The inclusion of adults with intellectual disabilities in health research - challenges, barriers and opportunities: a mixed-method study among stakeholders in England

BACKGROUND

The study aims to understand system barriers to research participation for people with intellectual disabilities.

METHODS

A mixed-methods approach examined the inclusivity of people with intellectual disabilities (IDs) in a random sample of National Institute for Health and Care Research (NIHR) studies conducted in 2019-2020. An online questionnaire (stage 1) was sent to the selected studies lead investigators. An expert by experience panel of 25 people with intellectual disabilities (IDs, stage 2), discussed the stage 1 feedback. Descriptive statistics for quantitative data and thematic analysis for qualitative data was conducted.

RESULTS

Of 180 studies reviewed, 131 studies (78%) excluded people with IDs. Of these, 45 (34.3%) study researchers provided feedback. Seven (20%) of the 34 studies which included people with IDs gave feedback. Of all respondents over half felt their study had some relevance to people with IDs. A minority (7.6%) stated their study had no relevance. For a quarter of respondents (23.5%), resource issues were a challenge. Qualitative analysis of both stages produced four overarching themes of Research design and delivery, Informed consent, Resource allocation, and Knowledge and skills.

CONCLUSION

Health research continues to exclude people with IDs. Researchers and experts by experience identified non-accessible research design, lack of confidence with capacity and consent processes, limited resources such as time and a need for training as barriers. Ethics committees appear reluctant to include people with cognitive deficits to 'protect' them. People with IDs want to be included in research, not only as participants but also through coproduction.

Developing a research approach to explore therapeutic relationships with children and young people with complex needs: A critical reflection

This article is a critical reflection on the development of a research approach to explore therapeutic relationships in psychodynamic music therapy with children and young people with complex needs. The article starts by positioning my research project within contemporary music therapy discourse, discussing literature from psychoanalysis, music therapy research and a broad range of related disciplines. This illustrates the development of a socially, culturally and politically contextualised understanding of the theory and practice of music therapy with people with complex needs and outlines the theoretical concepts which support and inform my research approach. Fricker’s Epistemic Injustice paradigm is used to provide a contextualised philosophical concept to explore why and how people with complex needs are frequently excluded from academic research. A critical disability study perspective is used to outline the need for inclusive research practice to develop epistemological frameworks and methodologies to include the voices of those marginalised in society. The article concludes with an outline of my current research project, discussing how the ideas previously described have informed the research approach and been integrated into the project design.

Conducting theory-based qualitative interviews with adults with intellectual disabilities and their carers: Adaptations to facilitate participation

BACKGROUND

Adults with mild-moderate intellectual disabilities have difficulties in accessing traditional evidence-based health promotion initiatives despite experiencing health disparities; yet there are few studies with this group and their carers exploring how their needs can be met.

METHOD

This study adapted a behaviour change theory-based approach to interview this group and their carers and ascertain if this method was feasible and appropriate to explore how healthier behaviour uptake could be improved amongst adults with intellectual disabilities.

RESULTS

A community-based, staged recruitment process and iterative approach to data collection and analysis supported successful participation amongst adults with intellectual disabilities in behaviour-change theory-based interview research. Methodological adaptations enabled richer data collection amongst adults with mild-moderate intellectual disabilities and carers.

CONCLUSIONS

It is feasible and important to include adults with intellectual disabilities in qualitative health research that uses theory-based complex constructs to inform development of person-centred health promotion interventions with this underserved cohort.

Successful strategies for including adults with intellectual disabilities in research studies that use interpretative phenomenological analysis

BACKGROUND

Adults with intellectual disabilities are not often asked to participate in health research. This may be because researchers perceive them as unable to participate meaningfully with or without significant support and anticipate difficulty in obtaining ethical approval because of issues concerning consent and mental capacity. This means that the voices of adults with intellectual disabilities are often missing from health research and their experiences and views are unexplored.

AIM

To share successful strategies for accessing, recruiting and collecting data from a purposive sample of adults with intellectual disabilities from a study that used interpretative phenomenological analysis (IPA).

DISCUSSION

IPA is a person-centred, flexible and creative approach to research. Meaningful collaboration with people with intellectual disabilities, their families, carers, advocacy group managers, specialists in intellectual disability services and research supervisors was vital to the success of the study. The authors share practical strategies for including people with intellectual disabilities, from the perspective of a novice researcher who is an outsider to the field of intellectual disability.

CONCLUSION

It is important to include people with intellectual disabilities in healthcare research. This article presents a framework to support researchers outside the specialist field of intellectual disabilities in achieving this.

IMPLICATIONS FOR PRACTICE

Personal views and perceptions of healthcare are important if health services are to meet individual needs. Adults with intellectual disabilities often receive poor healthcare and have poorer outcomes. This will be perpetuated without their input into research. People with intellectual disabilities can make valuable contributions to the evidence base.

Risk factors for falls among adults with intellectual disabilities: A narrative review

BACKGROUND

The prevalence of falls involving people with intellectual disabilities (ID) is high in comparison with the general population. There has been little evidence to date on the contributing risk factors. The objective of this review was to identify risk factors for people with intellectual disabilities.

METHOD

Literature searches were conducted using electronic databases to explore evidence on the subject, and narrative synthesis was employed to analyse the results.

RESULTS

Seven risk factors were identified: decreasing physical ability, epilepsy, paretic conditions, impulsiveness, previous falls, incontinence and non-use of assistive equipment. Thematic analysis identified factors across the four concepts: the person, the situation, ongoing and protective factors.

CONCLUSION

Factors for falls involving people with intellectual disabilities are dynamic and multifactorial. Some are specific to the population; however, further research is required to develop the understanding of the possible reasons. The findings have implications across policy, education, practice and research.

The Scottish police caution: do individuals with intellectual disabilities understand a verbally presented police caution, and can comprehension be improved?

This study considers comprehension of the Scottish police caution amongst people with an intellectual disability (n = 30). It applies techniques to the caution that are suggested to increase its 'listenability', to examine whether this could be a successful method of improving understanding. These techniques include providing instructions, further explanations and listing information. Half of the participants were assessed using the original version and half the modified version. Participants were assessed using an abbreviated IQ assessment, a measure of working memory and measure of state anxiety to consider potential predictors of performance. The modified version did not improve performance, with no participants judged to have adequate understanding in either version.

More Than Words: The Use of Video in Ethnographic Research With People With Intellectual Disabilities

There is a tendency to exclude people with intellectual disabilities from participating in research about their own lives. While the use of participatory research approaches is increasing, the methods used for engaging people with intellectual disabilities in research are generally limited to interviews and focus groups. Yet a focus on the spoken or written word can present a challenge for those who may prefer to use alternative forms of communication. The purpose of this article is to share the methodological insights gained from a visual ethnographic study that sought to explore the experiences of people with intellectual disabilities engaged in nature based (or "green care") therapeutic interventions for health and well-being. If used within carefully negotiated relationships, we suggest that video can be an empowering visual medium for doing research that can help to elicit the experiences of people with intellectual disabilities firsthand, without having to rely on the views and perspectives of other people.

'I'm sure we made it a better study…': Experiences of adults with intellectual disabilities and parent carers of patient and public involvement in a health research study

Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups' unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice.

Recruiting people with disabilities as research participants: challenges and strategies to address them

There are 56.7 million people with disabilities (PWD) living in the United States; yet, PWD are significantly underrepresented in health research. Even when researchers purposively seek to include PWD in studies, challenges emerge related to recruitment and retention, leading to inadequate representation and surface understandings of this population. This in turn contributes to the perpetuation of implicit and explicit health disparities that are already experienced by this population. Grounded within a qualitative, community-based participatory health research framework, we highlight challenges associated with recruiting and retaining PWD in health research, including a critical analysis of the research enterprise structure, how this disables accessible research practices for PWD, and leads to continued skepticism among PWD regarding the value of participating in research. Finally, we propose solutions to create and maintain a culture of access and inclusion as well as long-term collaborative and equity-focused partnerships.