Implementation of Annual Health Assessments for Adults With Intellectual Disabilities: An Integrative Review

People with intellectual disabilities (ID) face health inequalities, often arising from undiagnosed health conditions. An annual health assessment (or health check) administered by a primary care provider can be a systematic method of identifying these health conditions and initiating treatment and management, leading to better health outcomes. While these health checks are recommended in many countries, including the United Kingdom (UK), they have not been administered to all adults with ID. In light of this, the barriers and facilitators to systematic implementation have not been systematically studied. The aim of this Integrative review was to identify the barriers and facilitators to the systematic implementation of health checks, using the Consolidated Framework for Implementation Research (CFIR). This model has been used in implementation research and is useful in determining the levels of healthcare interaction that are involved in the delivery of this intervention. We identified 35 peer-reviewed primary research articles that met inclusion criteria. The barriers and facilitators to health check implementation were extracted and coded according to the individual involved, whether it was a barrier or facilitator, and the domains and constructs of the CFIR model. We concluded that most factors related to the physician's role, as well as many factors related to the intervention itself. Some of these facilitators included the perceived efficacy of the health check intervention and the belief that it provides more comprehensive care. Some of the barriers include additional time that is necessary to implement the intervention and a lack of resources. Future interventions could train physicians and target some structural health system barriers to implementing health checks, and further research with physicians, patients, and carers is needed. This research may confirm the barriers and facilitators to health check implementation and explore methods to promote health checks.