Good communication with adults with learning disabilities in long-term care settings: A realist review

BACKGROUND: Good communication is vital to high-quality care for adults with learning disabilities in long-term care settings, influencing their health and well-being. Evidence on how best to support their communication needs is limited. OBJECTIVES: To develop an initial programme theory that synthesises knowledge on how communication interventions work in these settings, how they can be best designed, implemented, and evaluated, and the resources needed. METHODS: A realist review was conducted following RAMESES II standards, using seven databases (CINAHL, EMBASE, Medline, PsycINFO, Scopus, Web of Science, Cochrane Library). After screening, included studies were assessed for quality and relevance, with data extracted from those rated moderate to high. Context-mechanism-outcome configurations were developed and refined through consultation with experts and stakeholders, including in meetings with 53 adults with learning disabilities, carers, and professionals. The review was registered on PROSPERO (Registration number: CRD42024501147). RESULTS: Of 5576 studies screened, 29 were assessed as moderate or highly relevant, contributing to ten context-mechanism-outcome configurations describing changes in: staff knowledge and awareness of communication; ability to assess individuals' needs; and use of practices, techniques, tools, and support for choice-making. Organisational resources key to enabling staff skill development referred to changes in leadership, policies and procedures, environmental modifications, training and ongoing support. Outcome measures include those reflecting effective communication. CONCLUSIONS: Good communication is a complex process that requires systemic support prioritising communication and meaningful relationships between staff and individuals. This initial program theory offers a framework to guide the implementation and evaluation of such support.