Accessible Communication in Healthcare for Deaf People as a Linguistic Minority: A Scoping Review of Barriers, Mediation Strategies, and the Governance of Care

Abstract

Abstract For Deaf sign language users, healthcare communication extends beyond a technical component of care and may influence equitable access, patient safety, and the effectiveness of healthcare systems. This scoping review mapped and synthesized the scientific literature on communication barriers, mediation strategies, and healthcare experiences of Deaf sign language users and other deaf populations included in studies addressing communication accessibility in healthcare, identifying institutional patterns that shape communication accessibility across care settings. The review followed the Joanna Briggs Institute recommendations and was reported according to PRISMA-ScR. Searches were conducted in February 2026 across PubMed/MEDLINE, Scopus, Web of Science, Embase, CINAHL, LILACS, SciELO, and PsycINFO databases. Thirty studies published between 2000 and 2025, in Portuguese, English, and Spanish, were included. The literature highlights persistent communication barriers throughout the care continuum, associated with a lack of sign language interpreters, the use of improvised strategies, technological limitations, and weaknesses in the institutionalization of accessible communication. These barriers are described as detrimental to autonomy, safety of care, the therapeutic relationship, and continuity of care, particularly in emergency, mental health, and other complex care settings. Mediation strategies range from informal solutions to institutionalized initiatives, the latter being less frequent but more sustainable. Accessible communication emerged as a structural dimension of equitable healthcare for Deaf sign language users. The findings suggest that health services may strengthen communication accessibility by considering institutional protocols, qualified sign language interpreter provision, professional training, systematic documentation of communication needs, and appropriate monitoring mechanisms.