WP238 Who gets to speak next: The patient with intellectual disabilities, her mother and her nurse

People with intellectual disabilities experience marked health inequalities and inadequate healthcare is a major contributing factor.? Nurses and other clinicians are urged to address this and adjust their communication to maximize the engagement of the patient with intellectual disabilities.? However, there is limited research that examines how they are managing this in practice.? So the aim of this study was to explore how clinicians manage the communicative challenges involved in triadic health consultations involving patients with intellectual disabilities and a companion by examining video recordings of naturally occurring health consultations.? Selected as a ?telling case?, the data presented here offers important theoretical insights about triadic health interactions.? Detailed interactional analysis was undertaken using Conversation Analysis of a case drawn from a data set of 34 videos of patients with intellectual disabilities attending their NHS health check, recorded between July 2016 and July 2017.? Analysis focused on how the allocation of speakership was organized in the interaction, and it revealed the micro-practices in play, particularly the mechanism of gaze, that contributed to the exclusion of the patient with intellectual disabilities as the key informant on her own health.? The interactional behaviour of all three participants contributed to the distribution of speakership within the interaction.? The study illustrates how the category of ?intellectual disabilities? is dynamically constituted in healthcare settings.? Micro-analysis of real-life health interactions can highlight avoidable pitfalls for clinicians who are committed to promoting the participation of patients with intellectual disabilities in healthcare.