Impact of Face Covering on Patient Communication and Health Outcomes (2020-2021)


Hearing loss is a common source of disability that can lead to poor speech perception and an increased reliance on lip-reading. Hearing loss has negative consequences on the ease and effectiveness of patient-provider communication and affects the degree to which patients have the capacity to obtain, process and understand information needed to ensure positive health outcomes.

The required use of face masks during the COVID-19 pandemic has eliminated visual access to facial information needed to complement suboptimal hearing in older patients. Face coverings also result in muffled, softer speech. With heightened anxiety around COVID-19, this added barrier to communication is likely affecting patient experience and the quality of patient-provider communication. The resulting impact on health literacy can lead to adverse health outcomes, particularly in older patients. 

Project Description

This project team will evaluate the impact of mandatory face mask use by providers, clinical staff and patients on communication and health outcomes in the outpatient setting. The team will focus on patients aged 60 or older, as this population has a higher risk of the effects of hearing loss compared to younger patients.

Currently, there are no objective data to guide efforts in mitigating the adverse impacts of face coverings on communication in healthcare settings. The team will investigate the impact of face masks through two primary outcome measures:

  1. Patient report of ease of communication
  2. Evaluation of listening effort and mental fatigue

The team will identify eligible patients to be evaluated by otolaryngology or audiology healthcare providers through a four-month study. The study will consist of 40 patients whose healthcare provider used a clear mask and 40 patients whose provider used a nonclear/standard surgical mask. By the end of each clinic visit, the team will obtain measures for analysis including hearing loss, patient provider communication, mental fatigue, anxiety, social engagement, health literacy and mask type.

The team will use statistical analysis to determine if there are differences in self-reported outcome measures by hearing status and/or mask type. Team members will use standardized assessments to measure the impact of face coverings on patient-provider communication and to define risk factors that can be used in future clinical trials to identify effective mitigation measures.

Anticipated Outputs

Manuscript; grant applications


Fall 2020 – Spring 2021

  • Fall 2020: Organize subgroups; start weekly meetings; develop questionnaire and survey materials; start recruitment and screening
  • Spring 2021: Analyze data; write abstract and manuscript; prepare grant

This Team in the News

Two Faculty Receive Inaugural Bass Connections Leadership Award


Image: Eric Westman, right, a physician at the Duke Outpatient Clinic and founder of Covering the Triangle, makes a delivery to Willie Patterson, staff member at a Crest Street neighborhood senior home, by Sam Miglarese/Duke Today

Face covering.

Team Leaders

  • Howard Francis, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Juliessa Pavon, School of Medicine-Medicine:Geriatrics
  • Kristal Riska, School of Medicine-Head and Neck Surgery and Communication Sciences

/graduate Team Members

  • Hannah Wessler, Medicine-MD
  • Jessica West, Sociology-PHD

/undergraduate Team Members

  • Jiayin Bao, Music (AB)
  • Bhavika Garg
  • Dana Guggenheim
  • Zella Hanson
  • Ila Kaul, Neuroscience (AB)
  • Margaret Lim, Biology (BS)
  • /undergraduate
  • Kevin Wiafe

/yfaculty/staff Team Members

  • Sherri Smith, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Heather Whitson, School of Medicine-Medicine:Geriatrics