Post by Sally Shaw, Founding Director of Ideas for Ears
Across the length and breadth of the UK, people with hearing loss are being affected by measures to combat coronavirus. Physical distancing and face masks have dramatically changed the way we engage, interact and connect with each other.
When it comes to hearing access, the issues go beyond the need for information to be shared in an accessible form.
There are pain points when we interact with people and services remotely by phone or video, or at a physical distance of 1 or 2 metres, or when a face mask or other covering is being used. This is the case across health, care, work, shops, social and other settings.
The challenges permeate through all demographic groups: frail elderly, active older, workers, young people and children.
But there is also some hope. Hearing access has received an important boost thanks to the technological response to lockdown. In some ways, it has allowed a glimpse of how a future that is more inclusive and less exhausting might look.
What is hearing access?
Hearing access is about how easily people can hear and follow the spoken word. It refers to any barrier or challenge imposed on people with hearing loss and deafness by the environment, the behaviour of people, or the actions of organisations. It is about what is done (and not done) to ensure inclusion, participation and equality.
How has coronavirus affected hearing access?
Efforts to combat coronavirus have had unintended consequences for people with hearing loss and deafness. There are 3 sweeping impacts that could be with us for some time:
1) Introduction of face coverings:
- prevents people from lipreading or using mouth shape to assist them in hearing
- reduces quality and clarity of speech because of the physical barrier affecting how sound moves
- hides facial expression from those who use British Sign Language and need to see it
2) Physical distancing of 1 or 2 metres:
- can put people out of range of hearing aids and other hearing devices, especially if there is also a plastic screen in place and/or the speaker is wearing a face covering
- creates difficulties for those who are quietly spoken and unable to raise their voices
- affects confidentiality when voices have to be raised to assist someone with hearing loss
3) A transition to greater reliance on phone and video calls:
- excludes or adds a burden to those not able to hear well on the phone
- excludes or creates anxiety for those unsure how or unable to, access subtitles, captions or remote sign interpreting on video calls
- requires challenges caused by internet speeds and IT to be managed
How should hearing access be delivered in a Covid-19 world?
1) Seek guidance on transparent face coverings – and support their wide adoption
Masks and other face coverings are used to help keep people safe. They are encouraged in some settings and mandatory in others.
In some instances, it is permitted for a person with hearing loss to request that a mask is temporarily removed. To make such a request requires confidence, tact and risk awareness – and this places a heavy burden on people with hearing loss.
“There is the constant dilemma – should we ask for it to be removed or not? There is anxiety and stress – what happens if they react badly to the request? What if someone else does?” survey respondent, Ideas for Ears, May 2020
A more practical and desirable way forward, is for the UK to introduce widespread use of transparent masks, so long as the materials used do not cause greater levels of sound distortion or sound blocking.
A variety of products already exist – but not all are a suitable solution because they distort/block sound, fog up, or because (in some circumstances anyway) they do not allow enough of the facial expression to be seen.
Currently, there is little guidance or information available as to how safe and effective clear-panel masks are, how they should be used, washed and so on. There is also little in the way of product comparison information.
As well as masks with clear panels, there are also face shields and visors. We need to know whether shields and visors are a suitable alternative to masks – and if so, in what public places they can be used e.g. at customer service desks, in open plan offices, by visitors to care homes?
Advice for staff, service users and the general public is required about transparent masks, shields and visors. The guidance should stipulate what can (and should) be used and where e.g. open plan offices, banks, retail outlets, GP surgeries, hospital wards, care homes, hospitality outlets.
2) Introduce digital screens with live subtitles
All round the country, see-through screens have been installed into shops, offices and other public places to act barriers to germs.
This is both a reason and an opportunity to speed up the process of installing digital screens at customer service desks and other points of contact so that speech recognition apps can provide ‘always on, always available‘ live subtitles.
Digital screens can massively improve access to communication and information in GP surgeries, shops, banks, hotel reception desks and a wide variety of other settings.
3) Ensure hearing loops are available at customer service points
These pick up the voice of the speaker and send it directly into the hearing aids of a customer who is standing where they can receive the signal (and who has their hearing aids set to the T-setting/loop programme).
Hearing loops should be ‘always on, always available‘ and should be used and maintained in accordance with this best practice guidance.
4) Become proficient in clear speaking
Proficiency in clear speaking has a huge bearing on how easily you can be heard and understood by people with hearing loss. This is especially the case on phone calls, when lipreading and facial expressions are not available to assist understanding.
Speaking clearly and with appropriate enunciation, pacing and pausing is a skill learnt through practice and awareness of what is required and why. It is easier for some people than others to master.
The UK is rich in diversity of accents, languages and dialects and speaking clearly is not about adopting a false old-fashioned BBC broadcaster accent. It is about conscious consideration of your listeners and taking care to articulate words and pace the rate of speaking to match what works for them.
It is also involves appropriate use of other important communication strategies:
1. Ensure you have the listener’s attention before speaking
2. Use everyday vocabulary – no jargon or abbreviations.
3. Use short sentences and order sentences in a straight forward way
4. Give people time to understand and respond
5. Repeat if they ask you to and if they still do not hear, rephrase what you have said
6. Offer to write things down if that makes it easier, or use some other method to show what you mean
7. Match your facial expression, body language and intonation with what you are saying
8. Take equal turns in the conversation.
9. Make it easy for people to request and receive language and communication support, including speech-to-text transcription, lip-speakers and sign language interpreters
10. Placing responsibility on the speaker, so the burden of fault if there is failure is not placed on the listener
5) Ensure door entry systems are accessible
Use of intercom systems to get entry to GP surgeries and other public places has increased with lockdown and the need to control movement in and out of buildings.
Intercom systems, however, are a major barrier for deaf sign language users and others who have hearing loss.
For those who are hearing aid users, an intercom system can be made more accessible by ensuring that it has a (properly working) hearing loop built into its operation. However, this doesn’t solve the problem for those without sufficient hearing (or hearing aids) that permit them to use a hearing loop.
A digital text display would assist these individuals. In addition, a procedure should be in place so those unable to communicate via the intercom can e.g. press the buzzer 3 times to indicate they need someone to come to the door.
6) Take extra care with phone calls
With the right approach and understanding, phone calls can be made accessible to most people with hearing loss. Here’s how to make that happen:
1. Ensure staff are proficient in clear speaking and advertise this fact so people feel more confident to connect by phone call.
2. Ensure phone receivers pick up the voice in the optimum way, and likewise if a headset with microphone is being used.
3. Phone calls should be free of noise and echo, both of which make it much harder for listeners with hearing loss to accurately and easily hear what is said. This is achieved be ensuring the call is made in a quiet, echo-free room and/or background noise reduction technology is used.
4. Recorded messages and automated phone systems should be checked for speech intelligibility as these can create a big and frustrating access barrier for people with hearing loss.
- A mid-pitch voice will suit more people than a high or very low pitch voice
- The message should be spoken very clearly and at a moderate pace
- If numbers are given, provide the opportunity to hear them more than once.
5. ‘On-hold’ music can be uncomfortable for listeners if it is too jarring, set too loud, or has bursts of loud volume mixed quiet volume. It is difficult to find music that suits all, but it is likely to suit most if it is :
- set at a moderate to low volume
- is instrumental rather than vocal
- avoids harsh sounds or sudden bursts of volume
7) Make your video calls accessible
Video calls can greatly improve access to voice calls because they allow people to see the speaker and can give a better quality audio than phone calls (assuming the internet is a good speed and good quality microphones are being used).
Here’s what to do to make video calls possible for as many people with hearing loss as possible:
- Ensure good quality sound – ensure your microphone picks up your voice well. Use a plug-in microphone or headset if need be.
- Light up your face – it needs to be seen clearly and easily
- Keep the background simple – people with hearing loss must concentrate on the speaker’s face, so there is also a busy, bright or moving background, it will distract attention.
- Offer automated subtitles (or captions, which are slightly different from subtitles) – ensure these are available as an option to turn on/off. This involves selecting a video platform that makes this available and being open to changing the platform used if requested to use a different one. Some platforms work better than others for ease of use, readability and accuracy.
- Ask if other language or communication support is needed – see below
8) Be ready for requests for language and communication support
Most common requirement for support required on video calls:
- Captions / subtitles. Two types of communication professional provide transcription services: Electronic Notetakers, and Speech To Text Reporters. They work slightly different but in each instance they connect by web link, listen to what is said, and type up a live transcript that can be viewed and read either on the video call platform, a split screen, or a separate device.
- Online interpreting. Online interpreting involves connecting a BSL/English Interpreter via a webcam. The interpreter communicates over the computer screen.
Support that may be required for in-person situations e.g. where physical distancing or masks are in use:
- Electronic Notetakers or Speech-to-Text Reporter
- Manual Notetaker
- British Sign Language / English Interpreters
- Language Service Professionals for deafblind
- Signed Supported English
- Signed English
9) Offer alternative methods of communication
As well as phone and video calls, other methods of communication must be offered to ensure equality of access. Other forms of communication can include:
- Relay UK
Relay UK is the new name for the national text relay service. It no longer requires a special textphone to access this service and can be accessed on a computer, laptop, tablet or mobile phone. Involves a third party joining the call to listen and type up what’s said so the listener can read it.