Communication in Healthcare Settings: Access and Barriers to Care Experienced by Deaf Patients

Deaf persons who use American Sign Language (ASL) as their primary form of communication are members of a cultural and linguistic minority that experiences significant health disparities yet are not recognized as a health disparity population by the National Institutes of Health. Studies have reported ineffective communication in healthcare interactions and reduced access to care experienced by Deaf patients. Requests for sign language interpreters in healthcare encounters are frequently denied, despite federal mandates to provide effective communication. Comprised of three articles, this dissertation investigates the diminished access to communication in healthcare settings experienced by Deaf patients and qualitative research methods when working with Deaf communities. Chapter One provides an overview of the dissertation purpose along with authorship and statement contributions for each article. Chapter Two features an autoethnographic study which recommends specific research methods and paradigms researchers who can hear should consider when conducting research with Deaf people. Reflections on the process of qualitative data analysis in this context is provided. Chapter Three reports the results in article form from a mixed-method, bilingual, and online survey which received 170 responses from Deaf respondents in 42 states. The survey provides a deeper understanding of the communication barriers experienced by Deaf patients than has been available or documented previously. Chapter Four documents the diminished access to care experienced by Deaf patients as documented in a “secret shopper” study. Appointment success rates of Deaf simulated patients compared to success rates of simulated patients who can hear, and reasons associated with denials are reported from a field-experiment audit study of a stratified random sample of primary care and general dentistry clinics throughout Idaho. Chapter Five provides a summary of the dissertation findings, action and policy recommendations, planned and completed dissemination of the research results, and areas of future research