Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. DATA SOURCES: Semistructured interviews in a qualitative design using a socio-ecological model (SEM). CONCLUSIONS: Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. IMPLICATIONS FOR PRACTICE: Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters.

Evaluation of the psychometric properties of the Korean language version of the Incontinence Quiz.

Psychometric properties of the Korean version of the Incontinence Quiz were evaluated in Korean-American women with urinary incontinence. Findings support the reliability and validity of both versions of the instrument in this population.

Working with translators and interpreters in research: lessons learned.

The purpose of this special section is to describe culturally competent approaches for working with translators or interpreters who participate in transcultural studies. This article provides background for three exemplars of lessons learned in working with translators in transcultural studies: (a) the resettlement transition experiences of women from the Dinka tribe of Southern Sudan (Baird), (b) Samoans' risk for heart disease (Siaki), and (c) culturally Deaf adults' perceptions about depression (Sheppard).Capitalizing the word "Deaf" has gained wide acceptance to indicate a linguistic minority of people who have a hearing loss and use American Sign Language, a hallmark of Deaf culture. In each case, the individual researcher made adaptations to the usual processes of translation/back-translation when appropriate to the cultural context and the specific situations of the translators. Although these lessons were learned during research-related activities, they may apply to other circumstances when nurses work with bilingual/bicultural translators (e.g., translating consent forms or communicating with persons who have limited literacy in their native language).

Creating and testing a deaf-friendly, stop-smoking web site intervention.

Deaf adults' access to smoking cessation programs is limited due to cultural, linguistic, and geographic barriers. Web-based stop-smoking interventions have demonstrated cessation rates comparable to other interventions. The Internet is widely used by Deaf adults, but difficulties with online English text remain. We found no published accounts of Internet interventions promoting smoking cessation among Deaf individuals. The purpose of our project was to create and pilot test a prototype interactive Web site that provides users with information in American Sign Language related to smoking cessation. We utilized web cams to create real-time "video chat rooms" for virtual support groups and had an "ask the experts" feature. Deaf community members participated in all phases of development and testing, and a Deaf former smoker served as the moderator for the site. Evaluations were positive, with emphasis on interactive and visual aspects of the site.

Body image perceptions in men with prostate cancer.

PURPOSE/OBJECTIVES: To describe changes in body image among men with prostate cancer who were either prescribed androgen-deprivation therapy (ADT) or were ADT naive and to explore the relationship of age, duration of therapy, and body mass index with body image perception. DESIGN: Exploratory and descriptive. SETTING: Ambulatory care clinic of a large urban Veterans Affairs medical center. SAMPLE: 132 men 60 years of age or older with prostate cancer recruited from the oncology and urology outpatient departments. METHODS: Participants completed a demographic survey and the Body Image Scale (BIS), an instrument developed to measure changes in body image. Descriptive and inferential statistics were used to explore body image dissatisfaction. MAIN RESEARCH VARIABLES: Body image and ADT. FINDINGS: A significant difference in body image dissatisfaction existed between men who had received ADT and men who were ADT naive. No relationship was identified between age and body image dissatisfaction or between duration of therapy and body image dissatisfaction. A significant positive relationship was found between body mass index and body image dissatisfaction for the sample overall. CONCLUSIONS: A greater degree of body image dissatisfaction existed in the men who received ADT as compared to those who were ADT naive. IMPLICATIONS FOR NURSING: Patients receiving ADT for prostate cancer may be at greater risk of body image dissatisfaction. The psychometric performance of the BIS lends support to its continued use in this population.

Self-efficacy for health-related behaviors among deaf adults.

The purpose of this quasi-experimental, pre-post-test study was to test the effectiveness of the Deaf Heart Health Intervention (DHHI) in increasing self-efficacy for health-related behaviors among culturally deaf adults. The DHHI targets modifiable risk factors for cardiovascular disease. A sample of 84 participants completed time-1 and time-2 data collection. The sign language version of the Self-Rated Abilities Scale for Health Practices (SRAHP) was used to measure self-efficacy for nutrition, psychological well-being/stress management, physical activity/exercise, and responsible health practices. Total self-efficacy scores were significantly higher in the intervention group than in the comparison group at time-2, controlling for scores at baseline (F [1, 81] = 26.02, p < .001). Results support the development of interventions specifically tailored for culturally deaf adults to increase their self-efficacy for health behaviors.

Perceived stress among deaf adults.

THE PRESENT ARTICLE describes the effectiveness of stress management classes in decreasing perceived stress among Deaf adults. Deaf adults may experience unique stressors, in addition to circumstances associated with increased stress in the general population. The Perceived Stress Scale (S. Cohen, Kamarck, and Mermelstein, 1983) was used as a pretest and posttest measure for participants in a study of the Deaf Heart Health Intervention. Results indicated that (a) some Deaf adults may have higher levels of perceived stress than the general population, and (b) culturally appropriate stress management interventions are promising as a means of assisting Deaf adults to decrease levels of perceived stress, and hence decrease risk for stress-related illnesses. Future research will focus on obtaining a larger, more diverse sample of Deaf adults and refining the intervention for maximum effectiveness.

Challenges in language, culture, and modality: translating English measures into American sign language.

BACKGROUND: Few health-related questionnaires have been translated into American Sign Language (ASL), precluding Deaf adults from full participation in health-related research. OBJECTIVES: To translate self-report measures (written English) into sign language and to evaluate the equivalence of the ASL versions to the original English versions of the measures. METHODS: A descriptive-comparative design with a derived etic (outsider) perspective was used to evaluate equivalency between the English version of the Self-Rated Abilities for Health Practices (SRAHP) and an ASL version. Both versions were administered to 24 bilingual (English and ASL) adults. Analysis included correlation between total scores and comparison of internal consistency of both versions; psychometric properties of the signed SRAHP were computed for 105 Deaf adults who participated in a study of the Deaf Heart Health Intervention (DHHI). RESULTS: The correlation between total scores on ASL and English versions was .92, item-to-total correlations ranged from .08 to .80 on the English version and from .33 to .80 on the ASL version. Cronbach's alpha was .91 for the English version and .90 for the ASL version. Mean scores on the ASL version were significantly lower for the all-Deaf DHHI sample (n = 105) than for the bilingual subjects (n = 24) although internal consistency remained high (Cronbach's alpha of .93 and item-to-total correlation of .38-.74) for the new ASL version. DISCUSSION: The use of an adapted translation model resulted in a sound ASL version of a health-related measure. Results support use of the derived etic strategy for translating measures from their original language into new languages. The approach is also appropriate for changing modalities from written form to other modalities, such as the visual-manual modality of ASL.

Deaf community analysis for health education priorities.

Deaf persons' access to health-related information is limited by barriers to spoken or written language: they cannot overhear information; they have limited access to television, radio, and other channels for public information; and the average reading level of Deaf adults is at a 3rd to 4th grade level. However, literature searches revealed no published reports of community analysis focusing specifically on health education priorities for Deaf communities. A seven-step community analysis was conducted to learn the health education priorities in Arizona Deaf communities and to inform development of culturally relevant health education interventions in Deaf communities. The word "Deaf" is capitalized to reflect the cultural perspective of the Deaf community. A 14-member Deaf Health Committee collected data using multimethods that included review of state census data, review of national health priorities, key informant interviews, discussions with key community groups, a mail survey (n = 20), and semistructured interviews conducted in sign language with 111 Deaf adults. The community diagnosis with highest priority for health education was vulnerability to cardiovascular disease (CVD). Following completion of the community analysis, a heart-health education intervention (The Deaf Heart Health Intervention) was developed using a train-the-trainer, community health worker model. If this model proves to be effective in addressing vulnerability to CVD, then a similar protocol could be employed to address other health concerns identified in the Deaf community analysis.

Use of American Sign Language in telepsychiatry consultation.

The aim of this study was to provide a psychiatric consultation to a deaf patient in a rural community via telemedicine. The patient successfully communicated with the telepsychiatrist via an American Sign Language (ASL) interpreter and her psychiatric symptoms improved. This case study demonstrated the feasibility of delivering specialty medical services to a special needs population via telemedicine.