Background
Methods
Setting
Design
Patient and public involvement
Procedures
Phase 1: problem identification
Phases 2–4: action planning, implementation and evaluation
Components | Tool | Participants | Timing of Assessment |
---|---|---|---|
Phase 1: Problem Identification | |||
Needs analysis | Qualitative assessment (one-on-one semi-structured interviews) | Healthcare staff D/deaf and hard of hearing individuals | Beginning of Phase 1 |
Healthcare staff D/deaf and hard of hearing individuals | Beginning of Phase 1 | ||
Phase 2: Action Planning No measure | |||
Phases 3 and 4: Action implementation and Evaluation | |||
Intervention Testing: Round 1 | |||
Participants’ reactions: perception of intervention’s content, quality and appropriateness, overall satisfaction | Adapted IMTEE questionnaire1 Qualitative assessment | Healthcare staff receiving intervention 1 | After intervention 1 |
Intervention Testing: Round 2 | |||
Participants’ reactions: perception of intervention’s content, quality and appropriateness, overall satisfaction | Adapted IMTEE questionnaire1 Qualitative assessment (semi-structured interviews) | Healthcare staff receiving intervention 2 | T14 T1 |
Changes in participants: perception of self-efficacy | Adapted IMTEE questionnaire2 Qualitative assessment | T0, T1, T24 T1 | |
Organizational payoffs: frequency of use | Adapted IMTEE questionnaire3 Qualitative assessment | T0, T1, T24 T1 |
Ethics and consent to participate
Phase 1: Problem identification - methods
Participants
Measures
Data analysis plan
Phase 1: Problem identification - results
Participants and qualitative findings
Theme 1: the experience and difficulties encountered in the healthcare system
Ineffective communication and difficulties related to the attitude of professionals
I went once to the [name of hospital], and there, there was no respect at all for D/deaf patients. It was catastrophic. I said: “I didn’t understand, I’m sorry, can we use written language?“, and it was always refused, rather curtly (ID175, D/deaf person).
I said, ‘I’m HoH, very HoH, did he understand what that means… I don’t know! (…) he kept talking on the phone and I said: “but I’m sorry, I can’t understand you” (…). And then I just had to pray that he understood.
Lack of time and fear of disturbance
Experience
In the operating room, the hearing aids must stay in the room, and they ask us questions with the mask on, it’s like speaking Chinese. You hear, you see the lips moving, but you understand absolutely nothing, and that’s scary (HoH, ID211).
Theme 2: objectives, content and form of the training: recommendations
Raising awareness of the experiences and needs of D/deaf and HoH patients
Teaching basic reflexes to improve communication and basic concepts in French sign language
Presenting existing tools and resources
Form of the training and trainers
Phase 2: Action planning - round 1 of testing
Phase 3: Action implementation - round 1 of testing
Objective 1: To understand the experiences and communication needs of people who are D/deaf or hard of hearing | |
Content | Form |
Deaf History and Culture | Theoretical presentation |
Deafness and hearing loss: • Definition • Hearing loss degrees and causes • Prevalence • Consequences (e.g., local language learning; isolation; inadequate health literacy) | Theoretical presentation Trainers’ testimonies |
Awareness of the experiences of D/deaf and HoH patients in healthcare setting | Broadcasting of 4 films displaying testimonies of negative experiences in healthcare of a HoH and a Deaf patient. |
Diversity of means and needs of communication • Sign language • Cued Speech • Communication supports (e.g., sign language interpreter; cued speech coder; hearing assistive devices, magnetic loop, lip reading) • Diversity of needs (e.g., depending on communication mode, local language proficiency and education, hearing loss degree) • Clinical encounter with a sign language interpreter (and intermediator) • Clinical encounter with a cued speech coder | Theoretical presentation Link to toolbox (part 3) |
Reminder of the legal basis | Theoretical presentation |
Role-playing situations | Situation with limited hearing (using earplugs and lowering the volume of the computer) |
Objective 2: To understand the importance of the first contact and apply good practices to reassure patients who are D/deaf or hard of hearing and to promote good follow-up care | |
Good practices (desk, waiting room and clinical encounter) • Make an appointment (e.g., smart phone messages, email, online sign language interpreting services) • Reception attitude and ground rules for better communication • Identification of communication’s needs (e.g., sign language interpreter, cued speech coder, magnetic loop) • How to behave in the waiting room and during the clinical encounter | Theoretical presentation• Broadcast of 3 educational films reinforcing good practices • Reception • Waiting room • Consultation |
Rudimentary knowledge of French sign language | Theoretical presentation Practice (learning some basic words) |
Introduction to lip reading | Theoretical presentation Putting it into practice |
Objective 3: To know the different tools available and the basic rules for communication and how and when to use them: Toolbox | |
Contents of the toolbox | • Course material of the intervention (condensed version). • Visual documents reminding good practices. • Visual document to be used with D/deaf and HoH patients for the choice of communication means. • Documents explaining the different interpreting possibilities. • Links and contacts of professionals in cued speech and French Sign Language. • Documentation on the magnetic loop. • Link to an Internet site offering a lexicon in French Sign Language. • Pictogrammes. • Links of the existing training possibilities (French Sign Language, cued speech, lip reading) • Summary document of the different degrees of hearing loss. |
Toolkit sent to participants before the intervention. Presented and discussed throughout the intervention. |
Phase 4: Action evaluation - round 1 of testing: methods
Measures
Quantitative and qualitative analysis
Phase 4: Action evaluation - round 1 of testing: results
Quantitative results
Participants
Results
Questions | |||||
---|---|---|---|---|---|
General Assessment | 1 (%) | 2 (%) | 3 (%) | 4 (%) | 5 (%) |
In general, how do you evaluate the training?1 | 0 | 0 | 0 | 30.8 | 69.2 |
The training met my expectations2 | 0 | 0 | 8.3 | 33.3 | 58.3 |
The training met my needs in the field2 | 0 | 7.7 | 7.7 | 46.2 | 38.5 |
Content | |||||
In general, how would you rate the content of the training?1 | 0 | 0 | 0 | 53.8 | 46.2 |
How would you rate the following parts1: | |||||
History of the Deaf | 0 | 0 | 58.3 | 33.3 | 8.23 |
Deafness and hard of hearing | 0 | 0 | 0 | 38.5 | 61.5 |
The Deaf Community and Culture | 0 | 0 | 7.7 | 69.2 | 23.1 |
Communication needs and tools | 0 | 0 | 7.7 | 23.1 | 69.2 |
Good practices | 0 | 0 | 0 | 23.1 | 76.9 |
Introduction of French Sign Language | 0 | 0 | 17.7 | 41.7 | 41.7 |
Introduction to Lip reading | 0 | 0 | 0 | 38.5 | 61.5 |
The toolbox | 0 | 0 | 0 | 30.8 | 69.2 |
The content of the training was sufficient2 | 0 | 0 | 23.1 | 38.5 | 38.5 |
The content of the training is applicable to my workplace2 | 0 | 0 | 16.7 | 25 | 58.3 |
The content of the training is useful for my practice2 | 0 | 0 | 15.4 | 15.4 | 69.2 |
Organization and logistics | |||||
How would you rate the organization of the training?1 | 0 | 0 | 0 | 53.8 | 46.2 |
What do you think of the intervention’s support (slides)?1 | 0 | 0 | 7.7 | 61.5 | 30.8 |
What do you think of the videos?1 | 0 | 0 | 0 | 15.4 | 84.6 |
What do you think of the duration of the training3 | 0 | 7.7 | 69.2 | 15.4 | 7.7 |
Usefulness | |||||
The training will influence my practice2 | 0 | 0 | 7.7 | 46.2 | 46.2 |
The training reinforced/improved my understanding of the experiences of people who are D/deaf and hard of hearing and their specific communication needs2 | 0 | 0 | 0 | 69.2 | 30.8 |
The training gave me a better understanding of the basic principles to apply in order to improve communication with people who are D/deaf or hard of hearing2 | 0 | 0 | 0 | 41.7 | 58.3 |
The training allowed me to learn more about the tools available to improve communication with D/ deaf or HoH patients2 | 0 | 0 | 7.7 | 38.5 | 53.8 |
After having followed the training and with the toolbox, I am able to pass on to my colleagues which basic principles to apply and which tools to use to improve communication with D/deaf or HoH patients2 | 0 | 0 | 15.4 | 46.2 | 38.5 |
At the end of the training and with the toolbox, I feel equipped to receive peopled/deaf or HoH patients2 | 0 | 0 | 30.8 | 53.8 | 15.4 |
Qualitative results
Participants
Overall impression of the intervention
Perceptions of the usefulness of the intervention
I work in nursing home, unfortunately following this training, I won’t really have the tools. When you have elderly people who suffer from hearing loss, it’s true that, despite what we’ve seen, we still don’t really manage to communicate (ID 1).
Suggested improvements related to the content of the intervention
Suggested improvements related to the form of the intervention
Back to phase 2: Action planning - round 2 of testing
Back to phase 3: action implementation - round 2 of testing
The finale intervention
Back to phase 4: Action evaluation - round 2 of testing: methods
Measures
Intervention content and design
Changes in participants
Organizational payoffs
Quantitative and qualitative analysis
Back to phase 4: action evaluation - round 2 of testing: results
Quantitative results
Participants
Attrition analysis
Participants’ reactions regarding the intervention content and design
General assessment | |||||
---|---|---|---|---|---|
Questions | 1 (%) | 2 (%) | 3 (%) | 4 (%) | 5 (%) |
In general, how do you evaluate the training?1 | 0 | 0 | 0 | 21.4 | 78.6 |
The training met my expectations2 | 0 | 0 | 0 | 29.6 | 70.4 |
The training met my needs in the field2 | 0 | 0 | 11.1 | 33.3 | 55.6 |
Content | |||||
The content of the training is applicable to my workplace2 | 0 | 0 | 10.7 | 50 | 39.3 |
The content is useful for my practice | 0 | 0 | 14.3 | 32.1 | 53.6 |
Logistics | |||||
How would you rate the organization of the training?1 | 0 | 0 | 0 | 28.6 | 71.4 |
What do you think of the duration of the training?3 | 0 | 7.4 | 44.4 | 29.6 | 18.5 |
Changes in participants
T0 | T1 | T2 | |
Knowledge1 | Mean (SD) | ||
1. People who are D/deaf or HoH encounter difficulties when interacting with healthcare and administrative staff | 4 (0.9) | 4.43 (0.63) | 4.04 (0.96) |
2. There is a Deaf community that has its own culture | 3.99 (1.17) | 4.78 (0.42) | 4.38 (1.14) |
3. I know the difference between deafness and hard of hearing | 3.29 (1.05) | 4.54 (0.64) | 4.13 (0.68) |
4. I know the consequences of deafness on the learning of spoken and written language | 2.89 (1.26) | 4.36 (0.73) | 3.91 (0.52) |
5. I know how French Sign Language and cued speech language are different | 2.11 (1.19) | 4.71 (0.66) | 4.09 (0.67) |
6. I know what tools I can use to improve communication with patients who are D/deaf or HoH | 2.68 (0.95) | 4.43 (0.57) | 3.96 (0.56) |
7. I can distinguish between a French Sign Language interpreter, an intermediary and a cued speech coder | 1.71 (1.11) | 4.5 (0.64) | 3.71 (0.75) |
8. I know what lip reading is | 3.29 (1.11) | 4.58 (0.36) | 4.2 (0.62) |
Knowledge total score | 23.41 (5.35) | 36.58 (3.16) | 32.5 (3.5) |
Self-efficacy1 | |||
1. I know how to contact a D/ deaf or HoH patient for an appointment | 2.43 (1.26) | 4.32 (0.77) | 3.64 (0.76) |
2. I know what basic reflexes to adopt to improve communication with a D/deaf or HoH patient | 3.18 (0.95) | 4.5 (0.64) | 4.08 (0.49) |
3. I know how to identify the communication needs of D/deaf or HoH patient who come to my workplace | 2.89 (0.96) | 4.29 (0.66) | 3.84 (0.62) |
4. I can distinguish when to use an interpreter in French Sign Language, an intermediary or a cued speech coder | 1.96 (1.04) | 3.93 (0.81) | 3.32 (0.9) |
5. I know how to contact an interpreter in French Sign Language, an intermediary or a cued speech coder | 1.93 (1.22) | 3.93 (0.83) | 3.24 (0.97) |
6. I know how to behave when I pick up a D/deaf or HoH patient in the waiting room | 2.89 (1.03) | 4.61 (0.63) | 4.17 (0.64) |
7. I know strategies to improve the interactions of an older patient with a hearing loss in their daily life | 2.43 (1.34) | 4.39 (0.57) | 3.92 (0.72) |
8. I can say 2 greeting words in French Sign Language | 1.68 (1.19) | 4.39 (0.83) | 3.56 (1.16) |
9. I can code 2 greeting words in Complete Spoken Language | 1.54 (0.84) | 3.26 (1.1) | 2.12 (1.04) |
10. I know how to make lip-reading easier for my interlocutor | 2.36 (1.13) | 4.5 (0.75) | 3.96 (0.68) |
Self-efficacy total score | 23.29 (7.62) | 42.17 (5.7) | 35.88 (5.34) |
T1 | T2 | ||
Institutional payoffs2 | Mean (SD) | ||
In the past 6 months, when you met with people who were deaf or hard of hearing, how often did you... | |||
1. Applied basic reflexes to improve communication with D/deaf or HoH patients? | 3.08 (1.12) | 2.8 (1.35) | |
2. Used communication aids to improve interactions with D/deaf or HoH patients? | 2.96 (1.2) | 2.56 (1.29) | |
3. Reminded any of your colleagues of the basic reflexes to adopt to improve communication with D/deaf or HoH patients? | 2.32 (1.28) | 2.2 (1.19) | |
4. Reminded any of your colleagues what tools are available to improve communication with patients D/deaf or HoH patients? | 2.24 (1.3) | 2.36 (1.19) | |
Institutional payoffs total score | 10.77 (4.54)) | 10.18 (4.54) |
Variables | Knowledge | Self-efficacy | Organizational Payoffs | |||
---|---|---|---|---|---|---|
Wald χ2 | B(SE) | Wald χ2 | B(SE) | Wald χ2 | B(SE) | |
Model | 38.9*** | 30.82*** | 2.58 | |||
Time | 4.79(0.79)*** | 6.56(1.19)*** | − 0.65(1.22) | |||
Profession | − 0.27(0.51) | 0.19(0.78) | 0.6(0.5) | |||
Gender | 0.44(3.36) | 0.89(0.09) | -2.32(3.11) | |||
Age | − 0.07(0.06) | − 0.0(0.09) | − 0.05(0.05) |
Qualitative results
Participants
The intervention is well received and raises awareness of the experience and communication needs of D/deaf and HoH patients
Positive perceptions of the intervention.
The way it is given is really the best of the training. Having HoH or Deaf people, who are there in front of us with interpreters who do it live (…) that really allows us to have an understanding a little more than just theoretical (…). Because, if you want to talk to them, you have to… well, you have to find ways to raise your hand, take off your mask, speak before you get a translation (ID 4).
The intervention raises awareness of experience and communication needs of D/deaf and HoH patients
The intervention improves perceived knowledge of how communicating with D/deaf and HoH patients
The fact of knowing how to look face to face, speak nicely, with gestures. After writing too, there are also videoconferences with [sign language] interpreters… There are certain telephone numbers, hotlines (…). There are many easy solutions now (ID 6).
The perceived anticipated benefits of the intervention in the working environment
Feeling more self-confident and more at ease.
Feeling somewhat more equipped to welcome and reassure D/deaf and HoH patients.
Yeah, I feel more equipped. (…) Now I think I’m a little bit quicker and I’m thinking: ah yes! I have this toolbox. In addition, we are lucky in that we know in advance the patients we have (…). So I can prepare myself by opening the toolbox. And even in front of him [a D/deaf or HoH patient], I think I’ll still remember it pretty well (ID 3).
I was a bit passive. I was waiting for her to tell me what to do. And if she didn’t say anything… well… I stayed in my corner too (…). But I think that today, I would go more into the interaction. I would suggest tools, methods or… yes, quite simply, writing.
Before starting a conversation, (…) I would ask in some ways what wants to use the person. If he prefers to write… that’s it. Or if they need a [sign language] interpreter actually over the phone… that would be a step that I would change now (ID 70).
Feeling more at ease yet not more equipped to communication with D/deaf and HoH patients
Too much theory and not enough practice to consolidate learning and feel equipped.
I would have found very interesting to do more practice. We did some, and I was able to participate in a practical case. And it’s true that hearing how to react is easy. But afterwards, when you find yourself in the situation, suddenly, you don’t know what to do when you’ve just heard the theory 3 seconds before (ID 8).