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Efforts to provide health care information to traditionally underserved persons who are deaf have been sporadic at best. Virtually no curricula or standardized materials that are tailored specifically to the unique needs of this group have existed. This curriculum was developed to convey basic health care information to traditionally underserved persons who are deaf, particularly those who are members of minority groups and/or reside in inner city environments and, in so doing, to address the aforementioned difficulties with accessing health information. The impetus for this project derived from communication with the Illinois State Vocational Rehabilitation Agency, whose director documented the lack of adequate health care among this population. The specific curriculum was developed following a year-long assessment process that brought together focus groups of professionals involved in delivering services to traditionally underserved persons who are deaf and health professionals who also interfaced with this population. The locations included New York, Chicago, Atlanta, San Antonio, Tucson, and Seattle. Participants in the focus groups provided opinions as to the type of health information that is needed by this population and identified barriers to adequate health care. Additionally, interviews were held with traditionally underserved persons who are deaf in each of these six locations. The interviewers were staff members from the programs attended by the subjects, who questioned health practices and access to health care and also solicited the subjects' perceptions as to what health information would be of most interest to them. Finally, parents of traditionally underserved deaf individuals were also asked to provide input regarding what they felt their offspring needed to be educated about. All of this information was used by a team of professionals at Northern Illinois University to determine the specific curricular areas.
Following a pilot test of the newly-developed curriculum at Northern Illinois University's Program for the Hearing Impaired, the curriculum was field tested at six programs, including the Lexington Center in New York; the Georgia Sensory Rehabilitation Center in Atlanta; the Southwest Center for the Hearing Impaired in San Antonio, Texas; the Community Outreach Program for the Deaf in Tucson, Arizona; the Seattle Hearing Speech and Deafness Center; and the Illinois School for the Deaf in Jacksonville, Illinois. The data from the field tests substantiated the usefulness of the curriculum for enhancing health education among traditionally underserved persons who are deaf. The field tests also yielded comments regarding effective strategies for using the curriculum with the target population. This feedback, coupled with the comments of several experts on using curricula with deaf students in general and traditionally underserved persons who are deaf in particular, were used to modify the draft curriculum into its final form.
The experts who participated in the field test noted, first and foremost, that the central concern in conveying any information to traditionally underserved persons who are deaf is communication. They noted that the hallmark of this population is individual variances and a great variety of communication styles and ranges of competence. They warned that one should expect communication levels to vary in any group consisting of two or more clients. It should be noted that this curriculum has been created with great ranges of communication styles and preferences in mind, including those of individuals whose only communication competence is in a foreign language. In those instances, it may be necessary to use an interpreter in the spoken and/or signed language of choice. There is an assumption, however, that some avenue of communication, however rudimentary, can be established.
Next, the experts noted that the user of this curriculum may need to make decisions regarding the specific content to be taught to a given group of students. Factors such as time available, level of communication, and existing knowledge base may influence how much of the curriculum can be presented to a particular group of clients. This curriculum was originally designed to be used as a complete entity in order to create a base of knowledge, then build on it to cover more specific issues. Use of the entire curriculum is also suggested in order to fulfill the intent that this be a wellness-oriented approach. The authors realize, however, that it may not always be possible to cover the entire curriculum, and that flexibility and creativity are demanded by the population for which this curriculum was designed. The individual units were found by the field test participants to have independent merit when used alone. They suggested that the above factors be considered and that the instructor give priority to those lessons that address topics of great importance such as AIDS, birth control, basic nutrition, and knowing how and when to access health care services.
Finally, data from the field test raised rather interesting philosophical questions regarding instruction with this population. Feedback seemed to divide generally along the lines of the old proverb that states if you fish for a person, he or she eats for a day, but if you teach a person to fish, he or she eats for a lifetime. Some of the experts subscribed strongly to this proverb and felt that it is critical to teach traditionally underserved persons who are deaf why their body works the way it does and how to take care of it in order to prevent serious problems. They felt conveying this information was so important that it justified whatever difficulties in communication were encountered in the process. Other experts, however, felt that the task of conveying such complex information was overwhelming and, perhaps, unnecessary. One expert suggested an approach of if it isn't broken don't fix it, that is, clients need only be taught about those conditions or risk factors that specifically affect them as individuals. To this way of thinking, the client who has coronary artery disease would need to receive instruction in preparing healthy meals and would need to understand the effect of cholesterol on the circulatory system, but this information might well be omitted with other clients. The authors of this curriculum, however, believe that a preventive approach to health education is essential, and we urge users of this curriculum to attempt to convey the information in the manner in which it is presented, regardless of the communication obstacles that must be overcome. It is only in so doing that one can truly address the dire consequences of inadequate health care information among traditionally underserved persons who are deaf.