What makes health checks acceptable and implementable in primary care for people with a learning disability and for autistic people?

What makes health checks acceptable and implementable for people with a learning disability and/or autistic people? Background

People with a learning disability and/or autistic people are more likely to experience health conditions and premature mortality (Heslop et al 2013; Hirvikoski et al 2016). We know that Annual Health Checks (AHCs) are useful for some people with a learning disability but uptake is lower than expected in some areas. Evidence for the uptake and effectiveness of AHCs for autistic people is being gathered.

We need to understand how the NHS can improve AHC provision and how healthcare staff and policymakers should implement them. This investigation into AHC implementation for people with a learning disability and/or autistic people will help improve AHC provision, uptake, and receipt through making AHCs more accessible to groups who may find them harder to access. Further, we will increase understanding of the best AHC delivery model.

Aims

1) Understand the factors that lead to effective AHC implementation for people with a learning disability and/or autistic people

2) Co-produce and field test an evidence based AHC implementation framework for people with a learning disability and/or autistic people to help the healthcare system to become more responsive needs (e.g. more effective reasonable adjustments to access AHCs) Objectives and Methods

1) Explore why, how and in what circumstances, AHCs are effective for people with a learning disability and/or autistic people and family/supporters/carers, health and social care staff, and policymakers through a Realist Review of the literature (Work package (WP)1a)

2) Develop a programme theory (i.e. an explanatory model) based on WP1a of how to empower clinicians to improve AHC delivery (including how identified needs are linked to onward referrals/actions) across different contexts for people with a learning disability and/or autistic people (WP1b)

3) Use a realist evaluation approach to explore the views of people with a learning disability, autistic people supporters/carers, health and social care staff and policymakers of AHCs. We will use Normalisation Process Theory (NPT) to frame solutions for healthcare staff in delivering AHCs and for people with a learning disability and/or autistic people receiving an AHC (WP2)

4) Gain a consensus agreement upon person specific and systems-related solutions for the implementation of AHCs for people with a learning disability and/or autistic people through a Delphi survey (WP 3)

5) Coproduce a clinical implementation framework to support AHCs in the NHS, maximising how AHCs are effectively delivered for people with a learning disability and/or autistic people (WP 4)

6) Field test the clinical implementation framework with people with a learning disability, autistic people, families/supporters and healthcare staff and develop a wider understanding of the framework will have upon people with a learning disability and/or autistic people (WP 5) Public Patient Involvement

We will work with advocacy and involvement agencies co-applicants (National Development Team for Inclusion, Autistica, Mencap) and with people with AHC expertise to plan and deliver this work, and to ensure stakeholders are aware of the findings, and their utility. Dissemination

We will share the study finding with stakeholders through publications, networks, newsletters, dissemination events. We will ensure the positive impact of AHCs and the implementation framework is widely understood to support further roll out.