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

Objective: Sexual 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. Methods: Four 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. Results: The 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. Conclusions: While 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.