Consequences for healthcare
The consequences of inaccessible communication are significant. Unmet communication needs can make it harder for people to access health information and maintain their physical and mental health, and cause avoidance of follow-up or review appointments, emergency care, and help for new health concerns.
Of NHS England patients who were denied the information and communication support they needed (RNID and SignHealth 2025):
- 47% gave up trying to make an appointment
- 21% missed an appointment
- 23% received a delayed or incorrect diagnosis
- 33% failed to understand their diagnosis
- 33% failed to understand the outcome of their appointment
- 25% failed to understand how to take medication or treatment prescribed
- 44% felt it resulted in them not getting the follow-up care they needed
This section considers consequences for the health of deaf people and people with hearing loss.
Sub-sections are as follows:
- Health literacy
- Avoiding or delaying care
- Missed appointments
- Diagnosis and treatment
- Safe use of medication
Health literacy
One consequence and driver of inaccessible healthcare is inaccessible health information.
Deaf people experience a ‘fund of information deficit’, due to fewer opportunities to encounter public health information than hearing people through everyday media such as podcasts, radio, and TV shows (Ferguson-Coleman et al. 2020, Flower et al. 2025, Rogers, Ferguson-Coleman and Young 2018, Rowland et al. 2025).
Past experience of inaccessible information, and low expectations around having better access in future leads to “a culture which does not actively seek out health information” (Rowland et al. 2025).
Deaf people have lower health literacy than the general public in regard to key health issues such as heart disease symptoms and risk factors, (Parmar et al. 2018, bowel cancer (Healthwatch Newham 2025), and dementia (Ferguson-Coleman et al. 2020).
Public health information is not always available to deaf sign language users. For example, during the COVID-19 pandemic daily televised updates were not translated into British Sign Language (BSL) until after the live broadcast, meaning deaf sign language users did not have equitable access to information about the pandemic (Rowland et al. 2025). People with a hearing, vision or dual-sensory impairment had a higher rate of mortality during the pandemic than those without (ONS 2022).
Health literacy can also be problematic for deaf people who are carers for deaf or hearing relatives, for example, family members with dementia.
Deaf people may face a double barrier, with few resources available within the deaf community, combined with lack of BSL interpretation and deaf awareness in mainstream dementia support groups (Ferguson-Coleman 2020).
Translation of health information into BSL is important, but health literacy is most improved when information is designed and presented with the cultural and linguistic needs and values of deaf sign language users in mind (Young, Ferguson-Coelman and Keady 2016).
The lack of culturally and linguistically appropriate support for deaf carers of people with dementia could also lead to safety concerns where deaf people do not have sufficient information about what is or is not safe for their family member with dementia (Ferguson-Coleman 2020).
Avoiding or delaying care
The emotional impacts of repeated communication barriers may result in deaf people and people with hearing loss becoming reluctant to engage with healthcare services (Parmar et al. 2025, Rogers, Ferguson-Coleman and Young 2018, Healthwatch Lancashire 2025, Healthwatch Rochdale 2025a).
Parmar et al. (2025) provided examples of this, quoting people who said “With the GP I find it so difficult and feel so upset by their behaviour that I don’t want to follow up on my health needs” and “I tend to avoid contacting the health services even when it’s likely I need them”. McMahon et al. (2021) argue that lack of trust in hearing healthcare services is a significant barrier to people seeking help with their hearing.
RNID and SignHealth (2025) found that 26% of sign language users had avoided calling an ambulance or attending A&E because of a lack of accessible communication. 26% had also avoided pursuing follow-up or review appointments for existing health conditions, while 40% had avoided seeking help for a new health concern. 47% of people who needed a communication support professional had avoided seeking help for a new health concern, as had 21% of people who are deaf or have hearing loss and need other reasonable adjustments.
However, this review identified no evidence about how long people delay seeking help, or the long-term impact on health outcomes.
Missed appointments
Research suggests that there is a risk of deaf people and people with hearing loss missing appointments.
This can occur because appointment information was not made available in an accessible format, or because lack of interpreters leads to last minute cancellations (Healthwatch Rochdale 2025a, Healthwatch Bolton 2024).
21% of people whose information and communication needs were not met indicated this had resulted in them missing an appointment (RNID and SignHealth 2025).
Diagnosis and treatment
Deaf people and people with hearing loss frequently experience barriers to fully understanding information they are given by healthcare professionals (HCPs). Of 95 people surveyed in one study, 59% had misheard a doctor or nurse in hospital, including misunderstanding diagnoses (Henn et al. 2021).
These misunderstandings may come from environmental factors such as loud background noise, or avoidable communication problems such as HCPs speaking too fast, wearing a mask, or turning away from deaf people while talking.
People are left without clear information, for example relating to how to take medication or pre-operation procedures (Terry Meara and England 2024). Parmar et al. (2025) reported that only 10.6% of deaf people and people with hearing loss surveyed understood all the information they had been given during NHS appointments, with 18.3% understanding none.
RNID and SignHealth (2025) found that when information and communication needs went unmet 33% of respondents had problems understanding their diagnosis and the outcome of their appointment, while 23% had experienced a delayed or incorrect diagnosis. This also affects deaf people and people with hearing loss acting as carers for family members (Ferguson-Coleman et al. 2020).
Communication barriers may prevent deaf people from being diagnosed correctly. Evaluation of a specialist cognitive clinic for the deaf community found a high incidence of misdiagnosis. Language and cultural differences can make cognitive diagnostic assessments challenging, with a lack of validated tools for working with deaf people. This may also be linked to a lack of knowledge about dementia within the deaf community (Harris et al. 2021).
Specialist clinics for deaf sign language users are not widely available. Similarly, deaf people face challenges accessing mental health services.
Barriers to communication such as a lack of BSL interpreters can increase the risk of misdiagnosis (Healthwatch Wandsworth 2017). If deaf people do not have access to an interpreter, they will also struggle to communicate how they are feeling to HCPs:
When I was pregnant, I was refused an interpreter by midwives. I didn’t know what was going on […] my dad had to come to the delivery room to interpret. After the birth I kept trying to tell the midwives I felt dizzy, but they ignored me. I collapsed and it was only on day 3 that they finally got an interpreter and they explained that I collapsed because I’d lost a lot of blood” (quoted in Healthwatch Warrington 2023).
There is limited evidence available about the experiences and outcomes of people receiving specialist care. This review primarily found studies focused on radiography and radiotherapy.
A survey of MRI radiographers found that every respondent had experienced difficulties communicating and relating with deaf people and people with hearing loss.
Being able to communicate with patients is important during MRIs, allowing HCPs to provide instructions and keep people calm (Ogwudu 2025).
Specific breathing techniques such as deep inspiration breath hold used to reduce cardiac toxicity in breast cancer radiotherapy can be hard to communicate to patients, with significant consequences for health if not properly used (Saby 2025). This suggests that further research into other areas of specialist healthcare is needed.
Safe use of medication
Communication barriers can also increase the risk of unsafe use of medication.
Alhusein et al. (2018, 2019) found that pharmacists in Scotland had significant concerns about patient safety for people with sensory impairments, including hearing loss.
Pharmacists stated that they were often not certain if a person had a sensory impairment, as people would “nod and smile” to indicate having heard, or ‘hide’ their hearing loss from the pharmacy staff. This could potentially compromise safety if the pharmacy staff incorrectly believed information about safely storing and taking medication had been successfully communicated.
47% of sign language users report that they did not understand how to take the medication or treatment given to them by HCPs as a result of not having their information and communication needs met, and 35% of people who need a communication professional reported the same issue (RNID and SignHealth 2025).
Older adults with sensory impairments have a high likelihood of comorbid conditions and therefore needing multiple medications (polypharmacy).
Older adults receiving polypharmacy experience lack of support and accessible information. Tools such as ordering online can help, but also reduce the number of opportunities for pharmacists to speak to people to check they’ve understood their medication.
Some people may not fully hear medication instructions over the phone or in person, and make assumptions based on what they expect to hear, or partial lip reading (Smith et al. 2019).