1st December 2017, Volume 130 Number 1466

Joanne Witko, Pauline Boyles, Kirsten Smiler, Rachel McKee

International studies show that deaf sign language users encounter barriers to healthcare and have worse outcomes than the general population. Contributing factors are limited health literacy,1 health practitioners’ unfamiliarity with…

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Summary

Part of the District Health Boards Sub-Regional Disability Strategy is to develop a comprehensive New Zealand Sign Language (NZSL) policy for the Wairarapa, Hutt Valley and Capital and Coast District Health Boards. To support this, research was carried out to investigate the quality of access to health services for deaf NZSL users. A co-design approach was used to collect qualitative data. Results suggest deaf NZSL users face multiple barriers within the health system mainly stemming from language barriers and a lack of information accessible in NZSL.

Abstract

Aim

The research described was undertaken as part of a Sub-Regional Disability Strategy 2017–2022 across the Wairarapa, Hutt Valley and Capital and Coast District Health Boards (DHBs). The aim was to investigate deaf New Zealand Sign Language (NZSL) users’ quality of access to health services. Findings have formed the basis for developing a ‘NZSL plan’ for DHBs in the Wellington sub-region.

Method

Qualitative data was collected from 56 deaf participants and family members about their experiences of healthcare services via focus group, individual interviews and online survey, which were thematically analysed. Contextual perspective was gained from 57 healthcare professionals at five meetings. Two professionals were interviewed, and 65 staff responded to an online survey. A deaf steering group co-designed the framework and methods, and validated findings.

Results

Key issues reported across the health system include: inconsistent interpreter provision; lack of informed consent for treatment via communication in NZSL; limited access to general health information in NZSL and the reduced ability of deaf patients to understand and comply with treatment options. This problematic communication with NZSL users echoes international evidence and other documented local evidence for patients with limited English proficiency.

Conclusion

Deaf NZSL users face multiple barriers to equitable healthcare, stemming from linguistic and educational factors and inaccessible service delivery. These need to be addressed through policy and training for healthcare personnel that enable effective systemic responses to NZSL users. Deaf participants emphasise that recognition of their identity as members of a language community is central to improving their healthcare experiences.

Author Information

Joanne Witko, Project Lead for the ‘NZSL in Health’ project, Office of Disability Strategy and Performance 3DHB, Wairarapa, Hutt Valley and Capital and Coast District Health Board and Psychotherapist, Te-Upoko-me-te-Whatu-o-Te-Ika, Mental Health, Addictions & Intellectual Disability Service; Pauline Boyles, Director of Disability Strategy and Performance, Wairarapa, Hutt Valley and Capital and Coast District Health Boards; Kirsten Smiler, Postdoctoral Scholar, School of Government, Victoria University of Wellington; Rachel McKee, Associate Professor, NZSL Studies, School of Linguistics and Applied Language Studies, Victoria University of Wellington.

Acknowledgements

Members of the steering group that guided this research; Anthony Sammons, Kellye Bensley, Lyneen Allen-Kuklinski, Shannon Krogmann, Gale Cull, Wenda Walton, Vivien Oakshott and the Wellington Deaf community for sharing their stories.

Correspondence

Joanne Witko, Strategy, Innovation and Performance, Capital and Coast District Health Board, Riddiford Street, Wellington 6021.

Correspondence Email

joanne.witko@sidu.org.nz

Competing Interests

Nil.

References

  1. Pollard RQ, Barnett S. Health-Related Vocabulary Knowledge Among Deaf Adults. Rehabil Psychol. 2009; 54;2:182–5.
  2. Emond A, Ridd M, Sutherland H, Allsop L, et al. The current health of the signing Deaf community in the UK compared with the general population: a cross-sectional study BMJ Open 2015; 5:1:eDD6668. 
  3. Royal National Institute for Deaf People. A Simple Cure: A national report into deaf and hard of hearing people’s experiences of the National Health Sevice. 2004; London: Royal National Institute for Deaf People.
  4. Smeijers AS, Pfau R. Towards a Treatment for Treatment: On communication between General Practitioners and Their Deaf Patients. The Sign Language Translator and Interpreter 2009; 3:1:1–14.
  5. Fellinger J, Holzinger D, Pollard R. Mental health of deaf people. Lancet 2012; 379:1037–44.
  6. Dugdale PO. Being Deaf in New Zealand: A Case Study of the Wellington Deaf Community. 2000. Unpublished PhD Thesis. Victoria University of Wellington.
  7. McKee R. People of the Eye: Stories from the Deaf World. 2001. Wellington : Bridget Williams Books.
  8. Collins-Ahlgren M. Aspects of New Zealand Sign Language. 1989. Unpublished PhD Thesis. Victoria Univeristy of Wellington.
  9. Fitzgerald & Associates Scoping support for New Zealand Sign Language users accessing the curriculum. Part II: A New Zealand Overview. Report prepared for the NZ Ministry of Education. 2010 Retrieved from http://www.educationcounts.govt.nz/publications/
  10. Powell D, Hyde M. Deaf education in New Zealand: Where we have been and where we are going. Deafness and Education International. 2014; 16:3:129–145.
  11. Dewalt DA, Berkman ND, Sheridan S, Lohr KN, et al. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004; 19:12:1228–39.
  12. Barnett S, McKee M, Smith SR, Pearson TA. Deaf Sign Language Users, Health Inequalities, and Public Health: Opportunity for Social Justice. Prev Chronic Dis. 2011 Mar; 8:2:A45. 
  13. McEwen E, Anton-Culver H. The medical communication of deaf patients. J Fam Practitioners, 1988; 26:3:289–91.
  14. Steinberg AG, Barnett S, Meador HE, Wiggins EA, et al. Health Care System. Accessibility: Experiences and Perceptions of Deaf People, J Gen Intern Med. 2006; 21:3:260–6.
  15. Mohay HA, Kleinig DF. Providing medical care for deaf patients. Med J Australia.1991; 155:498–9.
  16. WHO. The Determinants of Health. Retrieved from http://www.who.int/hia/evidence/doh/en/
  17. Harmer L. Health care delivery and deaf people: practice, problems, and recommendations for change. J Deaf Stud Deaf Educ. 1999; 2:73–110.
  18. Barnett S, McKee M, Smith SR, Pearson TA. Deaf Sign Language Users, Health Inequalities, and Public Health: Opportunity for Social Justice. Prev Chronic Dis. 2011; 8:2:A45.
  19. Alexander A, Ladd P, Powell S. (2012). Deafness might damage your health. Lancet. 2012; 379:9820:979–81.
  20. MacKinney T, Walters GD, Bird GL, Nattinger AB. Improvements in Preventive Care and Communication for Deaf Patients: Results of a Novel Primary Health Care Program. J Gen Intern Med. 1995; 10:3:133–7.
  21. Middleton A, Turner GH, Bitner-Glindzicz M, Lewis P, et al. Preferences for communication in clinic from deaf people: a cross-sectional study. J Eval Clin Pract. 2010; 16:4:811–7.
  22. Lowrie M. An Enquiry into access to AUSLAN interpreters in Victorian Hospitals. 2014. Deaf Victoria, Australia.
  23. Napier J, Kidd MR. English literacy as a barrier to health care information for deaf people who use Auslan. Aust Fam Physician. 2013; 42:12:896–9.
  24. Flores G. (2005). The impact of Medical Interpreter Services on the Quality of Health Care: A systematic review. Med Care Res Rev. 2005; 62:3:255–99.
  25. Haualand H, Allen C. Deaf people and human rights. 2009. Helsinki: World Federation of the Deaf.
  26. UNCRPD. Convention on the rights of persons with disabilities. 2006. Retrieved from http://www.un.org/disabilities/default.asp?navid=15&pid=150
  27. Office of the Minister of Disability Issues. (2003). Cabinet paper on the New Zealand Sign Language Bill. Wellington: Office for Disability Issues.
  28. Human Rights Commission. A New Era in the Right to Sign - He Houhanga Rongo te Tika Ki Te Reo Turi. Report of the New Zealand Sign Language Enquiry. 2013. Wellington: Human Rights Commission. 
  29. http://www.hdc.org.nz/the-act--code/the-code-of-rights
  30. Office for Disability Issues. New Zealand Sign Language Board Action Plan 2016-2018. Wellington: Office for Disability Issues. http://www.odi.govt.nz/new-zealand-sign-language-nzsl/
  31. Phillips BA. Bringing culture to the forefront: Formulating diagnostic impressions of deaf and hard of hearing people at times of medical crisis. Professional Psychology: Research and Practice, 1997; 27(2):137–144.
  32. Kuenburg A, Fellinger P, Fellinger J. Health Care Access Among Deaf People. J Deaf Stud Deaf Educ. 2016; 21:1:1–10.
  33. Gray B, Stanley J, Stubbe M, Hilder J. Communication difficulties with limited English proficiency patients: clinician perceptions of clinical risk and patterns of use of interpreters. NZ Med J. 2011; 124:1342:23–38.

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