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Authors: Raja Kushalnagar, Matthew Seita, Michaela Usha, Rachel Skwersky, Poorna Kushalnagar
Venue: Proceedings of the 22nd International Web for All Conference (W4A 2025) (2025). doi:10.1145/3744257.3744271
People who are Deaf or Hard of Hearing (DHH) experience significant health disparities primarily due to barriers in communication accessibility. Approximately 500,000 individuals in the United States primarily use American Sign Language (ASL) and frequently encounter difficulties with informed consent or intake forms that are presented exclusively in written English rather than their native language. Recent advancements in machine learning for Individual Sign Language Recognition (ISLR)—the translation of individual ASL signs—provide an opportunity to develop fully bilingual forms in both ASL and written English. These bilingual forms have significant potential in healthcare and employment contexts, ensuring comprehensive accessibility for Deaf signers fluent in ASL and hearing intake personnel fluent in English. We propose the concept of "joint bilingual navigation," which allows users to interact with digital forms either by signing into a camera-equipped device or through touchscreen interaction with written English. In this paper, we evaluate a bilingual informed consent and intake form that simultaneously supports navigation via natural ASL signs and traditional touchscreen input. Our user studies assessed interest and usability among Deaf signers and hearing non-signing intake staff, particularly focusing on obtaining informed consent and signatures from Deaf participants. The results indicate that such bilingual approaches are effective and positively received. These findings have broader implications, demonstrating that similar bilingual navigation techniques can be applied effectively in other domains requiring inclusive and accessible interactions.
Our research study focused on creating a joint bilingual informed consent or intake form that displays both an ASL and written English version of the informed consent or intake procedure that is fully accessible for both DHH participants, and healthcare professionals. While some minor improvements were suggested, both deaf signers and hearing non-signing healthcare participants found this technology to be accessible, easy to use, and worth expanding. DHH signers want to use interactive and responsive sign language recognition technology to navigate through processes that have historically been subject to the barrier of relying on written English. The development and testing of the ASL informed consent website application aims to ensure that informed consent processes are accessible to Deaf and Hard of Hearing individuals by providing information in their native language, ASL. By implementing features such as sign language recognition to navigate through the consent form, interactive user interface to improve participant experience and a streamlined onboarding process, this study has demonstrated the potential for the interactive joint bilingual form to bridge communication barriers in academic research and healthcare settings.
