Sound Communication? Language Preference of Deaf People in Accessing Services

Background Existing literature about access to services for deaf people is limited and focuses on the healthcare environment. Gaps in service provision for deaf people have been more widely recognised within the last two decades but providing for their language preference is poorly understood. Aims This doctoral study aimed to design, co-produce, and pilot the usability of a Language Preference Scale (LPS) tool intended to support the identification and articulation of language preference among Deaf people. The overarching purpose of the study was to establish whether a co-produced, Deaf-led tool could be meaningfully understood, completed, and applied in practice as a mechanism for expressing language preference, rather than to evaluate effectiveness or outcomes. To support this aim, the study explored Deaf participants’ experiences of accessing services, with particular attention to language preference, communication barriers, and experiences of misinterpretation or assumption within service contexts. These experiential data informed the participatory, Deaf-led co-production of the pilot LPS, ensuring that the tool reflected Deaf epistemologies and lived realities. A further objective was to examine non-Deaf specialist community service providers’ perceptions of the LPS, with a specific focus on usability, clarity, accessibility, and perceived relevance in practice. The study was explicitly framed as a pilot usability phase, concentrating on tool development and practical feasibility rather than formal evaluation, validation, or measurement of impact. Assessment of effectiveness and outcomes is therefore positioned as a subsequent phase of future research. Methods The study used a staged, participatory mixed-methods design focused on the co-production of a Language Preference Scale (LPS) pilot tool. Semi-structured interviews with six Deaf participants explored experiences of accessing services, with particular attention to communication challenges and language preferences. Thematic analysis informed the initial design of the LPS. The tool was co-produced with Deaf participants and designed to reflect variation in communication preferences across deafness, educational background, and service contexts. To support accessibility, the LPS was developed for independent community use and presented in British Sign Language, written English, and pictorial formats. Descriptive questionnaire data from 50 Deaf participants supported refinement of the pilot tool during real-world service interactions. Final-stage interviews with community service providers explored perceptions of the tool’s clarity, usability, and relevance. Results Seven themes were identified from the six semi-structured interviews with Deaf participants: emotion, avoidance, confidence and skills, family or friend involvement, healthcare, interpreters, and service sector. These themes reflect shared experiences and recurring challenges in accessing services and navigating communication across different contexts. Quantitative findings indicated changes in participants’ self-reported understanding of communication and awareness of who to approach for support. Quantitative responses showed notable shifts in agreement with statements such as “I understand people when they are communicating to me” and “I know who to ask to help explain information.” These findings suggest increased communication awareness within the selected service contexts. However, they do not constitute evidence of effectiveness or long-term impact. Despite these reported shifts, results also highlighted ongoing gaps in service access for Deaf people with differing communication needs and language preferences, indicating that access remains inconsistent across contexts. Interviews with community service providers generated four themes: lack of Deaf awareness, equity and equality, perceived usefulness of the LPS tool, and considerations for potential implementation. These themes reflect providers’ perspectives on communication access and inclusive practice, rather than evaluations of service outcomes. Collectively, they contributed to assessing the practical feasibility of embedding the LPS tool within routine service processes. Conclusions The continued lack of awareness and persistent gaps in provision for deaf people accessing services remain evident across service contexts. This research contributes new knowledge by proposing a co-produced Language Preference Scale (LPS) as a novel, developmental approach to addressing communication barriers in non-deaf specialist services. As a pilot tool, the LPS provides an original contribution by offering a structured means of identifying language preference alongside aspects of receptive and expressive communication, rather than attempting to measure outcomes or effectiveness. The LPS tool was designed to be accessible for self-assessment by Deaf individuals, with the option of professional support where required. While this study demonstrates the feasibility and perceived relevance of the tool, further research is required to formally pilot and evaluate its implementation across a wider range of services and participant groups. Such research would enable a systematic assessment of its effectiveness, scalability, and potential impact on service accessibility. The adaptability of the LPS tool for use within healthcare, education, and other service sectors highlights its potential applicability beyond the scope of this thesis. However, this potential should be explored through dedicated future studies that build on the pilot work presented here. In this way, the LPS tool establishes a foundation for ongoing research and development aimed at improving language access and promoting more inclusive service provision for deaf people.