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Background

The Deaf community is a unique cultural and linguistic minority whose culture is composed of shared experiences and the usage of sign language to communicate [1]. In the United States, the Deaf community uses American Sign Language (ASL) but across the world, sign language can vary across countries and regions.

 

Deaf culture refers to the collective beliefs, behaviors, artistic expressions, literary traditions, historical narratives, values, and communal structures shared among people with hearing impairments, shaped by their common experiences. Members of Deaf culture view deafness as a human experience and not as a condition that needs to be fixed. The term “Deaf gain” (coined by British deaf performing artist Aaron Williamson in 2005) [2]. is used opposed to “Hearing loss” to reframe the idea of deafness in a positive light [3]. Though some people fully embrace all aspects of Deaf culture and community, others may identify only marginally or not at all.

 

There are 3 types of hearing loss categorized based on the etiology of the condition: conductive - problems of the external ear and/or middle ears, sensory - problem of the inner ear and/or nerve conduction , and mixed (both conductive and sensory).

Health Beliefs

  • Each individual in the Deaf community has a preferred mode of communication, which consists of lip reading, written communication, visual aids or sign language [1,5]. It is best not to assume a Deaf person to have an effective lip-reading skill.  

  • Cochlear implants are devices that deliver sound signals by directly stimulating the auditory nerve of the brain compared to hearing aids which amplify the sound received. They have an added effect of being a “perceived cure” for deafness [6]. 

    • Opposition to cochlear implants argues that the devices lower the importance of Deaf culture [7]. Also, it is important to realize that those that do have implants are not necessarily in opposition to Deaf culture. 

  • Cochlear implants can be placed via 2-hour outpatient surgical procedure [8]. Recipients are followed up with an audiologist to have the implant mapped [8]. Mapping involves a series of appointments for 4 to 6 weeks to both program the implant and teach the patient how to use the external processor [8]. Total costs of devices, surgery, and rehabilitation range between $50,000 and $100,000.9 90% of private insurances cover these costs and up to 80% of the costs are covered by Medicare [9].

Implications for Health Practitioners/Health Questions

Greeting: In ASL, a greeting is performed by waving one’s hand in a clockwise direction  while mouthing the word “hello” (see end of profile for image) [10]. It is important to note that the etiquette in Deaf culture is different and some may be considered rude among hearing individuals [11]. These behaviors may include [11]: 

  1. Maintaining prolonged eye contact.

  2. Being blunt and direct, whether in description or opinion.

  3. Waving, tapping the shoulder, stamping on the floor, banging on the table, and turning the lights on and off to get someone's attention.

  4. Touching during conversations.

  5. Hugging when greeting or leaving.

  6. Long goodbyes (saying goodbye to multiple people and engaging in further conversation during this process).

  7. Walking between persons who are using sign language to communicate.

  8. Exaggerated facial expressions in conjunction with the use of ASL. 

 

Mental health: Studies have shown that compared with hearing patients in the same hospital, deaf patients were less likely to be diagnosed with a psychotic or substance abuse disorder and more likely to be diagnosed with a mood, anxiety, personality, or developmental disorder [12]. Psychosocial functioning of the deaf patients was generally similar to hearing psychiatric patients [12]. Deaf patients presented significantly higher risks than hearing patients in areas of self-harm and risk of being sexually abused [12]. 

Questions/Education

  • Method of communications: 

    • Your chart said that you have used an interpreter on previous visits. Would you like to have an interpreter assist you in today’s visit? 

      • Use of a certified interpreter ensures an accurate translation between the practitioner and the patient. 

      • Family members should only be used as a substitute for certified interpreters when it is an emergency situation [13].

  • Social History:

    • What are your thoughts on smoking?

      • Smoking is less prevalent in prelingually deafened individuals (those that become deaf prior to acquiring language) [14].

    • Do you consume alcohol?

      • How many drinks do you have when you do drink?

        • Hard of hearing individuals are more likely to be heavy drinkers than their hearing counterparts [15].

    • Do you use cannabis products?

      • How regular do you consume cannabis or cannabis related products?

        • Hard of hearing individuals are more likely to be regular users than their hearing counterparts [15].

  • Women’s Health:

    • Deaf and hard-of-hearing women were more likely to have chronic conditions, pregnancy complications, and poor birth outcomes. These poor outcomes included preterm birth and very low birth weight, even after accounting for race and socioeconomic status [16].

Health Challenges

  • Unfortunately, not much public health research exists on the public health needs of the deaf and hard of hearing population [13]. 

  • In an article by Malebranche, the Deaf community have poorer mental health, cardiovascular and sexual health outcomes than non-Deaf individuals [5].

Conclusion

  • The Deaf community is a diverse multiracial, multiethnic, multi-religious linguistic minority that is united via shared experiences and sign language communication.

  • Many of the health issues faced by the Deaf community are grounded in communication and lack of medical information. Deaf individuals have different degrees of deafness and fluency in sign languages, both of which defy the heterogeneity of healthcare experience and interactions.

  • There is not much available literature looking into the needs of the Deaf community. More comprehensive studies must be completed to better serve the community. 

(Image: Graphics of different people signing basic ASL words) [9]

Resources for Patients

  • The Office of Deaf Services

  • DEAF Inc

    • To provide high-quality interpreting services at low cost in an effort to bridge the communication gap between the Deaf, Hard of Hearing, DeafBlind and Hearing society.

    • Phone: (314) 968-8868 

    • Link: https://www.deafinc.org/ 

  • Hearing Loss Association of America, Greater St. Louis Chapter

This information was read and approved by ______, the representative of ____.

References

(1) National Deaf Center on Postsecondary Outcomes. (2022, November 4). Deaf Awareness. Deaf Awareness - National Deaf Center . Retrieved March 9, 2024, from https://nationaldeafcenter.org/resources/deaf-awareness/

(2)  Texas School for the Deaf. (2016a, September 19). Deaf awareness week bulletin: What is “deaf gain”? Texas School for the Deaf.https://www.tsd.state.tx.us/apps/news/article/612286#:~:text=Deaf%20Gain%20was%20coined%20by,was%20“gaining%20his%20deafness”. 

(3) UMass Magazine. (2018, October 11). What my deaf way of science?. What my deaf way of science?: UMass Magazine. Retrieved March 9, 2024, from https://www.umass.edu/magazine/fall-2018/what-my-deaf-way-science

(4) Hearing Loss Association of America. (2019, September 27). Types, Causes and Treatment of Hearing Loss - The Basics . Retrieved March 17, 2024, from https://www.hearingloss.org/hearing-help/hearing-loss-basics/types-causes-and-treatment/

(5) Malebranche, M., Morisod, K., & Bodenmann, P. (2020). Deaf culture and health care. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 192(50), E1809. https://doi.org/10.1503/cmaj.200772 

(6) Ouellette, A. R. (2011, April 14). Hearing the deaf: Cochlear implants, the Deaf community, and bioethical analysis. Hearing The Deaf: Cochlear Implants, The Deaf Community, and Bioethical Analysis. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1808978  

(7) Cooper A. (2019). Hear Me Out: Hearing Each Other for the First Time: The Implications of Cochlear Implant Activation. Missouri medicine, 116(6), 469–471.

(8) Johns Hopkins Medicine. (2022, November 30). Cochlear Implant Surgery and rehabilitation. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cochlear-implant-surgery 

(9) Duke University School of Medicine. (2023, January 27). Forbes Health: How much do cochlear implants cost?. Duke Department of Head and Neck Surgery & Communication Sciences. https://headnecksurgery.duke.edu/news/forbes-health-how-much-do-cochlear-implants-cost#:~:text=Average%20Cost%20of%20Cochlear%20Implants,as%20by%20Medicare%20and%20Medicaid. 

(10) ASL Sign Language Dictionary. (n.d.). Americian Sign Language ASL Sign Language Dictionary - hello. Retrieved March 9, 2024, from https://www.signasl.org/sign/hello

(11) National Resource Center on Domestic Violence. (2016, October 5). Etiquette. Etiquette. Retrieved March 9, 2024, from https://vawnet.org/sc/etiquette

(12) Black, P. A., & Glickman, N. S. (2006). Demographics, psychiatric diagnoses, and other characteristics of North American Deaf and hard-of-hearing inpatients. Journal of deaf studies and deaf education, 11(3), 303–321. https://doi.org/10.1093/deafed/enj042

(13) Correll, R. (2022, June 1). Challenges That Still Exist for the Deaf Community. Challenges That Still Exist for the Deaf Community. Retrieved March 9, 2024, from https://www.verywellhealth.com/what-challenges-still-exist-for-the-deaf-community-4153447

(14) Barnett, S., & Franks, P. (1999). Smoking and deaf adults: associations with age at onset of deafness. American annals of the deaf, 144(1), 44–50. https://doi.org/10.1353/aad.2012.0120

(15) Anderson, M. L., Chang, B. H., & Kini, N. (2018). Alcohol and drug use among deaf and hard-of-hearing individuals: A secondary analysis of NHANES 2013-2014. Substance abuse, 39(3), 390–397. https://doi.org/10.1080/08897077.2018.1442383

(16) Mitra, M., McKee, M. M., Akobirshoev, I., Valentine, A., Ritter, G., Zhang, J., McKee, K., & Iezzoni, L. I. (2020). Pregnancy, Birth, and Infant Outcomes Among Women Who Are Deaf or Hard of Hearing. American journal of preventive medicine, 58(3), 418–426. https://doi.org/10.1016/j.amepre.2019.10.012

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