Improving Patient Experience, Service Access and Outcomes in NHS Hearing Aid Services for Deaf Adults who use British Sign Language

Student thesis: Phd


Background There are 87,000 Deaf British Sign Language (BSL) users in the UK, and some of them wear hearing aids and access NHS adult hearing aid services. They are not typical hearing aid service users, but little is known about their experiences and expectations of an adult hearing aid service. Anecdotally, Deaf signers report a lack of equity in service provision and professional practice not suited to their needs. However, evidence from both a Deaf patient and professional service provider perspective is missing. Aims: From within a UK and National Health Service context: this thesis aimed to: (i) ascertain the parameters and characteristics of an effective hearing aid service for Deaf BSL users and (ii) develop guidelines to improve the access and usability of high-quality hearing aid services for Deaf BSL users. Methodology and Methods: An exploratory sequential mixed-methods research design was used. A formal scoping review of culturally competent audiology services for Deaf signers preceded Study 1; a qualitative interview study with 8 culturally Deaf signers who wear hearing aids. Study 1 informed the design of Study 2 which was an online survey in BSL and English about Deaf people’s experiences of clinical services involving 75 current patients. Study 3, a mixed-methods case study of two hearing aid clinics included interviewing 8 audiologists and analysing 19 documents from the services were collected for documentary analysis. Interpretative Phenomenological Analysis was used in Study 1, descriptive statistical analysis in Study 2 and Reflexive Thematic Analysis in Study 3. Results: The exclusion of Deaf signers within literature and professional guidance on cultural competence was revealed. Deaf signers were more readily identified as disabled people for whom linguistic access was required through interpreter provision. Findings show that hearing aid clinics do not address BSL accommodations of Deaf signers across their services and the onus is always on the Deaf person to understand staff and not the other way round. Audiologist showed an over-reliance on interpreters, which generates a false sense of accessibility. At a service level, information resources in BSL and routes for patient feedback in BSL were also missing. Deaf patients reported low levels of knowledge and understanding about the potential of their hearing aids. The top two reasons were (i) to assist with lipreading when engaging with English as a second language amongst others who did not sign. The findings have contributed to developing a guide to interpersonal competence practice for audiological staff working with Deaf signers and developing a conceptual model of what an effective hearing aid service should look like for Deaf signers from a whole service perspective. Conclusions: This is the first research study that has explored Deaf signers’ experiences of hearing aid services and motivations for hearing aid use. The survey has captured data for the first time from 75 Deaf signers who wear hearing aids and is the first study that has explored the cultural competence of hearing aid services and its staff concerning Deaf signers in the UK. The conceptual model of making hearing aid services culturally competent concerning Deaf signers is a starting point for service and system change.
Date of Award1 Aug 2023
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKevin Munro (Supervisor), Alys Young (Supervisor) & Katherine Rogers (Supervisor)


  • Audiology
  • Deaf
  • British Sign Language
  • Patient Experience

Cite this