PDF(Pubmed)
Abstract：
BACKGROUND: People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners\' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice.
METHODS: This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators.
RESULTS: The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners\' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout.
CONCLUSIONS: Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.
METHODS: This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators.
RESULTS: The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners\' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout.
CONCLUSIONS: Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.
摘要：
背景：与一般人群相比，智障人士的健康状况较差，部分原因是初级保健机构难以获得预防性护理。有充分的证据表明，结构化的年度健康评估可以提高智障人士的护理质量，它们的使用已成为几个高收入国家的推荐政策。然而,摄取仍然很低。理论领域框架（TDF）为理解实施障碍提供了一个概念结构，并已有效地应用于其他高需求群体的健康评估实施情况。但不适合智力残疾的人。我们对文献进行了范围审查，使用TDF，确定影响初级保健从业人员的障碍和促进因素，作为常规初级保健实践的一部分，对智障人士实施年度健康评估。
方法：本研究是根据JBI方法学方法进行范围审查的。搜索在Medline(OVID-SP)进行，Embase(OVID-SP),PsycINFO(OVID-SP),CINHAL(EBSCO)，Scopus（Elsevier）和WebofScience（Clarivate）提供截至2023年5月的相关同行评审出版物。筛选,全文审阅和数据提取由两名独立审阅者完成.数据被提取并映射到TDF以识别相关的障碍和促进者。
结果：搜索产生了1057种出版物，21人符合纳入标准。将数据映射到TDF，最常识别的领域是(A)环境背景和资源，(b)技能,(c)知识和(d)情感。影响实施的主要因素包括从业人员对健康评估及其已确定的益处缺乏认识；从业人员在为智障人士提供健康评估方面的培训和经验不足；提供健康评估的时间不足；以及从业人员倦怠。
结论：使用基于理论的行为框架，我们的审查有助于理解作为智障人士常规护理的一部分,改善健康评估实施的障碍和促进因素.然而,显然需要进一步的定性研究，以检查初级保健从业人员对实施障碍和促进者的总体健康评估的看法，包括目前没有进行健康评估的从业者的意见。
方法：本研究是根据JBI方法学方法进行范围审查的。搜索在Medline(OVID-SP)进行，Embase(OVID-SP),PsycINFO(OVID-SP),CINHAL(EBSCO)，Scopus（Elsevier）和WebofScience（Clarivate）提供截至2023年5月的相关同行评审出版物。筛选,全文审阅和数据提取由两名独立审阅者完成.数据被提取并映射到TDF以识别相关的障碍和促进者。
结果：搜索产生了1057种出版物，21人符合纳入标准。将数据映射到TDF，最常识别的领域是(A)环境背景和资源，(b)技能,(c)知识和(d)情感。影响实施的主要因素包括从业人员对健康评估及其已确定的益处缺乏认识；从业人员在为智障人士提供健康评估方面的培训和经验不足；提供健康评估的时间不足；以及从业人员倦怠。
结论：使用基于理论的行为框架，我们的审查有助于理解作为智障人士常规护理的一部分,改善健康评估实施的障碍和促进因素.然而,显然需要进一步的定性研究，以检查初级保健从业人员对实施障碍和促进者的总体健康评估的看法，包括目前没有进行健康评估的从业者的意见。
