Conveying Medication Prescriptions in American Sign Language: Use of Emphasis in Translations by Interpreters and Deaf Physicians

By Nicodemus, Brenda; Swabey, Laurie et al. | Translation & Interpreting, January 2014 | Go to article overview

Conveying Medication Prescriptions in American Sign Language: Use of Emphasis in Translations by Interpreters and Deaf Physicians


Nicodemus, Brenda, Swabey, Laurie, Moreland, Christopher, Translation & Interpreting


In the United States, deaf patients who use American Sign Language (ASL) typically communicate with their non-signing healthcare providers in one of two ways: in signed language (through an interpreter) or in English (by writing notes, lipreading, speaking, or a combination of these approaches).

The healthcare outcomes for deaf patients who use these different communication methods have not been thoroughly examined. However, deaf patients are frequently dissatisfied with communication in healthcare settings with non-signing providers (Harmer, 1999; Steinberg, Barnett, Meador, Wiggins, & Zazove, 2006; Steinberg, Wiggins, Barmada, & Sullivan, 2002; Ubido, 2002; Witte & Kuzel, 2000). Further, deaf patients report a variety of issues in accessing healthcare services and, notably, express concerns with medication safety posed by inadequate communication (Iezzoni, O'Day, Killeen, & Harker, 2004).

A critical issue in healthcare is compliance with prescription and treatment protocols (Alemanni, Touzin, Bussieres, Descoteaux, & Lemay, 2010; Cooper et al., 2009; Linn et al., 2012). Although providing medical instructions in ASL has positive results for deaf patients (MacKinney et al., 1995), it is not a panacea for communication problems, since instructions may be delivered with varying degrees of effectiveness in any language.

Studies have shown that the communication characteristics of some physicians appear to be more successful than others in achieving higher compliance among their patients (Sencan, Wertheimer, & Levine, 2011). Thus, investigations are needed to better understand how to deliver healthcare instructions effectively in ASL, with specific attention to the linguistic devices that support deaf patients' comprehension and recall of medication instructions.

In this study, we begin the process by examining common medication instructions as translated from English into ASL by two groups: deaf bilingual physicians and experienced ASL-English interpreters. We investigate the linguistic features used when rendering medication instructions in ASL, and discuss features that may promote deaf patients' comprehension. Specifically we sought to learn if participants emphasized key concepts throughout their renditions and, if so, to identify the linguistic features that served as emphatic markers

The importance of effective doctor-patient communication as a key component in healthcare has been well documented (Cicourel, 1981; Davidson, 2001; Ha, Anat, & Longnecker, 2010). Effective physician-patient communication has been linked to patient satisfaction and positive health outcomes (Betancourt, Carrillo, & Green, 1999). Critically, patients who experience effective communication with their doctor are more likely to comply with the prescribed plan of treatment (Harmon, Lefante, & Krousel-Wood, 2006; Sencan et al., 2011). Compliance is a complex health behavior determined by a variety of socioeconomic, individual, familial, and cultural factors.

Although studied extensively, non-compliance to prescribed treatment plans is a pervasive issue in the maintenance of public health worldwide (Sabate, 2003; Zolnierek & Dimatteo, 2009). Not adhering to prescription regimes has been directly tied to poor treatment outcomes for patients with a variety of illnesses, both chronic and acute. Non-compliance to medication plans carries societal implications as well. Patients with poor compliance may be unable to work or engage in family or community activities, thus negatively impacting their quality of life. Further, non-compliance results in a higher number of urgent care visits, hospitalizations, and other increases in costs related to treatment (Bond & Haussar, 1991; Svarstad, Shireman, & Sweeney, 2001). Disease management has also been cited as being negatively impacted by non-compliance.

No matter the demonstrated efficacy of a treatment plan, without compliance, the benefit of the treatment will not be realized. …

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