Health care system accessibility

Background: People who are deaf use health care services differently than the general population; little research has been carried out to understand the reasons. Objective: To better understand the health care experiences of deaf people who communicate in American Sign Language. Design: Qualitative analyses of focus group discussions in 3 U.S. cities. Participants: Ninety-one deaf adults who communicate primarily in American Sign Language. Measurements: We collected information about health care communication and perceptions of clinicians' attitudes. We elicited stories of both positive and negative encounters, as well as recommendations for improving health care. Results: Communication difficulties were ubiquitous. Fear, mistrust, and frustration were prominent in participants' descriptions of health care encounters. Positive experiences were characterized by the presence of medically experienced certified interpreters, health care practitioners with sign language skills, and practitioners who made an effort to improve communication. Many participants acknowledged limited knowledge of their legal rights and did not advocate for themselves. Some participants believed that health care practitioners should learn more about sociocultural aspects of deafness. Conclusions: Deaf people report difficulties using health care services. Physicians can facilitate change to improve this. Future research should explore the perspective of clinicians when working with deaf people, ways to improve communication, and the impact of programs that teach deaf people self-advocacy skills and about their legal rights.