Vulnerable Populations:

The deaf
By: Jacqueline Jamison, Stevie Anderson, Molly
Hughes, and Sami Dalessio
The deaf population defined
A population of people with varying hearing acuity, whose
primary mode of communication is a visual language (American
Sign Language [ASL] in the U.S.) and have a shared heritage
and culture

● The Deaf may also use other modes of communication such

as interpreting services and assistive technology
(including hearing aids, cochlear implants, real-time
captioning)
(Code of Colorado Regulations, 2010)
DEMOGRAPHICS: Educational attainment
● Only 18% of deaf adults in the United States had completed a bachelor’s degree, as
compared to 33% of the hearing population (Garberoglio, Cawthon, & Sales, 2017).
DEMOGRAPHICS: employment rates
● 48% of the Deaf are employed, 4.6% are considered unemployed (currently or recently
looking for work), and 47% are not in the labor force (includes those not employed nor
looking for work [ie: students, caretakers, parents, retired individuals, etc.]) (Garberoglio,
Cawthon, & Bond, 2016).
Demographics: income
● The Deaf consistently earn about 30-40% less than hearing peers. While individuals
without a high school diploma earn about 43% less, those with college education earn
about 21-22% less (Walter & Dirmeyer, 2012).
HEALTH[care] DISPARITIES IN THE DEAF POPULATION
Health Disparities:

➔ Violence
◆ (University of Rochester, 2011)
➔ Suicide
◆ (University of Rochester, 2011)

Healthcare Disparities:

➔ Care = Routinely Inaccessible

◆ (Kuenburg, Fellinger, & Fellinger, 2015)
HEALTH DISPARITY #1: violence
● Physical Violence
○ 21% of Deaf younger than 65 years old reported being physically
abused in their lifetime, versus 14% in the general population
(University of Rochester, 2011).
■ Deaf are 1.5x more likely to experience physical violence
● Sexual Violence
○ 21% of Deaf reported being forced to have sex in their lifetime,
compared with ~6% in the general population (University of Rochester,
2011).
■ Deaf are 3.5x more likely to be forced to have sex
HEALTH DISPARITY #2: suicide
● The incidence rate of suicide attempts in the last year
was found to be 22 attempts per 1,000 Deaf compared to 4
attempts per 1,000 persons in the general population
(University of Rochester, 2011).
HEALTHcare DISPARITY #3: routinely inaccessible
● 44% of deaf patients found the last contact with their
general practitioner or health center to be difficult or
very difficult, compared with only 17% from a general
population patient survey (Kuenberg, Fellinger, & Fellinger,
2016).
● A study in the U.S. found that miscommunication occurs often
between patients and their providers, leading to
misunderstanding in diagnosis and therapeutic management
(Kuenberg, Fellinger, & Fellinger, 2016).
● Inequitable access to care has been proven to lead to poorer
health outcomes, insufficient follow up, and inaccurate
assessments/limited assessment data (Pick, 2013).
NURSING INTERVENTION: advocacy (Public Health Interventions, 2001)

● Deaf people who have practiced lip reading for many years
and who are familiar with spoken language are able to
understand at best 30-45% of spoken English
○ (Kuenburg, Fellinger, & Fellinger, 2016)
● The Americans with Disabilities Act (ADA) and
Rehabilitation Act of 1973 requires hospitals and medical
providers to ensure effective communication with people who
are Deaf (Minimum Standards, 2018)
○ THIS IS THEIR CIVIL RIGHT
NURSING INTERVENTION: ADVOCACY [CONT.] (Public Health Interventions, 2001)

● Advocating for the Deaf by providing information on Deaf

related resources to healthcare providers
○ Implement advocacy via educating providers on how to acquire
services of interpreters, the need/benefit for qualified
interpreters to be present at all appointments, and
describing the role of the interpreter as part of the care
team (Advocacy and Support, 2017).
● How can this help?
○ Failing to meet this need puts patients’ health at risk,
increases liability, and drives up unnecessary medical
costs/spending (Minimum Standards, 2018).
○ Makes healthcare far more accessible to the Deaf
Nursing intervention: ADVOCACY [cont.] (Public Health Interventions, 2001)

● In the case that an interpreter cannot be present,

providers also need to be aware of how to properly use
video remote interpreting (VRI)
○ VRI uses videoconferencing technology, equipment, and a high speed
internet connection to provide services of a qualified interpreter
[whom is located in a central call center]
● Ability to contract for VRI services to be provided by
appointment or to be available on demand 24 hours/day
● Important Note: This is an interim solution, but warrants
more effective communication than no interpreting at all

(Minimum Standards, 2018)

REFERENCES
Advocacy and Support. (2017). St. Catherine University Catie Center. Retrieved from
http://healthcareinterpreting.org/faqs/fg-advocacy-and-support/

Code of Colorado Regulations. (2010). Rule Manual 27 Colorado Commission for the Deaf and Hard of Hearing. Retrieved from
https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=3504

Garberoglio, C. L., Cawthon, S., & Bond, M. (2016). Deaf people and employment in the United States: 2016. National Deaf Center on
Postsecondary Outcomes. Retrieved from
https://www.nationaldeafcenter.org/sites/default/files/resources/Deaf%20Employment%20Report_final.pdf

Garberoglio, C. L., Cawthon, S., & Sales, A. (2017). Deaf people and educational attainment in the United States: 2017. National Deaf
Center on Postsecondary Outcomes. Retrieved from
https://www.nationaldeafcenter.org/sites/default/files/DeafPeopleandEducational_Attainment_white_paper.pdf

Kuenburg, A., Fellinger, P., & Fellinger, J. (2016) Healthcare access among Deaf people. The Journal of Deaf Studies and Deaf Education,
21(1), 1-10. https://doi.org/10.1093/deafed/env042

Minimum Standards for Video Remote Interpreting Services in Medical Settings. (2018). National Association of the Deaf. Retrieved from
https://www.nad.org/about-us/position-statements/minimum-standards-for-video-remote-interpreting-services-in-medical-settings/
References [cont.]
Pick, L. (2013). Health care disparities in the deaf community. American Psychological Association. Retrieved from
http://www.apa.org/pi/disability/resources/publications/newsletter/2013/11/deaf-community.aspx

Public Health Interventions: Application for Public Health Nursing Practice. (2001). Minnesota Department of Health. Retrieved from
http://www.health.state.mn.us/divs/opi/cd/phn/docs/0301wheel_manual.pdf

University of Rochester Medical Center. (2011). Rochester research identifies health disparities with Deaf ASL users. Retrieved from
https://www.urmc.rochester.edu/news/story/3355/rochester-research-identifies-health-disparities-with-deaf-asl-users.aspx

Walter, G. & Dirmyer, R. (2012). The effect of education on the occupational status of Deaf and hard of hearing 26-64 year olds. National
Technical Institute for the Deaf. Retrieved from http://www.ntid.rit.edu/sites/default/files/effect_of_education_on_occupational.pdf