It is important to communicate clearly with everyone, including those who have hearing loss. 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 as Deaf (with an uppercase “D”) to indicate that they are part of a specific cultural and linguistic community. 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 sounds such as noisy air conditioners or medical monitors that often beep. Look for a space with adequate lighting so that the other person can clearly see you talking. As appropriate, tap people lightly on the shoulder to get their attention and orient them to certain sounds.
• 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 that 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 best ways 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 may not be skilled at interpreting medical information and can add concerns about confidentiality and privacy.
• 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 topics just discussed. If a concept is unclear, rephrase rather than simply repeat it. Confirm understanding throughout your time together, not just when appointments are almost done.

Recent news about people with hearing loss:

• Rihanna’s ASL Interpreter Goes VIRAL During Super Bowl Performance. Video, 2023.
• Mayor Wu Signs Ordinance Requiring Captions on Public-Facing Televisions to Increase Access for People With Disabilities. Mayor’s Office, City of Boston, 2022.
• Over-the-Counter (OTC) Hearing Aids. Information from the National Institute on Deafness and Other Communication Disorders about a new type of hearing aid, 2022.

Health Literacy Out Loud podcasts about communicating with people who have hearing loss:

• 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

This month’s How-To Tip is adapted from the chapter “Know Your Audience: Hearing Loss” in Helen Osborne’s book, Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Third Edition (2022)