American Sign Language Users Research Articles

Shared Decision-Making at the Intersection of Disability, Culture, and Language Accessibility: An Educational Session for Medical Students.

People with disabilities and those with non-English language preferences have worse health outcomes than their counterparts due to barriers to communication and poor continuity of care. As members of both groups, people who are Deaf users of American Sign Language have compounded health disparities. Provider discomfort with these specific demographics is a contributing factor, often stemming from insufficient training in medical programs. To help address these health disparities, we created a session on disability, language, and communication for undergraduate medical students. This 2-hour session was developed as a part of a 2020 curriculum shift for a total of 404 second-year medical student participants. We utilized a retrospective postsession survey to analyze learning objective achievement through a comparison of medians using the Wilcoxon signed rank test (α = .05) for the first 2 years of course implementation. When assessing 158 students' self-perceived abilities to perform each of the learning objectives, students reported significantly higher confidence after the session compared to their retrospective presession confidence for all four learning objectives (ps < .001, respectively). Responses signifying learning objective achievement (scores of 4, probably yes, or 5, definitely yes), when averaged across the first 2 years of implementation, increased from 73% before the session to 98% after the session. Our evaluation suggests medical students could benefit from increased educational initiatives on disability culture and health disparities caused by barriers to communication, to strengthen cultural humility, the delivery of health care, and, ultimately, health equity.

Medication-Related Experience of Deaf American Sign Language Users.

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

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

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

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

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

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

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

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

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

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

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

Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: A retrospective chart review.

Deaf and hard-of-hearing (DHH) patients are understudied in emergency medicine health services research. Theory and limited evidence suggest that DHH patients are at higher risk of emergency department (ED) utilization and poorer quality of care. This study assessed ED condition acuity, length of stay (LOS), and acute ED revisits among DHH patients. We hypothesized that DHH patients would experience poorer ED care outcomes. We conducted a retrospective chart review of a single health care system using data from a large academic medical center in the southeast United States. Data were received from the medical center's data office, and we sampled patients and encounters from between June 2011 and April 2020. We compared DHH American Sign Language (ASL) users (n= 108), DHH English speakers (n= 358), and non-DHH English speakers (n= 302). We used multilevel modeling to assess the differences among patient segments in outcomes related to ED use and care. As hypothesized, DHH ASL users had longer ED LOS than non-DHH English speakers, on average 30 min longer. Differences in ED condition acuity, measured through Emergency Severity Index and triage pain scale, were not statistically significant. DHH English speakers represented a majority (61%) of acute ED revisit encounters. Our study identified that DHH ASL users have longer ED LOS than non-DHH English speakers. Additional research is needed to further explain the association between DHH status and ED care outcomes (including ED LOS and acute revisit), which may be used to identify intervention targets to improve health equity.

Unmet Dental Needs Among Mid-to-Older Deaf and Hard of Hearing Women in the U.S.

IntroductionDespite the significant number of deaf and hard of hearing (DHH) people living in the U.S., oral health research on DHH people who use American Sign Language (ASL) is virtually nonexistent. This study aims to investigate dental needs among mid-to-older DHH women and identify social determinants of health that may place them at higher risk for unmet dental health needs as the primary outcome.MethodsThis cross-sectional study uses data drawn from Communication Health domain in the PROMIS-DHH Profile and oral health data from the National Health and Nutrition Examination Survey. Both measures were administered in ASL and English between November 2019 and March 2020. Univariate and bivariate analysis included only complete data, and multivariable logistic regression analyses were conducted on multiply imputed data.ResultsOut of 197 DHH women (41 to 71+ years old) who answered the dental visit question, 48 had unmet dental needs and 149 had met dental needs. Adjusting for sociodemographic variables, disparity in dental needs was observed across education [OR (95% CI): 0.45(0.15, 1.370)] and communication health [0.95 (0.90, 1.01)].DiscussionOur study is the first to describe DHH mid-to-older women's access to oral health care. DHH women who do not have a college degree may be impacted. Further research is needed to elucidate the particular risk factors, including cultural, to which DHH individuals from marginalized racial groups are susceptible to unmet oral health needs.ConclusionsEvidence shows that DHH ASL users who have less years of education or are single experience barriers in accessing dental care.

"It Would Have Been Nice to Have a Choice": Barriers to Contraceptive Decision-making among Women with Disabilities.

Engaging in contraceptive decisions is an important part of reproductive health for women and other people with the capacity for pregnancy. However, not all individuals capable of pregnancy have equal access to information and/or opportunities to make fully informed decisions. The goal of this study was to understand barriers women with disabilities experience around contraceptive decision-making and whether these differ based on type of disability. We conducted focus groups with 17 reproductive age adult women (aged 18-45years). Focus groups were homogenous with regard to disability type and consisted of one group for each of the following disability categories: 1) physical disability, 2) intellectual and developmental disabilities, 3) blind or low vision, and 4) Deaf users of American Sign Language. Data were collected in the Portland, Oregon, metropolitan area during 2016-2017. We analyzed focus group transcripts using content analysis. Barriers to informed contraceptive decision-making emerged in five main thematic areas: 1) lack of information in accessible formats, 2) incomplete information about contraceptive side effects, 3) limited clinician knowledge and relevant research specific to the care of women with disabilities, 4) taboos around discussing sexual activity, and 5) limited opportunities for shared contraceptive decision-making. Women with disabilities faced numerous barriers to contraceptive decision-making. Although the barriers differed somewhat by disability type, many barriers were consistent across groups, suggesting commonalities associated with the experience of disability in the context of contraceptive decision-making. Increased attention to the reproductive health needs of people with disabilities is important for improving health care equity and quality.

Attitudes Toward Signing Avatars Vary Depending on Hearing Status, Age of Signed Language Acquisition, and Avatar Type.

The use of virtual humans (i.e., avatars) holds the potential for interactive, automated interaction in domains such as remote communication, customer service, or public announcements. For signed language users, signing avatars could potentially provide accessible content by sharing information in the signer's preferred or native language. As the development of signing avatars has gained traction in recent years, researchers have come up with many different methods of creating signing avatars. The resulting avatars vary widely in their appearance, the naturalness of their movements, and facial expressions—all of which may potentially impact users' acceptance of the avatars. We designed a study to test the effects of these intrinsic properties of different signing avatars while also examining the extent to which people's own language experiences change their responses to signing avatars. We created video stimuli showing individual signs produced by (1) a live human signer (Human), (2) an avatar made using computer-synthesized animation (CS Avatar), and (3) an avatar made using high-fidelity motion capture (Mocap avatar). We surveyed 191 American Sign Language users, including Deaf (N = 83), Hard-of-Hearing (N = 34), and Hearing (N = 67) groups. Participants rated the three signers on multiple dimensions, which were then combined to form ratings of Attitudes, Impressions, Comprehension, and Naturalness. Analyses demonstrated that the Mocap avatar was rated significantly more positively than the CS avatar on all primary variables. Correlations revealed that signers who acquire sign language later in life are more accepting of and likely to have positive impressions of signing avatars. Finally, those who learned ASL earlier were more likely to give lower, more negative ratings to the CS avatar, but we did not see this association for the Mocap avatar or the Human signer. Together, these findings suggest that movement quality and appearance significantly impact users' ratings of signing avatars and show that signed language users with earlier age of ASL acquisition are the most sensitive to movement quality issues seen in computer-generated avatars. We suggest that future efforts to develop signing avatars consider retaining the fluid movement qualities integral to signed languages.

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

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

Tracking the time course of sign recognition using ERP repetition priming.

Repetition priming and event-related potentials (ERPs) were used to investigate the time course of sign recognition in deaf users of American Sign Language. Signers performed a go/no-go semantic categorization task to rare probe signs referring to people; critical target items were repeated and unrelated signs. In Experiment 1, ERPs were time-locked either to the onset of the video or to sign onset within the video; in Experiment 2, the same full videos were clipped so that video and sign onset were aligned (removing transitional movements), and ERPs were time-locked to video/sign onset. All analyses revealed an N400 repetition priming effect (less negativity for repeated than unrelated signs) but differed in the timing and/or duration of the N400 effect. Results from Experiment 1 revealed that repetition priming effects began before sign onset within a video, suggesting that signers are sensitive to linguistic information within the transitional movement to sign onset. The timing and duration of the N400 for clipped videos were more parallel to that observed previously for auditorily presented words and was 200ms shorter than either time-locking analysis from Experiment 1. We conclude that time-locking to full video onset is optimal when early ERP components or sensitivity to transitional movements are of interest and that time-locking to the onset of clipped videos is optimal for priming studies with fluent signers.

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

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

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

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

The Deaf Community's Experiences Navigating COVID-19 Pandemic Information.

Background:Users of American Sign Language (ASL) who are deaf often face barriers receiving health information, contributing to significant gaps in health knowledge and health literacy. To reduce the spread of coronavirus disease 2019 (COVID-19) and its risk to the public, the government and health care providers have encouraged social distancing, use of face masks, hand hygiene, and quarantines. Unfortunately, COVID-19 information has rarely been available in ASL, which puts the deaf community at a disadvantage for accessing reliable COVID-19 information.Objective:This study's primary objective was to compare COVID-19–related information access between participants who are deaf and participants who are hearing.Methods:The study included 104 adults who are deaf and 74 adults who are hearing who had participated in a prior health literacy study. Surveys were conducted between April and July 2020 via video conference, smartphone apps, or phone calls. COVID-19 data were linked with preexisting data on demographic and health literacy data as measured by the Newest Vital Sign (NVS) and the ASL-NVS.Key Results:Neither group of participants differed in their ability to identify COVID-19 symptoms. Adults who are deaf were 4.7 times more likely to report difficulty accessing COVID-19 information (p = .011), yet reported using more preventive strategies overall. Simultaneously, adults who are deaf had 60% lower odds of staying home and calling their doctor versus seeking health care immediately or doing something else compared with participants who are hearing if they suspected that they had COVID-19 (p = .020).Conclusions:Additional education on recommended COVID-19 management and guidance on accessible health care navigation strategies are needed for the deaf community and health care providers. Public health officials should ensure that public service announcements are accessible to all audiences and should connect with trusted agents within the deaf community to help disseminate health information online in ASL through their social media channels. [HLRP: Health Literacy Research and Practice. 2021;5(2):e162–e170.]Plain Language Summary:Compared to participants who are hearing, a higher portion of participants who are deaf reported challenges with accessing, understanding, and trusting COVID-19 information. Although respondents who are deaf had similar knowledge of symptoms compared to participants who are hearing, they used more prevention strategies and were more likely to plan immediate care for suspected symptoms. Improved guidance on COVID-19 management and health care navigation accessible to the deaf community is needed.

Access to Effective Communication Aids and Services among American Sign Language Users across North Carolina: Disparities and Strategies to Address Them

ABSTRACT Objective: To examine the extent to which communication aids and services used by American Sign Language (ASL) users and their healthcare providers aligns with preferences, satisfaction, and unmet needs; and to elicit from stakeholders strategies to address disparities. Methods: A cross-sectional study was conducted of ASL users in North Carolina. Respondents completed an online survey presented in ASL and English (N = 189). McNemar’s tests were used to compare rates of preferred and actual methods of communication. Logistic regression models explored relationships of accessible communication with dissatisfaction and unmet need. Qualitative interviews explored satisfaction with communication and reflections on what works, what does not, and outcomes (N = 54). Results: While 45% of respondents used a professional sign language interpreter, 65% of respondents preferred to do so. Accessible communication was associated with lower odds of dissatisfaction with communication (OR = .19, p < .05). Dissatisfaction with communication was associated with greater odds of unmet need for healthcare (OR = 8.95, p < .05). Interview respondents emphasized their preference for on-site interpreters, explaining how video remote interpreting was subject to technical difficulties while writing back-and-forth led to important gaps in understanding. Conclusions: While ASL users prefer to use professional, on-site sign language interpreters to communicate with providers, most use some other form of communication instead. Findings emphasize the need for policy strategies to facilitate access to high quality, well-functioning professional interpreter services and to have those services delivered on-site to overcome disparities.

Interpreting the Data: Reflections on ASL-English Cross Language Research

Cross language research typically ignores the role the translator and translation play in the research process. This paper adds to the literature by examining some of the challenges experienced during the translation and interpretation aspect of research. This autoethnography explores the positionality of a non-native user of American Sign Language who conducted research with native American Sign Language users. Findings indicate that translation and interpretation in research is not simply a matter of rote process and deserves more attention as an integral aspect of cross-language research.

Effects of age on American Sign Language sentence repetition.

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

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

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