Providing health care access to deaf people: Is interpreting a universal accommodation?

Lack of access to health care due to language barriers is an issue highlighted in Healthy People 2010 and 2020. Although American Sign Language interpretation by qualified professionals is considered an optimal solution for deaf patients and their families, diversity within deaf populations suggest that this might not be the case. In some cases interpretation may be the best accomodation, yet some Deaf patients, even those who would consider themselves primary users of American Sign Language, employ oral and printed communication methods with their providers. Other situations inherently require interpretation; yielding distress, medical errors, and misunderstanding when accommodated any other way. Trying to better understand the varied needs and preferences of deaf people, we conducted semi-structured ASL interviews with 7 Deaf adults, collecting their experiences and perspectives on the health care encounters and the accommodations they need and prefer. Participants ranged in age from 23-62 and all had current or prior healthcare experiences in the Rochester, NY area. Rochester is somewhat unique for its high percentage of deaf people, per capita, combined with plentiful access to skilled and qualified sign language interpreting services. Additional public commentary gleaned from internet message boards and forums frequented by Deaf people provided a broader, less location dependent perspective. Postings from 5 different sources were reviewed for applicable data, multiple examples of which were found on each site. Interview and internet obtained data from were reviewed and grouped under four over-arching themes, reflecting the Socio-Ecological Framework. In some situations the presence of an interpreter was welcomed. There were, however, many instances in which deaf adults did not want an interpreter. Participants gave many rationales for not preferring interpreters, including: long-standing patient / caregiver relationship; privacy concerns; desire for autonomy; preference for direct access to medical communication; and preferences for face-to-face spoken and lip-read conversation, written, or typed communications. The heterogeneity of the Deaf population and their communication preferences and needs demand a flexible approach to accommodations. Providers of health care, and the administrative systems around them, will need to develop additional cultural competencies to address patient requests in a timely and respectful manner.