Equitable Access to Telehealth and Other Services for Deaf People During the COVID-19 Pandemic.

Introduction: Deaf people who use American Sign Language (ASL) with low self-perceived ability to understand spoken information face inequitable access to health care due to systemic barriers. Methods: We conducted interviews with 266 deaf ASL users at baseline (May-Aug 2020) and 244 deaf ASL users at follow-up (3 months). Questions addressed (1) access to interpretation during in-person visits; (2) whether they visited clinics (3) or emergency departments (EDs); and (4) telehealth use. Analyses involved univariate and multivariable logistic regressions across levels of perceived ability to understand spoken language. Results: Less than a third were aged >65 (22.8%); Black, Indigenous, People of Color (28.6%), or LGBTQ+ (31.1%); and had no college degree (30.6%). More respondents reported outpatient visits at follow-up (63.9%) than at baseline (42.3%). Ten more respondents reported going to urgent care or an ED at follow-up than at baseline. At follow-up interviews, 57% of deaf ASL respondents with high perceived ability to understand spoken language reported receiving interpretation at clinic visits compared to 32% of ASL respondents with low perceived ability to understand spoken language (p<0.01). Telehealth and ED visits showed no between-group differences for low versus high perceived ability to understand spoken language. Discussion: Our study is the first to explore deaf ASL users' access to telehealth and outpatient encounters over time during the pandemic. The U.S. health care system is designed for people who have high perceived ability to understand spoken information. Systemic access to health care, including telehealth and clinics, must be made consistently equitable for deaf people who require accessible communication.

Unmet Dental Needs Among Mid-to-Older Deaf and Hard of Hearing Women in the U.S.

Introduction: Despite the significant number of deaf and hard of hearing (DHH) people living in the U.S., oral health research on DHH people who use American Sign Language (ASL) is virtually nonexistent. This study aims to investigate dental needs among mid-to-older DHH women and identify social determinants of health that may place them at higher risk for unmet dental health needs as the primary outcome. Methods: This cross-sectional study uses data drawn from Communication Health domain in the PROMIS-DHH Profile and oral health data from the National Health and Nutrition Examination Survey. Both measures were administered in ASL and English between November 2019 and March 2020. Univariate and bivariate analysis included only complete data, and multivariable logistic regression analyses were conducted on multiply imputed data. Results: Out of 197 DHH women (41 to 71+ years old) who answered the dental visit question, 48 had unmet dental needs and 149 had met dental needs. Adjusting for sociodemographic variables, disparity in dental needs was observed across education [OR (95% CI): 0.45(0.15, 1.370)] and communication health [0.95 (0.90, 1.01)]. Discussion: Our study is the first to describe DHH mid-to-older women's access to oral health care. DHH women who do not have a college degree may be impacted. Further research is needed to elucidate the particular risk factors, including cultural, to which DHH individuals from marginalized racial groups are susceptible to unmet oral health needs. Conclusions: Evidence shows that DHH ASL users who have less years of education or are single experience barriers in accessing dental care.

A Mixed Methods Study of Hysterectomy in a U.S. Sample of Deaf Women Who Use American Sign Language.

Background: Hysterectomy is one of the most common procedures performed in the United States. Yet, we know nothing about deaf women's experiences with hysterectomy. The study aims to establish a prevalence of hysterectomy among deaf women and provide insight into the experiences of those who have undergone hysterectomy. Materials and Methods: Quantitative data (n = 195; 27% Black, Indigenous, People of Color) were collected through a bilingual online patient-reported outcomes survey and reproductive health questions from the National Health and Nutrition Examination Survey (NHANES) between November 2019 and March 2020. Semistructured interviews were conducted between March and April 2021 with a smaller sample of deaf women who underwent hysterectomy. A multivariable logistic regression model identified the relationship between health care history and sociodemographic factors, while qualitative interview data were used to understand deaf women's experiences with hysterectomy. Results: Of the 195 deaf respondents, 34% underwent hysterectomy (n = 67). Results indicated that the odds of hysterectomy increased for higher age (per year), being African American/Black or Latinx, being married or living with a partner, being overweight or obese, and if communicating with the doctor through English writing or others. Qualitative interviews were conducted with eight women who provided consent to participate. Although all women reported improved quality of life posthysterectomy, patient-centered experience and decision making before hysterectomy were highly dependent on access to communication, information sources, and social support. Conclusions: Prioritizing the needs of deaf women leading up to, during, and after hysterectomy has the potential to improve overall experience with hysterectomy and patient-clinician communication.

Food Worry in the Deaf and Hard-of-Hearing Population During the COVID-19 Pandemic.

OBJECTIVE: The coronavirus disease 2019 (COVID) pandemic has highlighted preexisting health disparities, including food insecurity, in the deaf and hard-of-hearing (DHH) population. We examined factors associated with food worry during the COVID-19 pandemic. METHODS: We collected survey data on worry about food shortages, worry about contracting COVID-19, and concerns about DHH people staying home and being lonely from April 17 through May 1, 2020, via a bilingual American Sign Language/English online survey platform. The sample consisted of 537 DHH adults living in the United States. We examined the relationship between demographic characteristics and food worry. We used logistic regression and model fitting to predict the likelihood of experiencing food worry. RESULTS: The mean (SD) age of survey respondents was 47 (16), and 25% of the sample identified as people of color. Forty-two percent of survey respondents had a high level of food worry. Increased worry about contracting COVID-19 and concerns about DHH people staying home and being lonely among DHH younger adults or those without a college degree predicted food worry. Gender and race/ethnicity did not contribute to the model for food worry. CONCLUSIONS: Food worry was explained by multiple, intersecting factors, including demographic variables, worry about contracting COVID-19, and concerns about loneliness. Interventions or programs implemented by DHH-serving organizations as well as government programs, social service providers, and food banks should be fully accessible to subgroups of DHH young adults without a college degree who are at risk for food insecurity.