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Patient and Health Care Worker Perceptions of Communication and Ability to Identify Emotion When Wearing Standard and Transparent Masks

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Could transparent masks help to overcome communication barriers associated with widespread mask use among the general population, general health care workers, and health care workers who are deaf or hard of hearing in the United States?

Findings  In this survey study of 1000 members of the general public, 123 general health care workers, and 45 health care workers who are deaf or hard of hearing, participants perceived mask wearing as potentially impairing communication. Respondents reported an improved ability to read emotion with transparent mask use, and transparent masks were generally accepted across all 3 populations surveyed.

Meaning  These findings suggest that transparent masks have the potential to overcome barriers in communication brought on by universal mask wearing during the COVID-19 pandemic.

Abstract

Importance  Adoption of mask wearing in response to the COVID-19 pandemic alters daily communication.

Objective  To assess communication barriers associated with mask wearing in patient-clinician interactions and individuals who are deaf and hard of hearing.

Design, Setting, and Participants  This pilot cross-sectional survey study included the general population, health care workers, and health care workers who are deaf or hard of hearing in the United States. Volunteers were sampled via an opt-in survey panel and nonrandomized convenience sampling. The general population survey was conducted between January 5 and January 8, 2021. The health care worker surveys were conducted between December 3, 2020, and January 3, 2021. Respondents viewed 2 short videos of a study author wearing both a standard and transparent N95 mask and answered questions regarding mask use, communication, preference, and fit. Surveys took 15 to 20 minutes to complete.

Main Outcomes and Measures  Participants’ perceptions were assessed surrounding the use of both mask types related to communication and the ability to express emotions.

Results  The national survey consisted of 1000 participants (mean [SD] age, 48.7 [18.5] years; 496 [49.6%] women) with a response rate of 92.25%. The survey of general health care workers consisted of 123 participants (mean [SD] age, 49.5 [9.0] years; 84 [68.3%] women), with a response rate of 11.14%. The survey of health care workers who are deaf or hard of hearing consisted of 45 participants (mean [SD] age, 54.5 [9.0] years; 30 [66.7%] women) with a response rate of 23.95%. After viewing a video demonstrating a study author wearing a transparent N95 mask, 781 (78.1%) in the general population, 109 general health care workers (88.6%), and 38 health care workers who are deaf or hard of hearing (84.4%) were able to identify the emotion being expressed, in contrast with 201 (20.1%), 25 (20.5%), and 11 (24.4%) for the standard opaque N95 mask. In the general population, 450 (45.0%) felt positively about interacting with a health care worker wearing a transparent mask; 76 general health care workers (61.8%) and 37 health care workers who are deaf or hard of hearing (82.2%) felt positively about wearing a transparent mask to communicate with patients.

Conclusions and Relevance  The findings of this study suggest that transparent masks could help improve communication during the COVID-19 pandemic, particularly for individuals who are deaf and hard of hearing.

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Article Information

Accepted for Publication: September 26, 2021.

Published: November 22, 2021. doi:10.1001/jamanetworkopen.2021.35386

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Chu JN et al. JAMA Network Open.

Corresponding Author: Giovanni Traverso MB, BChir, PhD, Department of Mechanical Engineering, Massachusetts Institute of Technology and Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139 (cgt20@mit.edu).

Author Contributions: Dr Traverso had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr Chu and Ms Collins share co–first authorship.

Concept and design: Chu, Chen, Chai, Dadabhoy, Byrne, Wentworth, DeAndrea-Lazarus, Moreland, Wilson, Ghenand, Hur, Traverso.

Acquisition, analysis, or interpretation of data: Chu, Collins, Chen, Chai, Dadabhoy, Wilson, Booth, Hur.

Drafting of the manuscript: Chu, Collins, Chen, Chai, Dadabhoy, Moreland, Wilson, Hur, Traverso.

Critical revision of the manuscript for important intellectual content: Chu, Chai, Dadabhoy, Byrne, Wentworth, DeAndrea-Lazarus, Moreland, Wilson, Booth, Ghenand, Hur, Traverso.

Statistical analysis: Collins.

Obtained funding: Chai, Traverso.

Administrative, technical, or material support: Chen, Chai, Dadabhoy, Byrne, Wentworth, DeAndrea-Lazarus, Moreland, Wilson, Booth, Ghenand, Traverso.

Supervision: Chu, Chai, Wilson, Hur, Traverso.

Conflict of Interest Disclosures: Dr Chai reported receiving grants from the National Institutes of Health, the Hans and Mavis Psychosocial Foundation, the Defense Advanced Research Projects Agency, the Bill and Melinda Gates Foundation, and e Ink Corporation and receiving personal fees from Biobot Analytics outside the submitted work. Dr Byrne reported being founder of and holding equity in Teal Bio during the conduct of the study; holding equity in Advanced Chemotherapy Technologies outside the submitted work; and holding a patent for Elastomeric masks pending. Dr Wentworth reported being a cofounder of Teal Bio outside the submitted work and having a patent for mask design pending. Dr Moreland, Mr DeAndrea-Lazarus, Dr Wilson, and Ms Booth reported being members of the Association of Medical Professionals with Hearing Losses, a 501c3 nonprofit organization that supported survey dissemination to deaf and hard of hearing health care professionals. Dr Traverso reported having a financial interest in Teal Bio, a biotechnology company focused on developing the next generation of personal protective equipment including clear respirators, and having provisional patent applications surrounding clear masks pending. No other disclosures were reported.

Funding/Support: Dr Chu was supported by grant 5T32DK007191 from the National Institutes of Health. Ms Chen and Mr Ghenand were supported by the MIT Undergraduate Research Opportunities Program. Dr Chai was supported by grants K23DA044874 and R44DA051106 from the National Institutes of Health. Dr Traverso was supported by the Karl van Tassel (1925) Career Development Professorship and the Department of Mechanical Engineering at MIT and the Division of Gastroenterology, Brigham and Women’s Hospital.

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We would like to thank Ideas for Ears for sharing their survey with us.

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