Using an Ecological Framework to understand health disparities in the Deaf Community

Adults with hearing loss face many health-related challenges, including those unrelated to their hearing loss. A subset of those with hearing loss, members of the Deaf community, comprise a unique cultural and linguistic minority. An estimated 500,000 adults are members of this cultural group. Previous research has suggested that there may be health disparities in this group. For example, deaf adults have higher rates of HIV/AIDS and heart disease.

Ecological models have been used in public health to explain the diverse impacts on health from a number of sources; these models describe the personal and environmental factors that contribute to behavior. We apply this model to explain how different factors might be contributing to health disparities in the Deaf community. Individual level impacts might include lack of knowledge about health and body processes and lower self-efficacy to perform certain health behaviors. Interpersonal level impacts might include language barriers between Deaf children and parents or friends, tightly knit social circles in which misinformation pervades, and unique social norms that limit discussion about certain health behaviors. Organizational level impacts might include lack of health education curricula developed for this population. Community level impacts might include reduced access to media campaigns due to language or cultural barriers. Policy level impacts might include unintended consequences of the Americans with Disabilities Act, and health care financing of effective communication strategies.

We demonstrate how this model can be used to design culturally appropriate interventions for members of the Deaf community on a variety of health topics.