A Scoping Review of the Evidence on Disability Accommodations Targeting Equitable Communication Access in Health Care

Abstract

Purpose: The Americans with Disabilities Act (ADA) of 1990 protects the civil rights of people with disabilities, including their right to effective communication and equitable health care access through accommodations. The ADA website lists examples of accommodations (e.g., qualified notetaker, hearing amplifiers, cued speech interpreters), but no literature is cited to support this list. Scientific evidence is critical to advancing both the effectiveness and widespread implementation of accommodations. We scoped the literature on interventions supporting equitable communication access (accommodations) for adults with communication disabilities (CDs) in health care settings. We asked what accommodations have been studied, for what CD populations, and how they have been studied.

Method: We used a scoping review approach and conducted searches using MEDLINE, CINAHL, and Embase databases. Two reviewers independently screened abstracts and full texts indexed between January 1, 2003, and August 1, 2024. Data on accommodation type, CD-related health condition, setting, health care workers involved, evidence type, study design, and outcome were collected.

Results: Screening of 1,614 articles identified 58 investigations of 10 communication accommodations in health care settings. The range in number of publications rose from 0-2 to 2-9 over the 11-year period. The three most studied accommodations were customized plan, communication strategies, and augmentative and alternative communication aids (each 21%-22% of studies). Most investigations addressed populations with single CD-related conditions (e.g., aphasia), were descriptive (52%), and had sample sizes ≤ 50 participants. Speech-language pathologists infrequently provided or implemented accommodations (12% of all health care workers involved, by type of worker). Findings were typically positive, but outcome measures were heterogeneous.

Conclusions: The 10 researched accommodations addressed a wider range of CD populations as compared to accommodations found in policy documents, highlighting an opportunity to align policy and evidence. While accommodation studies generally yielded positive results, their small sample sizes, descriptive focus, and limited quantity suggest this research is early in its development. We outline potential strategies to advance knowledge on the implementation and effectiveness of communication accommodations in health care settings.