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Public health
Research
Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review
  1. Frédérique Lamontagne-Godwin1,
  2. Caroline Burgess2,
  3. Sarah Clement3,
  4. Melanie Gasston-Hales4,
  5. Carolynn Greene4,
  6. Anne Manyande1,
  7. Deborah Taylor4,
  8. Paul Walters5,
  9. Elizabeth Barley1
  1. 1 School of Human and Social Sciences, University of West London, London, UK
  2. 2 Primary Care and Public Health Sciences, King’s College London, London, UK
  3. 3 Freelance Researcher, London, UK
  4. 4 College of Nursing, Midwifery and Healthcare, University of West London, London, UK
  5. 5 Department of Research and Development, Dorset HealthCare University NHS Foundation Trust, Bournemouth, UK
  1. Correspondence to Frédérique Lamontagne-Godwin; frederique.lamontagne-godwin{at}uwl.ac.uk

Abstract

Objectives To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work.

Design Realist review.

Setting Primary, secondary and tertiary care.

Results A systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward.

Conclusions A range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.

  • organisation of health services
  • primary care
  • adult psychiatry
  • public health
  • lipid disorders

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-019412

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    Footnotes

    • Contributors EB, CB, SC and DT were involved in the study design. EB, MG-H, FRL-G, AM and DT acquired and analysed the data. EB, SC, FRL-G and PW interpreted the data. FRL-G and AM drafted the manuscript. CB, SC, FRL-G and PW critically revised the manuscript for intellectual content. EB, CB, SC, MG-H, CG, FRL-G, AM, DT and PW contributed to writing and interpretation of the results.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.