In this interview, Rafael Rodrigues de Moraes discusses the study’s objectives, methodology, and main findings, highlighting the communication barriers faced by Deaf Brazilian Sign Language (Libras) users in accessing health services and strategies to improve accessibility and inclusion.
How did this study come about, and what gap did it seek to fill?
The article is set within the broader context of the struggle for the rights and accessibility of people with disabilities in health care services, particularly non-oralized deaf individuals who use Libras. Recent laws, such as Law No. 13,146 of July 6, 2015—known as the Brazilian Inclusion Law or the Statute of Persons with Disabilities—consolidate the right to health care in Articles 18 through 26. These laws ensure access to both public and private health services, as well as to the information provided and received, by providing for all necessary forms of communication, including Libras, Braille, and adaptations to spoken and written language. Deaf individuals who do not use spoken language and rely on Libras depend on effective communication with healthcare professionals in their natural language—either directly or through interpreters—without which serious problems can arise, such as misdiagnoses, incorrect prescriptions, and failure to fully adhere to treatment.
How was the research conducted, and who participated in the study?
Upon reviewing the literature, we found no studies comparing public and private services for this population, and this study aims to fill that gap. Thus, the objective of this study is to analyze access to healthcare for adults who are deaf in the Campinas Metropolitan Region, by examining the quality of communication with healthcare professionals in public and private services, as well as the spatial distribution and structure of Basic Health Units in the municipality of Campinas.
What were the main challenges identified in accessing health care services?
This is a quantitative, cross-sectional epidemiological study conducted in the Campinas Metropolitan Region between August 2021 and March 2023, involving the administration of an online questionnaire—available in Brazilian Sign Language (Libras)—using Google Forms. The study was approved by the Research Ethics Committee of the Faculty of Medical Sciences at the State University of Campinas and was carried out in collaboration with the Campinas Brazilian Sign Language Interpreters Center and the Campinas Association of the Deaf (ASSUCAMP).
What do the results reveal about the quality of communication between deaf people and healthcare professionals?
Using purposive, non-probabilistic sampling, the questionnaire asked participants about their socioeconomic characteristics, their health status, communication with healthcare professionals from both healthcare systems, and the use of assistive listening devices, such as hearing aids and cochlear implants. The study’s microdata are available in Portuguese, English, and Spanish, and the forms are also available in Libras.
What measures are needed to ensure more accessible care for the deaf population?
The analyses were conducted in four stages. In the first stage, a simple descriptive analysis of all responses was performed. In the second stage, considering only participants who self-reported using both networks, we sought to determine whether their assessments agreed. In the third stage, focusing on those who self-reported using only one network, a logistic regression model was fitted to estimate the probability of effective communication with the healthcare professional and to identify which factors influence communication quality. In the fourth and final stage, considering only participants from Campinas, georeferenced data were used to determine the proximity and spatial distribution of these participants in relation to primary health care centers. Using different techniques and perspectives, in both the public and private health care systems, it was found that participants faced linguistic and communication barriers, primarily due to health care professionals’ lack of knowledge of Libras. Effective communication relies on the mediation of professional interpreters—to a lesser extent—and family members—to a greater extent—highlighting the lack of autonomy and privacy that deaf individuals experience when managing their own health care, which causes embarrassment, discomfort, frustration, and a consequent decrease in their attendance at medical appointments. Regardless of the healthcare system, the prevailing assessment is negative, although the private system receives the lowest ratings when compared to the public system. Among users of both systems, there is strong agreement—with twice as many users—in giving a negative assessment of communication. After applying the principle of parsimony in selecting the logistic regression model—which favors simpler models among those with similar performance—the variables “self-assessment of health status” and “health care system” were chosen as predictors of the quality of communication between health care professionals and participants. Among users of only one of the systems, it was found that in the private system, there is a 22% lower likelihood of having good communication with healthcare professionals, and those who rate their health status positively are three times more likely to have good communication. The probability of good communication is only 40% in the best-case scenario, which occurs when the user relies solely on the public system and has a positive self-assessment of their health status, indicating a shortage of healthcare professionals qualified to work with the deaf population. Therefore, it is recommended that more investments be made in hiring translators and interpreters and sign language professionals, expanding the Brazilian Sign Language (Libras) Interpretation Centers to other municipalities, offering Libras courses for SUS professionals as part of continuing education, and promoting the teaching of Libras in all health-related university programs. The SUS must be universal, comprehensive, and equitable—including for the deaf population.