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Table 2 Checklist of possible needs and barriers to good healthcare requiring adjustment

From: Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability

Example of impairment or deficit Example of adjustment (enabler of good healthcare)
 Intellectual disability/reduced mental capacity  Staff training in capacity assessment and inclusive practice
 Memory problems  Prompts, support for appointments
 Literacy/reading skills deficit  Accessible materials, communication skills
 Vision/hearing impairment  Visual aids
 Speech problems  Time, trained staff
 Mobility difficulties, physical symptoms or restrictions  May need OT/physio assessment/mobility aids
Attitudinal barriers  
 History of lack of dignity/respect in services  Staff training
 Threat to safety including bullying  Safeguarding protocols
 Overcoming stigma  Advocacy
 Instrumental barriers  
 Transport to services  Funding, safe provision
 Finance  Personal budget
 Lack of access to personal pleasure/R+R activities  Planning meeting with supporter
 Treatment burden—timing, side-effects  Support with adherence, modified regime
Social barriers  
 Lack of social support/networks  Identify, train and support carers; advocacy; third sector
 Talking with professionals  Staff training + supervision
 Communicating needs  LD register; Health Action Plan
 Understanding—health risks, necessary actions  Accessible information
 Low self confidence  Social engagement activities
Mental Health  
 Challenging behaviour  Pacing of change; staff training
 Distress + mental disorder  Mental health review with learning disability team