‘Understanding’ as a practical issue in sexual health education for people with intellectual disabilities: A study using two qualitative methods.

Abstract

ObjectiveSexual health education is important in addressing the health and social inequalities faced by people with intellectual disabilities. However, provision of health-related advice and education to people with various types and degrees of linguistic and learning difficulties involves addressing complex issues of language and comprehension. This paper reports an exploratory study using two qualitative methods to examine the delivery of sexual health education to people with intellectual disabilities. MethodsFour video-recordings of sexual health education sessions were collected. Conversation analysis was used to examine in detail how such education occurs as a series of interactions between educators and learners. Interviews with four educators were carried out and analyzed using thematic analysis. ResultsThe analysis shows how educators anticipate problems of comprehension and how they respond when there is evidence that a person does not understand the activity or the educational message.This occurs particularly when verbal prompts involve long sentences and abstract concepts. We show a characteristic pattern which arises in these situations, in which both educator and learner jointly produce a superficially correct response. ConclusionsWhile interviews allows us some insight into contextual issues, strategy, and aspects of sexual health education which occur outside of the actual teaching sessions, analysis of actual interactions can show us patterns which occur in interactions between educators and learners when comprehension is in question. Addressing how sexual health education is delivered in practice and in detail provides valuable lessons about how such education can be improved.

Sexual knowledge in adolescents with intellectual disabilities: A timely reflection

“…Despite these findings, there were more incidences of adolescents with ID misunderstanding sexuality concepts, indicative of an overall lack of comprehension (Finlay et al, 2015). Adolescents with ID showed significantly lower sexual knowledge than non-disabled adolescents in all areas (Jahoda & Pownall, 2014).…”

“…Specifically, Picture Exchange Communication System (PECS) and visual pictures depicting steps (jigs) were found to be effective in non-verbal adolescents with ID (Tissot, 2009). According to the literature, students with ID tended to create a superficial indication of comprehension due to teacher prompts, suggestive rephrasing, automatic 'yes' answers, guessing, and copying the teacher or other students (Finlay et al, 2015). Sexuality education that was concurrently delivered at home and school was found to be effective in two studies (Corona et al, 2016;Tissot, 2009).…”

“…The aforementioned authors theorised that adolescents with ID do not retain the information presented in sexuality education due to inappropriate teaching modalities (Corona et al, 2016), such as reliance on verbal explanations for abstract concepts (Finlay et al, 2015). Sexuality education therefore ought to be tailored (Healy et al, 2009), potentially on an individual level, as the group setting makes it difficult to cater to a wide range of knowledge levels (Corona et al, 2016), and reduces the educator's ability to ensure individuals have understood (Finlay et al, 2015).…”

“…Firstly, in terms of learning environments, the capacity of group-based programs to deliver the appropriate level of sexuality education for individuals across a wide range of cognitive functions and experience levels is unclear. Some studies report positive effects of groupbased learning (Löfgren-Mårtenson, 2012), while others stress the importance of individualised approaches (Corona et al, 2016;Finlay et al, 2015). As the results differ across sample groups, it may be that the suitability of group-based, versus individualised, sexuality education must be determined on an individual needs basis.…”

Disability and HIV in Africa: Breaking the barriers to sexual health care

“…Health psychologists can also offer valuable input in how health prevention information can and should be framed in a way that does not perpetuate assumptions and barriers. For example, in work on sexual health education and persons with learning disabilities in the United Kingdom, Finlay et al (2015) challenge the notion that difficulties around 'understanding' exist as a difficulty within the capabilities of the individual with learning disabilities. Using conversation analysis of recorded sex education sessions with young people with learning disabilities, observations could be made of the challenges and barriers to understanding that develop in the social interaction between the individual with a learning disability and others (in this case, the educators).…”