HINTS-ASL: Deaf Signers' Experience with Seeking Health Information

ID: 3165
School: Research Center/Lab
Program: Center for Deaf Health Equity
Status: Completed
Start date: August 2015
End Date: December 2020


The National Cancer Institute's Health Information National Trends Survey (HINTS) is heavily dependent on English, which presents serious language barriers to Deaf patients who use American Sign Language (ASL). The availability of HINTS and similar surveys in ASL and English that are valid for users of accessible technology and services will provide important insights on understanding the trends in Deaf people's use of the Internet for health-related purposes, therefore improving health communication models that will lead to better personal and public health within this underserved population.

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Kushalnagar, P., Paludneviciene, R., Bruce, S., Simons, A., & Sadler, G. (2016). HINTS-ASL: Inclusion of Deaf Adults in Cancer Health and Internet Research. Poster presented at the International Cancer Education Conference, Bethesda, MD.

Ryan, C., Kushalnagar, P., & Kushalnagar, R. (2016). Social Network Sites: Comparison of Deaf and Hearing Adult Users of SNSs for Health Related Purposes. Poster presented at the Undergraduate Research Symposium, Rochester, NY.


Harris, R. (2017, June 30). The evolution of graduate sign language teacher preparation programs. American Sign Language Teachers Association national biannual conference, Salt Lake City, Utah.

Harris, R., Kushalnagar, P., & Paludneviciene, R. (2017). Open-Ended Cognitive Interview Approach: Rethinking the Gold Standards for Translating Health Measures to ASL. Paper presented at the second Symposium on Signed Language Interpretation and Translation Research. Washington, DC.

Kushalnagar, P. (2017). HINTS-ASL survey: preliminary findings on deaf people's experience with video relay interpreting and on-site interpreting services in medical settings. Paper presented at the Telecommunications for the Deaf and Hard of Hearing Conference.

Kushalnagar, P., Harris, R., Paludneviciene, R., & Hoglind, T. (2017). Protocol for Cultural Adaptation and Linguistic Validation of Health Information National Trends Survey in American Sign Language (HINTS-ASL). Journal of Medical Internet Research Protocols. doi:10.2196/jmir.8067

Kushalnagar, P., Hoglind, T., Foreman, D., Lawrence, S., Lena, J., & Miller, J. (2017). Deaf Health Communication Film: Seek, Share, and Connect. American Public Health Association Film Festival, Atlanta, GA.

Kushalnagar, P., Ryan, C., Smith, S., & Kushalnagar, R. (2017). Critical Health Literacy in American Deaf College Students. Health Promotion International. doi:10.1093/heapro/dax022.


Kushalnagar, P. & Carrizales, S. (2018). Health inequity for shared decision making among deaf males with family history of cancer or of screening-eligible age for PSA tests. Poster presented at the HINTS Data Users Conference, Bethesda, MD.

Kushalnagar, P. & Ryan, C. (2017). Social network sites as accessible health venue for deaf people who use American Sign Language. Paper presentation at the American Public Health Association, Atlanta, GA.

Kushalnagar, P. (2018). Health film production as an educational experience for public health students. Presentation at the Undergraduate Public Health and Global Health Education Summit. Arlington, VA.

Kushalnagar, P. (2018). HINTS-ASL: Cultural adaptation and linguistic validation. Paper presented at the HINTS Data Users Conference, Bethesda, MD.

Kushalnagar, P., (2017). Perceived trust and understanding of cancer health information sources among deaf adults who use ASL. Poster presentation at the American Public Health Association, Atlanta, GA.

Kushalnagar, P., Engelman, A., & Sadler, G. (2018). Deaf Patient-Provider Communication and Lung Cancer Screening: Health Information National Trends Survey in American Sign Language (HINTS-ASL). Patient Education and Counseling. DOI:10.1016/j.pec.2018.03.003.

Kushalnagar, P., Moreland, C., Simons, A., & Holcomb, T. (2018). Perceived communication barrier in family is linked to increased risks for food insecurity among deaf adults who use American Sign Language. Public Health Nutrition. doi: 10.1017/S1368980017002865

Kushalnagar, P., Simons, A., & Kushalnagar, R. (2018). Use of Wellness Apps in Deaf American Sign Language Users to Improve Calorie Intake Differs Across Education. Poster presented at the mHealth Technology Showcase, National Institutes of Health, Bethesda, MD.

Kushalnagar,P. and Kushalnagar,R. (2018), Health-Related Information Seeking among Deaf Adults: Findings from the 2017 Health Information National Trends Survey in American Sign Language (HINTS-ASL), in Timothy M. Hale, Wen-Ying Sylvia Chou, Shelia R. Cotten, Aneka Khilnani (ed.) eHealth: Current Evidence, Promises, Perils and Future Directions (Studies in Media and Communications, Volume 15) Emerald Publishing Limited, pp.69 - 91.

Simons, Kushalnagar, P. Moreland, C. (2017). Health Disparity and Underdiagnosis of Hypertension in Deaf Signers. Poster presentation at the American Public Health Association, Atlanta, GA.


Kushalnagar, P, Holcomb, J, & Sadler, G.R. (2019). Genetic testing and eHealth usage among Deaf women. Journal of Genetic Counseling, 00: 1– 7. https://doi.org/10.1002/jgc4.1134

Miller, C.A., Biskupiak, A., & Kushalnagar, P. (2019). Deaf LGBTQ Patients' Disclosure of Sexual Orientation and Gender Identity to Health Care Providers. Psychology of Sexual Orientation and Gender Diversity. 62(2), 194-203. doi: 10.1037/sgd0000319

Spellun, A.H., Moreland, C.J., & Kushalnagar, P. (2019). Young Deaf Adults' Knowledge of Human Papillomavirus and Human Papillomavirus Vaccine's Effectiveness in Preventing Cervical, Anal, Penile, and Oral Cancer. Journal of Pediatric and Adolescent Gynecology. 32(3), 293-299. doi: 10.1016/j.jpag.2018.11.013


Argenyi M, Kushalnagar P. Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study. JMIR Public Health Surveill. 2019 Oct 2;5(4):e13658. doi: 10.2196/13658. PMID: 31579021; PMCID: PMC6777274.

Kushalnagar P, Holcomb J, Sadler GR. Genetic testing and eHealth usage among Deaf women. J Genet Couns. 2019 Oct;28(5):933-939. doi: 10.1002/jgc4.1134. Epub 2019 Jun 10. PMID: 31180177; PMCID: PMC6777990.