Access to preventive health assessments for people with intellectual disability: a systematic scoping review informed by the Levesque Access Framework.

Abstract

Introduction: Access to preventive care is essential for addressing the stark health inequities between people with intellectual disability and the general population. Despite evidence that structured annual preventive health assessments in primary care can support the delivery of evidence-based care to people with intellectual disability, their uptake remains low. This scoping review synthesises the literature examining the multiple dimensions of access to health assessments to identify the supply- and demand-side factors that are impacting on people with intellectual disability's access to them.

Methods: This scoping review followed JBI methodology. We systematically searched six databases on 15 February 2024 for relevant peer-reviewed empirical research. Two independent reviewers completed full-text screening and extracted data, mapping it to Levesque and colleagues' theoretical framework of access, which incorporates supply-side features of health systems and services, and demand-side characteristics of consumers and populations.

Results: Of the 1639 identified publications, 40 met the inclusion criteria, all originating from six high-income countries. Most of the published research focused on supply-side factors, such as the availability and promotion of assessments by health services, practitioners' views on their effectiveness; communication challenges; and the provision of reasonable adjustments. Less frequently included were demand-side factors such as communication challenges between the practitioners and the person with intellectual disability, the health literacy both of people with intellectual disability and their carers/supporters, and the level of involvement in, and engagement with, the process by carers/supporters.

Conclusion: This review systematically assesses the supply and demand-side factors impacting on access to health assessments for people with intellectual disability. Supply-side factors are well-documented, and findings on these factors show some consistency across multiple reviews, including this one. There is a need for further research to explore the perspective of practitioners who do not currently offer health assessments. Demand-side factors remain less explored than supply-side factors and warrant further investigation and research is needed to understand the perspectives of people with disability who do not currently access health assessments.