View in EDS HTML Full Text PDF Full Text

Evaluating the Usefulness of a Wordless Picture Book for Adults with Intellectual Disabilities about the COVID-19 Vaccination Programme Using Co-Production: The CAREVIS Study

Saved in:

Bibliographic Details
Title:	Evaluating the Usefulness of a Wordless Picture Book for Adults with Intellectual Disabilities about the COVID-19 Vaccination Programme Using Co-Production: The CAREVIS Study
Language:	English
Authors:	Helena Wythe (ORCID 0000-0003-1573-9679), Raj Attavar, Julia Jones, Jackie Kelly, Claire Palmer, Louise Jenkins, Romanie Dekker, Debra Fearns, Scott Watkins, Anne Hunt, Natalie Pattison
Source:	Journal of Applied Research in Intellectual Disabilities. 2024 37(2).
Availability:	Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed:	Y
Page Count:	11
Publication Date:	2024
Document Type:	Journal Articles Reports - Research
Descriptors:	Picture Books, Adults, Intellectual Disability, COVID-19, Immunization Programs, Instructional Material Evaluation, Allied Health Personnel, Visual Aids
DOI:	10.1111/jar.13203
ISSN:	1360-2322 1468-3148
Abstract:	Aim: To explore the usefulness of a co-designed wordless book showing processes of receiving COVID-19 vaccines designed by, and for, adults with intellectual disabilities. Methods: A qualitative evaluation of the resource using mixed methods. Semi-structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Results: Understanding the COVID-19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID-19 restrictions changing. Conclusion: A visual resource may help conversations about the COVID-19 vaccine for people with intellectual disabilities.
Abstractor:	As Provided
Entry Date:	2024
Accession Number:	EJ1412977
Database:	ERIC
Full text is not displayed to guests. Login for full access.

FullText	Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwF8CBwWtqk5aXB_2r06-xn1AAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDEtUY1P5oiEVM0XR8AIBEICBmh1jEIjXpht_r8PE0MnKcK_nvXIBSZK8kshEsLFS78etklQZOvpwjfoHzuE7gkrVrv71UbVeN6enOxcOb3mS0U8HGj23cqfns3AuN2ul-dNiEj9FDcKD6NeauaS63B88SYw99wZnaLqvv1uOw8LemKu1iYpyE0w1xjC3YOd4wfnFVXt8ghOjl2XbFmv6NFb4n5EDMhGOS0Fs-R4= Text: Availability: 1 Value: <anid>AN0175502862;e0301mar.24;2024Feb20.05:26;v2.2.500</anid> <title id="AN0175502862-1">Evaluating the usefulness of a wordless picture book for adults with intellectual disabilities about the COVID‐19 vaccination programme using co‐production: The CAREVIS study </title> <p>Aim: To explore the usefulness of a co‐designed wordless book showing processes of receiving COVID‐19 vaccines designed by, and for, adults with intellectual disabilities. Methods: A qualitative evaluation of the resource using mixed methods. Semi‐structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Results: Understanding the COVID‐19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID‐19 restrictions changing. Conclusion: A visual resource may help conversations about the COVID‐19 vaccine for people with intellectual disabilities.</p> <p>Keywords: co‐production; COVID‐19; intellectual disability; mixed‐methods research; vaccination; wordless information</p> <hd id="AN0175502862-2">INTRODUCTION</hd> <p>People with intellectual disabilities are a particularly vulnerable group in relation to congenital or acquired physical health issues, including respiratory conditions, obesity and mobility issues; which are accentuated by the accessibility of health care and polypharmacy (Glover et al., [<reflink idref="bib25" id="ref1">25</reflink>]; Javaid et al., [<reflink idref="bib34" id="ref2">34</reflink>]; O'Dwyer et al., [<reflink idref="bib49" id="ref3">49</reflink>]). Hospitalisations for treatable conditions are higher than those in the general population (Glover et al., [<reflink idref="bib25" id="ref4">25</reflink>]). On average, females with intellectual disabilities die 26 years younger (22 years for males) compared with the general population (LeDeR, [<reflink idref="bib36" id="ref5">36</reflink>]). Diagnostic overshadowing is a recognised complication whereby new symptoms of mental or physical ill‐health are misattributed to an individual's intellectual disability resulting in delayed diagnosis and treatment, increasing health inequalities (Javaid et al., [<reflink idref="bib34" id="ref6">34</reflink>]). A person's inability to effectively communicate their health concerns or to understand why treatment is necessary has also been highlighted as a key issue in this population (Cooper et al., [<reflink idref="bib12" id="ref7">12</reflink>]; Ninnoni, [<reflink idref="bib48" id="ref8">48</reflink>]).</p> <p>In the United Kingdom, people with intellectual disabilities were not initially prioritised in COVID‐19 vaccination roll‐out, although evidence later emerged that the risk of hospitalisation and death from COVID‐19 was proportionally higher for people with intellectual disabilities (Ninnoni, [<reflink idref="bib48" id="ref9">48</reflink>]), particularly for people with Down's syndrome (NICE, [<reflink idref="bib43" id="ref10">43</reflink>]). Evidence using General Practitioner (GP) data, from over 17 million people and 90,307 people with intellectual disabilities shows that people with intellectual disabilities were five times more likely to be admitted to hospital from COVID‐19 infection (Williamson et al., [<reflink idref="bib65" id="ref11">65</reflink>]). Recent data has shown that excess deaths in people with intellectual disabilities was more than double that of the general population and the leading cause of death of people with intellectual disabilities in 2021 (LeDeR, [<reflink idref="bib36" id="ref12">36</reflink>]), and those who were unvaccinated were eight times more likely to die from COVID‐19 than any other cause compared to the general population.</p> <p>People with intellectual disabilities should have equal access to the COVID vaccination programme to those in the general population along with all other clinical care and services (NHS England, [<reflink idref="bib44" id="ref13">44</reflink>]; United Nations, [<reflink idref="bib62" id="ref14">62</reflink>]). Accommodating cognitive differences and communication preferences aim to reduce the barriers to people with intellectual disabilities accessing services through empowered self‐advocacy and decision making (NHS England, [<reflink idref="bib44" id="ref15">44</reflink>]; NICE, [<reflink idref="bib43" id="ref16">43</reflink>]). Producing accessible public health information about these services in a variety of formats (pictorial, easy read, video) to support people in their decision making about their health is a recognised reasonable adjustment to accessing care (Great, [<reflink idref="bib26" id="ref17">26</reflink>]; The Equalities Act, [<reflink idref="bib58" id="ref18">58</reflink>]; United Nations, [<reflink idref="bib62" id="ref19">62</reflink>]), and underpins mandatory standards in England (NHS England, [<reflink idref="bib45" id="ref20">45</reflink>]).</p> <p>'Easy read' refers to constructing and presenting information that makes it easier for a reader to understand and can extend beyond simplifying language and grammar to encompass the use of illustrations or photographs, colour and the layout of text and pictures on a page (Sutherland &amp; Isherwood, [<reflink idref="bib57" id="ref21">57</reflink>]). Processing information and health literacy is challenging for some people with intellectual disabilities (Geukes et al., [<reflink idref="bib24" id="ref22">24</reflink>]; Riess &amp; Kraft‐Todd, [<reflink idref="bib54" id="ref23">54</reflink>]; Tuffrey‐Wijne et al., [<reflink idref="bib60" id="ref24">60</reflink>], [<reflink idref="bib61" id="ref25">61</reflink>]). It has been postulated that when written words and pictures occur together in an 'easy read' document there is an increased demand on the working short‐term memory to process both simultaneously which can lead to sensory overload (Hurtado et al., [<reflink idref="bib32" id="ref26">32</reflink>]; Mayer et al., [<reflink idref="bib40" id="ref27">40</reflink>]). Presenting pictures alone could therefore reduce sensory input, lessen anxiety and improve interaction with a conversation partner in those with an intellectual disability (Mander, [<reflink idref="bib39" id="ref28">39</reflink>]). Additionally decoding solely pictorial information can be easier for some who have communication needs in verbal reasoning (Murphy &amp; Cameron, [<reflink idref="bib42" id="ref29">42</reflink>]), allowing them to explore their own narratives using 'meaningful literacy' (Deagle &amp; D'Amico, [<reflink idref="bib16" id="ref30">16</reflink>]) enabling access to information. There is evidence that this individually tailored public health information has more impact with those with intellectual disabilities and to those in the wider general population (Chinn &amp; Homeyard, [<reflink idref="bib9" id="ref31">9</reflink>]). However, the effectiveness of accessible information on health behaviours has been difficult to establish (Chinn &amp; Homeyard, [<reflink idref="bib9" id="ref32">9</reflink>]). Wordless information (visual pictorial resources) for people with intellectual disabilities have been produced, evaluated (Mengoni et al., [<reflink idref="bib41" id="ref33">41</reflink>]) and the subject of literature review (Hollins et al., [<reflink idref="bib29" id="ref34">29</reflink>]), and compared with integrated literacy combining words and pictures (Alberto &amp; Fredrick, [<reflink idref="bib1" id="ref35">1</reflink>]). Efforts to present health information in an accessible pictorial format may however boost the uptake of services and improve the health of those with intellectual disabilities.</p> <p>With concerns that those with intellectual disabilities maybe hesitant to receive the Covid‐19 vaccine due to the high rate of needle phobia in this population (NICE, [<reflink idref="bib43" id="ref36">43</reflink>]), a draft visual storybook resource was co‐designed with people with intellectual disabilities to maximise accessibility with the charity 'Beyond Words' (BW) and their 'Books Beyond Words' series. The resource was entitled 'Having a Vaccine for Coronavirus' (Hollins, [<reflink idref="bib28" id="ref37">28</reflink>]) and used the key principles that underpin BW values, and ChangePeople's guidance (ChangePeople, [<reflink idref="bib8" id="ref38">8</reflink>]; Hollins et al., [<reflink idref="bib29" id="ref39">29</reflink>]) in working with people with intellectual disabilities The resource aim was to explore the feelings around having the COVID‐19 vaccine with someone with intellectual disabilities, through the personal story of two people.</p> <p>The aim of this research was to develop, and then evaluate the usefulness and impact of this resource, in collaboration with people with intellectual disabilities. Our objective was to gather opinions on the draft content, how and when the resource was received and used. We also wanted to know if it enhanced awareness of the COVID‐19 vaccine programme for adults with intellectual disabilities and to show the process of having the injections and how this conferred protection against the virus.</p> <hd id="AN0175502862-3">METHODS</hd> <p></p> <hd id="AN0175502862-4">Design</hd> <p>The research design was mixed methods evaluation, underpinned by a participatory and inclusive approach that strived to co‐develop meaningful outputs for people with intellectual disabilities (Bergold, [<reflink idref="bib4" id="ref40">4</reflink>]; Bigby et al., [<reflink idref="bib5" id="ref41">5</reflink>]; Cocks &amp; Cockram, [<reflink idref="bib10" id="ref42">10</reflink>]). We adopted a <emph>qual‐quant</emph> design, with greater emphasis on the qualitative element (Creswell &amp; Plano Clark, [<reflink idref="bib14" id="ref43">14</reflink>]), across two work packages. Work package 1 comprised of semi‐structured interviews to gauge understanding of the resource purpose and a national survey to establish reach and utility of the resource. Work package 2: resource mapping (including vaccination uptake) and the infrastructure to support both vaccine and resource roll‐out in the locality covered by a mental health NHS organisation and local authority in the East of England. In this article, we report on the findings from work package 1. Work package 2 will be reported elsewhere.</p> <hd id="AN0175502862-5">Ethics</hd> <p>NHS Research Ethics approval was granted (Leicester Central Rec, 21/EM/0089) and Health Research Authority (HRA) (Ref: 296159). All research activities with people with intellectual disabilities adhered to the ethical principles relating to research quality standards (NHS Health Research Authority, [<reflink idref="bib46" id="ref44">46</reflink>]; ICH Harmonised Tripartite, [<reflink idref="bib33" id="ref45">33</reflink>]), and good practice principles for research with people with intellectual disabilities (Di Lorito et al., [<reflink idref="bib17" id="ref46">17</reflink>]; Nind, [<reflink idref="bib47" id="ref47">47</reflink>]).</p> <hd id="AN0175502862-6">Patient and public involvement in the research</hd> <p>Meaningful co‐production and participatory methods are integral to the research design (Chinn &amp; Homeyard, [<reflink idref="bib9" id="ref48">9</reflink>]). We sought inclusive patient and public involvement (PPI) on all research processes from people with intellectual disabilities, who helped develop study resources, interview schedules and sense‐checked study data. We designed the initial draft resource (tested in the study) with people with intellectual disabilities, drawing on imagery from an existing resource 'Love in Lockdown', (Hollins &amp; Hollins, [<reflink idref="bib30" id="ref49">30</reflink>]) which had previously undergone internal Books Beyond Words review processes with people with intellectual disabilities.</p> <p>The PPI for the research was input through two key mechanisms. Firstly, working with an organised group of people with intellectual disabilities in Hertfordshire who support delivery of health messages through creative arts from Hertfordshire County Council (HCC). This group contributed to early design discussions (outlined below), alongside reviewing study documentation and ethics approval processes by choosing wording/images. The research team also included an expert by experience (EbE), a person with intellectual disabilities, employed as a visiting lecturer at the University, who reviewed the ethics documentation, interview guide and survey questions.</p> <hd id="AN0175502862-7">Initial design of the draft resource</hd> <p>The research team met with the group of people with intellectual disabilities at HCC online in the early part of 2020 to review images for the draft resource about the COVID‐19 vaccine. Amendments to imagery were made following these discussions for example seasonal images were added to convey time passing between vaccinations.</p> <hd id="AN0175502862-8">Recruitment and sampling</hd> <p></p> <hd id="AN0175502862-9">Interviews</hd> <p>Inclusion criteria for the interviews were adults (aged over 18) with mild to moderate intellectual disabilities who were able to provide supported consent using visual 'easy read' information sheets and consent forms and were in receipt of care under HCC Health Liaison Team or Hertfordshire Partnership NHS Foundation Trust (HPFT). We wanted to obtain the views of the person with intellectual disabilities directly who could communicate those views to a researcher and so sought individuals who had mental capacity rather than seeking consent through a third‐party (NHS Health Research Authority, [<reflink idref="bib46" id="ref50">46</reflink>]).</p> <p>Formal (paid) and informal carers (&gt;18 years) of people with intellectual disabilities and health professionals able to provide informed consent were also approached to participate. Purposive recruitment was undertaken through convenience sampling of known individuals who accessed health support through either the mental health team or social care team (health liaison team) during the recruitment stage of the study to gather rich qualitative contextualised data about the resource and how it influenced health decisions around the COVID‐19 vaccine uptake (Coyne, [<reflink idref="bib13" id="ref51">13</reflink>]; Palinkas et al., [<reflink idref="bib51" id="ref52">51</reflink>]). Staff referring on potential participants also gave an indication about their likely ability in expressing their views in relation to the research and the book (and whether they had capacity to consent with professional support). We planned to recruit 35 participants to gain a broad picture, rich data and likely data saturation (Guest et al., [<reflink idref="bib27" id="ref53">27</reflink>]).</p> <p>Ethical approval permitted both face‐to‐face and remote research participation. However, given the ongoing risk of COVID‐19 infection during the research, participants were recruited and interviewed remotely using the Microsoft Teams™ platform or by telephone. Some interviewed needed support from a carer to access the link for the online interview on the computer and help to rephrase questions from the interviewer. Furthermore, one participant needed a British Sign Language Interpreter intermediary so that their views could be relayed during the interview. Participants were given an electronic (and/or hard) copy of the draft resource following consent if they had no personal copy.</p> <p>Participants with intellectual disabilities were given the opportunity to have someone present with them throughout the interview for support and assistance in understanding the interview questions only, not to influence their opinions. Carers who wished to provide their own views did so in separate interviews. Dyadic interviews with people with intellectual disabilities and carers were also offered whereby interviews with the carer followed after those untaken with the person with a learning disability.</p> <hd id="AN0175502862-10">Survey</hd> <p>A short on‐line survey was co‐developed with our EbE member of the team to understand the opinions on, and the impact of, the draft resource use of other resources and the perceived need for such a book. SurveyMonkey® (Momentive Inc. software) was used to circulate the survey widely through relevant networks (including social media) via forums including RADiANT (a clinical and research network hosted by HPFT, <ulink href="http://www.radiant.org.uk">www.radiant.org.uk</ulink>) and other Intellectual disabilities networks totalling approximately 6000 individuals on those lists (as reported by list hosts). The URL link to the online survey was emailed to potential participants (distributed between October 2021 to mid‐November 2021 and again in Jan 2022) and ran in parallel with the interviews.</p> <p>Study information and consent prefaced the survey and respondents could withdraw prior to submission. Questions were asked about the respondent's type and scope of caring roles, opinions on the resource, whether/how it had been used and open questions on the need for such a resource. No names or contact information were gathered to ensure anonymity.</p> <hd id="AN0175502862-11">Data analysis</hd> <p></p> <hd id="AN0175502862-12">Interviews</hd> <p>Interviews took place from September 2021 to January 2022, were audio‐recorded and transcribed verbatim using a university approved supplier. The anonymised transcripts were uploaded onto NVivo© software (QSR International, version 13).</p> <p>Explorative qualitative data analysis was adopted from a critical realist interpretative stance using 'reflexive' and 'flexible' Thematic Analysis (Braun &amp; Clarke, [<reflink idref="bib6" id="ref54">6</reflink>]; Braun &amp; Clarke, [<reflink idref="bib7" id="ref55">7</reflink>]) to draw out meaning and patterns in the data.</p> <p>Each transcript was read while listening to the audio recording; checking for inaccuracies and for data familiarisation (Ashworth, [<reflink idref="bib3" id="ref56">3</reflink>]; Lincoln &amp; Guba, [<reflink idref="bib37" id="ref57">37</reflink>]). Deductive and inductive descriptive nodes were generated, following the six‐phase process of analysis allocating semantic (descriptive) and latent (conceptual meaning) nodes (Braun &amp; Clarke, [<reflink idref="bib6" id="ref58">6</reflink>]). Initially, three master nodes were generated from the interview topic: 'The resource' 'Work role' 'Books Beyond Words'. Semantic nodes were then formed directly from the interviewees words for example 'they self‐check' which related to people with intellectual disabilities monitoring their own safety to COVID‐19 infection, demonstrating credibility.</p> <p>Rigour was applied through member checking of the transcripts and dataset (credibility) and by reviewing of the analytical reflexive memo recorded in NVivo, to demonstrate transparency in decision‐making (confirmability) (Lincoln &amp; Guba, [<reflink idref="bib37" id="ref59">37</reflink>]; Speziale et al., [<reflink idref="bib56" id="ref60">56</reflink>]), by the wider study team. The data were then summarised in tabular format according to the main themes to identify the range of opinions and outliers (dependability). Findings were presented to a group of people with intellectual disabilities at HCC during a meeting in March 2022 for sense‐checking and to further enhance credibility.</p> <hd id="AN0175502862-13">Survey</hd> <p></p> <hd id="AN0175502862-14">Data analysis</hd> <p>The survey comprised of open and closed questions. Qualitative data from free text sections of the survey was extracted from the SurveyMonkey® outputs via Microsoft Excel®. Codes were assigned to facilitate grouping. Qualitative excerpts were then coded alongside the interview data in NVivo®.</p> <p>Quantitative data was extracted into Excel and then into SPSS® (IBM Statistics, version 26) for descriptive statistical analyses (proportions). No other statistics were planned, since this was not powered to detect differences in effect size and we were not looking for associations.</p> <p>Data integration took place to integrate the survey findings alongside the qualitative data and is reported on collectively as much as possible (Fetters et al., [<reflink idref="bib21" id="ref61">21</reflink>]).</p> <hd id="AN0175502862-15">RESULTS</hd> <p></p> <hd id="AN0175502862-16">Study sample</hd> <p>Thirty‐five people participated in in‐depth interviews (Table 1), with a broad sample of: people with a mild–moderate intellectual disability (<emph>n</emph> = 11); informal and formal carers (<emph>n</emph> = 10); health professionals (<emph>n</emph> = 14) from one region in the United Kingdom, as outlined above.</p> <p>1 TABLE Responder category by site.</p> <p> <ephtml> &lt;table&gt;&lt;thead valign="bottom"&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;Person with learning disabilities&lt;/th&gt;&lt;th align="left"&gt;Carer&lt;/th&gt;&lt;th align="left"&gt;Health professional&lt;/th&gt;&lt;th align="left"&gt;Other&lt;/th&gt;&lt;th align="left"&gt;Total&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody valign="top"&gt;&lt;tr&gt;&lt;td align="left"&gt;Interview&lt;/td&gt;&lt;td align="left"&gt;Mental health trust&lt;/td&gt;&lt;td align="char" char="."&gt;8&lt;/td&gt;&lt;td align="char" char="."&gt;9&lt;/td&gt;&lt;td align="char" char="."&gt;10&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="char" char="."&gt;27&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;Local council&lt;/td&gt;&lt;td align="char" char="."&gt;3&lt;/td&gt;&lt;td align="char" char="."&gt;1&lt;/td&gt;&lt;td align="left" char="."&gt;4&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" char="."&gt;8&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Survey&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="char" char="."&gt;2&lt;/td&gt;&lt;td align="char" char="."&gt;8&lt;/td&gt;&lt;td align="char" char="."&gt;42&lt;/td&gt;&lt;td align="char" char="."&gt;3&lt;/td&gt;&lt;td align="char" char="."&gt;55&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <hd id="AN0175502862-17">Survey data</hd> <p>We received 55 responses to the survey data, and the key quantitative (from closed questions) items are outlined below in Table 2, the open‐ended free‐text qualitative data is integrated into the overall qualitative data below.</p> <p>2 TABLE Survey responder by caring role.</p> <p> <ephtml> &lt;table&gt;&lt;thead valign="bottom"&gt;&lt;tr&gt;&lt;th align="left"&gt;Number of people with learning disabilities cared for&lt;/th&gt;&lt;th align="left"&gt;Caring/professional role&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody valign="top"&gt;&lt;tr&gt;&lt;td align="left"&gt;1 person&lt;/td&gt;&lt;td align="left"&gt;7&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;2&amp;#8211;5 people&lt;/td&gt;&lt;td align="left"&gt;3&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;6&amp;#8211;10 people&lt;/td&gt;&lt;td align="left"&gt;5&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;11 or more people&lt;/td&gt;&lt;td align="left"&gt;28&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Total&lt;/td&gt;&lt;td align="left"&gt;43 (12 people skipped question)&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>Forty‐two Health professionals, seven informal carers, one formal carer, two people with intellectual disabilities and three 'others' including a speech and language therapy student and social care professional (unqualified) responded. In a separate article, we describe the processes and include some of this survey data, therefore are only reporting on the qualitative open‐ended survey data here.</p> <hd id="AN0175502862-18">Exposure to and use of the resource</hd> <p>Everyone interviewed, except one carer, had reviewed and/or used the book previously. From the survey, however, only half had heard of the book (<emph>n</emph> = 27, 49%) and 8/55 (14%) people had used the resource. Only one health professional interviewed had used the resource directly (1/14). Reasons provided by health professionals for not using the resource included: perceived irrelevance to their roles, timing of the resource launch, circulation and awareness (lack of). One health professional who worked in needle desensitisation services with people with intellectual disabilities had not used it because of the depiction of the needles.</p> <p>Thematic development (as outlined earlier) resulted in three key themes: Why? The importance of understanding; How and when it was used: Facilitating communication; Use of other resources.</p> <p>Theme 1: Why? The importance of Understanding.</p> <p>The purpose of the book was to relay the process and potential benefits of receiving the COVID‐19 vaccine through the social story of two people, Stephan and Kali. In line with other BBW books, the pictorial storyline could be adapted and related to individual life‐experiences with a suggested storyline written at the end of the book; the books could be used to have broad conversations around the subject. During the interview the interviewer asked questions such as 'what's happening in the story?' and 'what's your favourite page?' and 'why is that?' In this way, the interviewer used their personal judgement, based on the interview conversation, on whether they understood the intended story or had used the resource for an alternative purpose.</p> <p>The majority of the interviewees (Creswell &amp; Plano Clark, [<reflink idref="bib14" id="ref62">14</reflink>]) reported either they, or the people they were supporting, were able to use the book to generate conversations around having a vaccine. This included people in the book depicted in conversation about, and then having, a vaccine, and the resumption of their normal daily activities, such as being around friends and family. The two respondents who did not understand were a mother and son who stated that they struggled half‐way through:</p> <p>Yeah. The first picture was fine, the second, but then the middle we start losing it. (Interview Carer32)</p> <p>Some carers and health professionals did not understand certain visual elements in the book but indicated they had not read the storyline words supplied by 'Books Beyond Words' (located at the back of the resource), which were aimed to supplement the images and help provide clarity. These visual elements were the depiction of the two vaccinations. Two carers and three health professionals interviewed did not interpret it in this way suggesting visual or text ambiguity; this was reflected in open‐ended data from two people in the survey (one informal and one formal carer). Confusion also surrounded the horse image as a usual activity returned to following full vaccination (three health professionals and one carer interviewed and two health professionals from the survey misunderstood this).</p> <p>In addition, two carers (a mother and a care home manager) reported that the image of the virus on pages one and two did not, or would not, make sense to the people that they cared for (not interviewed):</p> <p>No, it's definitely not clear enough, it's just not saying anything, it's just like to [son—not interviewed] it would be like a blob, a syringe and a tick, it's not saying anything. (Interview Carer30)</p> <p>These two carers thought that those they cared for would not be able to relate the pictures and storyline to their own lives and life experience. Two informal carers from the survey reported that the resource would not be useful, nor suitable for their sons. Instead, these carers talked to those they cared for in simple language they were confident would be understood, relying on the inbuilt trust in that relationship to relay this and any other important health messages.</p> <p>Seven interviewees (three carers, two people with intellectual disabilities and two health professionals) and seven survey respondents (all health professionals) wanted to incorporate more about the reasons why the vaccine was needed, the serious nature of COVID‐19 and social responsibility behind having the vaccine:</p> <p>...it's about not what the act is, but what it's trying to achieve. So it's not about helping someone, no one is ever going to, who doesn't understand why, is ever going to say, I love having my arm stabbed with a needle. (Interview Health Professional8)</p> <p>The participants thought that although the resource would help people agree to have the vaccine (compliance), it did not necessarily explain why it was needed (including consent) and a missed opportunity to include this background:</p> <p>I like the fact that people can have a discussion about words and that, but I think on a subject like this, as big as this and as important as this from their health perspective. (Interview Carer9)</p> <p>Five interviewed people with intellectual disabilities described not understanding elements of the storyline in terms of why the vaccine was needed. The majority of participants with intellectual disabilities who did explain the impetus to get vaccinated, largely focused on protecting their own or their family or friend's health and returning to normal activities, in line with the resource storyline.</p> <p>Similarly, three health professionals and three people with intellectual disabilities interviewed wanted the depiction of more COVID‐19 restrictions or up‐to‐date restrictions in the resource and thought that it sent mixed safety messages. This sentiment was mirrored in the survey with nine people expressing the same (two carers, one 'other' and six health professionals):</p> <p></p> <ulist> <item> Interviewer Okay, all right and how did you feel about the story that they... at the end of the book when they're holding hands at a café, how did you find that part of the story?</item> <p></p> <item> (Person with Intellectual Disability25) That I didn't think it appropriate because you're not allowed even to hold their hands. You have to be socially distanced and sitting at the table.</item> <p></p> <item> Interviewer Yes.</item> <p></p> <item> (Person with Intellectual Disability25) Then you can.</item> <p></p> <item> Interviewer Okay.</item> <p></p> <item> (Person with Intellectual Disability25) But if you're in a family unit you can do it as a family unit, so...</item> <p></p> <item> Interviewer Hmm. So still to stay safe?</item> <p></p> <item> (Person with Intellectual Disability25) Yes.</item> <p></p> <item> Interviewer Even though they've had the vaccine?</item> <p></p> <item> (Person with Intellectual Disability25) Yes.</item> </ulist> <p>It was recognised by the majority of respondents that a book cannot suit everyone. Conversations stimulated by the book, that interviewees reported, indicated varied understanding around the vaccine or its purpose. Furthermore, some carers thought that full understanding or even partial understanding was not always desirable. Two carers described 'filtering' (or they debated filtering) information about the severity of COVID‐19 and the pandemic to 'shield' people with intellectual disabilities that they cared for:</p> <p>And we didn't appreciate how shielded we'd managed to keep her from how serious COVID‐19 was and it was only when we got round to going for the first vaccine that we suddenly realised, gosh, she hasn't actually worried or anything, she's had great fun. (Interview Carer3)</p> <p>Shielding information was reported as a mechanism of limiting stress, which would negatively impact on mental health, and potentially increase behaviours that communicate distress. Carers in the study decided which information could be shared (verbal or pictorial), tailored to those they cared for and their level of need/ability accordingly. One health professional who worked with a person with intellectual disabilities, who partially understood restrictions, described that this person would unnecessarily limit their social activity due to the fear of legal prosecution.</p> <p>The ability of the resource to be 'understood' depended on the underlying purpose of the conversation. The resource could be used as traditional storybook as per the suggested storyline or as jumping off point to explore wider issues relating to the coronavirus pandemic. As a traditional storybook it did not meet the needs of some people who found the pictures story confusing. Some would have liked more information on the severity of the pandemic and regulations aimed to minimise transmission of the virus whilst others preferred not to have a resource that contained that background level of information.</p> <p>Theme 2: How and when it was used: Facilitating communication.</p> <p>A larger proportion of carers interviewed had used the resource, compared to health professionals. However, two health professionals who planned to use the resource in the future described plans to pass the resource onto family members and carers to use it with a person with intellectual disabilities. Survey data indicated fewer people (less than half) had come across it or used it (Table 2). Of those interviewed, those who had used the resource, or similar 'Books Beyond Words' resources, expressed the importance of tailoring the storyline to the person with intellectual disabilities. This was recognised by five surveyed carers and health professionals as easier if the 'reader' could directly relate it to the life of the person, which required a degree of knowledge and understanding from an established relationship:</p> <p>I liked it, I used it with patients in an inpatient setting to good effect. It minimised the fear an enabled a great deal of additional conversation about the virus, the story in pictures doesn't reflect the same setting I am in but it was easy to adapt. (Survey HealthProfessional18)</p> <p>Responding to the survey question of when this resource should be used, the most common suggestion (by 12 participants) was when the person with intellectual disabilities was calm and relaxed, receptive to new information and in quiet/familiar surroundings. The timing of using the resource was also stressed, as soon as it became available, revisiting it a few times before the vaccination appointment.</p> <p>The adaptability of the resource storyline may not have been apparent to all who used it or know their conversation partner well enough to make this personalisation possible.</p> <p>Theme 3: Use of other resources.</p> <p>Carers and health professionals interviewed reported that they relied most heavily on unstructured one‐to‐one verbal communication to explain COVID and vaccinations to people with intellectual disabilities that they cared for:</p> <p></p> <ulist> <item> Interviewer So we talked about this resource, this Books Beyond Words one, did you use any other resources that were available at the time to talk to [her] with?</item> <p></p> <item> Interview Carer12 No not really, no, we just talked to her.</item> </ulist> <p>However, some people described using a mixture of resources at different timepoints, such as government produced media (three), google searching (three) and 'Facebook' (Meta Platforms, Inc) groups (two), on aspects of the pandemic to fill knowledge gaps as needs and comprehension level warranted. Five health professionals even created their own resources; this was particularly common at the start of the pandemic when information tailored to those with intellectual disabilities was hard to find:</p> <p>...the Government started to actually create these documents that we could then send out, but at the very beginning, it was quite difficult because we had to make this easy read stuff quite quickly. then things would suddenly change at the drop of a hat, so it was then rattling around trying to get that sorted and I think that was the main source of confusion for a lot of the service users and carers was when things were changing. (Interview Health Professional26)</p> <p>People with milder intellectual disabilities who had the ability and access to the internet sought information independently or with help and supervision of family.</p> <p>No. I just Googled stuff. [name] is really good with his computer skills. Yes. I think, to be honest, because he's really, really good, I do leave him to his own devices. (Interview Carer10)</p> <p>One health professional told of a parent of someone with autism whose stress levels were so elevated, that she created her own COVID‐19 newsletter to supply her son with appropriately levelled information on the pandemic. This echoed the survey data, which outlined that the majority (73%) of respondents had used other resources, such as videos, pictures or other written information.</p> <p>Types of information about the COVID‐19 pandemic used in discussion with people with intellectual disabilities therefore depended on their perceived needs, abilities and communication preferences.</p> <hd id="AN0175502862-19">Suggested changes to the resource</hd> <p>Eight people interviewed (three people with intellectual disabilities, two carers and three health professionals) and 16 people from the survey thought no changes were necessary to the resource:</p> <p>But to be...he's just saying I liked it all really, I did like it, I liked the whole thing, I liked it all. I liked it all, yeah, I liked it all, it was good. (Interview [Interpreted] with person with intellectual disability)</p> <p>Suggestions for modifications/improvements to the resource were linked to the images discussed above (first and second vaccines, horse, safety messages, science/purpose to vaccine). Additional suggestions included: clarifying the passage of time between the vaccines and later activities; depicting administration paperwork at the vaccination appointment; using photos and not drawings; depicting positive emotions during and after the vaccine by both vaccine staff and the patient. Health professionals responding to the survey suggested there should be better depiction of support, and information about managing side‐effects. The other mostly commonly requested suggestions from carers and people with intellectual disabilities were to include some easy‐read words, or Makaton, on each page for those who were able to read them, to promote independence and/or avoid ambiguity and stress of potential misunderstanding.</p> <p>From the interviews, three people with intellectual disabilities who were needle‐phobic and seven health professionals working with needlephobia thought that the image of the needle on pages 1 and 2 was disproportionately large and/or should come into the story later in the book. This finding was mirrored in the survey with nine others expressing the same (two carers, one 'other' and six health professionals). Others were more pragmatic:</p> <p>The reality is, that's the reality. It doesn't matter if it's on the front page or the back page, it's going to come. (Interview Health Professional21)</p> <p>One person with intellectual disabilities was so concerned by the pictures of the needles that she mistakenly thought that there was blood on the needle depicted where there was none:</p> <p>I think the needle next to the arm, because I think they [could be] showing a little bit of blood, which is scary. (Person with Intellectual Disability10)</p> <p>In summary, a variety of suggestions were made to improve the clarity of the storyline or to minimise needlephobia.</p> <hd id="AN0175502862-20">DISCUSSION</hd> <p>The purpose of the new resource was to improve accessibility of information about the benefits of the COVID‐19 vaccination programme to individuals with intellectual disabilities with the hope that uptake of the vaccine would be improved, protecting their health and improving their health outcomes.</p> <p>The resource was used in the setting of 'teachable moments' (Dowling et al., [<reflink idref="bib18" id="ref63">18</reflink>]), between carers or health professionals and people with intellectual disabilities, or used independently in naturalistic settings (Chinn &amp; Homeyard, [<reflink idref="bib9" id="ref64">9</reflink>]). When resources can be used independently at an individual's convenience then evidence suggests that this approach can promote privacy and reduce confusion (Waight &amp; Oldreive, [<reflink idref="bib63" id="ref65">63</reflink>]), while others argue that it can create fear and anxiety (Codling &amp; Macdonald, [<reflink idref="bib11" id="ref66">11</reflink>]). The presentation of pictures and symbols can tip the balance in either direction, adding confusion or supporting greater understanding. Additionally, neo‐liberal ideological discourses on disability have postulated that teachable moments with a conversation partner can result in power imbalances between a 'teacher' and a 'learner' with the misplaced assumption that people with intellectual disabilities need educating thereby reducing choice and control (Pilnick et al., [<reflink idref="bib52" id="ref67">52</reflink>]). However, it is intended that Books Beyond Words stories can be personalised during discourse in mutual exploration, relating the pictures to an individual's life. The ethos of BBW is therefore more in line with Williams and Porter ([<reflink idref="bib64" id="ref68">64</reflink>]) when they argue that people with intellectual disabilities need trusted relationships to make good decisions, and Dowling et al ([<reflink idref="bib18" id="ref69">18</reflink>]) in believing that relational autonomy (at the interface between the environment/relationships and disability) is a more achievable goal than isolated independence.</p> <p>The survey and interview data indicated local reach was better than national reach, with only half in the survey having come across the resource. Other resources of COVID‐19 information were accessed by interviewees and survey respondents, in line with research by Flynn et al. ([<reflink idref="bib23" id="ref70">23</reflink>]) where 76% of people with intellectual disabilities surveyed felt that information was easy to find.</p> <p>As the data shows, opinions on the resource varied. As Mander ([<reflink idref="bib39" id="ref71">39</reflink>]) states 'It is impossible to produce an accessible resource that will meet the needs of every person that requires accessible information' (p. 15) and individuals interviewed and surveyed had specific views and communication preferences which aligned with the resource or did not. This was similar to the findings of others (Chinn &amp; Homeyard, [<reflink idref="bib9" id="ref72">9</reflink>]; Codling &amp; Macdonald, [<reflink idref="bib11" id="ref73">11</reflink>]). To optimise clarity and increase appeal, we involved the views of people with intellectual disabilities in the design of the resource from an existing resource that had been through the Books Beyond Words rigorous review process. We also consulted people with intellectual disabilities during the project to further maximise accessibility. It is also possible that through the process of designing this resource and hearing seldom heard voices (Crook et al., [<reflink idref="bib15" id="ref74">15</reflink>]; Feldman et al., [<reflink idref="bib20" id="ref75">20</reflink>]) increased the social capital of those involved (Chinn &amp; Homeyard, [<reflink idref="bib9" id="ref76">9</reflink>]).</p> <p>Assessing the comprehension of the intended purpose of the resource is difficult (Mander, [<reflink idref="bib39" id="ref77">39</reflink>]) and the researcher and carers interviewed relied on personal judgement without supporting in‐depth conversation analysis. Others using conversation analysis have used the method to reflect on decisions making processes in research teams with people with intellectual disabilities (Ellis, [<reflink idref="bib19" id="ref78">19</reflink>]) and during daily events (Dowling et al., [<reflink idref="bib18" id="ref79">18</reflink>]; Pilnick et al., [<reflink idref="bib52" id="ref80">52</reflink>]). These reflections on assumptions on understanding and power relationships within these settings were helpful to the researchers but shed no light on the understanding and perceptions of the people with intellectual disabilities themselves. To address this uncertainty, to provide additional data and enhance rigour, seven interviews were dyadic whereby carers were interviewed directly after those with an intellectual disability and could feedback to the researcher how the resource was used in discourse, easily and as intended or otherwise.</p> <hd id="AN0175502862-21">FINDINGS IN CONTEXT</hd> <p>A meta‐analysis of literature by Chinn and Homeyard ([<reflink idref="bib9" id="ref81">9</reflink>]) raised the importance of avoiding ambiguity of easy‐read information content for people with intellectual disabilities and our research demonstrates how important it is to optimise clarity. Where co‐design does take place, it is not infallible, dealing with conflicting suggestions and expectations (Aschhoff &amp; Vogel, [<reflink idref="bib2" id="ref82">2</reflink>]; Oliver et al., [<reflink idref="bib50" id="ref83">50</reflink>]) requiring ongoing refinement. Importantly, the aim of these wordless books is to open and support conversations, rather than replacing these (Hollins et al., [<reflink idref="bib29" id="ref84">29</reflink>]). This research shows that care professionals also need to engage with such resources to relate information to support decision making for those in their care (Finlay et al., [<reflink idref="bib22" id="ref85">22</reflink>]). The key issue is for people with intellectual disabilities to receive information in the way that is accessible to them and in their preferred format (Thurman et al., [<reflink idref="bib59" id="ref86">59</reflink>]).</p> <p>Current research in this area continues to be scant, with research centring on population‐level health outcomes with respect to mortality (Williamson et al., [<reflink idref="bib65" id="ref87">65</reflink>]). Continued prioritisation for vaccination in this group was recommended as a result of the OpenSAFELY platform research by Williamson et al. ([<reflink idref="bib65" id="ref88">65</reflink>]), however to our knowledge, there has not been published research on how professionals and carers encourage people with intellectual disabilities to engage in health conversations to receive COVID‐19 vaccines.</p> <p>It is clear from wider work that this underserved population still have unmet health needs in relation to COVID‐19. Reasonable adjustments to facilitate vaccine uptake, as outlined in the Public Health England paper (Public Health England, [<reflink idref="bib53" id="ref89">53</reflink>]), require supported conversations and our research suggests a visual resource may be helpful here, alongside other resources.</p> <p>An international survey of professionals supporting people with intellectual disabilities reported the wider impact of the COVID‐19 pandemic, including isolation, distress and increased carer burden and differing impacts of telehealth on maintenance of health (Howkins et al., [<reflink idref="bib31" id="ref90">31</reflink>]). This resonates in further surveys examining family and carer experiences, all of which report adverse effects of the pandemic on engagement with health (Jeste et al., [<reflink idref="bib35" id="ref91">35</reflink>]; Rosencrans et al., [<reflink idref="bib55" id="ref92">55</reflink>]) as people try to navigate strained health care systems and telehealth (Linehan et al., [<reflink idref="bib38" id="ref93">38</reflink>]). This study demonstrates people with intellectual disabilities need to be supported in accessing health care, and that carers often take on this role.</p> <p>There are policy implications from our research, specifically consideration for the infrastructure, support, time and resources required to administer COVID‐19 vaccinations when planning vaccination programmes for people with intellectual disabilities, and the individualistic nature of information needs. From a public health perspective, providing such a resource for free, and embedding the access to these resources within existing health care system, such as online via GPs, who hold registers of people with intellectual disabilities, might be considered as a preventive measure to improve health outcomes. However, the clinical and cost effectiveness of such an intervention remains untested.</p> <hd id="AN0175502862-22">STRENGTHS AND LIMITATIONS</hd> <p>While this was a small study primarily focused in one locality in the United Kingdom, it has identified several key issues with wider transferability beyond this study. This research yielded rich qualitative data from 35 participants, several of whom had intellectual disabilities, and including someone who was hearing impaired, emphasising the commitment to an inclusive approach to the research. Our research was not intended to provide definitive answers as to whether the book worked in improving vaccination uptake, but instead to examine the usefulness of the resource in supporting conversations about the vaccination programme.</p> <p>This research was conducted during a national pandemic, consequently recruitment and data collection were limited to remote online methods because of the need for social distancing. It is acknowledged that this may have limited engagement to those able to use these platforms, or carers to support them.</p> <p>Despite repeated mail‐outs the survey responses were lower than was expected given the prominence of the networks and estimated reach. In future studies, alternative approaches could be considered to enhance the reach of the survey, such as circulating through primary care networks and integrated care systems. It is unfortunate that due to the low response rate to the survey no statistical analyses were possible. However, insight was gained from beyond the locality which enriched the overall picture and emphasised the need for resources like this and a coordinated approach to sharing such resources widely through targeted campaigns. Our focus was necessarily narrow for this project, however with a broader scope we could have examined why some professionals, as elicited in the survey, chose not to engage with this or other resources and what other mechanisms they used to engage people with intellectual disabilities in health decisions.</p> <p>Those who participated had mild to moderate intellectual disabilities, and those with significant severe or profound intellectual disability were precluded from participating, through the informed consent process. This means we may not have fully captured the views of those with more complex needs, and this is an important consideration for future work. Future research should also consider alternative multi‐modal approaches, and evaluation, in complex health issues, like the COVID‐19 vaccination in people with intellectual disabilities. Wider lessons can also be drawn across other health issues, such as supporting the influenza vaccination programme and managing needlephobia.</p> <hd id="AN0175502862-23">CONCLUSION</hd> <p>This research has demonstrated the need for varied modes of information‐giving around the COVID‐19 vaccination in people with intellectual disabilities. Our research shows that a visual resource can be a useful resource, as part of a panoply of approaches, to support people with intellectual disabilities in having conversations about health decisions.</p> <p>Co‐production and inclusivity demonstrates good practice and provided insights around understanding that may otherwise have been missed, enriching the resource and the research.</p> <hd id="AN0175502862-24">ACKNOWLEDGEMENTS</hd> <p>Expert By Experience NH and Dr. Kamalika Mukherjee.</p> <hd id="AN0175502862-25">FUNDING INFORMATION</hd> <p>This study was partly funded by the Royal College of Nursing Foundation, UK and supported by the National Institute for Health Research Applied Research Collaboration East of England.</p> <hd id="AN0175502862-26">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0175502862-27">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p> <p>GRAPH: Data S1: CAREVIS survey.</p> <ref id="AN0175502862-28"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref35" type="bt">1</bibl> <bibtext> Alberto, P. A., &amp; Fredrick, L. D. (2011). Integrated literacy for students with moderate and severe disabilities. Society for Research on Educational Effectiveness.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref82" type="bt">2</bibl> <bibtext> Aschhoff, N., &amp; Vogel, R. (2018). Value conflicts in co‐production: Governing public values in multi‐actor settings. International Journal of Public Sector Management, 31, 775 – 793.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref56" type="bt">3</bibl> <bibtext> Ashworth, P. D. (1997). The variety of qualitative research. Part one: Introduction to the problem. Nurse Education Today, 17 (3), 215 – 218.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref40" type="bt">4</bibl> <bibtext> Bergold, J. (2012). Thomas S (pp. 191 – 222). Historical Social Research/Historische Sozialforschung.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref41" type="bt">5</bibl> <bibtext> Bigby, C., Frawley, P., &amp; Ramcharan, P. (2014). Conceptualizing inclusive research with people with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 27 (1), 3 – 12.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref54" type="bt">6</bibl> <bibtext> Braun, V., &amp; Clarke, V. (2012). Thematic analysis. APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 57 – 71). American Psychological Association.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref55" type="bt">7</bibl> <bibtext> Braun, V., &amp; Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11 (4), 589 – 597.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref38" type="bt">8</bibl> <bibtext> ChangePeople. (2022). How to make information accessible. A guide to producing easy‐read documents 2016. https://<ulink href="http://www.changepeople.org/getmedia/923a6399-c13f-418c-bb29-051413f7e3a3/How-to-make-info-accessible-guide-2016-Final">www.changepeople.org/getmedia/923a6399-c13f-418c-bb29-051413f7e3a3/How-to-make-info-accessible-guide-2016-Final</ulink></bibtext> </blist> <blist> <bibl id="bib9" idref="ref31" type="bt">9</bibl> <bibtext> Chinn, D., &amp; Homeyard, C. (2017). Easy read and accessible information for people with intellectual disabilities: Is it worth it? A meta‐narrative literature review. Health Expectations., 20 (6), 1189 – 1200.</bibtext> </blist> <blist> <bibtext> Cocks, E., &amp; Cockram, J. (1995). The participatory research paradigm and intellectual disability. Mental Handicap Research, 8 (1), 25 – 37.</bibtext> </blist> <blist> <bibtext> Codling, M., &amp; Macdonald, N. (2008). User‐friendly information: Does it convey what it intends? Mary Codling and Nicky Macdonald, 2006 winners of the National Network for Learning Disability Nurses award, report on the outcome of their research into the effectiveness of information targeted at people with learning disabilities. Learning Disability Practice, 11 (1), 12 – 18.</bibtext> </blist> <blist> <bibtext> Cooper, S.‐A., McLean, G., Guthrie, B., McConnachie, A., Mercer, S., Sullivan, F., &amp; Morrison, J. (2015). Multiple physical and mental health comorbidity in adults with intellectual disabilities: Population‐based cross‐sectional analysis. BMC Family Practice, 16 (1), 110.</bibtext> </blist> <blist> <bibtext> Coyne, I. (1997). Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? Journal of Advanced Nursing, 26 (3), 623 – 630.</bibtext> </blist> <blist> <bibtext> Creswell, J. W., &amp; Plano Clark, V. L. (2007). Designing and conducting mixed methods research. SAGE Publications.</bibtext> </blist> <blist> <bibtext> Crook, B., Tomlins, R., Bancroft, A., &amp; Ogi, L. (2016). 'So often they do not get recruited': Exploring service user and staff perspectives on participation in learning disability research and the barriers that inhibit it. British Journal of Learning Disabilities, 44 (2), 130 – 137.</bibtext> </blist> <blist> <bibtext> Deagle, E., &amp; D'Amico, M. (2016). Defining meaningful literacy: Findings from a socially‐oriented literacy intervention for adults with developmental disabilities. International Journal of Disability, Development and Education, 63 (2), 163 – 180.</bibtext> </blist> <blist> <bibtext> Di Lorito, C., Bosco, A., Birt, L., &amp; Hassiotis, A. (2018). Co‐research with adults with intellectual disability: A systematic review. Journal of Applied Research in Intellectual Disabilities, 31 (5), 669 – 686.</bibtext> </blist> <blist> <bibtext> Dowling, S., Williams, V., Webb, J., Gall, M., &amp; Worrall, D. (2019). Managing relational autonomy in interactions: People with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 32 (5), 1058 – 1066.</bibtext> </blist> <blist> <bibtext> Ellis, L. (2018). Making decisions together? Exploring the decision‐making process in an inclusive research project. Disability &amp; Society, 33 (3), 454 – 475.</bibtext> </blist> <blist> <bibtext> Feldman, M. A., Bosett, J., Collet, C., &amp; Burnham‐Riosa, P. (2014). Where are persons with intellectual disabilities in medical research? A survey of published clinical trials. Journal of Intellectual Disability Research, 58 (9), 800 – 809.</bibtext> </blist> <blist> <bibtext> Fetters, M. D., Curry, L. A., &amp; Creswell, J. W. (2013). Achieving integration in mixed methods designs—Principles and practices. Health Services Research, 48, 2134 – 2156.</bibtext> </blist> <blist> <bibtext> Finlay, W. M., Walton, C., &amp; Antaki, C. (2008). Promoting choice and control in residential services for people with learning disabilities. Disability &amp; Society, 23 (4), 349 – 360.</bibtext> </blist> <blist> <bibtext> Flynn, S., Hayden, N., Clarke, L., Caton, S., Hatton, C., Hastings, R., Abbott, D., Beyer, S., Bradshaw, J., Gillooly, A., Gore, N., Heslop, P., Jahoda, A., Maguire, R., Marriott, A., Oloidi, E., Paris, A., Mulhall, P., Scior, K., ... Todd, S. (2021). Coronavirus and people with learning disability study. University of Warwick.</bibtext> </blist> <blist> <bibtext> Geukes, C., Bröder, J., &amp; Latteck, Ä. D. (2019). Health literacy and people with intellectual disabilities: What we know, what we do not know, and what we need: A theoretical discourse. International Journal of Environmental Research and Public Health, 16 (3), 463.</bibtext> </blist> <blist> <bibtext> Glover, G., Williams, R., &amp; Oyinlola, J. (2020). An observational cohort study of numbers and causes of preventable general hospital admissions in people with and without intellectual disabilities in England. Journal of Intellectual Disability Research, 64 (5), 331 – 344.</bibtext> </blist> <blist> <bibtext> Great, B. (2005). Mental capacity act. HMSO.</bibtext> </blist> <blist> <bibtext> Guest, G., Bunce, A., &amp; Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18 (1), 59 – 82.</bibtext> </blist> <blist> <bibtext> Hollins S. (2021). Having a vaccine for coronavirus. Books Beyond Words. https://static1.squarespace.com/static/551cfff9e4b0f74d74cb307e/t/60a3d632949154502805c844/1621350036393/Having+a+Vaccine+for+Coronavirus.pdf</bibtext> </blist> <blist> <bibtext> Hollins, S., Carpenter, B., Bradley, E., &amp; Egerton, J. (2017). Using wordless books to support clinical consultations. The Journal of Mental Health Training, Education and Practice, 12, 260 – 271.</bibtext> </blist> <blist> <bibtext> Hollins, S., &amp; Hollins, N. (2021). Love in lockdown. Books Beyond Words. https://static1.squarespace.com/static/551cfff9e4b0f74d74cb307e/t/60a2274868856f2a6ab759e3/1621239641810/Love+in+Lockdown+‐+web.pdf.</bibtext> </blist> <blist> <bibtext> Howkins, J., Hassiotis, A., Bradley, E., Levitas, A., Sappok, T., Sinai, A., Thakur, A., &amp; Shankar, R. (2022). International clinician perspectives on pandemic‐associated stress in supporting people with intellectual and developmental disabilities. BJPsych Open, 8 (3), e84.</bibtext> </blist> <blist> <bibtext> Hurtado, B., Jones, L., &amp; Burniston, F. (2014). Is easy read information really easier to read? Journal of Intellectual Disability Research, 58 (9), 822 – 829.</bibtext> </blist> <blist> <bibtext> ICH Harmonised Tripartite. (2001). Guideline for good clinical practice. Journal of Postgraduate Medicine, 47 (3), 199 – 203.</bibtext> </blist> <blist> <bibtext> Javaid, A., Nakata, V., &amp; Michael, D. (2019). Diagnostic overshadowing in learning disability: Think beyond the disability. Progress in Neurology and Psychiatry, 23 (2), 8 – 10.</bibtext> </blist> <blist> <bibtext> Jeste, S., Hyde, C., Distefano, C., Halladay, A., Ray, S., Porath, M., Wilson, R. B., &amp; Thurm, A. (2020). Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions. Journal of Intellectual Disability Research, 64 (11), 825 – 833.</bibtext> </blist> <blist> <bibtext> LeDeR. (2022). Learning from lives and deaths—People with a learning disability and autistic people (LeDeR) report for 2021. The Institute of Psychiatry.</bibtext> </blist> <blist> <bibtext> Lincoln, Y. S., &amp; Guba, E. G. (1985). Naturalistic inquiry. Sage.</bibtext> </blist> <blist> <bibtext> Linehan, C., Birkbeck, G., Araten‐Bergman, T., Baumbusch, J., Beadle‐Brown, J., Bigby, C., Bradley, V., Brown, M., Bredewold, F., Chirwa, M., Cui, J., Godoy Gimenez, M., Gomeiro, T., Kanova, Š., Kroll, T., Li, H., MacLachlan, M., Narayan, J., Nearchou, F., ... Tossebro, J. (2022). COVID‐19 IDD: Findings from a global survey exploring family members' and paid staff's perceptions of the impact of COVID‐19 on individuals with intellectual and developmental disabilities (IDD) and their caregivers. HRB Open Research, 5, 5.</bibtext> </blist> <blist> <bibtext> Mander, C. (2016). An investigation of the delivery of health‐related accessible information for adults with learning disabilities. Tizard Learning Disability Review, 21 (1), 15 – 23.</bibtext> </blist> <blist> <bibtext> Mayer, R. E., Heiser, J., &amp; Lonn, S. (2001). Cognitive constraints on multimedia learning: When presenting more material results in less understanding. Journal of Educational Psychology, 93 (1), 187 – 198.</bibtext> </blist> <blist> <bibtext> Mengoni, S. E., Gates, B., Parkes, G., Wellsted, D., Barton, G., Ring, H., Khoo, M. E., Monji‐Patel, D., Friedli, K., Zia, A., Irvine, L., &amp; Durand, M. A. (2016). Wordless intervention for people with epilepsy and learning disabilities (WIELD): A randomised controlled feasibility trial. BMJ Open, 6 (11), e012993.</bibtext> </blist> <blist> <bibtext> Murphy, J., &amp; Cameron, L. (2008). The effectiveness of talking Mats® with people with intellectual disability. British Journal of Learning Disabilities, 36 (4), 232 – 241.</bibtext> </blist> <blist> <bibtext> National Institute for Health and Care Excellence (NICE). (2018). Learning disabilities and behaviour that challenges: service design and delivery. NICE.</bibtext> </blist> <blist> <bibtext> NHS England. (2015). Supporting people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition. Service model for commissioners of health and social care services. NHS England.</bibtext> </blist> <blist> <bibtext> NHS England. (2017). Accessible information standard. Making Health and Social Care Information Accessible.</bibtext> </blist> <blist> <bibtext> NHS Health Research Authority UK Policy Framework for Health and Social Care Research. https://<ulink href="http://www.hra.nhs.uk/planning&amp;#8208;and&amp;#8208;improving&amp;#8208;research/policies&amp;#8208;standards&amp;#8208;legislation/uk&amp;#8208;policy&amp;#8208;framework&amp;#8208;health&amp;#8208;social&amp;#8208;care&amp;#8208;research/2020">www.hra.nhs.uk/planning&amp;#8208;and&amp;#8208;improving&amp;#8208;research/policies&amp;#8208;standards&amp;#8208;legislation/uk&amp;#8208;policy&amp;#8208;framework&amp;#8208;health&amp;#8208;social&amp;#8208;care&amp;#8208;research/2020</ulink></bibtext> </blist> <blist> <bibtext> Nind, M. (2008). Conducting qualitative research with people with learning, communication and other disabilities: Methodological challenges. ESRC National Centre for Research Methods Review Paper.</bibtext> </blist> <blist> <bibtext> Ninnoni, J. P. K. (2019). A qualitative study of the communication and information needs of people with learning disabilities and epilepsy with physicians, nurses and carers. BMC Neurology, 19 (1), 12.</bibtext> </blist> <blist> <bibtext> O'Dwyer, M., McCallion, P., McCarron, M., &amp; Henman, M. (2018). Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: A neglected area of research. Therapeutic Advances in Drug Safety, 9 (9), 535 – 557.</bibtext> </blist> <blist> <bibtext> Oliver, K., Kothari, A., &amp; Mays, N. (2019). The dark side of coproduction: Do the costs outweigh the benefits for health research? Health Research Policy and Systems, 17 (1), 1 – 10.</bibtext> </blist> <blist> <bibtext> Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., &amp; Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health, 42 (5), 533 – 544.</bibtext> </blist> <blist> <bibtext> Pilnick, A., Clegg, J., Murphy, E., &amp; Almack, K. (2010). Questioning the answer: Questioning style, choice and self‐determination in interactions with young people with intellectual disabilities. Sociology of Health &amp; Illness, 32 (3), 415 – 436.</bibtext> </blist> <blist> <bibtext> Public Health England. (2020). Deaths of people identified as having learning disabilities with COVID‐19 in England in the Spring of 2020.</bibtext> </blist> <blist> <bibtext> Riess, H., &amp; Kraft‐Todd, G. (2014). E.M.P.A.T.H.Y.: A tool to enhance nonverbal communication between clinicians and their patients. Academic Medicine, 89 (8), 1108 – 1112.</bibtext> </blist> <blist> <bibtext> Rosencrans, M., Arango, P., Sabat, C., Buck, A., Brown, C., Tenorio, M., &amp; Witwer, A. (2021). The impact of the COVID‐19 pandemic on the health, wellbeing, and access to services of people with intellectual and developmental disabilities. Research in Developmental Disabilities, 114, 103985.</bibtext> </blist> <blist> <bibtext> Speziale, H. S., Streubert, H. J., &amp; Carpenter, D. R. (2011). Qualitative research in nursing: Advancing the humanistic imperative. Lippincott Williams &amp; Wilkins.</bibtext> </blist> <blist> <bibtext> Sutherland, R. J., &amp; Isherwood, T. (2016). The evidence for easy‐read for people with intellectual disabilities: A systematic literature review. Journal of Policy and Practice in Intellectual Disabilities, 13 (4), 297 – 310.</bibtext> </blist> <blist> <bibtext> The Equalities Act (2010). HM Government.</bibtext> </blist> <blist> <bibtext> Thurman, S., Jones, J., &amp; Tarleton, B. (2005). Without words–meaningful information for people with high individual communication needs. British Journal of Learning Disabilities, 33 (2), 83 – 89.</bibtext> </blist> <blist> <bibtext> Tuffrey‐Wijne, I., Giatras, N., Goulding, L., Abraham, E., Fenwick, L., Edwards, C., &amp; Hollins, S. (2013). Health services and delivery research. Identifying the factors affecting the implementation of strategies to promote a safer environment for patients with learning disabilities in NHS hospitals: A mixed‐methods study. NIHR Journals Library.</bibtext> </blist> <blist> <bibtext> Tuffrey‐Wijne, I., Goulding, L., Giatras, N., Abraham, E., Gillard, S., White, S., Edwards, C., &amp; Hollins, S. (2014). The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: Evidence from a mixed‐methods study. BMJ Open, 4 (4), e004606.</bibtext> </blist> <blist> <bibtext> United Nations. (2022). Convention on the rights of persons with disabilities (CRPD). Department of Economic and Social Affairs.</bibtext> </blist> <blist> <bibtext> Waight, M., &amp; Oldreive, W. (2022). Investigating accessible information formats with people who have learning disabilities. Learning Disability Practice, 25 (3), 23–30.</bibtext> </blist> <blist> <bibtext> Williams, V., &amp; Porter, S. (2017). The meaning of 'choice and control'for people with intellectual disabilities who are planning their social care and support. Journal of Applied Research in Intellectual Disabilities, 30 (1), 97 – 108.</bibtext> </blist> <blist> <bibtext> Williamson, E. J., McDonald, H. I., Bhaskaran, K., Walker, A. J., Bacon, S., Davy, S., Schultze, A., Tomlinson, L., Bates, C., Ramsay, M., Curtis, H. J., Forbes, H., Wing, K., Minassian, C., Tazare, J., Morton, C. E., Nightingale, E., Mehrkar, A., Evans, D., ... Kuper, H. (2021). Risks of covid‐19 hospital admission and death for people with learning disability: Population based cohort study using the OpenSAFELY platform. BMJ, 374, n1592.</bibtext> </blist> </ref> <aug> <p>By Helena Wythe; Raj Attavar; Julia Jones; Jackie Kelly; Claire Palmer; Louise Jenkins; Romanie Dekker; Debra Fearns; Scott Watkins; Anne Hunt and Natalie Pattison</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib25" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib34" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib49" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib36" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib12" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib48" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib43" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib65" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib44" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib62" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib26" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib58" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib45" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib57" firstref="ref21"></nolink> <nolink nlid="nl15" bibid="bib24" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib54" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib60" firstref="ref24"></nolink> <nolink nlid="nl18" bibid="bib61" firstref="ref25"></nolink> <nolink nlid="nl19" bibid="bib32" firstref="ref26"></nolink> <nolink nlid="nl20" bibid="bib40" firstref="ref27"></nolink> <nolink nlid="nl21" bibid="bib39" firstref="ref28"></nolink> <nolink nlid="nl22" bibid="bib42" firstref="ref29"></nolink> <nolink nlid="nl23" bibid="bib16" firstref="ref30"></nolink> <nolink nlid="nl24" bibid="bib41" firstref="ref33"></nolink> <nolink nlid="nl25" bibid="bib29" firstref="ref34"></nolink> <nolink nlid="nl26" bibid="bib28" firstref="ref37"></nolink> <nolink nlid="nl27" bibid="bib10" firstref="ref42"></nolink> <nolink nlid="nl28" bibid="bib14" firstref="ref43"></nolink> <nolink nlid="nl29" bibid="bib46" firstref="ref44"></nolink> <nolink nlid="nl30" bibid="bib33" firstref="ref45"></nolink> <nolink nlid="nl31" bibid="bib17" firstref="ref46"></nolink> <nolink nlid="nl32" bibid="bib47" firstref="ref47"></nolink> <nolink nlid="nl33" bibid="bib30" firstref="ref49"></nolink> <nolink nlid="nl34" bibid="bib13" firstref="ref51"></nolink> <nolink nlid="nl35" bibid="bib51" firstref="ref52"></nolink> <nolink nlid="nl36" bibid="bib27" firstref="ref53"></nolink> <nolink nlid="nl37" bibid="bib37" firstref="ref57"></nolink> <nolink nlid="nl38" bibid="bib56" firstref="ref60"></nolink> <nolink nlid="nl39" bibid="bib21" firstref="ref61"></nolink> <nolink nlid="nl40" bibid="bib18" firstref="ref63"></nolink> <nolink nlid="nl41" bibid="bib63" firstref="ref65"></nolink> <nolink nlid="nl42" bibid="bib11" firstref="ref66"></nolink> <nolink nlid="nl43" bibid="bib52" firstref="ref67"></nolink> <nolink nlid="nl44" bibid="bib64" firstref="ref68"></nolink> <nolink nlid="nl45" bibid="bib23" firstref="ref70"></nolink> <nolink nlid="nl46" bibid="bib15" firstref="ref74"></nolink> <nolink nlid="nl47" bibid="bib20" firstref="ref75"></nolink> <nolink nlid="nl48" bibid="bib19" firstref="ref78"></nolink> <nolink nlid="nl49" bibid="bib50" firstref="ref83"></nolink> <nolink nlid="nl50" bibid="bib22" firstref="ref85"></nolink> <nolink nlid="nl51" bibid="bib59" firstref="ref86"></nolink> <nolink nlid="nl52" bibid="bib53" firstref="ref89"></nolink> <nolink nlid="nl53" bibid="bib31" firstref="ref90"></nolink> <nolink nlid="nl54" bibid="bib35" firstref="ref91"></nolink> <nolink nlid="nl55" bibid="bib55" firstref="ref92"></nolink> <nolink nlid="nl56" bibid="bib38" firstref="ref93"></nolink>
Header	DbId: eric DbLabel: ERIC An: EJ1412977 AccessLevel: 3 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0
IllustrationInfo
Items	– Name: Title Label: Title Group: Ti Data: Evaluating the Usefulness of a Wordless Picture Book for Adults with Intellectual Disabilities about the COVID-19 Vaccination Programme Using Co-Production: The CAREVIS Study – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Helena+Wythe%22">Helena Wythe</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1573-9679">0000-0003-1573-9679</externalLink>)<br /><searchLink fieldCode="AR" term="%22Raj+Attavar%22">Raj Attavar</searchLink><br /><searchLink fieldCode="AR" term="%22Julia+Jones%22">Julia Jones</searchLink><br /><searchLink fieldCode="AR" term="%22Jackie+Kelly%22">Jackie Kelly</searchLink><br /><searchLink fieldCode="AR" term="%22Claire+Palmer%22">Claire Palmer</searchLink><br /><searchLink fieldCode="AR" term="%22Louise+Jenkins%22">Louise Jenkins</searchLink><br /><searchLink fieldCode="AR" term="%22Romanie+Dekker%22">Romanie Dekker</searchLink><br /><searchLink fieldCode="AR" term="%22Debra+Fearns%22">Debra Fearns</searchLink><br /><searchLink fieldCode="AR" term="%22Scott+Watkins%22">Scott Watkins</searchLink><br /><searchLink fieldCode="AR" term="%22Anne+Hunt%22">Anne Hunt</searchLink><br /><searchLink fieldCode="AR" term="%22Natalie+Pattison%22">Natalie Pattison</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. 2024 37(2). – Name: Avail Label: Availability Group: Avail Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 11 – Name: DatePubCY Label: Publication Date Group: Date Data: 2024 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Picture+Books%22">Picture Books</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Immunization+Programs%22">Immunization Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Instructional+Material+Evaluation%22">Instructional Material Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Personnel%22">Allied Health Personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Aids%22">Visual Aids</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1111/jar.13203 – Name: ISSN Label: ISSN Group: ISSN Data: 1360-2322<br />1468-3148 – Name: Abstract Label: Abstract Group: Ab Data: Aim: To explore the usefulness of a co-designed wordless book showing processes of receiving COVID-19 vaccines designed by, and for, adults with intellectual disabilities. Methods: A qualitative evaluation of the resource using mixed methods. Semi-structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Results: Understanding the COVID-19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID-19 restrictions changing. Conclusion: A visual resource may help conversations about the COVID-19 vaccine for people with intellectual disabilities. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2024 – Name: AN Label: Accession Number Group: ID Data: EJ1412977
PLink	https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1412977
RecordInfo	BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/jar.13203 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 11 Subjects: – SubjectFull: Picture Books Type: general – SubjectFull: Adults Type: general – SubjectFull: Intellectual Disability Type: general – SubjectFull: COVID-19 Type: general – SubjectFull: Immunization Programs Type: general – SubjectFull: Instructional Material Evaluation Type: general – SubjectFull: Allied Health Personnel Type: general – SubjectFull: Visual Aids Type: general Titles: – TitleFull: Evaluating the Usefulness of a Wordless Picture Book for Adults with Intellectual Disabilities about the COVID-19 Vaccination Programme Using Co-Production: The CAREVIS Study Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Helena Wythe – PersonEntity: Name: NameFull: Raj Attavar – PersonEntity: Name: NameFull: Julia Jones – PersonEntity: Name: NameFull: Jackie Kelly – PersonEntity: Name: NameFull: Claire Palmer – PersonEntity: Name: NameFull: Louise Jenkins – PersonEntity: Name: NameFull: Romanie Dekker – PersonEntity: Name: NameFull: Debra Fearns – PersonEntity: Name: NameFull: Scott Watkins – PersonEntity: Name: NameFull: Anne Hunt – PersonEntity: Name: NameFull: Natalie Pattison IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2024 Identifiers: – Type: issn-print Value: 1360-2322 – Type: issn-electronic Value: 1468-3148 Numbering: – Type: volume Value: 37 – Type: issue Value: 2 Titles: – TitleFull: Journal of Applied Research in Intellectual Disabilities Type: main
ResultId	1