Title: Telemedicine as a treatment for Deaf people with common mental health problems who use British Sign Language: a mixed methods feasibility study
Funder: Department of Health and Social Care

Abstract: Research question: Is telemedicine psychological therapy in British Sign Language effective?Background: Deaf people experience poorer mental health, health-related outcomes and experience inequality in accessing services compared to the hearing population. Telemedicine potentially offers creative and accessible solutions for addressing a range of health-related matters amongst communities who use a signed language because of its visual modality. Telemedicine is an under-developed area of study as the efficacy of the delivery medium and its effectiveness regarding health improvements in general and psychological interventions has not yet been tested with Deaf sign language users.Aims and objectives: The overarching research aim is to test the acceptability, feasibility and preliminary efficacy of telemedicine intervention in the delivery of psychological therapy in BSL to Deaf people who are experiencing anxiety and/or depression. The objectives are:i.To test the equivalence of two modes of remote delivery of psychological assessments in BSL (EQ-5D-5L and CORE-10/6D) (asynchronous online assessment versus synchronous in person assessment) (Study one); ii.To co-develop with the Deaf community a bespoke Patient Experience Survey in BSL suitable for culturally Deaf people and to test its acceptability and reliability (Study two); iii.To carry out a feasibility study to assess the acceptability, demand and limited-efficacy testing of the two modes of therapeutic engagement in BSL (in person or remote via video conferencing) neither case utilising an interpreter (Study three); iv.To explore the acceptability of randomisation of the two modes of therapeutic engagement (Study three); v.To test the feasibility of recruitment to a large scale trial designed to evaluate the effectiveness of the two modes of therapeutic engagement (Study three).Methods: Study one: Experimental study with randomised crossover design (n=35) involving two modes of remote delivery (asynchronous online assessment in BSL versus synchronous face-to-face assessment) of EQ-5D-5L BSL and CORE-10/CORE-6D BSL plus qualitatively interview of sub-sample of participants. Study two: Exploratory qualitative study using focus groups (n=10) to develop a culturally appropriate BSL Patient Experience Survey followed by pilot testing of acceptability and reliability (n=50). Study three: Feasibility study to assess the acceptability, demand, and limited efficacy testing of the two modes of therapeutic engagement (in person or remote via videoconferencing) (n=70). Timelines for delivery (0.6 wte fellowship): Preparatory work, ethical application and literature review (year 1) Study one: winter 2020 - winter 2021 (year 2/3) Study two: spring 2020 -h; spring 2021 (year 2/3) Study three: summer 2021 -h; summer 2022 (year 3/4) Anticipated impact and dissemination: The findings will inform a full trial of telemedicine therapy for Deaf people with common mental health problems. New understanding of the impact of the mode of delivery of BSL self-report assessments is of relevance to all instruments delivered in a visual language. The patient experience BSL questionnaire will be available for any clinical or research application concerning Deaf patients where a measure of patient experience is required. Results will be disseminated in BSL and English via social media feeds, Deaf organisations/networks and academic publishing and conference outlets.

Lay abstract: Background to the research: This research concerns Deaf people who use British Sign Language (BSL) and who experience anxiety and/or depression. BSL, the language of the Deaf community in the UK, is a visual, non-written, language. There are around 87,000 Deaf BSL users. Deaf people are more likely to have poorer mental health than the general population. They face difficulties in accessing services and recovery from mental health difficulties is often not as good.In some parts of the UK, Deaf people receive therapy from Deaf professionals in BSL, without an interpreter. But this is not always possible because Deaf people live all over the country and there are very few Deaf therapists. One possible solution is for Deaf people to have therapy in BSL via videoconferencing but we do not know if this is helpful. We are unsure if it would be as effective as the Deaf person having face-to-face therapy in person without this technology. Another potential problem is measuring recovery. Usually a therapist will ask a patient to fill in questionnaires about their mood and how they feel at the start of therapy and at regular intervals to track progress and recovery. These are available in BSL but we do not know if patients will respond differently or not if they do this 'live' in BSL with a therapist or if they do this via a computer in response to a video.It is also important to find out what patients' experiences are of health services. Amongst hearing people there is a questionnaire designed to do this. There is not one for Deaf people that matches their culture and language.Aims of the research: To find out if video conferencing therapy in BSL is helpful for Deaf people who use BSL and have anxiety and/or depression. To find out if doing an assessment online in BSL is the same as doing it live in BSL. To design and test a new questionnaire about Deaf patients' experience of services By doing this work we will know whether we should develop a much bigger study to test video conferencing psychological therapy for Deaf patients. Design and methods: Study one: We will recruit 35 Deaf people. Some will do questionnaires in BSL online, some will do them face-to-face. They will then swap over. We will analyse the results to find out if people respond in the same way regardless of how they do the questionnaire. Study two: We will design a new questionnaire called BSL Patient Experience Survey. It will include questions in BSL that are important and relevant to Deaf people and their experience. We will check with Deaf people if it makes sense to them and will test it out with 50 Deaf people. Study three: We will compare therapy in BSL via videoconferencing and via face-to-face. We will recruit 70 Deaf people with anxiety and/or depression. By doing this study we will test out if we can recruit enough people in good time, if Deaf people mind being told which therapy to have, if there are differences in the recovery of Deaf people who received therapy via videoconferencing compared to those who received face-to-face therapy. Participants will complete the BSL Patient Experience Survey and some will be interviewed. Patient and public involvement: Deaf people who use BSL, some of whom have mental health patient experience, will be in an advisory group and will help design the Patient Experience Survey.Dissemination: Results will be in BSL and English with up-to-date feeds via social media. We will use professional Deaf organisations and networks as well as traditional academic publications.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: EAR