Deaf adults at higher risk for severe illness: COVID-19 information preference and perceived health consequences.

OBJECTIVES: This study explores deaf and hard of hearing (DHH) individuals' preferred sources of information for COVID-19 and their perceptions of developing severe illness from COVID-19 given underlying medical conditions. METHODS: A national online bilingual American Sign Language/English survey was conducted from April 17 to May 1, 2020. Weighted sample of 474 DHH adults living in the United States. Multivariate logistic regression analyses were conducted to examine independent associations of sociodemographic variables and health indicators with perceived COVID-19 health consequences. RESULTS: About 44% of the medical condition sample used the Internet (English-based text) first for COVID-19 information, followed by TV (24%). Only 1% selected healthcare provider as the go-to source; the remainder got information from family or friends. Perceived health consequences increased with age (adjusted OR = 1.04; CI 95% = 1.02, 1.06). At-risk respondents who self-identified as persons of color were nearly three times more likely to believe that their health will be severely affected by COVID-19 compared to respondents who self-identified as white (adjusted OR = 2.94; CI 95% = 1.20, 7.18). CONCLUSIONS: Perception of COVID-19 health consequences vary among DHH adults at higher risk for severe illness. PRACTICE IMPLICATIONS: Information delivery methods must be flexible and comprehensive to meet the diverse community's needs, especially during the COVID-19 pandemic.

Perception of COVID-19 Physical Distancing Effectiveness and Contagiousness of Asymptomatic Individuals: Cross-sectional Survey of Deaf and Hard of Hearing Adults in the United States.

BACKGROUND: During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency. OBJECTIVE: The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person. METHODS: This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform. RESULTS: The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors. CONCLUSIONS: This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics.

Food Worry in the Deaf and Hard-of-Hearing Population During the COVID-19 Pandemic.

OBJECTIVE: The coronavirus disease 2019 (COVID) pandemic has highlighted preexisting health disparities, including food insecurity, in the deaf and hard-of-hearing (DHH) population. We examined factors associated with food worry during the COVID-19 pandemic. METHODS: We collected survey data on worry about food shortages, worry about contracting COVID-19, and concerns about DHH people staying home and being lonely from April 17 through May 1, 2020, via a bilingual American Sign Language/English online survey platform. The sample consisted of 537 DHH adults living in the United States. We examined the relationship between demographic characteristics and food worry. We used logistic regression and model fitting to predict the likelihood of experiencing food worry. RESULTS: The mean (SD) age of survey respondents was 47 (16), and 25% of the sample identified as people of color. Forty-two percent of survey respondents had a high level of food worry. Increased worry about contracting COVID-19 and concerns about DHH people staying home and being lonely among DHH younger adults or those without a college degree predicted food worry. Gender and race/ethnicity did not contribute to the model for food worry. CONCLUSIONS: Food worry was explained by multiple, intersecting factors, including demographic variables, worry about contracting COVID-19, and concerns about loneliness. Interventions or programs implemented by DHH-serving organizations as well as government programs, social service providers, and food banks should be fully accessible to subgroups of DHH young adults without a college degree who are at risk for food insecurity.

Adverse Childhood Communication Experiences Associated With an Increased Risk of Chronic Diseases in Adults Who Are Deaf.

INTRODUCTION: This study explores adverse childhood communication experiences and its RRs for acquiring specific chronic diseases and mental health disorders in adults who are deaf and hard of hearing. METHODS: A cross-sectional design with snowball sampling was used to recruit adults who were deaf and hard of hearing and were born or became deaf in both ears before age 13 years. Patient-reported outcomes surveys in American Sign Language and English were disseminated to collect data about early life communication experiences with caregivers. Modified Poisson regression with robust SEs was used to calculate RR estimates and 95% CIs for all medical conditions with early life communication experiences as main predictors. RESULTS: Data collection occurred from May 2016 to July 2016, October 2016 to April 2018, and October 2018 to May 2019. The U.S. sample consisted of 1,524 adults who were born or became deaf early. After adjusting for parental hearing status and known correlates of medical conditions, poorer direct child-caregiver communication was significantly associated with an increased risk of being diagnosed with diabetes (RRR=1.12, 95% CI=1.01, 1.24), hypertension (RRR=1.10, 95% CI=1.03, 1.17), and heart disease (RRR=1.61, 95% CI=1.39, 1.87). Poor indirect family communication/inclusion increased risks for lung diseases (RRR=1.19, 95% CI=1.07, 1.33) and depression/anxiety disorders (RRR=1.34, 95% CI=1.24, 1.44). The absolute risk increase and number needed to harm are also reported. CONCLUSIONS: Outcomes data reported by patients who were deaf and hard of hearing demonstrated that poorer direct child-caregiver communication and ongoing exclusion from incidental family communication were associated with increased risks for multiple chronic health outcomes. Practices should consider developing and utilizing an adverse childhood communication screening measure to prevent or remediate language deprivation and communication neglect in pediatric patients who were deaf and hard of hearing.

Video Remote Interpreting Technology in Health Care: Cross-Sectional Study of Deaf Patients' Experiences.

BACKGROUND: The advent of new rehabilitation and assistive technologies has led to the creation of video remote interpreting (VRI) as an accessible communication technology for deaf patients. Although there has been a rapid growth in the use of VRI technology by health care providers, there is scant published information on VRI users and their satisfaction. Current, timely data are needed to understand deaf patients' use and satisfaction with the quality of VRI technology in health care settings. OBJECTIVE: This study aimed to investigate the national trends of deaf patients' satisfaction with the quality of video remote interpreting (VRI) in health settings and recommend actions to improve VRI quality and deaf patients' satisfaction with VRI in health care settings. METHODS: Secondary data related to deaf adults' experiences of using VRI service in a medical setting were obtained from the Health Information National Trends Survey in American Sign Language, which was administered to a US sample of deaf adults between 2016 and 2018. RESULTS: Among our VRI users (N=555, all in the United States) who answered questions about VRI usage in health between 2016 and 2018, only 41% were satisfied with the quality of the VRI technology service. Respondents with fewer years of education or those who were male were more likely to rate the VRI quality as acceptable. After adjusting for covariates in a binary regression analysis, deaf patients' self-reported interference (ie, VRI interpreter's interference with disclosure of health information) increased patient dissatisfaction with the quality of VRI technology service by three-fold. CONCLUSIONS: To increase satisfaction with VRI technology service in health care and rehabilitation settings among deaf patients, special attention needs to be given to video technology, as the use of sign language requires high-fidelity video for optimal communication between the interpreter and patient. To promote the willingness to disclose medical information through VRI among deaf patients, the interpreter must be highly skilled in both expressive and receptive communication and have the requisite background in medicine and rehabilitation.

Health Information National Trends Survey in American Sign Language (HINTS-ASL): Protocol for the Cultural Adaptation and Linguistic Validation of a National Survey.

BACKGROUND: The Health Information National Trends Survey (HINTS) collects nationally representative data about the American's public use of health-related information. This survey is available in English and Spanish, but not in American Sign Language (ASL). Thus, the exclusion of ASL users from these national health information survey studies has led to a significant gap in knowledge of Internet usage for health information access in this underserved and understudied population. OBJECTIVE: The objectives of this study are (1) to culturally adapt and linguistically translate the HINTS items to ASL (HINTS-ASL); and (2) to gather information about deaf people's health information seeking behaviors across technology-mediated platforms. METHODS: We modified the standard procedures developed at the US National Center for Health Statistics Cognitive Survey Laboratory to culturally adapt and translate HINTS items to ASL. Cognitive interviews were conducted to assess clarity and delivery of these HINTS-ASL items. Final ASL video items were uploaded to a protected online survey website. The HINTS-ASL online survey has been administered to over 1350 deaf adults (ages 18 to 90 and up) who use ASL. Data collection is ongoing and includes deaf adult signers across the United States. RESULTS: Some items from HINTS item bank required cultural adaptation for use with deaf people who use accessible services or technology. A separate item bank for deaf-related experiences was created, reflecting deaf-specific technology such as sharing health-related ASL videos through social network sites and using video remote interpreting services in health settings. After data collection is complete, we will conduct a series of analyses on deaf people's health information seeking behaviors across technology-mediated platforms. CONCLUSIONS: HINTS-ASL is an accessible health information national trends survey, which includes a culturally appropriate set of items that are relevant to the experiences of deaf people who use ASL. The final HINTS-ASL product will be available for public use upon completion of this study.

American Sign Language Comprehension Test: A Tool for Sign Language Researchers.

The American Sign Language Comprehension Test (ASL-CT) is a 30-item multiple-choice test that measures ASL receptive skills and is administered through a website. This article describes the development and psychometric properties of the test based on a sample of 80 college students including deaf native signers, hearing native signers, deaf non-native signers, and hearing ASL students. The results revealed that the ASL-CT has good internal reliability (α = 0.834). Discriminant validity was established by demonstrating that deaf native signers performed significantly better than deaf non-native signers and hearing native signers. Concurrent validity was established by demonstrating that test results positively correlated with another measure of ASL ability (r = .715) and that hearing ASL students' performance positively correlated with the level of ASL courses they were taking (r = .726). Researchers can use the ASL-CT to characterize an individual's ASL comprehension skills, to establish a minimal skill level as an inclusion criterion for a study, to group study participants by ASL skill (e.g., proficient vs. nonproficient), or to provide a measure of ASL skill as a dependent variable.

Health websites: accessibility and usability for American sign language users.

To date, there have been efforts toward creating better health information access for Deaf American Sign Language (ASL) users. However, the usability of websites with access to health information in ASL has not been evaluated. Our article focuses on the usability of four health websites that include ASL videos. We seek to obtain ASL users' perspectives on the navigation of these ASL-accessible websites, finding the health information that they needed, and perceived ease of understanding ASL video content. ASL users (n = 32) were instructed to find specific information on four ASL-accessible websites, and answered questions related to (a) navigation to find the task, (b) website usability, and (c) ease of understanding ASL video content for each of the four websites. Participants also gave feedback on what they would like to see in an ASL health library website, including the benefit of added captioning and/or signer model to medical illustration of health videos. Participants who had lower health literacy had greater difficulty in finding information on ASL-accessible health websites. This article also describes the participants' preferences for an ideal ASL-accessible health website, and concludes with a discussion on the role of accessible websites in promoting health literacy in ASL users.