Communication between pharmacists and patients who are d/Deaf in Thailand

Abstract

Communication challenges between healthcare professionals and patients with hearing loss were common. Information on the challenges and suggestions to improve communication was identified in this study. First, a systematic review and meta-analysis summarizing communication modes and barriers between healthcare professionals and patients with hearing loss was conducted. Modes and communication barriers between healthcare professionals and patients who were deaf or Deaf (d/Deaf) were used as a foundation for five in-depth interviews and one focus group interview with students who were d/Deaf, patients who were d/Deaf, pharmacists, and sign language interpreters. This was to determine their preferred communication methods, barriers, and suggestions for medication counseling with d/Deaf patients by pharmacists. In addition, information from hospital and community pharmacists in Thailand regarding their communication with patients who were d/Deaf was collected through an online survey.

MEDLINE/PubMed, Scopus, CINAHL, ScienceDirect, and Thai JO databases were searched from conception to August 2023. Forty-two studies were included in the systematic review and 20 were included in the meta-analysis. We found that using hearing aids (pooled prevalence = 57.4%, 95%CI: 11.4% to 103.4%, N = 3, I2 = 99.33) and gestures (pooled prevalence = 54.8%, 95%CI: 17.4% to 92.1%, N = 7, I2 = 99.68) were the common mode of communication between healthcare professionals and patients with hearing loss. Communication barriers were limited education level, health knowledge, and written language literacy in d/Deaf patients. This information was used to construct semi-structured interview questions. Fifteen d/Deaf students, 24 d/Deaf adults, 4 sign language interpreters, and 11 pharmacists participated in the interviews. The participants reported that patients who were d/Deaf preferred direct communication with pharmacists to sign language interpreters. We also found that pharmacists usually communicated with d/Deaf patients by writing or speaking to accompanying people in Thai and English. However, d/Deaf people were more confident in their Thai sign language (TSL) communication skills than in Thai and English. Differences in how d/Deaf patients perceived nonverbal language expressed by pharmacists were also an issue. Pharmacists needed standard procedures and d/Deaf-specific tools that help them counsel d/Deaf patients.

A cross-sectional study was then conducted online to address the prevalence of communication modes used and barriers to communication between pharmacists and patients who were d/Deaf. Two hundred and fifty-nine registered pharmacists in Thailand participated. Most of the participants were female; graduated with a Bachelor in Pharm (B.Pharm.) or Doctor of Pharmacy (Pharm D); and were hospital pharmacists. We found that 58.3% of Thai pharmacists had experience in communicating with patients who were d/Deaf, usually via writing (36.1%) and gesturing (24.9%). Pharmacists also opinionated that the communication methods that they used were effective (42.5%). Only 6.1% of Thai pharmacists can use sign language. We also found several challenges in communication between Thai pharmacists and patients who are d/Deaf. Limited Thai literacy in patients who were d/Deaf (22.5%), the lack of sign language skills in pharmacists (20.2%), the inability of pharmacists and the patients to convey two-way communication (15.6%), the lack of equipment or tools to help communicate with patients who were d/Deaf (14.8%), and no sign language interpreters (10.8%) were reported as a barrier. The findings from this research suggest that training pharmacists in Deaf culture and sign language, enhancing access to sign language interpreters, using telecommunication services, and providing sufficient d/Deaf-specific tools are necessary to improve communication between pharmacists and patients who are d/Deaf.

-