In order to ensure that respondents had experience in communication settings using face masks, we first carried out one-sample t-tests on the measures of frequency of mask wearing (see Table 3; see also Fig. 1 for mean and distribution of responses). Results revealed that on average the participants and their deaf and hearing friends wore masks most of the time. Their family members wore masks on average some of the time. Finally, on average participants spent around 1 and 3 h a day communicating with people who wear masks. The values for all measures were significantly higher than the lowest possible value, indicating that respondents had participated often in communication settings where face masks were worn. This pattern of results was the same when residents in the UK and Spain were considered separately (all ps < 0.001, all Cohen’s d > 2.2). However, independent samples t-tests comparing UK and Spanish residents showed that Spanish residents wore masks more often than UK residents, t (392) = 6.97 p < 0.001. Spanish residents’ interlocutors also wore masks more often than UK residents’ interlocutors: family members, t(393) = 8.96 p < 0.001, deaf friends, t (207) = 7.23 p < 0.001, and hearing friends, t(251) = 6.33 p < 0.001. Finally, Spanish residents spent more time communicating with people wearing masks than UK residents, t(390) = 5.94 p < 0.001.

Fig. 1
figure 1

a Mean responses to measures assessing frequency of interactions involving masks and to the study’s dependent variables. Mean values are shown for UK and Spanish residents separately, the grey bar in the background corresponds to the total average. b The distribution of responses to the same measures, a violin plot rather than a pie chart has been used for those measures that comprise continuous values

Then we carried out similar one-sample t-tests on the study-dependent variables (except for the wellbeing measure for which we did not have an appropriate standardised value to test against since it has not been validated in this population before). The results shown in Table 3 and in Fig. 1 indicate that on average, respondents thought that communication was “very difficult” in general and in professional settings, and “difficult” in informal social settings. They thought they had missed “a lot of information” in these interactions; they have felt disconnected from society “a good bit of the time”. On average, respondents thought that when they were experiencing difficulties in communication, people wearing masks engaged in alternative ways of communication “a little”. Finally, respondents thought that clear window masks help to solve communication problems “a moderate amount”, while transparent face shields help “a lot”. The values for all measures were significantly higher than the lowest possible value, indicating that respondents had significantly experienced communication difficulties, lack of information, and disconnection from society and at the same time, some efforts from others to communicate in alternative ways as well as the benefits of seeing their interlocutor’s lip patterns. This pattern of results was the same when residents in the UK and Spain were considered separately (all ps < 0.001, all Cohen’s d > 1.5).

Table 3 Average values and one sample t-tests for frequency of mask use and dependent variables
Fig. 2
figure 2

Heatmap showing the correlation between the different measures. Darker red colours represent a larger negative correlation while darker purple show a larger positive correlation

To study to what extent country of residence (− 1 = Spain, 1 = UK), level of deafness − 1 = HoH and 1 = deaf), onset of deafness (− 1 = late, 1 = early), knowledge of sign language (− 1 = non-signer, 1 = signer), and lipreading fluency (− 1 = non-fluent, 1 = fluent) predicted (A) experienced difficulty communicating with people wearing masks, (B) perceived loss of information and wellbeing and (C) opinion on ways to improve communication, we conducted a series of hierarchical regression analyses with the mentioned predictors and each of the dependent measures of interest. In the hierarchical regression the first step contained the main effects, successive steps (2 to 5) included all possible 2-way, 3-way, 4-way and 5-way interactions between predictors. There were no 4-way nor 5-way interactions (ps > 0.067), therefore we limit reporting to the highest-order significant interactions in Tables 4, 5, and 6 (the remaining statistics are shown in the Additional file 1). Significant interactions were decomposed to test for the simple effects using Aiken et al., (1991). For clarity, only the significant simple effects are reported in the text (the remaining statistics are shown in the Additional file 1). Figure 2 shows the correlations between the different predictors and outcome measures. Weak to moderate significant correlations can be observed between our predictors, indicating some degree of shared variance. For example, respondents with early-onset deafness also tended to be signers as well as deaf (as opposed of HoH). Deaf respondents also tended to be signers (as opposed to not knowing SL). Those who reported knowing sign language (signers) also reported being fluent lipreaders. Significant correlations can also be observed between the three different measures of difficulty communicating with others who wear masks and the rest of the outcome measures.

Table 4 Summary of significant effects in the regression analysis for experienced difficulty communicating with people who wear masks
Table 5 Summary of significant effects in the regression analysis amount of missed information, feeling of being disconnected from society, and wellbeing
Table 6 Summary of significant effects in the regression analysis on measures related with communication improvement

A. Experienced difficulty communicating.

Table 4 and Fig. 3 summarise the significant effects found in this section.

Fig. 3
figure 3

Overview of significant effects for the three measures of experienced difficulty communicating with people who wear masks: Level by onset of deafness interaction in general as well as professional and informal social situations (a), main effect of lipreading fluency in the general difficulty measure (b) and country of residence by level of deafness and Knowledge of SL interactions for the informal social settings (c). Effects that were significant in the simple slopes analysis are coded as follows, *** = p < .001, ** = p > .01, * = p < .05, and +  = p < .10

General difficulty communicating with people wearing masks

The main effect of lipreading fluency in the main effects model indicated that fluent lipreaders found it more difficult than non-fluent lipreaders to communicate with people wearing masks in general.

The single slope analyses of the level of deafness by onset of deafness interaction in the 2-way interaction model showed that people who became deaf later in life experienced more difficulty if they were deaf than if they were HoH, b = 0.224, t(367) = 2.175, p = 0.030, 95% CI [0.015, 0.300]. This was not the case for those with early-onset deafness (p > 0.2).

The single slope analyses of the country of residence by lipreading fluency interaction in the 2-way interaction model revealed a trend for fluent lipreaders in the UK to experience more mean difficulty than those living in Spain, b = 0.203, t(367) =  − 1.935, p = 0.054, 95% CI [− 0.280, 0.002], this was not significant in non-fluent lipreaders (p > 0.1).

Overall, people who had become deaf later in life experienced more general difficulty communicating with people who were wearing masks both if they were deaf and if they were HoH. Furthermore, fluent speechreaders, particularly in the UK, struggled to a greater extent.

Difficulty communicating with people who wear masks in professional settings

The main effect of country of residence in the main effects-only model indicated that UK residents found more difficult than Spanish residents to communicate with people wearing masks in professional settings.

The single slope analyses of the significant interactions on the 2-way and 3-way models showed significant simple effects only for the lipreading fluency by country of residence interaction in the 3-way interaction model (all other ps > 0.1). Specifically, for fluent lipreaders UK residents (1) perceived communicating with people using masks in professional settings more difficult than Spanish residents (− 1), b = 0.154, t(366) = 2.119, p = 0.035, 95% CI 0.008, 0.222], this was not significant for non-fluent lipreaders (p > 0.05).

Overall, people in the UK, particularly fluent lipreaders, found it more difficult to communicate with people wearing masks in professional settings than people living in Spain but there were no other significant differences.

Difficulty communicating with people wearing masks in informal social situations

The significant effects in the main effects only model showed that early-onset deaf people experienced less difficulty than people who became deaf later in life, signers experienced less difficulty than non-signers, and fluent lipreaders experienced more difficulty than non-fluent lipreaders.

The simple slope analyses of the level of deafness by onset of deafness interaction in the 2-way interaction model showed that deaf people who became deaf early in life experienced less difficulty than people who became deaf later in life, b = − 0.368, t(356) =  − 3.719, p < 0.001, 95% CI − 0.702, − 0.216], this was not significant for HoH people (p > 0.4). In addition, for participants with early onset deafness, deaf participants experienced less difficulty than HoH participants, b = − 0.193, t(356) =  − 2.241, p = 0.026, 95% CI − 0.467, − 0.030]. The opposite pattern was found for late deafness onset people, HoH people experienced more difficulty than deaf people, b = 0.232, t(356) = 2.462, p = 0.014, 95% CI 0.060, 0.537].

The simple slope analyses of the country of residence by level of deafness interaction in the 2-way interaction model showed that HoH people living in the UK experienced more difficulty compared to those living in Spain, b = 0.330, t(356) = 3.465, p < 0.001, 95% CI 0.179, 0.650], this was not significant for deaf people (p > 0.401).

The simple slope analyses of the country of residence by knowledge of SL interaction in the 2-way interaction model showed that residents in Spain who know SL experienced significantly less difficulty than non-signers, b = − 0.275, t(356) =  − 2.150, p = 0.032, 95% CI − 0.676, − 0.030], this was not the case for UK residents, (p > 0.8). In addition, signers who lived in the UK experienced relatively more difficulty than signers who lived in Spain, b = 0.348, t(356) = 3.910, p < 0.001, 95% CI 0.217, 0.656], this was not the case for non-signers (p > 0.05).

Overall, people who became deaf later in life, especially the HoH people, and fluent lipreaders experienced more difficulty communicating with people wearing masks in informal social situations. Furthermore, people in the UK reported communication with people using masks in informal social situations more difficult than Spanish residents. Indeed, Spanish signers reported less difficulties in communication in informal social situations.

B. Loss of information and wellbeing

Table 5 and Fig. 4 summarise the significant effects found for Amount of information missed, feeling of disconnection from society, and general wellbeing.

Fig. 4
figure 4

Overview of significant effects for the three measures of perceived loss of information and wellbeing: amount of information missed (a), feeling of disconnection from society (b) and general wellbeing: quality of life (c). Effects that were significant in the simple slopes analysis are coded as follows, *** = p < .001, ** = p > .01, * = p < .05, and +  = p < .1

Amount of information missed

The significant effects in the main effects only model showed that HoH people (− 1) missed less information that deaf people (1; p = 0.026), and signers (1) tend to miss more information than non-signers (− 1; p = 0.054).

The simple slope analyses of the level of deafness by onset of deafness interaction in the 2-way interaction model showed that for people with late-onset deafness, deaf people missed more information than HoH people, b = − 0.274, t(358) = 2.686, p = 0.008, 95% CI 0.081, 0.524], this was not the case for early onset deafness (p > 0.8).

Overall, signers and deaf, specifically late-onset deaf people, reported to have missed more information.

Emotional wellbeing: feeling of being disconnected from society

The main effect of deafness in the 2-way and the 3-way interaction model showed that deaf people (1) felt more disconnected from society than HoH people (− 1; p = 0.009).

The simple slope analyses of the country of residence by level of deafness interaction in the 2-way interaction model showed that deaf people living in Spain felt more disconnected from society than UK residents, b = − 0.202, t(365) =  − 2.288, p = 0.023, 95% CI − 0.632, − 0.048], this was not significant for HoH people (p > 0.06). In addition, in Spain HoH people felt less disconnected from society than deaf people, b = 0.376, t(365) = 2.983, p = 0.003, 95% CI [0.222, 1.080], this was not significant for UK residents (p > 0.8).

The simple slope analyses of the country of residence by knowledge of SL interaction in the 2-way and the 3-way interaction models showed a trend for residents in Spain who know SL to feel less disconnected from society than non-signers, b = − 0.264, t(365) =  − 1.874, p = 0.062, 95% CI − 0.939, 0.022], this was not the case for UK residents (p > 0.5).

The simple slope analyses of the 3-way interaction between level of deafness, onset of deafness, and knowledge of SL showed that none of the simple effects reached significance (all ps > 0.5).

Overall, deaf people reported feeling more disconnected from society. However, there is a trend for Spanish signers to feel less disconnected from society than non-signers.

General wellbeing: quality of life

Significant effects in the main effects-only model revealed that HoH people reported worst wellbeing than deaf people (p = 0.018), signers reported lower wellbeing than non-signers (p = 0.010), and non-fluent lipreaders reported lower wellbeing than fluent lipreaders (p = 0.038).

The simple slope analyses of the country of residence by onset of deafness interaction in the 2-way interaction model showed that for Spanish residents early-onset people (1) reported higher quality of life than people who became later in life (− 1; b = 0.384, t(367) = 2.583, p = 0.010, 95% CI 2.086, 15.405]), this was not the case for UK residents (p > 0.4).

The simple slope analyses of the level of deafness by onset of deafness interaction in the 3-way interaction model showed that for deaf people those who became deaf early in life (1) experienced more quality of life than people who became deaf later in life (− 1), b = 0.339, t(367) = 3.131, p = 0.002, 95% CI 2.897, 12.679], this was not significant for HoH people (p > 0.3).

The simple slope analyses of the country of residence by level of deafness interaction in the 3-way interaction model showed no significant simple effects (all ps = 0.07).

Overall, HoH people, deaf people with late-onset deafness, non-fluent lipreaders, and signers reported the worst general wellbeing.

C. Ways to improve communication

Table 6 and Fig. 5 summarise the significant effects found for the outcome variables included in this section.

Fig. 5
figure 5

Overview of significant effects for the three measures on respondent’s opinion on ways to improve communication: other’s efforts to engage in alternative communication such as gesturing or writing (a), efficacy of face masks with a clear window (b), and efficacy of transparent face shields (c). Effects that were significant in the simple slopes analysis are coded as follows, *** = p < .001, ** = p > .01, * = p < .05, and +  = p < .1

Perceived effort from others to improve communication

Significant effects in the main effects-only model revealed that deaf people reported that others have made more efforts to communicate with them while wearing a mask than HoH people (p = 0.016). Residents in the UK had experienced that other people had done fewer extra efforts to communicate with them (p = 0.009).

The analysis of the simple slopes of the country of residence by onset of deafness interaction in the 3-way interaction model showed a trend for UK residents to report that other had done less efforts to communicate with them than for Spanish residents, b = − 0.171, t(356) =  − 1.949, p = 0.052, 95% CI − 0.403, 0.002] for people who became deaf early in life but not for people with late-onset deafness (p > 0.4).

Overall, deaf people, and Spanish residents reported having observed more attempts by others to engage in alternative ways of communication such as writing or gesturing.

Perceived efficacy of transparent or clear window masks to facilitate communication

Significant effects in the main effects-only model revealed that signers (1) perceived clear window masks as less useful than non-signers (− 1; p = 0.003), and fluent lipreaders (1) thought that clear windows masks were more useful than non-fluent lipreaders (− 1; p = 0.02).

The analysis of the simple slopes of the country of residence by knowledge of SL interaction in the 2-way interaction model showed that for Spanish residents, non-signers perceived transparent masks as more useful than signers, b = − 0.439, t(368) =  − 3.194, p = 0.002, 95% CI [− 0.997, − 0.237], this was not the case for UK residents (p > 0.9). Additionally, signers who lived in the UK reported that clear window masks were more useful than signers in Spain, b = 0.260, t(368) = 2.711, p = 0.007, 95% CI [0.098, 0.614].There were no differences for non-signers (p > 0.05).

The analysis of the simple slopes of the level of deafness by knowledge of SL interaction in the 2-way interaction model showed that deaf people who do not know SL perceived transparent masks as more useful than signers, b = − 0.388, t(368) =  − 3.887, p < 0.001, 95% CI [− 0.822, − 0.270], this was not the case for HoH people (ps > 0.091).

There were no other significant simple effects for the significant interaction in the 3-way model (all ps > 0.174).

Overall, non-signers and fluent lipreaders found face coverings with a clear window more useful.

Perceived efficacy of transparent face shields to facilitate communication

Significant effects in the main effects-only model revealed that HoH people (− 1) considered face shields as less helpful to facilitate communication than deaf people (1; p = 0.049). Fluent lipreaders (1) valued the transparent face shields as more positive than less fluent lipreaders (− 1; p = 0.001).

Overall, deaf people and fluent lipreaders found transparent face shields more useful.

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