Ottavia Carlino (University of Salento)

Accessibility is increasingly at the centre of the international debate, especially in view of the ongoing efforts to achieve the digital transformation in all fields. A field where accessibility is fundamental is certainly healthcare in which placing the person at the centre of the caring process is the key to facilitating access to and use of health care services, improving the person’s experience and achieving more satisfactory results. Communication between healthcare professionals and patients takes place in different contexts and with a wide range of purposes. In all cases, it is crucial that communication be effective and timely. However, it becomes particularly challenging when healthcare professionals attend hearing-impaired patients, those who do not understand the local language, or in the presence of physical barriers that hinder listening, such as glass panels, face masks, etc.  

A number of projects examined the specific problems of two-way communication between deaf sign language users and hearing users (Sobhan et al., 2019; Tsimpida et al., 2018), and on communication between healthcare professionals and foreign patients (Schouten et al., 2020; Baraldi et al., 2021; Anderson et al., 2021). Also, because of the COVID-19 pandemic, studies on communication difficulties in the presence of physical barriers have been launched (Chodosh et al., 2020; Trecca et al., 2020; Rahne et al., 2021). Yet, there are no specific studies on communication problems with people who are hearing impaired or have temporary hearing loss, nor are there any systems designed to facilitate communication between healthcare professionals and such people.

For this reason, the ABC Stereo project aims to find a common solution for three different groups of patients: the main target group are patients with chronic hearing loss (the elderly) or temporary hearing loss (those who have suffered an injury to the auditory system); the secondary target group are foreign patients (whenever an interpreter is not available), and the third target group is represented by patients who are required to communicate through physical barriers (as they are either contagious or septic). Although these patients are widely different, we believe that a common solution to their problems can be found: using automatic voice recognition to create real-time subtitles could represent a step forward towards the establishment of a truly symmetrical relationship between healthcare professionals and patients. In addition, the use of voice recognition combined with voice-to-text technology would enable the whole conversation to be transcribed for possible future use.

The project consists of five main phases: the theoretical study of real-time subtitling and healthcare professional-patient communication; the data gathering through questionnaires and interviews with healthcare professionals and patients; the identification of the voice recognition and subtitling technologies best suited to healthcare contexts; the on-site testing in at least one hospital unit and one nursing home; finally, the identification and resolution of possible shortcomings and failures of the system and the awareness raising among healthcare managers and staff on the benefits it could bring.

In order to define the needs of healthcare professionals, we created a Google form preliminary self-completion questionnaire and sent it to Italian physicians, nurses, and social and health workers. The results of this questionnaire helped us to understand the main communication difficulties encountered and whether there was an interest in adopting a new communication system. Next, to better delineate the features of this communication system, we conducted semi-structured interviews with a selected number of healthcare professionals based on their answers to the preliminary questionnaire. Using the data collected directly from the end users, in the next phases of the project we will choose among the technologies that are currently available those best suited to healthcare settings and user needs, and we will go ahead and test the system outlined in at least one hospital unit and one nursing home, where we will compare the performance of the healthcare workers and the compliance of the patients with and without our system. Once the shortcomings of the system have been traced and fixed, awareness will be raised among the staff of hospitals and nursing homes of the need to adopt a patient-centred communication system to minimise errors, often due to the time constraints clinical practice entails.


Anderson, L. J.; Cirillo, L. (2021). The emergence and relevance of cultural difference in mediated health interactions, Health Communication, 36 (9), 1101-1114.

Baraldi, C.; Laura Gavioli; L. (2021). When clinicians and patients do not speak the same language: a preface to interpreting in health care, Health Communication, 36 (9), 1057-1058.

Chodosh, J.; Weistein, B. E.; Blustein, J. (2020). Face masks can be devastating for people with hearing loss, British Medical Journal, 370.

Rahne, T.; Fröhlich, L.; Plontke, S.; Wagner, L. (2021). Influence of surgical and N95 face masks on speech perception and listening effort in noise, PLoS ONE, 16 (7).

Schouten, B. C.; Cox, A.; Duran, G.; Kerremans, K.; Köseoğlu Banning, L.; Lahdidioui, A.; Van den Muijsenbergh, M.; Schinkel, S.; Sungur, H.; Suurmond, J.; Zendedel, R.; Krystallidou, D. (2020). Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach, Patient Education and Counseling, 103 (12), 2604-2608.

Sobhan, M., Chowdhury, M. Z., Ahsan, I., Mahmud, H., & Hasan, M. K. (2019). A Communication Aid System for Deaf and Mute using Vibrotactile and Visual Feedback. 2019 International Seminar on Application for Technology of Information and Communication (iSemantic), 184-190.

Trecca, E. M. C.; Gelardi, M.; Cassano, M. (2020). COVID-19 and hearing difficulties,  American Journal of Otolaryngology, 41 (4).

Tsimpida, D., Kaitelidou, D., & Galanis, P. (2018). Barriers to the use of health services among deaf and hard of hearing adults in Greece: a cross-sectional study. European Journal for Person Centered Healthcare, 6(4), 638-649.

Ottavia Carlino is a first-year PhD student at the Department of Humanities at the University of Salento. Her doctoral project, which was started in January 2022, focuses on communication between healthcare professionals and patients and, in particular, concerns the use of real-time subtitling to facilitate communication between healthcare professionals and hearing-impaired or foreign patients or across physical barriers.