Assessment of community pharmacists’ communication and comfort levels when interacting with Deaf and hard of hearing patients

Keywords: Hearing Loss, Sign Language, Hearing, Communication Barriers, Patient Safety, Pharmacies, Pharmaceutical Services, Pharmacists, Cross-Sectional Studies, Malaysia

Abstract

Background: Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks.

Objective: 1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support.

Methods: This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer’s level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA.

Results: A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6).

Conclusions: The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.

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References

World Health Organization. Deafness and hearing loss. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss#:~:text=Over%205%25%20of%20the%20world's,will%20have%20disabling%20hearing%20loss (accessed Jan 4, 2021).

World Federation of the Deaf. Who we are. Helsinki, Finland: 2020 26th August. Who we are. http://wfdeaf.org/who-we-are/ (accessed Jan 4, 2021).

Padden C, Humphries T. Deaf in America: Voices from a Culture. Ear Hear. 1989;10(2):139. https://doi.org/10.1097/00003446-198904000-00022

Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J N Y State Nurses Assoc. 2009;40(1):4-10.

Pendergrass KM, Nemeth L, Newman SD, Jenkins CM, Jones EG. Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach. J Am Assoc Nurse Pract. 2017;29(6):316-323. https://doi.org/10.1002/2327-6924.12461

McKee MM, Barnett SL, Block RC, Pearson TA. Impact of communication on preventive services among deaf American Sign Language users. Am J Prev Med. 2011;41(1):75-79. https://doi.org/10.1016/j.amepre.2011.03.004

Ferguson M, Liu M. Communication needs of patients with altered hearing ability: Informing pharmacists' patient care services through focus groups. J Am Pharm Assoc (2003). 2015;55(2):153-160. https://doi.org/10.1331/japha.2015.14147

Ferguson MC, Shan L. Survey Evaluation of Pharmacy Practice Involving Deaf Patients. J Pharm Pract. 2016;29(5):461-466. https://doi.org/10.1177/0897190014568379

Middleton A, Niruban A, Girling G, Myint PK. Communicating in a healthcare setting with people who have hearing loss. BMJ. 2010;341:c4672. https://doi.org/10.1136/bmj.c4672

Sirch L, Salvador L, Palese A. Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study. Scand J Caring Sci. 2017;31(2):368-377. https://doi.org/10.1111/scs.12356

Hommes RE, Borash AI, Hartwig K, DeGracia D. American Sign Language Interpreters Perceptions of Barriers to Healthcare Communication in Deaf and Hard of Hearing Patients. J Community Health. 2018;43(5):956-961. https://doi.org/10.1007/s10900-018-0511-3

Smith WT, Catney CM, Rickles NM, Hermansen-Kobulnicky CJ, Broeseker AE, Garvan CW, Kimberlin CL. Pharmacy student comfort in communicating with persons with disabilities. Curr Pharm Teach Learn. 2014;6(2):175-184. https://doi.org/10.1016/j.cptl.2013.11.011

Ray MK, Beach MC, Nicolaidis C, Choi D, Saha S, Korthuis PT. Patient and provider comfort discussing substance use. Fam Med. 2013;45(2):109-117.

Stephan WG, Stephan CW. Intergroup Anxiety. J Soc Issues. 1985;41(3):157-175. https://doi.org/10.1111/j.1540-4560.1985.tb01134.x

Grant AD, Miller MM, Hollingshead NA, Anastas TM, Hirsh AT. Intergroup anxiety in pain care: impact on treatment recommendations made by white providers for black patients. Pain. 2020;161(6):1264-1269. https://doi.org/10.1097/j.pain.0000000000001806

Ralston E, Zazove P, Gorenflo DW. Communicating with deaf patients. JAMA. 1995;274(10):794-795. https://doi.org/10.1001/jama.274.10.794b

Ilardo ML, Speciale A. The Community Pharmacist: Perceived Barriers and Patient-Centered Care Communication. Int J Environ Res Public Health. 2020;17(2):536. https://doi.org/10.3390/ijerph17020536

Kritzinger J, Schneider M, Swartz L, Braathen SH. "I just answer 'yes' to everything they say": access to health care for deaf people in Worcester, South Africa and the politics of exclusion. Patient Educ Couns. 2014;94(3):379-383. https://doi.org/10.1016/j.pec.2013.12.006

Zulu T, Heap M, Sinanovic E. The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa. PLoS One. 2017;12(12):e0189983. https://doi.org/10.1371/journal.pone.0189983

Hsieh E. Not just "getting by": factors influencing providers' choice of interpreters. J Gen Intern Med. 2015;30(1):75-82. https://doi.org/10.1007/s11606-014-3066-8

Kuenburg A, Fellinger P, Fellinger J. Health Care Access Among Deaf People. J Deaf Stud Deaf Educ. 2016;21(1):1-10. https://doi.org/10.1093/deafed/env042

Brown HL, Hughes-Bell A, McDuffie AW. Caring for patients who are deaf or hard of hearing. JAAPA. 2015;28(12):50-55. https://doi.org/10.1097/01.jaa.0000473363.92597.91

Juckett G, Unger K. Appropriate use of medical interpreters. Am Fam Physician. 2014;90(7):476-480.

Cárdenas-Valladolid J, Martín-Madrazo C, Salinero-Fort MA, et al. Prevalence of adherence to treatment in homebound elderly people in primary health care: a descriptive, cross-sectional, multicentre study. Drugs Aging. 2010;27(8):641-651. https://doi.org/10.2165/11537320-000000000-00000

Tsimpida D, Kaitelidou D, Galanis P. Barriers to the use of health services among deaf and hard of hearing adults in Greece: a Cross-Sectional Study. Eur J Pers Cent Healthc. 2018 12/04;6:638. http://doi.org/10.5750/ejpch.v6i4.1566

Steinberg AG, Barnett S, Meador HE, Wiggins EA, Zazove P. Health care system accessibility. Experiences and perceptions of deaf people. J Gen Intern Med. 2006;21(3):260-266. https://doi.org/10.1111/j.1525-1497.2006.00340.x

Ryan EB, Bajorek S, Beaman A, Anas AP. "I Just Want You to Know That 'Them' Is Me". In: Intergroup Perspectives on Communication and Disability. Harwood J, Giles H, eds. Multiple perspectives. New York: Peter Lang; 2005. ISBN: 0-8204-6739-1.

Department of Statistics Malaysia. Registration of Persons With Disabilities (PWD). https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=152&bul_id=NU5hZTRkOSs0RVZwRytTRE5zSitLUT09&menu_id=U3VPMldoYUxzVzFaYmNkWXZteGduZz09 (accessed Jan 4, 2021).

Tannenbaum-Baruchi C, Feder-Bubis P. New sign language new(S): The globalization of sign language in the smartphone era. Disability & Society. 2018;33(2):309-312. https://doi.org/10.1080/09687599.2017.1383034

Hurlbut HM. A preliminary survey of the sign languages in Malaysia. https://www.google.com/search?q=sign+writing&rlz=1C1CHBF_enMY926MY926&oq=sign+writing&aqs=chrome.0.0j0i20i263i457j0i20i263j0l3j69i60l2.1250j0j1&sourceid=chrome&ie=UTF-8 (accessed Jan 4, 2021).

Laws of Malaysia. Persons with Disabilities Act 2008 Act 685. http://www.ilo.org/dyn/natlex/docs/ELECTRONIC/86297/117930/F139356912/MYS86297.pdf (accessed Jan 4, 2021).

ADA.gov. Effective Communication. https://www.ada.gov/effective-comm.htm (accessed Jan 4, 2021).

Laur A. Healthcare access for deaf patients - The legal and ethical perspectives. Med Leg J. 2018;86(1):36-41. https://doi.org/10.1177/0025817217743416

Jacob SA, Chin JR, Ying Qi T, Palanisamy UD. The needs of the deaf and hard of hearing when seeking pharmaceutical care. Res Social Adm Pharm. 2016;12(4):664-665. https://doi.org/10.1016/j.sapharm.2016.02.009

Chong EY, Palanisamy UD, Jacob SA. A qualitative study on the design and development of an mHealth app to facilitate communication with the Deaf community: perspective of community pharmacists. Patient Prefer Adherence. 2019;13:195-207. https://doi.org/10.2147/ppa.s182516

Pharmacy Board Malaysia. Standards on approval and recognition of pharmacy programme 2008. https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/standards-approval-and-recognition-pharmacy-programme-2018.pdf (accessed Jan 4, 2021).

Pocock NS, Chan Z, Loganathan T, et al. Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand. PLoS One. 2020;15(4):e0231154. https://doi.org/10.1371/journal.pone.0231154

Ministry of Health, Pharmaceutical Services Programme. [List of community pharmacies in Malaysia]. http://www.data.gov.my/data/ms_MY/dataset/senarai-farmasi-komuniti-di-malaysia/resource/ecba1648-1133-4b88-a3dc-6d14bca25f8b (accessed Jan 4, 2021).

Malaysian Pharmaceutical Society. Pharmacies Directory. http://mps.org.my/html/directory_listing.htm (accessed Jan 4, 2021).

Hsu CC, Sandford BA. The Delphi technique: making sense of consensus. Practical Assessment, Research & Evaluation. 2007;12(10):1-8.

Akins RB, Tolson H, Cole BR. Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC Med Res Methodol. 2005;5:37. https://doi.org/10.1186/1471-2288-5-37

Vázquez-Ramos R, Leahy M, Estrada Hernández N. The Delphi method in rehabilitation counseling research. Rehabil Couns Bull. 2007;50(2):111-118. https://doi.org/10.1177%2F00343552070500020101

Skulmoski GJ, Hartman FT, Krahn J. The Delphi Method for Graduate Research. J Inf Educ Technol. 2007;6:1-21.

Pettigrew TF. Intergroup contact theory. Annu Rev Psychol. 1998;49:65-85. https://doi.org/10.1146/annurev.psych.49.1.65

LaBelle S, Booth-Butterfield M, Rittenour CE. Attitudes toward profoundly hearing impaired and deaf individuals: links with intergroup anxiety, social dominance orientation, and contact. West J Commun. 2013;77(4):489-506. https://doi.org/10.1080/10570314.2013.779017

Napier J, Kidd MR. English literacy as a barrier to health care information for deaf people who use Auslan. Aust Fam Physician. 2013;42(12):896-899.

Witko J, Boyles P, Smiler K, McKee R. Deaf New Zealand Sign Language users' access to healthcare. N Z Med J. 2017;130(1466):53-61.

Emond A, Ridd M, Sutherland H, Allsop L, Alexander A, Kyle J. Access to primary care affects the health of Deaf people. Br J Gen Pract. 2015;65(631):95-96. https://doi.org/10.3399/bjgp15x683629

Ferndale D, Watson B, Munro L. An exploration of how health care professionals understand experiences of deafness. Crit Public Health. 2017;27(5):591-603. https://doi.org/10.1080/09581596.2016.1258454

Alhusein N, Killick K, Macaden L, et al. "We're really not ready for this": A qualitative exploration of community pharmacy personnel's perspectives on the pharmaceutical care of older people with sensory impairment. Disabil Health J. 2019;12(2):242-248. https://doi.org/10.1016/j.dhjo.2018.10.006

Pereira PC, Fortes PA. Communication and information barriers to health assistance for deaf patients. Am Ann Deaf. 2010;155(1):31-37. https://doi.org/10.1353/aad.0.0128

Lesch H, Burcher K, Wharton T, Chapple R, Chapple K. Barriers to healthcare services and supports for signing deaf older adults. Rehabil Psychol. 2019;64(2):237-244. https://doi.org/10.1037/rep0000252

McKee MM, Paasche-Orlow MK, Winters PC, et al. Assessing Health Literacy in Deaf American Sign Language Users. J Health Commun. 2015;20 Suppl 2(0 2):92-100. https://doi.org/10.1080/10810730.2015.1066468

Kusters A, Sahasrabudhe S. Language ideologies on the difference between gesture and sign. Lang Commun. 2018;60:44-63. https://doi.org/10.1016/j.langcom.2018.01.008

Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

World report on disability. Lancet. 2011;377(9782):1977. https://doi.org/10.1016/s0140-6736(11)60844-1

Wong KH. Sign language interpreters should be trained and accredited. https://www.malaysiakini.com/news/537365?utm_source=dlvr.it&utm_medium=facebook&fbclid=IwAR2NG-KkoXXte7hBU_kIPaGOdhgoUEsgBaMXJwUJuw02_7FheddlsBs3uB8 (accessed Jan 4, 2021).

Bailey N, Kaarto P, Burkey J, Bright D, Sohn M. Evaluation of an American Sign Language co-curricular training for pharmacy students. Curr Pharm Teach Learn. 2021;13(1):68-72. https://doi.org/10.1016/j.cptl.2020.08.002

Jensen LG, Nakaji M, Harry KM, Gallegos N, Malcarne VL, Sadler GR. Ovarian cancer: Deaf and hearing women's knowledge before and after an educational video. J Cancer Educ. 2013;28(4):647-655. https://doi.org/10.1007/s13187-013-0529-2

Hyoguchi N, Kobayashi D, Kubota T, Shimazoe T. Effects on Deaf Patients of Medication Education by Pharmacists. J Deaf Stud Deaf Educ. 2016;21(4):416-421. https://doi.org/10.1093/deafed/enw037

Kho BP, Hassali MA, Lim CJ, Saleem F. Challenges in the management of community pharmacies in Malaysia. Pharm Pract (Granada). 2017;15(2):933. https://doi.org/10.18549/pharmpract.2017.02.933

Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree, version 2.0. www.acpe-accredit.org/pdf/FinalS2007Guidelines2.0.pdf accessed Jan 4, 2021).

Australian Pharmacy Council. Accreditation Standards for Pharmacy Programs in Australia and New Zealand 2020. https://www.pharmacycouncil.org.au/standards/accreditation-standards-2020.pdf (accessed Jan 4, 2021).

Alhusein N, Macaden L, Smith A, et al. 'Has she seen me?': a multiple methods study of the pharmaceutical care needs of older people with sensory impairment in Scotland. BMJ Open. 2018;8(8):e023198. https://doi.org/10.1136/bmjopen-2018-023198

Published
2021-05-12
How to Cite
1.
Chong EY, Jacob SA, Ramadas A, Goh PH, Palanisamy UD. Assessment of community pharmacists’ communication and comfort levels when interacting with Deaf and hard of hearing patients. Pharm Pract (Granada) [Internet]. 2021May12 [cited 2021Jul.27];19(2):2274. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/2274
Section
Original Research