TUGAS INDIVIDU

Mata Kuliah : METODOLOGI PENELITIAN

Dosen : Dr. dr. Arifin Seweng, MPH

TOPIK PENELITIAN

OLEH:

Rifa’ah Mahmudah Bulu’

P1806216028

PROGRAM PASCASARJANA
FAKULTAS KESEHATAN MASYARAKAT
KONSENTRASI MANAJEMEN RUMAH SAKIT
UNIVERSITAS HASANUDDIN
MAKASSAR
2016
 Tuliskan 1 topik penelitian disertai hal berikut :

1. Justifikasi topik berdasarkna kriteria FINER

Pelayanan Kesehatan Rumah sakit X terhadap pasien Tuna Rungu

1. Feasible
1) Objek
Pasien Tuna Rungu
Pekerja kesehatan di rumah sakit
2) Waktu dan Biaya
Waktu : Kunjungan dengan komunitas pasien Tuna Rungu (Gerkatin) untuk
mendengar pengalaman mereka berobat di pusat pelayanan kesehatan, serta
kunjungan di rumah sakit untuk mengetahui pelayanan kepada pasien tuna
tungu
3) Fasilitas
Dana penelitian melalui proposal tugas Akhir LPDP
4) Keahlian
Komunikasi dengan tuna rungu dapat dilakukan melalui bahasa isyarat dengan
interpreter
Sehingga masalah ini dari segi feasible dapat dicarikan jawabannya melalui sumber yang
jelas, tidak banyak menghabiskan dana, tenaga, dan waktu

2. Interisting
1) Peneliti : Peneliti tertarik untuk melihat pelayanan kesehatan terhadap tuna rungu
2) Reviewer : Hasil penelitian ini membantu pasien tuna rungu untuk mendapatkan
solusi akses pelayanan yang lebih baik

Topik penelitian ini menarik sehingga menimbulkan minat dan semangat peneliti
untuk melakukan penelitian berdasarkan topik yang telah ada

1. Masalah itu menyangkut kepentingan umum (masyarakat) baik mendesak maupun

tidak mendesak.
2. Masalah itu merupakan mata rantai, apabila tidak dipecahkan banyak masalah lain
yang terbengkalai.
 3. Masalah itu penting dan pemecahannya dapat mengisi kekosongan dan kekurangan
ilmu dan pengetahuan, dan sebagainya.
3. Novel
1) Referensi : Jurnal dan penelitian internasional
2) Metode : wawancara dengan bahasa Isyarat kepada pasien tuna rungu
Penelitian ini adalah penelitian yang mengembangkan hasil penelitian asing, dan
belum ada referensi yang jelas di indonesia mengenai akses pelayanan tuna rungu
di rumah sakit. Sehingga penelitian ini bertujuan untuk menemukan solusi dari
permasalahan akses pelayanan tuna rungu di rumah sakit.
4. Ethical
1) Komisi etik : Melalui komisi etik
2) Budaya : Tidak melanggar budaya
3) Agama : Tidak melanggar Agama
4) Norma : Tidak melanggar norma
Tidak bertentangan dengan etika, data adalah jujur dan hasil wawancara dengan
pasien tuna rungu dan informasi dirahasiakan identitasnya serta proposal akan
dikirim ke komisi etik untuk ditunggu balasan apakah penelitian ini sesuai dengan
etik atau tidak.
5. Relevant
1) Pengembang Ilmu pengetahuan
2) Manajemen Pelayanan Kesehatan
3) Kebijakan bidang Kesehatan
4) Penelitian selanjutnya
Penelitian ini menyangkut semua aspek relevant , penelitian ini mengembangkan
ilmu pengetahuan, serta untuk tata laksana pasien yang nantinya akan diatur dalam
kebijakan kesehatan jika hal ini termasuk masalah yang harus diselesaikan.
 2. Dasar Teori Diagram

Pasien Tuna Rungu Sensional/

Konduktif MALPRAKTIK

Membaca bibir
Interpreter
Faktor Psikologi Tuna Rungu Menulis
Dokter mampu berbahasa Isyar
Komunikasi yang tidak ideal

Sakit

Konvensi PBB hak-hak tentang Penyandang CacatKomunikasi Pasien-dokter

3. Kerangka konsep diagram

Psikologi
Tuna Rungu Tuna Akses
Pelayanan
Rungu
Kesehatan
 4. Variabel penelitian
Variabel Terikat :Akses Pelayanan Kesehatan
Variabel Bebas : Tuna rungu
Variabel Antara : Psikologi Tuna Rungu

5. Definisi Operasional variabel Penelitian

Tuna Rungu adalah Tunarungu adalah seseorang yang mengalami kekurangan
atau kehilangan kemampuan mendengar baik sebagian atau seluruhnya yang
diakibatkan karena tidak berfungsinya sebagian atau seluruh alat pendengaran,
sehingga ia tidak dapat menggunakan alat pendengaranya dalam kehidupan
sehari-hari yang membawa dampak terhadap kehidupannya secara kompleks

Akses Pelayanan kesehatan adalah akses terhadap fasilitas kesehatan seperti

puskesmas, rumah sakit, tenaga kesehatan, yang dapat dicapai oleh masyarakat.
Akses pelayanan masyarakat yang baik adalah yang tidak terhalang oleh keadaan
geografis seperti lama pekerjaan, jarak, serta sosial maupun ekonomi.

Psikologi tuna rungu adalah perilaku dan fungsi mental dari seseorang yang
mengalami kekurangan atau kehilangan kemampuan mendengar baik sebagian
atau seluruhnyayang membawa dampak terhadap kehidupannya secara kompleks.

6. Referensi Minimal 3 referensi berbahasa inggris

1. Iezzoni, L.I et all. 2004. Communicating about Health Care: Observations from
Persons Who Are Deaf or Hard of Hearing. Ann Intern Med. 2004;140:356-362.

2. Kritzinger, Janis et all. 2014. ‘‘I just answer ‘yes’ to everything they say’’: Access to
health care for deaf people in Worcester, South Africa and the politics of exclusion. J.
Patient Education and Counseling 94 (2014) 379–383. Elsevier Ireland Ltd.

3. Kuenberg, A, et all. 2015. Health Care Access Among Deaf People. Journal of Deaf
Studies and Deaf Education, 2015, 1–10 doi:10.1093/deafed/env042

4. Pollard, R Q et all. 2009. Health-Related Vocabulary Knowledge Among Deaf

Adults. Rehabilitation Psychology 2009, Vol. 54, No. 2, 182–185

7. Copy halaman 1 setiap referensi dan paste pada laporannya.

Communicating about Health Care: Observations from Persons Who

Are Deaf or Hard of Hearing
Lisa I. Iezzoni, MD, MSc; Bonnie L. O’Day, PhD; Mary Killeen, MA; and Heather
Harker, MPA

Background: Achieving patient-centered care requires effective communication between

physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to
communicating with physicians.
Objective: To understand perceptions of health care experiences and suggestions for
improving care among deaf or hard-of-hearing individuals.
Design: 4 semistructured group interviews, 2 conducted in American Sign Language (for
deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-
hearing individuals). Men and women were interviewed separately. Tapes of interviews were
transcribed verbatim for analysis.
Setting: Greater Boston, Massachusetts, and Washington, DC, in 2001.
Participants: 14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74
years of age).
Measurements: Commonly expressed themes or views organized around dimensions of
communication.
Results: Concerns coalesced around 6 broad themes: conflicting views between physicians
and patients about being deaf or hard of hearing; different perceptions about what constitutes
effective communication (such as lip reading, writing notes, and sign language interpreter);
medication safety and other risks posed by inadequate communication; communication
problems during physical examinations and procedures; difficulties interacting with office
staff, including in waiting rooms; and problems with telephone communication, such as
lengthy message menus. Participants offered extensive suggestions for improvements,
starting with clinicians’ asking patients about their preferred communication approach.
Having patients repeat critical health information (such as medication instructions) can
identify potentially dangerous miscommunication.
Conclusions: As the population ages, physicians will encounter many more persons with
hearing limitations. Physicians are not reimbursed for making some accommodations, such as
hiring sign language interpreters. However, ensuring effective communication is essential to
safe, timely, efficient, and patient-centered care.

Ann Intern Med. 2004;140:356-362. www.annals.org

Patient-centeredness—respect for and responsiveness to patients’ preferences, needs, and

values—must guide fundamental health care reform (1, 2). This laudable goal poses
particular challenges for certain patient populations. Achieving patient-centered care requires
complete and effective communication between clinicians and patients. Today, however,
communication between clinicians and many persons who are deaf or hard of hearing falls far
from this ideal.
A growing literature— commentaries (3– 8) and small surveys of patients (9 –11) or
clinicians (12–14)—compellingly documents important difficulties confronting persons
who are deaf or hard of hearing. Medicare beneficiaries with impaired hearing report lower
satisfaction with health care quality and access than do others (15, 16). Some deaf persons
have fewer physician visits or mammograms than hearing individuals, although these
differences vary by age at onset of deafness (17). In one study involving 14 elderly
individuals who have been deaf since early childhood, interviewees reported many practical
barriers to communicating with clinicians and office staff (18). Another study interviewed 54
deaf adults about mental health services; interviewees described communication difficulties
posing major impediments to mental health care (19). We used group interviews (20 –23) to
gather detailed information from 26 persons who are deaf or hard of hearing about
their health care experiences, as well as suggestions for improving care.

METHODS
This study occurred within a larger project examining health care experiences of adults with
disabling conditions, using quantitative (15, 16, 24–26) and qualitative research techniques.
Moderator’s Guide From our quantitative findings and literature reviews, we designed an
interview addressing 8 topics: overall health care quality, access to primary care, access to
specialized services, communication, accessibility experiences in physicians’ offices, training
physicians about disability accommodations, suggestions for designing accessible health care
settings, and disseminating our results among persons with disabilities.
To refine our interview procedures, we consulted an independent living center in Boston,
Massachusetts, that targets the Deaf community. We also conducted 2 key informant
interviews (23) with a physician–researcher experienced in caring for deaf persons and a
hearing American Sign Language expert. To pilot test the draft guide, we

‘‘I just answer ‘yes’ to everything they say’’: Access to health care for
deaf people in Worcester, South Africa and the politics of exclusion
Janis Kritzinger a,*, Marguerite Schneider a,b, Leslie Swartz a, Stine Hellum Braathen a,c
a Department of Psychology, Stellenbosch University, South Africa
b Alan J. Flisher Centre for Public Mental Health, Psychiatry and Mental health, University
of Cape Town, South Africa
c SINTEF Technology and Society, Department of Health, Norway

ABSTRACT
Objective: To explore whether there are other factors besides communication difficulties that
hamper access to health care services for deaf patients.
Methods: Qualitative methodology using semi-structured interviews with 16 deaf participants
from the National Institute for the Deaf in Worcester and 3 Key informants from the
Worcester area, South Africa.
Results: Communication difficulties were found to be a prominent barrier in accessing health
care services. In addition to this interpersonal factors including lack of independent thought,
overprotectedness, non-questioning attitude, and lack of familial communication interact with
communication difficulties in a way that further hampers access to health care services.
Conclusion: These interpersonal factors play a unique role in how open and accepting health
services feel to deaf patients.
Practice implications: Health care services need to take cognizance of the fact that providing
sign language interpreters in the health care setting will not necessarily make access more
equitable for deaf patients, as they have additional barriers besides communication to
overcome before successfully accessing health care services.

_ 2013 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
It is well established that deaf1 patients face particular challenges regarding communication
with healthcare providers, and this is probably a key reason why deaf people use health care
services differently from the general population [1]. Tamaskar et al. [2] found that deaf and
hard of hearing people were more likely than others to avoid health care providers because of,
among other factors, lack of communication and lack of available interpreters. This is
consistent with other reports that deaf people see doctors less often [3,4]. Steinberg et al. [1]
examined the accessibility to health care for deaf people (mainly American Sign Language
(ASL) users) and found that they had both positive and negative experiences. The positive
experiences were found in situations where medically experienced interpreters were used,
where health care providers used sign language and where providers made an effort to
improve communication. The main barrier was found to be problems with communication,
which elicited feelings of fear, mistrust and frustration with the health services. Patients felt
afraid of the consequences of miscommunication between themselves and their health care
providers, and this often led to patients harbouring feelings of mistrust towards providers and
towards the services as a whole. Deaf interviewees, furthermore, felt that some providers did
not respect their intelligence, motivation and desire to be actively involved in their health
care understanding and decision-making [1,5].
Communication barriers experienced by deaf people operate as a constant throughout their
lives in a hearing world, and at a range of levels, including the individual, interpersonal and
systemic levels, all of which come into play in health care communication [6]. In busy health
care settings where there is a culture of rapid diagnosis, treatment, use of services and
minimum interaction time with the patient, access for deaf people is further compromised [6].
When dealing with hearing personnel who do not speak sign language, deaf people need
longer appointment times in order to be understood and to understand treatment

Health-Related Vocabulary Knowledge Among Deaf Adults

Robert Q Pollard Jr. and Steven Barnett
University of Rochester School of Medicine

Background: Many deaf individuals are at increased risk for fund-of-information deficits,
including deficits in health-related information. Research on health information knowledge,
an aspect of health literacy, demonstrates an association between low health literacy and
health disparities in many populations. Deaf individuals are at particular risk for low health
literacy, but no research has been conducted on this topic.
Objective: To investigate health-related vocabulary knowledge in a sample of deaf adults.
Measure: A task based on the Rapid Estimate of Adult Literacy in Medicine (REALM).
Participants: Fifty-seven deaf adults reported whether they did or did not comprehend 66
health-related terms from the REALM. Of the participants, 81% possessed a college degree.
Results: Thirty-two percent of the deaf participants earned scores on the modified REALM
task comparable to REALM scores considered indicative of low health literacy. The pattern
of words that were least commonly and most commonly understood differed from normative
expectations of hearing REALM respondents.
Conclusions: This highly educated deaf participant sample demonstrated risk for low health
literacy. The general deaf population is likely at even higher risk for health problems
associated with low health literacy.
Keywords: deafness, REALM, age of onset, sign language, health literacy, reading

Approximately 4.8 million Americans report being unable to hear or understand speech (Ries,
1994). Deaf individuals who communicate via American Sign Language (ASL) make up a
sizable portion of this population. ASL is the primary language of an estimated 200,000 –
500,000 Americans (Barnett, 2005; Marschark, 1997) as well as of deaf Canadians. ASL is
characterized by phonologic, syntactic, grammatical, and dialogic properties that differ
markedly from English (Valli, Lucas, & Mulrooney, 2005).
The majority of ASL users are individuals who have been deaf since birth or early childhood.
People deaf since birth or early childhood commonly struggle with English literacy; it is
estimated that the average deaf high school senior reads at the fourth-grade level (Holt,
1993). Low literacy contributes to what Pollard (1998) has termed fund-of-information
deficit, that is, a distinct limitation in one’s factual knowledge base in comparison to the
general population, despite normal IQ and educational attainment. For deaf individuals, many
of whom already struggle with English literacy, access to information is made even more
difficult because radio, television and movie soundtracks, overheard conversations, public
address announcements, and other auditory sources of information are also not accessible,
further increasing the risk of fund-ofinformation deficit. Among the many topics to which a
fund-ofinformation deficit may pertain are health-related topics. In the health care field, there
has been an increasing focus on how knowledge deficits regarding illnesses, their symptoms
and causes, illness prevention, treatment options and risks, medicines, and related matters
may contribute to health disparities. The term most frequently used to describe this particular
knowledge base and the skills associated with it is health literacy. Health literacy has become
an important topic in medical research, practice, and public policy (Davis & Wolf, 2004;
Mayer & Villaire, 2004; Nielsen-Bohlman, Panzer, & Kindig, 2004). Yet, there have been no
studies of health literacy in the deaf population, despite the obvious risk for lower health
literacy arising from lower English literacy and fund-of-information challenges. Some
efforts to address this risk have been made, including the development of health education
materials for deaf individuals who communicate via ASL (Burgess, Shaw, Larew, Oellette, &
Long, n.d.; League for the Hard of Hearing, 1996; Pollard, 2003; Walters, 2004). Such
educational materials clearly presume lower health Robert Q Pollard Jr., Deaf Wellness
Center, Department of Psychiatry, University of Rochester School of Medicine and Rochester
Prevention Research Center: National Center for Deaf Health Research, Department of
Community and Preventive Medicine, University of Rochester School of Medicine. Steven
Barnett, Department of Family Medicine, University of Rochester School of Medicine and
Rochester Prevention Research Center: National Center for Deaf Health Research,
Department of Community and Preventive Medicine, University of Rochester School of
Medicine. This study was supported by Cooperative Agreement Number U48-DP-
000031 from the Centers for Disease Control and Prevention (CDC). Its contents are solely
the responsibility of the authors and do not necessarily represent the views of the CDC. This
study was also supported by a grant from the National Institute on Disability and
rehabilitation Research in the U.S. Department of Education’s Office of Special Education
and Rehabilitative Services. However, the contents of this article do not necessarily
represent the policy of the U.S. Department of Education, and you should not assume
endorsement by the federal government. The Rochester, New York, Deaf Awareness Week
organizing committee also provided support for this study. Steven Barnett is supported by
Agency for Healthcare Research and Quality grant K08 HS15700. We thank Brianne Testa-
Wojteczko and Anna Crisologo for their assistance in preparing the manuscript and the
Rochester, New York, Deaf Awareness Week organizing committee for allowing us to
conduct this study. The data reported herein were presented at the annual meeting of the
American Public Health Association in Philadelphia, Pennsylvania, on December 13, 2005.
Correspondence concerning this article should be addressed to Robert Q Pollard Jr., Deaf
Wellness Center, 300 Crittenden Boulevard, Rochester, NY 14642. E-mail:
Robert_Pollard@urmc.rochester.edu
Journal of Deaf Studies and Deaf Education, 2015, 1–10
doi:10.1093/deafed/env042
Empirical Manuscript
1
theory/review manuscript
Health Care Access Among Deaf People
Alexa Kuenburg1, Paul Fellinger2, Johannes Fellinger*,2,3
1Universitäts Spital Zürich 2Hospital St. John of God 3Medical University of Vienna
*Correspondence should be sent to Johannes Fellinger, Health Centre for the Deaf, Hospital
St. John of God, Linz, Austria (e-mail: johannes.fellinger@
bblinz.at).
Abstract
Access to health care without barriers is a clearly defined right of people with disabilities as
stated by the UN Convention on the Rights of People with Disabilities. The present study
reviews literature from 2000 to 2015 on access to health care for deaf people and reveals
significant challenges in communication with health providers and gaps in global health
knowledge for deaf people including those with even higher risk of marginalization.
Examples of approaches to improve access to health care, such as providing powerful and
visually accessible communication through the use of sign language, the implementation of
important communication technologies, and cultural awareness trainings for health
professionals are discussed. Programs that raise health knowledge in Deaf communities and
models of primary health care centers for deaf people are also presented. Published
documents can empower deaf people to realize their right to enjoy the highest
attainable standard of health. According to the United Nations enjoyment of the highest
attainable standard of health is one of the fundamental rights of every human being. Recently,
disparate health care of people with disabilities has captured the attention of the international
health and development community (Tomlinson et al., 2009; WHO, 2011). The need to
identify barriers that people with disabilities face in accessing health services at a variety of
levels, and to find optimum strategies to integrate their needs into primary health care
systems by focusing on delivering effective interventions have been highlighted as priorities
(Tomlinson et al., 2009). The World Federation of the Deaf which represents mainly deaf
people who are part of signing communities (characterized with a capital D) indicated that the
Convention on the Rights of Persons with Disabilities is a powerful tool for working toward
achieving human rights for deaf people. This convention is generally acknowledged as
marking a paradigm shift concerning attitudes and approaches toward persons with
disabilities, including deaf persons. It shifts from viewing persons from viewing them as
“objects of charity, medical treatment, and social protection toward viewing persons with
disabilities as subjects with rights, who are capable of claiming those rights and making
decisions for their lives based on their free and informed consent, as well as being active
members of society” (UN-SCRPD, 2006). Access is a broad topic that is regularly discussed
within the Deaf community. It involves access to communication, information,
education and culture, as well as access to services, including to health services. Research
about access to health care is generally conducted with regard to sociodemographic factors,
investigating the relationship between need, provision, and utilization of health services
(Gulliford et al., 2002). In migrant and ethnic minority groups, challenges in health care
access have been studied in increasing numbers (Nielsen & Krasnik, 2010; Scheppers, van
Dongen, Dekker, Geertzen, & Dekker, 2006). Community perceptions of health such as
diverse experiences and understanding of ill-health as well as language and communication
barriers have been linked to challenging health care access in culturally and linguistically
diverse populations (Komaric, Bedford, & van Driel, 2012). Access to health care
affects the health of deaf people and a call for action to provide better access to health
services has been highlighted (Emond et al., 2015). Access to mental health services for deaf
people, as well as to access to primary care for those with mental illnesses have been studied
(Fellinger, Holzinger, & Pollard, 2012; Levine, 2014; Steinberg, Sullivan, & Loew, 1998;
Vernon, 2005). Despite the growing number of Deaf health programs and research initiatives,
accessing primary care for deaf people is often still very