Deaf culture awareness among physicians and advanced practice providers in the emergency department: A multicenter study

Background and Objective

In areas with a large Deaf/hard-of-hearing (DHH) population, emergency medicine (EM) providers may benefit from cultural awareness training as this has been shown to foster delivery of more equitable care in other minority populations. Rochester, New York, has been touted to be the home to the largest per-capita DHH population in the United States. Given the large local DHH community and DHH professionals working in Rochester, University of Rochester (UR) providers likely have higher exposure to DHH people than most other EM providers in the United States. All UR providers receive annual institutional cultural sensitivity e-training that includes information about the DHH community. In addition to the e-training, the UR EM residents also receive a workshop during intern year and recurrent DHH culture education throughout their residency. The purpose of this study was to measure impact of preexisting cultural sensitivity training and higher DHH person exposure on DHH cultural awareness in UR providers compared to non-UR EM providers who may have lower DHH person exposure and culture training.

Methods

In this cross-sectional study, a survey on DHH cultural awareness was distributed to UR and Emergency Research Network in the Empire State (ERNIES) emergency departments. As surrogates for cultural awareness, the survey evaluated providers’ exposure, knowledge, comfort, and attitudes to Deaf culture. Descriptive statistics were employed to characterize the sample. Bivariate analysis was performed to compare UR provider responses to others using chi-square and Fisher's exact testing.

Results

Of 83 recruited participants, 75 providers completed the survey, and 53/75 (71%) responders were from UR. While high percentages of UR and non-UR participants reported seeing DHH patients recently (98% vs. 96%, respectively), one-third (24/75) of all participants reported having no experience or training on Deaf culture. Compared to only 10% of other providers, one-third of UR providers were better able to identify cultural nuances within the DHH community (p = 0.01). UR providers were significantly less comfortable communicating with Deaf patients via lipreading, which is typically an unreliable/unsafe mode of communication (11% vs. 69%, p = 0.002). When knowledge was assessed, UR providers better identified Deaf patient rights in a clinical setting (89% vs. 77%, p = 0.002). Also, all trainees had significantly higher scores on questions related to Deaf culture compared to all advance practice providers and attendings (mean scores 6.86 vs. 6.06 and 6, respectively, p = 0.03).

Conclusions

EM providers with high exposure to DHH people and DHH culture training are more comfortable with and able to better identify nuances of Deaf culture. Additionally, EM providers with DHH culture training are less comfortable communicating using lipreading with DHH patients suggesting increased awareness of a common, yet ineffective and inaccurate, communication pitfall with this population. The study suggests that implementing Deaf culture education in areas with a large DHH population may enhance cultural awareness and comfort of future providers in caring for Deaf patients.