Bilingual approach to online cancer genetics education for Deaf American Sign Language users produces greater knowledge and confidence than English text only: A randomized study.
Deaf American Sign Language-users (ASL) have limited access to cancer genetics information they can readily understand, increasing risk for health disparities. We compared effectiveness of online cancer genetics information presented using a bilingual approach (ASL with English closed captioning) and a monolingual approach (English text).



Bilingual modality would increase cancer genetics knowledge and confidence to create a family tree; education would interact with modality.



We used a parallel 2:1 randomized pre-post study design stratified on education. 150 Deaf ASL-users ≥18 years old with computer and internet access participated online; 100 (70 high, 30 low education) and 50 (35 high, 15 low education) were randomized to the bilingual and monolingual modalities. Modalities provide virtually identical content on creating a family tree, using the family tree to identify inherited cancer risk factors, understanding how cancer predisposition can be inherited, and the role of genetic counseling and testing for prevention or treatment. 25 true/false items assessed knowledge; a Likert scale item assessed confidence. Data were collected within 2 weeks before and after viewing the information.



Significant interaction of language modality, education, and change in knowledge scores was observed (p = .01). High education group increased knowledge regardless of modality (Bilingual: p < .001; d = .56; Monolingual: p < .001; d = 1.08). Low education group increased knowledge with bilingual (p < .001; d = .85), but not monolingual (p = .79; d = .08) modality. Bilingual modality yielded greater confidence creating a family tree (p = .03).



Bilingual approach provides a better opportunity for lower educated Deaf ASL-users to access cancer genetics information than a monolingual approach.
Department of Psychiatry & Biobehavioral Sciences, UCLA, USA; Department of Human Genetics, UCLA, USA; Institute for Society and Genetics, UCLA, USA. Electronic address: cpalmer@mednet.ucla.edu.
Christina G S
CG
Palmer
Gallaudet University, Washington DC, USA.
Patrick
P
Boudreault
Department of Health Policy and Management, Fielding School of Public Health, UCLA, USA.
Barbara A
BA
Berman
Department of Psychiatry & Biobehavioral Sciences, UCLA, USA.
Alicia
A
Wolfson
Department of Psychiatry & Biobehavioral Sciences, UCLA, USA.
Lionel
L
Duarte
Veterans Health Administration, UT, USA.
Vickie L
VL
Venne
Department of Human Genetics, UCLA, USA; Institute for Society and Genetics, UCLA, USA; Department of Biomathematics, UCLA, USA.
Janet S
JS
Sinsheimer
D022126:Access to Information; D000328:Adult; D003638:Deafness; D006233:Persons with Disabilities; D004522:Educational Status; D005260:Female; D020022:Genetic Predisposition to Disease; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D007802:Language; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D009369:Neoplasms / Q000209:etiology / Q000235:genetics*; D019986:Persons with Hearing Disabilities; D012307:Risk Factors; D020377:Self Efficacy; D012813:Sign Language
Deaf; Genetic counseling; Health disparities; Health education; Sign language