Who is Asked and Who Gets to Answer the Health-Care Practitioner's Questions When Patients with Intellectual Disabilities Attend UK General Practice Health Checks with Their Companions?

When patients with intellectual disabilities (ID) attend a General Practice annual health check, current guidance directs health-care practitioners (HCPs) to involve them as much as possible as informants on their health. However, previous research based on interviews with participants suggests that during health consultations their communicative contributions of patients with ID may be sidelined in favor of information provided by caregivers perhaps because of HCPs' uncertainties about how to address the communication needs of these patients. The aim of this study was to establish, within naturally occurring health consultations, who HCPs select to answer their questions during health checks - patients with ID or their companions - and who actually answers. A nonconsecutive case series of primary care annual health checks involving patients with ID and their companions (n = 24) was conducted. Health checks were video-recorded and analyzed using tools of Conversation Analysis. We found that HCPs consistently selected patients with ID to answer their questions and patients then responded without significant gaps or dyfluencies in the immediate next turn at talk 70.1% of the instances. Companions were selected to respond in 9.3% of the total question-answer sequences recorded. Family members were more likely to be chosen as the addressee of HCP questions, compared to staff companions. They were also more likely to intervene to answer questions that had been directed at the patient. We conclude that health communication with patients with ID need not necessarily pose insurmountable challenges for HCPs, though the structure of the health check, with many questions requiring only a yes/no response may have reduced the communicative demand on patients. More research is needed to investigate how HCP involve patients with ID in more extensive health information exchange or health decision-making.