Lifting the lid on potential bias: Audiologists and Speech Therapists and Audiologists and South African Sign Language as a tool of service delivery in the Deaf Community and SASL users in South Africa - An explanatory study

Abstract

Background: Despite training in Deaf culture and South African Sign Language (SASL), many speech therapists and audiologists (STAs and AUDs) do not actively use sign language or integrate Deaf cultural perspectives into their practice. This reflects a bias toward the medical model of deafness, which prioritizes hearing and speech interventions over sign language. Many STAs and AUDs lack fluency and confidence in SASL, reinforcing the idea that spoken language is superior. This can marginalize Deaf patients, limiting their access to people-centred care. The continued exclusion of sign language highlights the need for a culturally inclusive approach that fully respects Deaf individuals' linguistic and cultural identity. Aims: Firstly, this study aimed to do the following: to explore STAs and AUDs’ knowledge and perceptions regarding Deaf culture and SASL, secondly, to understand the motivations of STAs and AUDs for using or not using SASL when providing services to Deaf individuals or SASL users. Thirdly, to evaluate the confidence levels of STAs and AUDs in delivering services using SASL. Lastly, to explore the perspectives of STAs and AUDs on the tensions between professionals in their fields and the Deaf community. Methodology: This two-phased explanatory mixed-methods study in Phase One, an online survey was completed by 24 AUDs and STAs. Phase Two involved semi-structured interviews with 12 AUDs and STAs. Participants were purposively recruited through professional platforms, including the South African Association of Audiologists (SAAA), National Student Speech- Language-Hearing Association (NABSLHA), and South African Speech-Language and Hearing Association (SASLHA) as well as Facebook. The inclusion criteria included Qualified AUDs and STAs working in public hospitals, schools, academia, or private practices, STAs and AUDs who have studied at South African universities where SASL was offered at an undergraduate level. Lastly, the participants had to be registered with the HPCSA. The exclusion criteria involved those who were still studying. iii Findings: The study found a significant gap between theoretical SASL training and practical competence among speech therapy and audiology professionals. While SASL was included in academic programmes, many felt unprepared to use it confidently in clinical settings. Limited practical exposure led to low proficiency, making communication with Deaf patients challenging and potentially affecting patient care. Participants highlighted the need for continuous, hands-on SASL training, including immersion in Deaf communities, real-world interactions, and working with interpreters. Many professionals felt their academic training did not align with clinical realities, emphasizing the need for structured, experiential learning throughout their education. The findings suggest that academic programmes should integrate more practical SASL exposure to enhance fluency and cultural understanding, ultimately improving people-centred care for Deaf individuals. Discussion: The discussion highlighted a significant gap between theoretical SASL training and the practical skills required for effective communication with Deaf patients in clinical settings. Many professionals reported feeling inadequately prepared to engage confidently with Deaf individuals despite having undergone formal SASL training. This disconnect underscored the need for a more immersive and practice-oriented approach to SASL education. To address these concerns, several recommendations were put forward. Firstly, integrating more robust SASL training into university curricula was emphasized as a critical step. This would involve moving beyond theoretical instruction to incorporate practical experiences such as structured interactions with Deaf individuals. Additionally, fostering stronger connections between universities and Deaf communities was proposed as a means to create authentic learning environments. These partnerships could facilitate mentorship programmes, community-based learning initiatives, and cultural competency training, all of which would help bridge the gap between academic learning and real-world application. Interprofessional collaboration was also identified as a key factor in improving communication access and service delivery. Encouraging cross-disciplinary teamwork among healthcare providers, interpreters, and Deaf professionals iv could enhance people-centred care and ensure that Deaf individuals receive equitable healthcare services. Recommendations: This study offers several recommendations to improve communication between AUDs, STAs, and Deaf patients. First, training programs should encourage direct engagement with Deaf patients, reducing reliance on interpreters, and fostering confidence in SASL. Second, professionals should be encouraged to communicate directly in SASL whenever possible, with the development of collaborative models involving STAs, AUDs and interpreters. Future research should include Deaf individuals' perspectives to assess communication strategies and the effectiveness of SASL training. Additionally, cultural competence training should be prioritized, promoting a people-centered approach and reflecting on professional biases. Finally, stronger collaborations between AUDs, STAs, and the Deaf community are essential to improve cultural and linguistic understanding, with partnerships between Deaf organizations to establish best practices for healthcare communication. Conclusions: This study underscores the critical need for South African STAs and AUDs to enhance their proficiency in SASL and deepen their cultural competence regarding the Deaf community. The findings reveal persistent barriers to communication and healthcare access, stemming from an overreliance on interpreters, systemic discrimination, and a prevailing medicalized view of deafness. Despite existing training programmes, many professionals continue to prioritize spoken language interventions over linguistic and cultural inclusivity, exacerbating the disconnect between healthcare providers and Deaf patients. Addressing these challenges requires a fundamental shift in professional attitudes, training curricula, and healthcare policies. Encouraging direct engagement with Deaf patients, promoting continuous SASL learning, and reducing dependence on interpreters are essential steps toward fostering equitable healthcare access. Moreover, strengthening cultural competence through ongoing reflection and collaboration with the Deaf community will ensure that STAs and AUDs provide people-centred care that respects the linguistic rights of Deaf individuals.