Health-related quality of life of deaf and hard of hearing adults and issues related to use of and access to health services

Abstract

Aim: exploring the issues related to the use of and access to health services by the deaf and hard of hearing adults in Greece and the assessment of their health-related quality of life.

Method: a cross-sectional study was conducted between 1 April 2015 and 31 June 2015. The study population consisted of 237 adults, aged 18-65 that live in Attica (86 deaf, 54 hard of hearing and 97 hearing people), sampled by the convenience sampling technique. Data collection concerning the use and access to health services of the deaf and hard of hearing, was made using a questionnaire that was specially developed for this study, based on the relevant literature. The assessment of the quality of life of all participants was conducted via the Greek version of the SF-36v2. Statistical analysis included x² test, x² test for trend, t-test, Mann-Whitney, analysis of variance, Kruskal-Wallis, Pearson correlation coefficient, Spearman correlation coefficient and multivariate linear regression.

Results: among the 86 deaf, 79 (91.9 %) were sign language users (Deaf) and 7 (8.1 %) were not. Among the 54 hard of hearing, 11 (20.4 %) were able to communicate through the spoken word, 27 (50 %) through cheileanagnosis and 16 (29.6 %) through the Greek Sign Language. The deaf were unmarried (p=0,006), didn’t live with anyone hearing (p=0,002), had a lower educational level (p<0,001), were unemployed (p<0,001), had a lower median annual family income (p<0,001) and were overweight and obese (p=0,004) at higher rates compared to the hard of hearing and hearing people. Compared to the hearing, the deaf and hard of hearing used to smoke a greater median number of cigarettes daily (p<0,001), had acquired the smoking habit for a greater median number of years (p=0,01), were drinking quantities of alcohol in a greater median per week and exercised physically in a lower median number of hours per week (p<0,001). Regarding the use of health services the last 12 months, the deaf were more often ill than the hard of hearing (p=0,02) and they visited a public hospital to cope with their illness(p=0,002). Whilst the exorbitant fees charged for a visit in the private health sector (p=0,01) were a valid complaint, the long waiting time in order to make an appointment (p=0,003) and the small interpreter availability on the appointment day (p=0,001), resulted in them visiting a private physician/clinic. Also, they considered the existence of an attendant who would help in communicating with the physician/hospital very important (p<0,001) and they preferred a GSL interpreter for their accompaniment (p<0,001). This provided a new source of complaint due to the small number of interpreters, the lack of availability and the absence of permanent interpreters in hospitals (p<0,001). Furthermore, they complained of the lack of: equipment for the deaf (p=0,01), 24h emergency center for communication with SMS (p<0,001), non-existence of ambulance personnel who can communicate via Greek Sign Language (p<0,001) and non-existence of persons in hospitals who can communicate in Greek Sign Language (p<0,001). On the other hand, the hard of hearing visited a private physician/clinic more often during the last 12 months (p=0,02), they preferred a family member to accompany them to the doctor (p <0,001) and had trouble understanding the doctor's instructions (p=0,002) at higher rates than the deaf. Regarding the access to health services, the deaf, at higher rates compared to the hard of hearing, did not know where to go (p=0,002), could not make appointments because they did not have anyone to help them (p<0,001), they could not afford the long waiting time for an appointment (p=0,01), there was a lack of available interpreters (p<0,001) and they preferred making interpretation hours saving (p<0,001). They also had a higher degree of difficulty in making an appointment to visit a doctor/ hospital comparing to the hard of hearing (p<0,001) and said that if their communication was easier they would arrange health appointments more often (p<0,001). Moreover, they did not receive the necessary medication (p<0,001), with main causes the disability to pay for the cost because of lack of prescription and the sense of self-esteem that he/she does not need it (p=0,02). According to the results of the multivariate analysis, determinants of quality of life, was the degree of hearing loss (almost in all scores of SF-36v2, except general health score), body mass index (almost in all scores of SF- 36v2, except bodily pain), the educational level (in physical function scores, physical role, bodily pain, general health, social functioning, physical health summary scale), physical activities (in physical function scores, general health, emotional role and physical health summary scale score), alcohol consumption (almost in all scores of SF-36v2, except for social functioning score), while the number of family individuals were determinant in physical health summary scale score. We also performed bivariate correlations between the independent variables of use and access to health services and the physical and mental health summary scale scores of the deaf, to investigate which of these were associated with the lowest scores that they had in the SF-36v2.

Conclusions: in Greece, people with hearing disability are the most invisible citizens, systematically absent from health policy and planning, while there is a marked tendency for global efforts aimed on improving their quality of life. In the Greek health system a special effort must be made so as to achieve significant improvements and in order for an organized health service network to exist, accessible for the deaf and hard of hearing and ensuring thus the provision of adequate health care for long-term improvement of health outcomes of this population.

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ORCID for Dialechti Tsimpida: orcid.org/0000-0002-3709-5651

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