In the realm of preventative medicine, a one-size-fits-all approach often leaves historically underserved populations behind. For adults who are Deaf, Deafblind, and Hard of Hearing (DDBHH), the path to a routine cancer screening is frequently blocked by a complex web of systemic barriers. From the lack of health information available in American Sign Language (ASL) to the recurring struggle of ineffective patient-physician communication, these challenges do more than just cause frustration—they lead to delayed diagnoses and poorer health outcomes.
| Key Takeaways |
| Dismantling Communication Barriers: Adults who are Deaf, Deafblind, and Hard of Hearing (DDBHH) face systemic obstacles to routine cancer screening, primarily due to ineffective patient-physician communication and a lack of health information available in American Sign Language (ASL). |
| ASL-CHNs Boost Screening Rates: Preliminary findings from the randomized trial show that ASL-fluent Community Health Navigators (ASL-CHNs) significantly increase participants’ recommended cancer screening completion rates. |
| Scalable Model for Health Equity: By addressing individual, clinician, and system barriers, the program aims to become a national blueprint for using remote technology to improve early cancer detection. |
Dr. Poorna Kushalnagar, a principal investigator from the Center of Deaf Health Excellence at Gallaudet University, is leading a transformative study to dismantle these obstacles. Her team’s research, published in JMIR Research Protocols, details the implementation of a randomized controlled trial designed specifically for the DDBHH community. The study centers on a specialized role: the ASL-fluent Community Health Navigator (ASL-CHN).
The research utilizes a videoconference-delivered, block-randomized design, stratifying 200 DDBHH participants by age and sex. Half of these participants are assigned to work with trained ASL-CHNs, while the other half receives standard care. This digital approach is vital; by using videoconferencing, the study provides a face-to-face, language-concordant environment that traditional healthcare settings often fail to provide.
These navigators offer one-on-one support, helping participants understand the nuances of various screenings including for breast, cervical, colorectal, lung, and prostate cancers. Beyond mere translation, the ASL-CHNs act as advocates and coaches. They assist with the logistics of setting up appointments and, perhaps most importantly, help patients feel comfortable and empowered when discussing their health with doctors, ensuring no question goes unasked or unanswered.
| Dr. Poorna Kushalnagar from Gallaudet University’s Center of Deaf Health Excellence discusses a groundbreaking randomized controlled trial designed to reduce cancer health disparities. |
The early data from this ongoing trial is a significant signal for health equity. Preliminary findings indicate that participants who worked with an ASL-CHN were consistently more likely to complete their recommended cancer screenings compared to those in the standard care group. This success suggests that the barrier isn't a lack of interest in health, but rather a lack of accessible navigation support.
By addressing the triple threat of individual, clinician, and healthcare system barriers, this project aims to create a replicable model. If the ASL-CHN intervention proves successful over the long term, it could serve as a national blueprint for how healthcare systems can use remote technology to improve early detection rates and, ultimately, reduce cancer mortality in underserved communities.
The choice to publish with JMIR Publications was a strategic one for the Kushalnagar team. While the journal's high impact and wide dissemination were factors in their decision, the primary draw was JMIR’s commitment to truly accessible science. By supporting formats that include ASL video features alongside English text, the journal ensures that the DDBHH community can engage directly with the research that concerns their own health and well-being.
Curious to see how personalized navigation is closing the gap in preventive health for the DDBHH community? Watch the video featuring Dr. Poorna Kushalnagar and read the full research protocol to explore the methodology behind the ASL-CHN intervention.
Kushalnagar P, Rao S, Bergeron E, Valdez R, Wang R, Kushalnagar R, Sadler G. Using American Sign Language–Fluent Community Health Navigators to Advance Cancer Screening Adherence through Videoconferencing With Deaf, Deafblind, and Hard of Hearing Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2025;14:e65078