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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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.



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.


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.


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.


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.


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.


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

Correspondence Email


Competing Interests



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