How Is Psychotropic Use for Challenging Behaviour in People With Intellectual Disability Understood by Stakeholders? A Concept Analysis Using Rodgers' Evolutionary Approach

Psychotropic use for challenging behaviours in people with intellectual disability persists despite initiatives and prescribing guidelines encouraging judicious use. The use of some medications, such as psychiatric medications, can be stigmatised or linked to certain social and cultural beliefs. Rodgers' (1989) evolutionary framework of concept analysis was employed, alongside qualitative data collection, to examine the extent to which people with intellectual disability, their family members and health professionals have similar beliefs about appropriate psychotropic use and shared decision making processes. This study found that the justification for psychotropic use ranges from maintaining mood and safety according to service users and service providers; however, only service providers spoke about the use of medication as a last resort or legacy use. We identified organisational and health system factors, as well as professional, cultural, and relational factors stemming from diverging perceptions of psychotropic risk and power imbalances that influence psychotropic use. This suggests that there are gaps in understanding how to support decision making among people with intellectual disability about their medications. The results clarify the need for further research on effective interventions to enhance the shared decision making process around medications.