Healthcare Accessibility for the Deaf and Hard of Hearing: A Descriptive Study of Rural Health Care Systems

Submitted by Amanda Reinhart, BS, M2 Student at the University of Illinois College of Medicine, Rockford

Both my own past experience as an EMT and previous research into healthcare systems have revealed the existence of communication obstacles for deaf and hard of hearing patients seeking medical care in urban or generalized settings. However, when I dove deeper, I found very little research into the kinds of accessibility that exist within rural regions. Part of this research disparity may be due to how small and spread out deaf populations are within rural communities, making research into their accessibility more difficult and appear less relevant, but I personally believe that, given the increasing numbers of elderly patients that are making up our rural populations, many of whom may have increased hearing needs, communication accessibility within rural healthcare is more relevant than ever. With this problem in mind, during the summer of 2021 I worked alongside Dr. Martin MacDowell, DrPH, and Ellen Reter, a fellow medical student, to assess and research the current protocols in place to promote functional accessibility for deaf and hard of hearing patients in the rural healthcare setting and hopefully start filling part of this hole in our understanding of rural care.

To pursue this knowledge, we created a survey to assess the accessibility tools already available for deaf and hard of hearing patients in our participating rural hospitals. After receiving the data, we could compare the effectiveness of different current strategies and open up a dialogue of what improvements can be made. Survey requests were sent to 57 ICAHN associated hospitals and nine larger rural hospitals, with responses accepted from June 22, 2021-September 8, 2021. Eighteen hospitals responded (27% participation rate). The frequencies of responses were isolated and analyzed, and recommendations for improvement were collected (Table 1).

The survey itself asked participants to mark what types of strategies they currently utilize and then rate each’s effectiveness. Per the survey, participants cited EMR notifications and word of mouth amongst staff as the most common means of communicating a patient’s hearing needs (Figure 1), and 83% of participants were satisfied with the effectiveness of these tools.

Written communication was cited as the most common means of communicating with deaf and hard of hearing patients (89%) (Figure 2), followed by family interpreters (50%) and professional interpreters (39%). Participants were generally satisfied with the tools available at their respective hospitals, but when they did have issues, the most commonly cited problems were extended time being required to explain news to patients (67%), general technical issues (61%), and a lack of staff confidence in how to use available tools (39%).

While in-person training and online modules were cited as the most common means of educating healthcare providers in deaf accessibility (Figure 3), 72% of participants still stated that they were only somewhat comfortable in their knowledge of how to accommodate a patient’s hearing needs, and several recommendations were made for increased educational opportunities and increased access to communication tools (Table 1), suggesting the current training regimen is still insufficient. All in all, our study demonstrated that, while our rural Illinois hospitals are utilizing tools and plans to make healthcare accessible for deaf and hard of hearing patients, there is still room for improvement.


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