Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review

Abstract

ObjectivesTo 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.DesignRealist review.SettingPrimary, secondary and tertiary care.ResultsA 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.ConclusionsA 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.

What works and why in the identification and referral of adults with comorbid obesity in primary care: A realist review

“…The mechanisms identified in this review resonate with those described in two realist reviews exploring screening or referral by practitioners in other health care contexts . In O'Campo et al's review of intimate partner violence screening across a range of health care settings, they also found that most studies were multicomponent.…”

“…In the realist review of physical health screening in people with mental health conditions by Lamontagne‐Godwin and colleagues, interventions were divided into those focusing on health service delivery changes (eg, staff training and protocol development) and those using tools designed to facilitate screening (eg, electronic prompts). As with the O'Campo study, the authors did not employ the CMO heuristic or make any attempt to discern mechanisms or theories of change underpinning the identified intervention strategies.…”

“…They did, however, detail a range of barriers and facilitators to the successful implementation of both the health system delivery changes and the tools to facilitate screening. Some of the barriers resonate with those from this review, including resource constraints (eg, lack of time, staff turnover), environmental barriers (eg, poor communication between primary and secondary care), and unclear boundaries around professional role …”

“…72 The mechanisms identified in this review resonate with those described in two realist reviews exploring screening or referral by practitioners in other health care contexts. 73,74 In O'Campo et al's review of intimate partner violence screening across a range of health care settings, 74 they also found that most studies were multicomponent. The four programme components that increased practitioner self-efficacy for screening were institutional support, effective screening protocols, thorough initial and ongoing training, and immediate access/referrals to onsite and/or offsite support services.…”

“…In the realist review of physical health screening in people with mental health conditions by Lamontagne-Godwin and colleagues, 73 interventions were divided into those focusing on health service delivery changes (eg, staff training and protocol development) and those using tools designed to facilitate screening (eg, electronic prompts).…”