The perspective of deaf patients on health care / A perspectiva do paciente surdo acerca do atendimento à saúde

ABSTRACT Purpose: to learn the deaf people's perspective on the improvements needed in this population's health care. Methods: an observational, cross-sectional study conducted with 124 deaf people who answered a semi-structured questionnaire to characterize the sample (age, sex, and means of communication) and collect answers to the open question: "Do you have any suggestion to improve the health care for the deaf?" - which was answered either in writing or in the Brazilian Sign Language (Libras). A descriptive analysis was conducted to characterize the sample, as well as a quantitative and qualitative content analysis (thematic-categorical), to identify categories and occurrence frequency of the content in the answers to the open question. Results: the sample's mean age was 44 years (standard deviation 15, minimum 18, and maximum 70 years), 65% were women, and 78% used Libras to communicate. Most of the participants (83%) answered the open question in writing. Six theme categories were identified: 1) Needed improvements; 2) Communication barriers); 3) Health promotion; 4) Autonomy; 5) Achievements; and 6) Law. Conclusion: the results reveal a need for improvements in the health care of deaf people. The perspective of the studied deaf population is based on their desire to gain autonomy, overcome communication barriers, and have access to information, aiming at health promotion.

RESUMO Objetivo: conhecer a perspectiva do surdo quanto às melhorias necessárias no atendimento à saúde para essa população. Métodos: estudo observacional transversal realizado com 124 surdos que responderam a questionário semiestruturado, visando caracterizar amostra (idade, sexo e tipo de comunicação) e coletar resposta à questão aberta: "Você tem alguma sugestão para melhorar o atendimento de saúde ao surdo?, respondida nas modalidades escrita ou Língua Brasileira de Sinais (Libras). Realizou-se análise descritiva para caracterização da amostra e análise quanti-qualitativa de conteúdo (temático-categorial), para identificação de categorias e frequência de ocorrência dos conteúdos das respostas à questão aberta. Resultados: amostra apresentou média de idade de 44 anos (desvio padrão: 15, mínima de 18 e máxima de 70 anos), sendo 65% mulheres e 78% usuários de Libras. A maioria dos participantes (83%) respondeu à questão aberta na modalidade escrita. Foram identificadas seis categorias temáticas: 1) Necessidade de melhorias; 2) Barreiras de comunicação); 3) Promoção da saúde; 4) Autonomia; 5) Conquistas; e 6) Legislação. Conclusão: os resultados evidenciaram necessidade de melhorias no atendimento à saúde do usuário surdo. A perspectiva da população surda estudada é pautada no desejo de autonomia, de superação das barreiras de comunicação e de acesso à informação visando promoção da saúde.

Access to healthcare for deaf people: a model from a middle-income country in Latin America

ABSTRACT OBJECTIVE To determine if there are existing healthcare access inequities among the deaf Chilean population when compared to the general Chilean population. METHODS Data were obtained from a population-based national survey in Chile. In total, 745 prelingually deaf individuals were identified. The number of times the person used the healthcare system was dichotomized and analyzed using a multivariate logistic regression model. RESULTS Prelingually deaf people had lower incomes, fewer years of education, and greater rates of unemployment and poverty when compared with the general population. Moreover, they visited more general practitioners, mental health specialists, and other medical specialists. On average, they attended more appointments for depression but had fewer general checkups and gynecological appointments than the general population. CONCLUSIONS Deaf people in Chile have a lower socioeconomic status than the rest of the Chilean population. The results from this study are similar to the findings reported for high-income countries, despite differences in the magnitude of the associations between being deaf and healthcare access. Further studies should be conducted to determine the health status of deaf people in Chile and other Latin American countries and what factors are associated with a significantly lower prevalence of gynecological appointments among deaf women when compared with non-deaf women.

Acesso de pessoas deficientes auditivas a serviços de saúde em cidade do Sul do Brasil / Access by hearing-disabled individuals to health services in a southern Brazilian city

Este estudo transversal, de base populacional, tem como objetivo comparar o acesso dos portadores de deficiência auditiva incapacitante a serviços assistenciais e de prevenção com os ouvintes de Canoas, Rio Grande do Sul, Brasil. A amostra incluiu 1.842 pessoas com 15 anos ou mais, sendo a maioria mulheres (52,9 por cento). A renda individual de dois salários mínimos ou mais foi a mais freqüente (42,7 por cento). As pessoas com deficiência auditiva incapacitante tiveram 30 por cento maior probabilidade de ter consultado nos dois meses anteriores à entrevista (RP = 1,3, IC95 por cento: 1,10-1,51) e ter sido internado nos 12 meses anteriores à entrevista (RP = 2,1, IC95 por cento: 1,42-3,14). Nas variáveis relativas à saúde mental, os deficientes auditivos tiveram 1,5 mais probabilidade de terem consultado para problemas de nervos (IC95 por cento: 1,18-1,95) e 4,2 mais probabilidades de terem sido internados em hospital psiquiátrico que os ouvintes (IC95 por cento: 2,17-8,16). Assim como encontrado na literatura, as mulheres deficientes auditivas realizaram menos auto-exame das mamas e exame citopatológico de colo uterino. Os dados encontrados indicam a necessidade de investir em educação em saúde e campanhas específicas para o grupo de pessoas investigado.

This cross-sectional study aimed to compare access to health services and preventive measures by persons with hearing disability and those with normal hearing in Canoas, Rio Grande do Sul State, Brazil. The sample included 1,842 individuals 15 years or older (52.9 percent of whom were females). The most frequent income bracket was twice the minimum wage or more, or approximately U$360/month (42.7 percent). Individuals with hearing disability were more likely to have visited a physician in the previous two months (PR = 1.3, 95 percentCI: 1.10-1.51) and to have been hospitalized in the previous 12 months (PR = 2.1, 95 percentCI: 1.42-3.14). Regarding mental health, individuals with hearing disability showed 1.5 times greater probability of health care due to mental disorders and 4.2 times greater probability of psychiatric hospitalization as compared to those with normal hearing. Consistent with other studies, women with hearing disability performed less breast self-examination and had fewer Pap smears. The data indicate the need to invest in specific campaigns for this group of individuals with special needs.

Deficiência visual, auditiva e física: prevalência e fatores associados em estudo de base populacional / Visual, hearing, and physical disability: prevalence and associated factors in a population-based study

O estudo descreve as prevalências de deficiências segundo características demográficas e sócio-econômicas, bem como as suas causas. A pesquisa utilizou dados de inquéritos de base populacional realizados em áreas do Estado de São Paulo, Brasil, em 2002 e 2003, com amostragem estratificada por conglomerados. Os entrevistados que referiram deficiências foram a população estudada segundo as variáveis que compõem o banco de dados. A prevalência de alguma deficiência foi de 110,8‰; deficiência visual, 62‰; deficiência auditiva, 44‰ e a deficiência física de 13,3‰. As prevalências das deficiências variaram com a idade; sexo e escolaridade. A prevalência de deficiências auditiva e física foi maior entre os homens. A principal causa das deficiências foi a doença. As causas externas também foram umas das principais causadoras de incapacidades. As deficiências aumentaram com a idade, foram mais prevalentes em mulheres e em pessoas com menor escolaridade, sendo sua principal causa as doenças e as causas externas.

The aim of this study was to describe the prevalence of disabilities according to demographic and socioeconomic characteristics, as well as to determine the main causes. The research used data from two population-based health surveys in São Paulo State, Brazil, in 2002 and 2003, designed with complex sampling techniques. Interviewees that reported disabilities comprised the study sample, according to the database variables. Prevalence of any disability was 110.8‰; visual disability, 62‰; hearing disability, 44‰; and physical disability, 13.3‰. Prevalence rates for disabilities varied according to age, gender, and schooling. Prevalence of hearing and physical disability was higher among men. The principal cause of disabilities was the disease itself. External causes were also one of the causative factors in disabilities. Disabilities increased with age and were more prevalent among women and persons with less schooling, and the principal causes were diseases and injuries.