The findings support the hypothesis that deaf ASL users with language-concordant healthcare communication are more likely to receive preventive services than deaf ASL users with language-discordant healthcare communication. These findings are consistent with research showing an association between language-concordant healthcare communication and appropriate healthcare services, including preventive services. 7, 10
With poor communication, preventive services may be relegated to a low priority or delayed for a variety of reasons, including time constraints and inability to communicate complex medical information for shared decision making and informed consent.
Influenza vaccination was the only individual preventive service significantly associated with ASL-concordant communication. Influenza vaccination is a recommended annual preventive service. The authors believe that better adherence here may reflect better communication, trust and patient–clinician continuity relationships associated with concordant communication. Future research should explore the reasons for influenza vaccination adherence.
Cholesterol screening (if ever) and colonoscopy/sigmoidoscopy (if ever) were not significantly associated with language concordance. The DHS did not ask follow-up questions regarding the preventive services. One possible reason the analyses did not find an association with language concordance and cholesterol is that cholesterol screening starts relatively young which leads to a higher number of opportunities for deaf ASL users to be screened, regardless of whether discordant communication occurs. This likely explains the high prevalence of cholesterol screening (if ever) rates seen for both concordant and discordant groups. For colon cancer, there are several approved methods available for screening, including the use of fecal occult blood tests (FOBT). The DHS did not ask about FOBT use. It may be that concordant communication results in higher rates of colon cancer screening via FOBT. Future research should include items on FOBT.
Communication is vital to appropriate, effective and successful healthcare. Many people, including clinicians, believe that deaf ASL users can understand non-sign-based communication. Research shows that note-writing and speech-reading, while commonly used by clinicians to communicate with deaf patients, are likely ineffective. According to one study, only 20% of deaf individuals demonstrated fluency in written English11
, and that the average English reading level of deaf high school seniors is at or below a 4th
Speech reading is also inadequate, when the majority of English sounds are not clearly visible on the lips.27
The results suggest that ASL-fluent clinicians may be crucial to addressing healthcare communication barriers experienced by deaf ASL users. Research with other language minority groups suggests that bilingual clinicians have better health outcomes, including better patient satisfaction and understanding, lowered healthcare expenditures, avoidance of diagnosis and treatment errors, and improved patient–provider relationships, than healthcare using other modes of communication, including the use of professional interpreter services.28,29
ASL-fluent clinicians are uncommon, and it is important to note that the use of sign language interpreter services is still associated with better adherence with recommended preventive services compared with healthcare without sign language accessible communication.11
The use of interpreter services may also protect clinicians from malpractice concerns generated by poor communication.
This research would be difficult to do outside of Rochester NY, a city with a high per capita population of deaf ASL users. One third (31 of 89) of the respondents reported seeing a clinician who signs (language-concordant healthcare communication); this broad access to ASL-skilled clinicians is likely unique to Rochester and few other areas around the country. The participants were also predominately white (95.5%), similar to demographics in other published studies.30–32
Future research should explore the epidemiologic, genetic and/or biobehavioral reasons for the strong association between white race and deafness. The educational attainment of the DHS participants was higher than reported for deaf adults in published research using national data sets.30,31
The high educational attainment may mean that concordant communication is more important for preventive services adherence in deaf communities outside of Rochester NY.
The DHS data are all self-reported – the authors did not confirm the use of preventive services. The DHS question on healthcare communication asks about the most recent healthcare visit. It is possible that some respondents were misclassified as discordant who usually see an ASL-skilled clinician (but not at the most recent healthcare visit). This misclassification would likely result in the analyses underestimating the magnitude of the benefit of language concordant healthcare communication. Future studies could include chart audits (or other measures of preventive services use) and more detailed questions regarding healthcare communication and continuity relationships with a physician.