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‘I Have to Explain to him’: How Companions Broker Mutual Understanding Between Patients with Intellectual Disabilities and Health Care Practitioners in Primary Care

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)1215-1229
Number of pages15
JournalQualitative Health Research
Issue number8-9
Early online date18 Apr 2022
E-pub ahead of print18 Apr 2022
PublishedJul 2022

Bibliographical note

Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Research Trainees Coordinating Centre (PDF-2013-06-060). Publisher Copyright: © The Author(s) 2022.

King's Authors


People with intellectual disabilities (ID) experience marked health inequalities. This is attributable, at least in part, to suboptimal healthcare communication with health care practitioners (HCPs) whereby patients with ID and HCPs struggle to understand each other. Companions who attend healthcare appointments with patients with ID can support the communicative exchange between patient and HCP, but their involvement can have unintended consequences. This article uses Conversation Analysis (CA) to analyse video-recorded data from primary care health checks involving 24 patients with ID. This method shows that companions use their linguistic and experiential resources to intervene as ‘brokers’ to address real or potential threats to mutual understanding between patients with ID and HCPs. Their interventions can fill in the gaps in knowledge and understanding of the other parties, but also run the risk of deskilling the others in the interaction, by relieving them of the obligation to address communication breakdown directly themselves.

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