Enhancing communication in healthcare: Supports for interactions between adults with hearing loss and healthcare providers

Introduction

Hearing loss is a sensory impairment, a hidden disability that affects many adults worldwide [1–4]. The World Health Organization (WHO) estimates that by 2050, hearing loss will affect about 10 percent of global population [5]. Hearing loss can lead to communication breakdowns when speech comprehension is impaired [5,6]. The miscomprehension of spoken messages creates barriers to efficient communication for adults with hearing loss (AwHL) and disrupts appropriate patient-clinician interactions [7–9]. Furthermore, AwHL may struggle to understand health-related information due to communication failure or misunderstanding verbal messages, which can result in poorer health outcomes compared to those without hearing loss [10,11].

Lack of support for communication can also negatively affect AwHL’s clinical outcomes and social interactions [10,12]. Communication failure in the clinical setting continues to adversely impact the well-being of people with hearing loss. Consequently, these individuals often experience a sense of exclusion, isolation, and frustration resulting from the absence of supportive strategies and adequate modifications to accommodate their communication requirements [13]. To prevent communication breakdown and sustain effective interactions, healthcare providers (HCPs) are advised to use supportive communication strategies for patients with hearing problems [6]. This support encompasses any strategy or adaptation that enhances communication and ultimately improves interaction [13,14].

Indeed, HCPs play a significant role in the health outcomes of patients with hearing loss [15]. When an HCP communicates effectively with an AwHL, the likelihood of errors in diagnosis or medication prescription is often reduced, leading to better patient outcomes [16,17]. Many individuals with hearing loss experience communication challenges during clinical visits to physicians or primary care providers [17]. To address this issue, it is necessary to conduct a study and update information about communication supports available to HCPs to improve interaction with AwHL.

Methods

This scoping review was based on Arksey and O’Malley’s methodological framework [18] and Levac et al.’s recommendations [19]. The framework consists of five steps: 1. Identifying the research question; 2. Identifying relevant studies; 3. Selecting studies, 4. Charting the data, 5. Collating, summarizing, and reporting results. This study reviewed the existing literature on communication supports that can be used to improve interactions between HCPs and AwHL.

Results

The initial search yielded 4,030 studies. After removing duplicates, the first and second authors screened 2,393 records based on their titles and abstracts. Of these, 2,251 records were found to be ineligible and excluded. The remaining 34 articles were thoroughly evaluated in a full-text review, and 12 studies were included in the research sample. A PRISMA diagrammatic representation of the screening process is shown in Fig 1.

Discussion

The objective of this scoping review was to understand the communication supports that can be employed by HCPs to enrich interactions with AwHL. Health professionals can use these supports in different contexts (Table 1) to optimize communication in clinical practice. Seven concepts were identified (Table 2, Fig 2).

According to the current literature, supportive nonverbal strategies were mostly used by HCPs to enhance interactions with AwHL [20–24,26,27,30,31]. Using gestures such as arm movements, hand movements, mutual gaze, eye contact, and writing has been reported as a supportive nonverbal communication strategy to facilitate the access of patients with hearing loss to the healthcare system [21,23,30]. Many emergency medical services recommend using hand signals, physical gestures, and body language [16,17,20,23]. People with hearing loss rely heavily on visual cues to understand speech, particularly under adverse hearing conditions [32]. Hyoguchi et al. (2016) recommended that pharmacists use nonverbal strategies to provide AwHL with necessary information about prescribed medicine. These strategies include gestures, facial expressions, and printed slides [31]. Individuals with hearing loss typically comprehend messages more effectively when they can both see and listen to the speaker, as opposed to when they can only hear the message. Such an audiovisual advantage can convey extra information, leading to better speech comprehension, particularly under adverse hearing conditions [33].

Effective verbal communication is a critical component of information exchanges. When AwHL fail to understand the spoken information conveyed by HCPs, communication breakdown can occur. As such, HCPs must collaborate with their patients and employ communication support to overcome these challenges [6,34,35]. Community HCPs are highly encouraged to employ supportive verbal strategies, including slower speech rates, shorter phrases, appropriate volume, and avoidance of complex medical terminologies when interacting with patients with hearing loss [29,32]. In addition, HCPs are advised to provide educational lectures tailored to their AwHL literacy levels when explaining medication-related information [31]. Therefore, healthcare professionals must familiarize themselves with these verbal techniques and implement them to enhance professional-patient communication. Using verbal support enables healthcare professionals to address the identified gaps in effectively communicating with AwHL [6].

Human support for communication has been accentuated in many studies, among which sign language interpreters and assistance were emphasized and recommended for healthcare workers in medicine, physiotherapy, nursing, nutrition, psychology, dentistry, and primary and emergency medical services [21,22,26–28]. The American Disabilities Act (ADA, 1990) mandates that healthcare providers ensure equal healthcare treatment and effective communication for individuals who are deaf or hard of hearing [35]. Despite this directive, deaf and AwHL still face significant communication barriers in healthcare [22, 35]. These barriers can result in negative healthcare events due to a lack of clear communication between AwHL and HCPs [27]. In a primary medical and mental healthcare context, Pendergrass et al. (2017) investigated nurse practitioners’ perspectives on the challenges and opportunities that arise when providing services to deaf individuals. Their findings showed that nurse practitioners prefer to use interpreters to support their visits [28]. Moreover, if other communication methods fail, nursing practitioners should consider seeking official single-language interpreters [26]. Ayala-Hernandez et al. (2021) attempted to study  the communication barriers between HCPs (including medicines, physiotherapists, nurses, nutritionists, psychologists, and dentists) and patients with hearing loss. The report suggested that AwHL should be provided with interpreters during their visits to healthcare services [22].Therefore, HCPs can use human support strategies to better understand AwHL’s clinical symptoms during medical histories and make better treatment decisions.

Environmental and physical adaptations can support interaction and lead to more successful and effective communication in diverse healthcare settings [26,29]. Stevens et al. (2019) conducted a survey of 1,581 self-report individuals with hearing loss in primary care settings. The clinical implications of this study necessitated adjustments aimed at improving communication, particularly in enhancing the interaction between community HCPs and patients [24]. This aim was achieved by ensuring appropriate lighting, clear speech, and implementing environmental modifications, such as using tactile or visual aids in waiting areas, installing noise-absorbing materials (carpeting and curtains), and avoiding the use of telephones for conveying important health information [24]. Other studies have indicated that the environment should be designed to accommodate individuals with hearing loss, including seating them near the receptionist, utilizing heavy draping or carpeting to minimize echoes, and employing visual cues in clinics and public health systems [23,26,29]. Stans et al. (2017) assert that healthcare professionals should be aware of the potential influence of environmental elements on conversations, because small adjustments to the physical environment have implications for rehabilitation and can contribute to a communication-friendly environment for conversations with people who find verbal communication challenging [36].

AwHL have the highest risk of experiencing social isolation, and using hearing aids may help overcome the loss of signal intensity and optimize speech intelligibility to maintain good interactions. In the healthcare context, the utility of technological support for AwHL can be accomplished through text messaging and email instead of phone calls, as well as employing the speakerphone function or a two-way headset [22,24,29,37].

Education and training in the field of hearing loss have been recommended to community HCPs, audiologists, nurses. This aim could be achieved by attending virtual knowledge transfer workshops focusing on hearing loss and short-term educational courses covering the basics of hearing aids [20,25,29]. Marquete et al. (2018) investigated the extent of knowledge and training among nurses, nurse technicians, and nursing assistants regarding effective communication with individuals with hearing loss. The authors found that communication barriers with deaf individuals are often caused by HCPs’ lack of knowledge of how to communicate, and that this is due to the absence of training opportunities [27]. Accordingly, it has been recommended that registered nurses and emergency medical service workers attend communication training courses focused on hearing loss, which can take the form of online knowledge transfer workshops or short-term training programs [21,25].

Psychological support and counseling can be used by HCPs to address AwHL’s psychosocial issues [23,29]. It is recommended that HCPs consult with patients about the communication breakdowns they experience due to hearing loss, show empathy, and discuss their agreements and disagreements with patients while identifying negative emotions that arise due to hearing loss. Studies with community health workers, audiologists, and neurologists reveal that an absence of communication support in the workplace has a detrimental effect on the well-being of individuals with hearing loss, resulting in feelings of isolation and frustration [23,29]. To better support individuals with hearing loss in healthcare systems, it is crucial to develop psychological support programs that consider the specific needs of this population [38].

This scoping review contributes to an understanding of supportive communication strategies for healthcare providers in hearing healthcare and makes recommendations for optimizing communication in specific care situations. Any profession can use communication support, but its use will depend on the context of each professional. Future research could investigate the broader impact of combining verbal and nonverbal communication strategies. It could also examine whether using multiple supportive communication strategies simultaneously yields better outcomes in long-term care facilities and hospitals than using single strategies. Using this study’s results, we developed an evidence-based brochure by gathering information from current research, which can be shared with healthcare providers in hospitals, rehabilitation centers, clinics, pharmacies, and other relevant institutions associated with the Institut Universitaire de Gériatrie de Montréal (IUGM).

Limitations and strengths

This scoping review had some limitations. Studies published in languages other than English with no accompanying translation were excluded. Language bias was present in this review because most of the included studies were in English and were performed with convenience samples from health professionals and/or patients, which may not be representative of all communication supports used by people with hearing loss.

Conclusion

Healthcare professionals can utilize various communication supports to interact with adults who experience hearing loss. These supports include nonverbal, verbal, human, environmental and physical, technological, education and training, and psychological support and counseling. The choice of communication supports will depend on the context (place and situation) in which each professional finds themselves. According to the studies included in this scoping review, the most frequently utilized concepts were nonverbal, verbal, and human support.