Hearing loss ranges from being hard of hearing (mild hearing loss) to being deaf (total hearing loss). People who are deaf from birth often identify themselves as Deaf (with an uppercase “D”) to indicate that they are part of a specific cultural and linguistic community. More commonly, people lose hearing as they age. The 1990 United States Americans with Disabilities Act (ADA) requires that public facilities, including hospitals and health centers, communicate in ways that people with hearing loss can understand. Here are some ways to help:
- Determine the preferred method for communicating. Ask Deaf patients and those who are hard of hearing how they prefer to communicate. This may be moving your chair to face patients directly so they can see your lips, communicating in writing, or using an ASL (American Sign Language) interpreter.
- Consider the environment. Meet in a quiet space that is free of distracting noises such as air conditioners or overhead pages. Look for a space that has adequate lighting so that the other person can clearly see you when you talk. As appropriate, tap people lightly on their shoulders to get their attention and to orient them to where the sound is coming from.
- Articulate clearly. Speak distinctly, not necessarily loudly. Shouting is unpleasant and not helpful as it distorts mouth movements and makes lip reading more difficult. Shouting may also interfere with a hearing aid’s ability to pick up usable sounds. Instead, use a slower rate of speech, but don’t exaggerate pronunciation to the point that you distort individual words.
- Facilitate lip reading. People lip-read when they look at someone’s mouth and speech-read when they also look at the other person’s gestures, expressions, and pantomime actions. Messages are sometimes misinterpreted because pairs of words look alike; for example, “bed” and “men,” or “pain” and “main.” People who rely on visual cues may have particular difficulty understanding someone who has a mustache or speaks with an accent. To improve understanding, do not cover your mouth, chew gum, or talk at the same time as someone else.
- Be aware that written notes don’t always work. It is widely assumed that all people with hearing loss benefit from written information. But this is not necessarily so. Rather than assume that written notes will help, ask the other person about the best way to communicate.
- Use ASL interpreters. When communicating with people who use ASL, ask to work with certified or qualified interpreters whose competency is verified according to professional and regulatory standards. Despite good intentions, untrained family members or friends who volunteer to interpret may not be skilled at communicating medical information and may also bring confidentiality and privacy concerns.
- Confirm understanding. As with all types of health communication, take time to confirm understanding. Whether communicating directly or through an interpreter, ask Deaf and hard-of-hearing patients to tell you, in their own words, their understanding of the topics discussed. If a concept is unclear, rephrase it rather than just repeat it. Confirm understanding throughout your time together, not just when appointments are almost over.
These how-to tips are adapted from Helen Osborne’s award-winning book, Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Second Edition (updated 2018).
Helen has recorded several Health Literacy Out Loud podcasts on this topic. Click the links below to listen to the interviews and read their transcripts:
- Health Literacy and Hearing Loss (HLOL #130), an interview with Dr. Mike McKee
- Health Literacy and Hearing Loss (HLOL #103), an interview with Bonnie Bartos
- Health Education for Children with Disabilities (HLOL #89), an interview with Charlotte Cushman