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Exploring the Barriers and Facilitators to Health Care Services and Health Care Information for Deaf People in Worcester

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Exploring the Barriers and Facilitators to Health Care Services and Health Care Information for Deaf People in Worcester View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Stellenbosch University SUNScholar Repository Exploring the barriers and facilitators to health care services and health care information for deaf people in Worcester by Janis Kritzinger Thesis presented in fulfilment of the requirements for the Degree of Master of Arts (Psychology) at Stellenbosch University Supervisor: Professor Leslie Swartz Faculty of Arts and Social Sciences Department of Psychology December 2011 Stellenbosch University http://scholar.sun.ac.za ii Declaration By submitting this thesis/dissertation electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the sole author thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof by Stellenbosch University will not infringe any third party rights and that I have not previously in its entirety or in part submitted it for obtaining any qualification. Signature: Date: 12/11/2011 Copyright © 2011 Stellenbosch University All rights reserved Stellenbosch University http://scholar.sun.ac.za iii ABSTRACT The Deaf community face similar access barriers to health care services and information as do other linguistic minority groups. Amongst others, this includes limited access to English communication, misunderstanding of medical terminology, irregular contact with health care professionals of the same language and cultural background and the need to overcome the challenges experienced by using others as interpreters in a health care setting. Barriers to the written and spoken word limit access to health care information as deaf people cannot overhear conversations, have limited access to mass media and present with low literacy rates. The South African Constitution stipulates that every citizen has an equal right to health care services and should not be unfairly discriminated against, on the basis of language. Unfortunately, despite what is written in the Constitution, the reality is that many South Africans are denied equal access or receive compromised access to health care services because of language barriers. The lack of access to interpreters at health care facilities across South Africa inhibits patients from expressing themselves correctly and limits the providers’ professional ability to make a correct diagnosis and provide relevant information. The current study explores the barriers and facilitators to accessing health care services and health care information for people who are deaf in a relatively well-resourced setting. A sample of deaf participants from the National Institute for the Deaf in Worcester were interviewed to gain an understanding of problems experienced with accessing health care services and health care information. Participants reported communication and socio-economic factors as barriers to accessing health care services. The main barrier to accessing health care information was considered to be the inaccessibility of the mass media. Recommendations were made by participants on ways to improve access to health care services and health care information for the deaf population of South Africa. Keywords: Health care acces, Health care information, Deaf, Worcester, Barriers and facilitators to health care services. Stellenbosch University http://scholar.sun.ac.za iv OPSOMMING Die dowe gemeenskap ervaar soortgelyke struikelblokke as ander linguistiese minderheidsgroepe met toegang tot gesondheidsdienste en inligting. Dit sluit onder andere in beperkte toegang tot Engelse kommunikasie, wanbegrip van mediese terminologie, ongereelde kontak met mediese dienspraktisyne van dieselfde taal en kulturele agtergrond, en die uitdaging wat oorkom moet word om ander mense te gebruik as tussenganger en tolk in ’n mediese situasie. Hindernisse met geskrewe- en spreektaal beperk die toegang tot gesondheidsinligting. Dowe mense kan nie na gesprekke luister nie, het beperkte toegang tot massamedia en vertoon oor die algemeen 'n laer geletterdheidsprofiel. Die Suid Afrikaanse Grondwet stipuleer dat elke burger ’n gelyke reg tot gesondheidsdienste het en verbied onregverdige diskriminasie op grond van taal. Ten spyte van die Grondwet is die realiteit dat baie Suid Afrikaners nie gelyke toegang het nie en ’n laer vlak van mediese dienslewering ervaar as gevolg van taalprobleme. Die ontoereikende beskikbaarheid van tolke by gesondheidsfasiliteite reg oor Suid Afrika beperk die vermoë van pasiënte om hulself behoorlik uit te druk. Dit beperk daarom ook die mediese praktisyn se vermoë om ’n korrekte diagnose te maak en relevante inligting rakende die diagnose aan die pasiënt oor te dra. In die huidige studie is die struikelblokke en fasiliteerders vir toegang tot gesondheidsdienste en inligting ondersoek vir dowe mense in ’n relatief goed toegeruste omgewing. ’n Steekproef van dowe deelnemers is by die Nasionale Instituut vir Dowes in Worcester geselekteer. Deur middel van onderhoude is die probleme wat ondervind word met toegang tot gesondheidsdienste en gesondheidsinformasie geïdentifiseer. Deelnemers het kommunikasie en sosio-ekonomiese faktore as struikelblokke tot die toegang van gesondheidsdienste geïdentifiseer. Die grootste struikelblok met toegang tot mediese inligting was die beperkte toegang tot massamedia. Voorstelle is deur die deelnemers gemaak vir die verbetering van die toeganklikheid tot mediese dienslewering en gesondheidsinligting vir die dowe populasie in Suid Afrika. Stellenbosch University http://scholar.sun.ac.za v Sleutelwoorde: Toegang tot gesondheidsdienste, Gesondheidsinligting, Dowe, Worcester, Struikelblokke en fasiliteerders tot gesondheidsdienste. Stellenbosch University http://scholar.sun.ac.za vi ACKNOWLEDGEMENTS I would first like to thank my inspiring supervisor Professor Leslie Swartz, without whose positive enthusiasm and optimism I would not have been able to complete this research within the timeframe provided. I would also like to thank the rest of the EquitAble team who were always available to bounce ideas off and the research assistants who helped collect the data. Without the support of the National Institute of the Deaf in Worcester, this research would not have been possible. Finally I would like to thank my husband for his patience and support while I worked on this thesis. Stellenbosch University http://scholar.sun.ac.za vii CONTENT PAGE Declaration ii Abstract iii Opsomming iv Acknowledgements vi List of Tables xiii CHAPTER ONE : INTRODUCTION 1 1.1 Research problem and rationale 3 1.2 Outline of the study 4 CHAPTER TWO : THEORETICAL OVERVIEW AND A REVIEW OF THE LITERATURE 5 2.1 Disability in South Africa 5 2.2 Deafness 7 2.3 Health 9 2.4 Health care services 12 2.4.1 Equal access to health care 13 2.4.2 Barriers and facilitators to health care services 14 Stellenbosch University http://scholar.sun.ac.za viii 2.4.2.1 Communication barriers and facilitators 14 2.4.2.2 Structural - Environmental barriers 18 2.4.2.3 Process barriers 19 2.5 Health care information 20 2.5.1 Access to health care information 21 2.5.2 Barriers to health care information 21 2.5.3 Facilitators to health care information 23 2.5.4 Recommendations 24 2.5.5 Facilitators to health care information in South Africa 25 2.6 General language barriers to health access in South Africa 25 2.7 Education and South African Sign Language (SASL) 28 2.7.1 Brief overview of deaf schooling in South Africa 28 2.7.2 SASL 29 2.7.3 SASL interpreters 30 CHAPTER THREE : METHODOLOGY 32 3.1 Background to the study 32 3.2 Study aim 34 3.3 Study setting 34 3.3.1 Worcester 34 Stellenbosch University http://scholar.sun.ac.za ix 3.3.2 National Institute for the Deaf (NID) 35 3.3.2.1 Background and policies 35 3.3.2.2 Lewensruimte 37 3.3.2.3 Shalom Old Age Home 39 3.3.2.4 NID College 41 3.4 Study design 41 3.5 Instruments 41 3.6 Participants 42 3.6.1 User population 42 3.6.2 Key informant population 42 3.6.3 Criteria of inclusion and exclusion 43 3.6.4 Sample characteristics 43 3.6.5 Participant recruitment 44 3.7 Procedure 46 3.8 Interpreter issues 47 3.9 Data analysis 48 3.10 Confidentiality and informed consent 49 3.10.1 Informed consent 49 3.10.2 Data protection and privacy 50 Stellenbosch University http://scholar.sun.ac.za x 3.11 Ethical considerations 50 CHAPTER FOUR : RESULTS 52 4.1 Deafness 52 4.2 Participants’ understanding of Health 55 4.3 Communication barriers to health care services 58 4.3.1 Alternative forms of communication 64 4.3.2 Dependent on support 67 4.4 Structural-environmental barriers 70 4.4.1 Socio-economic factors 70 4.4.2 Private vs. public health care services 74 4.4.3 Transport 75 4.5 Process barriers 77 4.5.1 Timeliness 78 4.6 Patient satisfaction 81 4.7 Health care information and health knowledge 82 4.7.1 Health care information 82 4.7.2 Health knowledge 86 4.8 Recommendations to improve access to health care services and health care information 89 4.9 Institutional support 95 Stellenbosch University http://scholar.sun.ac.za xi 4.10 Sign language and interpreters 99 4.10.1 Sign language 99 4.10.2 Interpreters 102 CHAPTER FIVE : DISCUSSION 107 5.1 Limitations of the study affecting interpretation of the data 107 5.2 Deafness 108 5.3 Participants’ understanding of Health 108 5.4 Barriers to accessing health care services 109 5.5 Communication barriers to health care services 110 5.5.1 Alternative forms of communication 111 5.5.2 Dependent on support 113 5.6 Structural-environmental barriers 113 5.6.1 Socio-economic factors 113 5.6.2 Private vs. public health
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