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Increasing the cultural competence of health care providers serving Minnesota's diverse populations
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Common health equity issues for deaf and hard of hearing populations
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
Deaf individuals were nearly 7 times more likely than hearing participants to have inadequate health literacy.
Approximately one in five Minnesotans (20%) is deaf or hard of hearing—more than 1.1 million people. Every year about 200 babies are born deaf or hard of hearing. As people age, the likelihood of hearing loss increases. By age 65, one in three people has hearing problems. By 75, half of the population is deaf or hard of hearing.
Deaf, hard of hearing?
Hearing loss is described in several ways. An individual’s experience with hearing will influence their relationship with the dominant hearing world. Someone who loses hearing early in life may adapt quite differently compared to someone who lose it later in life.
American Sign Language (ASL) is the most commonly used language in the U.S. for people who rely on visual communication. It is a complete, distinct language consisting of signs made by the hands, facial expressions, and body language. It is not a form of English. Most people who lose their hearing gradually do not learn sign language or speech reading, which uses the speaker’s lips as well as facial expressions and gestures to understand conversation. Only 30 percent of the English language is readable on the lips, which means 70 percent is filled in by knowing the context or guessing the meaning of spoken language.
A profoundly deaf person can be bilingual in ASL and written English and a person with some hearing ability may be bilingual in spoken and written English and ASL.
Communication challenges between deaf and hard-of-hearing patients and their health care providers has a direct effect on patient health and outcomes. Lack of health literacy for people in the deaf community has been associated with not picking up medical information from sources like radio and television, or overhearing family conversations about health.
Social determinant disparities
For a baby born with a hearing loss, language development can be delayed without early intervention. When hearing loss is found early, support from a variety of resources can prevent or reduce these delays.
Culturally deaf. More than 90 percent of deaf children are born to hearing parents. People who are born deaf or became deaf at an early age are “culturally deaf” and more likely to identify as a member of the Deaf community. They may have lived within a Deaf community, learned to communicate using sign language, and/or developed the skill of speechreading. Being Deaf may be seen as a source of positive identity and pride. Hearing family members who embrace the Deaf community can strengthen the bonds between themselves and their child.
Physically deaf. People who become deaf later in life are physically deaf. They are more likely to hide their hearing problem. Many people who lose their hearing gradually over time become isolated because their lack of hearing impairs their ability to engage in conversation. They may withdraw from conversational situations or attempt to dominate conversations. They lose energy and stop socializing, resulting in a breakdown of family communication. They may go for years not knowing why they are withdrawing and becoming isolated.
If left untreated, hearing loss can have negative social and health impacts for both adults and children that go beyond the hearing impairment itself and include reduced quality of life and well-being. Potential health impacts from hearing loss can include headaches, muscle tension, and increased stress and blood pressure levels. Some studies have linked untreated hearing loss in adults to depression, fatigue, social withdrawal and impaired memory. Older people wait an average of seven years to accept they have a hearing problem and get treated.
Approximately one in five of all adults in the U.S. experiences mental illness in a given year. Adults age 50 and older with untreated hearing loss were more likely to report depression, anxiety, and paranoia and were less likely to participate in organized social activities, compared to those who wear hearing aids. Culturally Deaf people may not seek treatment because few providers have sufficient knowledge of ASL and how it differs from English, as well as the differences between deaf people and with-hearing people.
End of life
As with the hearing community, end-of-life care discussions are best during non-urgent appointments. Deteriorating communication can be particularly problematic for individuals with significant hearing loss during times of medical crisis. Some hospices and organizations that work with individuals with hearing loss maintain lists of volunteers who are deaf or hard of hearing themselves. These volunteers can be helpful in meeting the social needs of these patients at the end of their lives.
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