeners enrich customary notions of musical expertise: deafness belongs in musicology as a diverse set of experiences within the full spectrum of listening.

Collaboration With Deaf Communities to Conduct Accessible Health Surveillance

Populations of deaf sign language users experience health disparities unmeasured by current public health surveillance. Population-specific health data are necessary to collaboratively identify health priorities and evaluate interventions. Standardized, reproducible, and language-concordant data collection in sign language is impossible via written or telephone surveys. Deaf and hearing researchers, community members, and other stakeholders developed a broad computer-based health survey based on the telephone-administered Behavioral Risk Factor Surveillance System. They translated survey items from English to sign language, evaluated the translations, and filmed the survey items for inclusion in their custom software. They initiated the second Rochester Deaf Health Survey in 2013 (n=211). Analyses (conducted in 2015) compared Rochester Deaf Health Survey 2013 findings with those of the Behavioral Risk Factor Surveillance System with the general adult population in the same community (2012, n=1,816). The Rochester Deaf Health Survey 2013 participants' mean age was 44.7 (range, 18-87) years. Most were deaf since birth or early childhood (87.1%) and highly educated (53.6% with ≥4 years of college). The median household income was <$35,000. The prevalence of current smokers was low (8.1%). Nearly all (93.8%) reported having health insurance, yet barriers to appropriate health care were evident, with high emergency department use (16.2% with two or more past-year visits) and 22.7% forgoing needed health care in the past year because of cost. Community-engaged research with deaf populations identifies strengths and priorities, providing essential information otherwise missing from existing public health surveillance, and forming a foundation for collaborative dissemination to facilitate broader inclusion of deaf communities.

Telecommunication relay services as a tool for deaf political participation and citizenship

ABSTRACTIt has long been recognised that deaf people experience barriers to political participation and that notions of citizenship do not take into account the needs of deaf sign language users. In light of an effort at the European level to increase the potential for deaf sign language users to participate in political processes through technology, this paper provides results from a survey study of deaf sign language users across Europe as to their preferences in using Telecommunications Relay Services (TRS), whether they would like to see the establishment of a pan-European multilingual TRS and if they would make use of such a service for the purposes of political participation. Responses from 74 deaf people across 14 European member states confirm that deaf people want to see such a service, and would be willing to use it in order to make contact with European institutions. Therefore, the establishment of such a service has the potential to contribute to improved access to, and increased willingness to engage in, democracy through telecommunications and thus enhance the citizenship status of deaf Europeans, and therefore enhance their political participation and access to information and communication in society.

Bimodal code-mixing: Dutch spoken language elements in NGT discourse

Mouthings, the spoken language elements in sign language discourse, are typically analysed as having a redundant, one-on-one relationship with manual signs, both semantically and temporally. We explore exceptions to this presupposed semantic and temporal congruency in a corpus of spontaneous signed conversation by deaf users of Sign Language of the Netherlands (NGT). We identify specifying mouthings (words with a different meaning than the co-occurring sign), solo mouthings (uttered while the hands are inactive) and added mouthings (words added to a signing stream without their corresponding sign), and make a sentence-level analysis of their occurrences. These non-redundant mouthings occurred in 12% of all utterances, and were made by almost all signers. We argue for the presence of a code-blending continuum for NGT, where NGT is the matrix language and spoken Dutch is blended in, in various degrees. We suggest expansion of existing code-mixing models, to allow for description of bimodal mixing.

The prominence of spoken language elements in a sign language

AbstractCode-blendsin sign languages consist of simultaneously articulated manual signs and spoken language words. These “mouthings” (typically silent articulations) have been observed for many different sign languages. The present study aims to investigate the extent of such bimodal code-mixing in sign languages by investigating the frequency of mouthings produced by deaf users of Sign Language of the Netherlands (NGT), their co-occurrence with pointing signs, and whether any differences can be explained by sociolinguistic variables such as regional origin and age of the signer. We investigated over 10,000 mouth actions from 70 signers, and found that the mouth and the hands are equally active during signing. Moreover, around 80 % of all mouth actions are mouthings, while the remaining 20 % are unrelated to Dutch. We found frequency differences between individual signers and a small effect for level of education, but not for other sociolinguistic variables. Our results provide genuine evidence that mouthings form an inextricable component of signed interaction. Rather than displaying effects of competition between languages or spoken language suppression, NGT signers demonstrate the potential of the visual modality to conjoin parallel information streams.

“Making meaning”: Communication between sign language users without a shared language

AbstractIn a small group of deaf sign language users from different countries and with no shared language, the signers’ initial conversational interactions are investigated as they meet in pairs for the very first time. This case study allows for a unique insight into the initial stages of pidginisation and the conceptual processes involved. The participants use a wide range of linguistic and communicative resources, and it can be argued that they construct shared multilingual-multimodal cognitive spaces for the purpose of these conversations. This research explores the nature of these shared multilingual-multimodal spaces, how they are shaped by the signers in interaction, and how they can be understood in terms of conceptual blending. The research also focuses on the meta-linguistic skills that signers use in these multilingual-multimodal interactions to “make meaning”.

Understanding dementia: effective information access from the Deaf community's perspective.

This study concerns older Deaf sign language users in the UK. Its aim was to explore how to enable effective information access and promote awareness and understanding of dementia from a culturally Deaf perspective. A purposive sample of 26 Deaf people without dementia participated in one of three focus groups facilitated directly in British Sign Language (BSL) without an intermediate interpreter. The sample was differentiated by age, role in the Deaf community, and diversity of educational attainment and professional experience. A phenomenological approach underpinned the thematic analysis of data. The findings demonstrate: (i) translation into (BSL) is a necessary but not sufficient condition to support understanding. Attention to culturally preferred means of engagement with information is vital; (ii) the content of information is best presented utilising structures and formats which cohere with Deaf people's visual cognitive strengths; and (iii) the importance of cultural values and cultural practices in raising awareness and building understanding of dementia. These include collective rather than individual responsibility for knowledge transfer and the pan-national nature of knowledge transfer among Deaf people(s). The discussion demonstrates how these specific features of effective information access and awareness building have universal implications relevant to public engagement and the promotion of general knowledge consistent with the National Dementia Strategy (England).

Word production errors in children with developmental language impairments.

This review focuses on the errors that children with developmental language impairments make on three types of word production tasks: lexical retrieval, the elicitation of derivationally complex forms and the repetition of non-sense forms. The studies discussed in this review come principally from children with specific language impairment, and from children who are English-speakers or deaf users of British sign language. It is argued that models of word production need to be able to account for the data presented here, and need to have explanatory power across both modalities (i.e. speech and sign).

Deaf People as British Sign Language Teachers: Experiences and Aspirations

Little research has been undertaken into the profession of British Sign Language (BSL) teaching, despite a huge increase in the number of BSL classes offered over the past twenty years. Following the introduction of Qualified Teacher Learning and Skills standards in 2007, BSL teachers working in ‘further education’ (FE) colleges were required to hold formal teaching qualifications for the first time. Therefore, it is timely to investigate the impact of these changes on the teaching of BSL in the five years since their introduction. This new framework offered the opportunity to greatly enhance BSL teaching through the development of professional skills among BSL teachers but the stark reality is that this has not occurred. This article draws on two research projects that investigated the teaching qualifications held by BSL teachers, their career and professional development aspirations and their views on the training opportunities currently available to deaf sign language users. The research highlighted that there is a need to improve access to relevant information, establish and strengthen peer support networks as well as to establish a designated career path for BSL teachers. Although there are a number of training programmes by which teachers can achieve these new minimum core requirements, very few are specifically tailored to the pedagogic needs of deaf people wishing to gain these qualifications. The potential impact of recent government proposals for teacher qualifications in the FE sector will also be addressed, together with the likely consequences for those wishing to train as BSL teachers.

日本の手話における語彙共通化現象

This paper brings lexical variation among sign language users in Japan into focus. A nationwide data collection project, completed in 2010 with the help of 94 Deaf sign language users from all 47 prefectures of Japan, found that most items among the 30 lexical items showing extensive variation appear in data from the 70 year-old group, and there is little variation in data from the 30 year-old group. The further analysis on the data demonstrates explicitly that the lexical sharing phenomenon is occurring on sign language users in Japan.

Community Participatory Research With Deaf Sign Language Users to Identify Health Inequities

Deaf people who use American Sign Language (ASL) are medically underserved and often excluded from health research and surveillance. We used a community participatory approach to develop and administer an ASL-accessible health survey. We identified deaf community strengths (e.g., a low prevalence of current smokers) and 3 glaring health inequities: obesity, partner violence, and suicide. This collaborative work represents the first time a deaf community has used its own data to identify health priorities.

Looking across the Hearing Line?: Exploring Young Deaf People’s Use of Web 2.0

Looking across the Hearing Line?: Exploring Young Deaf People’s Use of Web 2.0

Information structure and practice as facilitators of deaf users' navigation in textual websites

Deaf users might find it difficult to navigate through websites with textual content which, for many of them, constitutes the written representation of a non-native oral language. With the aim of testing how the information structure could compensate for this difficulty, 27 prelingual deaf users of sign language were asked to search a set of headlines in a web newspaper where information structure and practice were manipulated. While practice did not affect deep structures (web content distributed through four layers of nodes), wide structures (web content concentrated in two layers) did facilitate users' performance in the last trial block and compromised it in the first trial block. It is argued that wide structures generate a textual information overload for deaf users, which decreases with practice. Thus, wide structures seem preferable for websites requiring frequent use, rather than for those intended for occasional interaction.

HIV/AIDS and disability: a pilot survey of HIV/AIDS knowledge among a deaf population in Swaziland

This study sought to establish whether there were measurable differences in the level of knowledge about HIV/AIDS between hearing individuals and individuals who identified themselves as deaf sign language users in Swaziland. A cross-sectional survey of 191 rural and urban hearing and deaf adults was undertaken in Swaziland in December 2003. A structured questionnaire was administered, seeking to establish whether there were statistically significant differences between hearing and deaf populations in their level of knowledge about HIV/AIDS symptoms, transmission and prevention, as well as differences in sources of information about HIV/AIDS. Additional questions were asked regarding whether there were differences in accessibility of HIV testing services and HIV/AIDS-related healthcare for the two groups. Significant differences in levels of knowledge about HIV/AIDS were identified between the hearing and deaf respondents. The deaf population was significantly more likely (P<0.05) to believe in incorrect modes of HIV transmission (e.g. hugging and airborne transmission) and HIV prevention (e.g. avoiding sharing utensils and eating healthy foods). Almost all of the deaf respondents (99%) reported difficulties in communicating with healthcare facility staff, which may result in less use of HIV voluntary counseling and testing services. This paper reports the results of this study, and discusses the need for targeted HIV/AIDS education campaigns and improved accessibility in healthcare facilities for deaf sign language users in countries such as Swaziland.

Everyday activities and social contacts among older deaf sign language users: Relationships to health and well‐being

The purpose of this study was to describe the everyday activities and social contacts among older deaf sign language users, and to investigate relationships between these phenomena and the health and well-being within this group. The study population comprised deaf sign language users, 65 years or older, in Sweden. Data collection was based on interviews in sign language, including open-ended questions covering everyday activities and social contacts as well as self-rated instruments measuring aspects of health and subjective well-being. The results demonstrated that the group of participants was homogeneous in their productive and leisure activities, regardless of gender and age. The number of productive activities was related to all aspects of health, while the number of leisure activities was related to perceived health and subjective well-being. No significant relationship was found between aspects of health and subjective well-being and the frequency of social contacts with family/relatives or visiting the deaf club and meeting friends. It is concluded that the variety of activities at the deaf clubs are important for the subjective well-being of older deaf sign language users. Further research should investigate the importance and perceived value of the various activities at the deaf clubs. When evaluating the results of this study, the fact that the total number of participants was small, and the dropout rate was high, has to be borne in mind.