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Scholarly Works (7 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2012)

It is critically important to foster a resilient Deaf and hard-of-hearing (Deaf/HH) population empowered to act in a pre-event phase before and respond during and after critical large-scale public health emergencies. Standard all-hazards emergency preparedness risk & response communication efforts don't always reach people with barriers relating to literacy, language, culture or disability. This is a significant problem given that there is a growing body of evidence of higher risk during disasters for injury, death, property loss for 32 million Deaf/HH Americans and for 90 million Americans with low-literacy skills. It is beneficial to use a participatory, community-directed approach to improve all-hazards preparedness capacity for the Deaf/HH.

This dissertation is in a three-paper format. Part I, a literature review, systematically examines all-hazards emergency communication access for the Deaf/HH during large-scale disasters with an eye towards maximizing emergency preparedness capacity within the Deaf community. The literature review does not simply examine lessons learned from any access issues that have been documented in previous disasters but also reviews the peer reviewed and gray literature (non-peer-reviewed literature, often non-published reports) to determine the need for interventions or systemic change on a policy-level. By identifying the scope and magnitude of the problem, this literature review is a stepping stone for Parts II and III, which aim to develop best practices for educational outreach and training for first responders.

Part II is a program evaluation utilizing mixed methods of a training program for law enforcement officers at the scene of domestic violence (DV) emergencies involving the Deaf/HH. A program evaluation of cultural competency training for the Deaf/HH has never been published, to my knowledge, despite several available trainings for first responders or medical professionals and students nationally (Appendix 1). Once trainings are developed, standardized and shown to be beneficial, they can be distributed to Deaf/HH audiences and/or first responders, which can sustain longer-term development efforts that might mitigate the impact of future emergencies or improve the quality of life/infrastructure on broader levels.

Part III is a qualitative exploration of barriers, attitudes, perceptions, and knowledge of law enforcement and first responders regarding working with the Deaf/HH in an emergency. Specific abstracts for each Part can be found in the corresponding section.

The closing section provides a summary of policy and legislative developments on a national level that are informed by Deaf/HH experts in emergency communication; these developments have implications for further research and practice to address disparities in emergency preparedness communication for the Deaf/HH.

    Cover page: Addressing Disparities in Emergency Communication with the Deaf and Hard-of-Hearing: Cultural Competence and Preparedness for First Responders
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2018)
    OBJECTIVE:To assess whether mode of communication and patient centered communication (PCC) with physicians were associated with the likelihood of deaf smokers inquiring about lung cancer screening. METHODS:An accessible health survey including questions about PCC, modes of communication, smoking status and lung cancer screening was administered in American Sign Language (HINTS-ASL) to a nationwide sample of deaf adults from February to August 2017. Of 703 deaf adults who answered the lung screening question, 188 were 55-80 years old. RESULTS:The odds ratio of asking about a lung cancer screening test was higher for people with lung disease or used ASL (directly or through an interpreter) to communicate with their physicians. PCC was not associated with asking about a lung cancer screening test. CONCLUSION:Current or former smokers who are deaf and use ASL are at greater risk for poorer health outcomes if they do not have accessible communication with their physicians. PRACTICE IMPLICATIONS:Optimal language access through interpreters or directly in ASL is critical when discussing smoking cessation or lung cancer screening tests. Counseling and shared decision-making will help improve high-risk deaf patients' understanding and decision-making about lung cancer screening.
      Cover page: Deaf patient-provider communication and lung cancer screening: Health Information National Trends survey in American Sign Language (HINTS-ASL)
      • Article
      • Peer Reviewed
      Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 19, Issue 6 (2018)

      Approximately 23% of Americans over age 12 have some level of hearing loss.1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities’ commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice.

      In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication.

       

       

        Cover page: Deaf and Hard of Hearing Learners in Emergency MedicineCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2021)

        Objective

        There is a lack of qualitative research developing sugar-sweetened beverage (SSB) warning labels with their intended end users. We sought to identify promising SSB warning elements for improving label effectiveness and for future testing in policy and institutional settings.

        Design

        Mixed methods design using ten focus groups, a design task and a survey. The design task was used to generate ideas for an icon that would dissuade SSB consumption. The survey and focus group guide assessed participant perceptions of SSB warning label mock-ups of text (loss frame, gain frame and loss frame with attribution), colour and icon options.

        Setting

        Three large public universities in California from February to March 2018.

        Participants

        Young adult SSB consumers (n 86) enrolled in one of three diverse California public universities.

        Results

        Participants perceived the following elements as most effective for reducing SSB consumption: loss-frame text with attribution to a credible source, yellow and red colour for label background and an image or icon to accompany the text. Preferred images included sugar near or inside of an SSB, intuitive shapes like a triangle with exclamation mark or octagon and a visual indicator of SSB sugar content compared with recommended limits. Support was high for using SSB warning labels in university cafeterias and on bottles/cans.

        Conclusions

        Loss-frame text with a credible source, yellow or red label colour and icons could potentially enhance effectiveness of SSB warning labels and warrant further testing.
          Cover page: Developing sugar-sweetened beverage warning labels for young adults
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2014)

          Objectives

          Substantial evidence exists that emergency preparedness and response efforts are not effectively reaching populations with functional and access needs, especially barriers related to literacy, language, culture, or disabilities. More than 36 million Americans are Deaf or hard of hearing (Deaf/HH). These groups experienced higher risks of injury, death, and property loss in recent disasters than the general public. We conducted a participatory research study to examine national recommendations on preparedness communication for the Deaf/HH.

          Methods

          We assessed whether previous recommendations regarding the Deaf/HH have been incorporated into state- and territorial-level emergency operations plans (EOPs), interviewed state- and territorial-level preparedness directors about capacity to serve the Deaf/HH, and proposed strategies to benefit Deaf/HH populations during emergencies. We analyzed 55 EOPs and 50 key informant (KI) interviews with state directors.

          Results

          Fifty-five percent of EOPs mentioned vulnerable populations; however, only 31% specifically mentioned Deaf/HH populations in their plan. Study findings indicated significant relationships among the following factors: a state-level KI's familiarity with communication issues for the Deaf/HH, making relay calls (i.e., calls to services to relay communication between Deaf and hearing people), and whether the KI's department provides trainings about serving Deaf/HH populations in emergencies. We found significant associations between a state's percentage of Deaf/HH individuals and a KI's familiarity with Deaf/HH communication issues and provision by government of any disability services to Deaf/HH populations in emergencies. Further, we found significant relationships between KIs attending training on serving the Deaf/HH and familiarity with Deaf/HH communication issues, including how to make relay calls.

          Conclusion

          This study provides new knowledge that can help emergency agencies improve their preparedness training, planning, and capacity to serve Deaf/HH populations in emergencies.
            Cover page: Assessment of State- and Territorial-Level Preparedness Capacity for Serving Deaf and Hard-of-Hearing Populations in Disasters
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2013)
            Abstract Background Deaf and hard-of-hearing (Deaf/HH) individuals have been underserved before and during emergencies. This paper will assess Deaf/HH related emergency preparedness training needs for state emergency management agencies and deaf-serving community-based organizations (CBOs). Methods Four approaches were used: 1) a literature review; 2) results from 50 key informant (KI) interviews from state and territorial-level emergency management and public health agencies; 3) results from 14 KI interviews with deaf-serving CBOs in the San Francisco Bay Area; and 4) a pilot program evaluation of an emergency responder training serving the Deaf/HH in one urban community. Results Results from literature review and state and territorial level KIs indicate that there is a substantive gap in emergency preparedness training on serving Deaf/HH provided by state agencies. In addition, local KI interviews with 14 deaf-serving CBOs found gaps in training within deaf-serving CBOs. These gaps have implications for preparing for and responding to all-hazards emergencies including weather-related or earthquake-related natural disasters, terrorist attacks, and nuclear-chemical disasters. Conclusion Emergency preparedness trainings specific to responding to or promoting preparedness of the Deaf/HH is rare, even for state agency personnel, and frequently lack standardization, evaluation, or institutionalization in emergency management infrastructure. This has significant policy and research implications. Similarly, CBOs are not adequately trained to serve the needs of their constituents.
              Cover page: Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations
              • Article
              • Peer Reviewed
              Berkeley Research Impact Initiative (BRII) (2013)
              A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people’s literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4th grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6th grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations.
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