Owens Janine, Ravindrarajah Rathi, Norman Gill, Hopkin Elinor, Shi Chunhu, Lovell Karina, Bee Penny E
School of Nursing, Midwifery and Social work, The University of Manchester, Manchester, UK
School of Nursing, Midwifery and Social work, The University of Manchester, Manchester, UK.
BMJ Open. 2025 Aug 4;15(8):e093426. doi: 10.1136/bmjopen-2024-093426.
Individuals living with severe mental illness (SMI) are at a significantly higher risk of mortality. This mixed-methods systematic review identifies and explores factors, including access inequalities to annual health checks (AHCs), for people living with SMI sharing protected characteristics in the UK, as identified in Core20PLUS5.
Mixed-methods systematic review.
MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, Google Scholar and the grey literature were searched from 1 January 2004 to 30 January 2025.
Inclusion criteria were adults >18 years of age living with SMI. We included studies of AHCs, short health screening interventions, health promotion interventions, considering or aiming to improve uptake and/or access to screening for people living with SMI. We included mixed-methods and quantitative studies: randomised controlled trials, non-randomised controlled studies, cohort studies, cross-sectional studies and process evaluations. We also included qualitative studies.
Two reviewers independently assessed the evidence for inclusion using the eligibility criteria at title, abstract and at full-text screening. Quality Assessment with Diverse Studies was used for methodological quality. Analysis used Levesque's Conceptual Framework of Access as an a priori framework and dimensions of equality from Core20PLUS5 and PROGRESS PLUS. Separate and independent quantitative and qualitative narrative syntheses and integration of the evidence from both occurred.
36 studies were included. Five studies applied reasonable adjustments to increase access to AHCs but lacked evaluation, controls and comparisons. 26 studies failed to discuss deprivation or ethnicity and only 6 studies discussed barriers and facilitators of access to AHCs for people of different ethnic, linguistic or cultural backgrounds. There was no evidence for interventions improving access to AHCs. Access focused primarily on dimensions of services, over abilities to access AHCs for people living with SMI.
There are access inequalities to AHCs for people living with SMI sharing protected characteristics. Robust research is urgently needed to identify, modify and ameliorate barriers to the policy recommended AHCs.
CRD42023437905.
患有严重精神疾病（SMI）的个体死亡风险显著更高。这项混合方法的系统评价识别并探讨了影响因素，包括年度健康检查（AHCs）的获取不平等情况，针对的是英国具有《核心20加5》中所确定的受保护特征的SMI患者。
混合方法的系统评价。
检索了2004年1月1日至2025年1月30日期间的MEDLINE、EMBASE、PsycINFO、CINAHL、ASSIA、谷歌学术以及灰色文献。
纳入标准为年龄大于18岁的患有SMI的成年人。我们纳入了关于AHCs、简短健康筛查干预、健康促进干预的研究，这些研究考虑或旨在提高SMI患者接受筛查的比例和/或机会。我们纳入了混合方法和定量研究：随机对照试验、非随机对照研究、队列研究、横断面研究和过程评估。我们还纳入了定性研究。
两名评审员独立使用纳入标准在标题、摘要和全文筛选阶段评估纳入证据。使用不同研究的质量评估来评估方法学质量。分析使用Levesque的获取概念框架作为先验框架，并结合《核心20加5》和“PROGRESS PLUS”中的平等维度。分别独立进行定量和定性的叙述性综合，并整合来自两者的证据。
纳入了36项研究。5项研究进行了合理调整以增加获得AHCs的机会，但缺乏评估、对照和比较。26项研究未讨论贫困或种族问题，只有6项研究讨论了不同种族、语言或文化背景的人获得AHCs的障碍和促进因素。没有证据表明干预措施能改善获得AHCs的机会。获取主要关注服务维度，而非SMI患者获得AHCs的能力。
具有受保护特征的SMI患者在获得AHCs方面存在获取不平等。迫切需要进行有力的研究，以识别、修改和改善政策推荐的AHCs的障碍。
PROSPERO注册号：CRD42023437905。
