This book guides healthcare professionals, hospital administrators, and medical interpreters in the United States (and internationally) in ways to better communicate with Deaf and Hard of Hearing (D/HH) patients and sign language interpreters in healthcare settings. It also provides an overview of the healthcare communication issues with healthcare professionals and D/HH patients, and the advantages and disadvantages of using in-person interpreters vs. video remote interpreting (VRI). Due to technology development, hospital administrators have popularized the use of VRI and reduced the number of in-person interpreting services, which have negatively affected the quality of medical interpreting services and patient-provider communication. The COVID-19 pandemic also has accelerated the move toward more VRI, particularly in the US.
The book addresses an understudied aspect of access and is written by an international deaf researcher from Japan who uses American Sign Language (ASL) and English as non-native languages. In order to identify appropriate interpreting services for specific treatments, the author focuses on healthcare professionals' and D/HH patients' interpreting preferences for critical and non-critical care in the US, and offers a new theoretical framework, an Ecology of Health Communication, to contextualize and analyze these preferences. The ecological matrix and its five analytical dimensions (i.e., physical-material, psychological, social, spatial, and temporal) allow readers to understand how these dimensions influence healthcare professionals' and D/HH patients' interpreting preferences as well as the treatment outcomes. This book concludes by prioritizing the use of an appropriate interpreter for specific treatments and allocating funds for in-person interpreters for critical care treatments.
Deaf Rhetoric: An Ecology of Health Communication is primarily designed for healthcare professional students and professionals, hospital administrators, medical interpreters, VRI companies, and healthcare researchers. Scholars interested in the communication preferences of healthcare professionals and deaf people also will find this text useful. The book counters some of the power differences between healthcare providers and those who use medical services, and subtly reminds others that deaf people are not solely the receivers of medical care but actually are full people. The field of health care is growing and medical schools are increasingly called on to address cultural competencies; this resource provides a needed intervention.
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Manako Yabe, PhD, MSW is the first Deaf faculty member in the Division of Disability Sciences at the University of Tsukuba, Japan. Dr. Yabe was born deaf in Japan and grew up in three countries: Japan, the United Kingdom, and the United States. She earned a Bachelor of Arts in Deaf Studies from California State University, Northridge, a Master's in Social Work from the University of Southern California, and a Doctor of Philosophy in Disability Studies from the University of Illinois, Chicago. Her areas of specialization include: Technical Communication, Deaf Studies, Disability Studies, Disability Rhetoric, Writing Center Studies, and Mixed Methods Research.
PrefaceThe preface introduces the author's healthcare communication experiences throughout her childhood from living in Japan, the United Kingdom, and the United States. As an international deaf patient, she has experienced the barriers of healthcare communication and health literacy through family translation, written communication, in-person interpreter, and VRI in different languages: Japanese, English, Japanese Sign Language, British Sign Language, and American Sign Language. At college, she was in a car accident, which led her to start researching VRI and pioneering a disability studies curriculum for medical schools in the US. The preface also provides a preview of each chapter.
Chapter 1: Deaf People and Health CommunicationChapter 1 introduces an overview of healthcare communication barriers for deaf patients, the impact of communication barriers on health outcomes and healthcare experiences of deaf patients, the advantages and disadvantages of in-person interpreting versus VRI, the research on healthcare communication for deaf patients, and the culture and intersectionality (e.g., language, race/ethnicity, gender/socioeconomic status, disability) in patient-provider communication. Chapter 1 offers the readers to become familiar with the characteristics of deafness, and to understand the common issues of healthcare communication between healthcare providers and deaf patients.
Chapter 2: What Is Ecology of Health Communication?Chapter 2 introduces a new theoretical framework, an Ecology of Health Communication (EHC). The author originally proposed the hybrid theoretical framework that combines the social model of disability and the cultural perspective of deafness because she assumed that the interpreting preferences of healthcare professionals and deaf patients regarding use of VRI and in-person interpreting were affected by cultural knowledge on deafness. However, after quantitative survey and qualitative interview data collection through a mixed methods study, the study found that the interpreting preferences of healthcare professionals and deaf patients were affected by social fields (e.g., physical, environmental, economic factors). The author developed EHC, an idea that came from Margaret Syverson (1999)'s Ecology of Composition and its ecological matrix, which consists of five analytical dimensions: physical-material, social, spatial, psychological, and temporal. The author discusses interpreting preferences of healthcare professionals and deaf patients through the lens of EHC in Chapters 3 and 4.
Chapter 3: Deaf and Hard of Hearing Patients' Perspective
Chapter 3 introduces deaf patients' experiences for using VRI versus in-person interpreters, and their interpreting preferences for critical care and non-critical care. To clarify, the study collected quantitative online surveys and qualitative interviews from deaf patients who were fluent in ASL and had experienced in using VRI in medical settings (n=41). Unfortunately, the study did not allocate recruiting deaf patients who had limited literacy and had no computer accesses at home, which left the characteristics of deaf patients who were educational and professionals. Through the lens of EHC, the author brings deaf patients' voices. The study found that deaf patients still preferred in-person interpreters for both critical and non-critical care for effective communication, translation accuracy, and human trust relationship. The study confirmed that VRI would be inferior to in-person interpreters for patient-provider communication.
Chapter 4: Healthcare Professionals' PerspectivesChapter 4 introduces healthcare professionals' experiences for treating deaf patients versus LEP patients, and their interpreting preferences regarding VRI and in-person interpreting services for critical care and non-critical care (n=62). To clarify, critical care means care such as emergency care, surgery care, cancer treatments, or something which required more serious treatment. Noncritical care means concerns like colds, follow-up appointments, or refilling medicines; things which require less serious treatment. The study found that healthcare professionals' experiences for treating deaf patients versus LEP patients did not have any differences: They preferred in-person interpreters for critical care, but they did not have a specific interpreting preference for non-critical care. However, they recognized the different communication methods: LEP patients depend on spoken languages and deaf patients depend on sign languages, so that VRI still would be acceptable for limited English proficiency (LEP) patients' communication methods, but it would not be feasible for deaf patients' communication methods. Through the lens of EHC, the author brings examples from healthcare providers' voices to understand why healthcare professionals made their priorities and their interpreting preferences for critical care versus non-critical care.
Chapter 5: Conclusion and ImplicationsChapter 5 summarizes the voices from healthcare professionals and deaf patients. More importantly, the study concludes that financial concerns and hospital systems often played a role in the choice of interpreting modality for healthcare providers. These concerns can be closely linked with the political economy of American health care - the imperative for cost control, quick services, and efficiency under managed care and a for-profit health system. This EHC allows readers to help in understanding the attitudes of hospital administrators toward VRI services. It would be likely that administrators are motivated to save costs and avoid a loss of their benefits, rather than ensuring accessible and effective provider-patient communication, which could lead to better treatment choices. The author proposes that hospital administrators do not popularize VRI at 100% and continue to allocate some funding for in-person interpreting for clinical care encounters. The author also proposes the importance of training needs for healthcare professional students, healthcare professionals, VRI companies, VRI interpreters, and deaf patients and their families for understanding cultural competence, legal obligation, and empowerment.
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