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Meeting in the middle: improving communication in primary health care consultations with people with an intellectual disability
Abstract
The increased presence and participation in Australian society of people with an intellectual disability provides challenges for the provision of primary health care. General practitioners (GPs) identify themselves as ill equipped to provide for this heterogeneous population. A major obstacle to the provision of appropriate health care is seen as inadequate communication between the GP and the person with an intellectual disability, who may or may not be accompanied by a carer or advocate. This qualitative study in which five GPs, three people with intellectual disability, seven carers and two advocates (parent and friend) were interviewed was conducted in Brisbane, Australia. The aim was to better understand the factors that have an impact upon the success of communication in a medical consultation. Findings suggested that GPs were concerned with the aspects of communication difficulties which influenced their ability to adequately diagnose, manage and inform patients. Implications for practice management were also identified. People with intellectual disability reported frustration when they felt that they could not communicate adequately with the GP and annoyance when they were not included in the communication exchange. Carers were strong advocates for the person with intellectual disability, but indicated insufficient skill and knowledge to provide the level of assistance required in the consultation. The outcome was a model of cooperation that outlined the responsibilities of all players in the medical encounter, prior to, during and after the event.
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In the citing paper
“Healthcare practitioners may rely on communicating with a carer, family member, or support worker rather than with the service user directly.23,25,36,45,47”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [36]
In the citing paper
“A warm, friendly, and caring attitude from healthcare providers enables service users to access healthcare facilities and discuss sensitive health concerns.22,34–37”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [36]
In the citing paper
“Facilitators, in terms of reasonable adjustments in the clinical environment, may include easy-read information, coloured pictures, models, photos, videos, symbols, and demonstration dolls.13,36,48,65”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [36]
In the citing paper
“Additional time is often required for effective communication with people who have intellectual disabilities and/or autism.31,36,47,48”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [36]
In the citing paper
“This notion is also shared by healthcare professionals themselves, with suggestions that this would provide the opportunity to gain a better understanding of the medical history and communication style of the service user.36”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [36]
In the citing paper
“A joined-up approach, in which the sharing of inter-agency information is key, may help alleviate service users’ healthcare fears.26,36”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [36]
Citations
Cited by
Sorted by citations
A cascade of disparities: Health and health care access for people with intellectual disabilities
Krahn, G. L., Hammond, L., & Turner, A. (2006) · Mental Retardation and Developmental Disabilities Research Reviews · doi:10.1002/mrdd.20098 · Cited by 775
Ali, A., Scior, K., Ratti, V., Strydom, A., King, M., & Hassiotis, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070855 · Cited by 334
Buckley, N., Glasson, E. J., Chen, W., Epstein, A., Leonard, H., Skoss, R., Jacoby, P. A., Blackmore, A. M., Srinivasjois, R. M., Bourke, J., et al. (2020) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420924101 · Cited by 287
“Children with ID encounter greater communication barriers when interacting with their parents, carers and teachers, and in turn, with doctors and other health professionals, which can render detection and diagnosis of a specific condition more difficult (Ziviani et al., 2004).”
BackgroundDoherty, A. J., Atherton, H., Boland, P., Hastings, R., Hives, L., Hood, K., James-Jenkinson, L., Leavey, R., Randell, E., Reed, J., et al. (2020) · BJGP Open · doi:10.3399/bjgpopen20x101030 · Cited by 244
“Healthcare practitioners may rely on communicating with a carer, family member, or support worker rather than with the service user directly.(23,25,36,45,47) Carers do not always allow the service user to speak for themselves or carers might try to protect them from perceived harmful communication,(28) thereby prevent…”
BackgroundInfluentialRocque, R., & Leanza, Y. (2015) · PLoS ONE · doi:10.1371/journal.pone.0139577 · Cited by 212
“For instance, adults with intellectual disabilities and adolescents with chronic illnesses report stronger feelings of being dismissed and unrecognized as autonomous individuals [38, 41, 94].”
Background
Metadata
- Authors
- Ziviani, J., Lennox, N., Allison, H., Lyons, M., & Del Mar, C.
- Affiliations
- The University of Queensland (AU)
- University of Newcastle Australia (AU)
- Centre for General Practice, University of Queensland, Australia
- Venue
- Journal of Intellectual & Developmental Disability
- Publisher
- Informa UK Limited
- Published
- 2004-09
- Volume
- 29
- Issue
- 3
- Pages
- 211-225
- ISSN
- 0045-0634 (ISSN-L)
- 1366-8250
- 1469-9532
- OpenAlex
- W1990912406
- Cited by
- 132
- References
- 0
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 14 · 2021: 3 · 2020: 6 · 2019: 9 · 2018: 4 · 2017: 10 · 2016: 12 · 2015: 5 · 2014: 10 · 2013: 7 · 2012: 9
- FWCI
- 5.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Intellectual & Developmental Disability (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Health Sciences › Health Professions › General Health Professions › Interpreting and Communication in Healthcare
- Keywords
- intellectual disability, primary care, physician-patient communication, general practitioners, caregivers, patient advocates, medical consultation, communication difficulties, diagnosis and management, patient inclusion, practice management, cooperation models
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