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Annual Health Checks for People with Intellectual Disabilities: An Exploration of Experiences, Follow-Up and Self-Management of Health Conditions

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Title: Annual Health Checks for People with Intellectual Disabilities: An Exploration of Experiences, Follow-Up and Self-Management of Health Conditions
Language: English
Authors: Dawn E. Cavanagh (ORCID 0000-0002-5204-9485), Ruth Northway (ORCID 0000-0001-8420-733X), Stuart Todd (ORCID 0000-0003-1640-2111)
Source: Journal of Applied Research in Intellectual Disabilities. 2024 37(3).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 12
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Descriptors: Intellectual Disability, Physical Examinations, Access to Health Care, Barriers, Self Management, Adults, Health Conditions
DOI: 10.1111/jar.13233
ISSN: 1360-2322
1468-3148
Abstract: Background: Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this. Methods: People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken. Results: Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check. Conclusion: A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1421446
Database: ERIC
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  Value: <anid>AN0176717642;e0301may.24;2024Apr23.05:02;v2.2.500</anid> <title id="AN0176717642-1">Annual health checks for people with intellectual disabilities: An exploration of experiences, follow‐up and self‐management of health conditions </title> <p>Background: Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self‐manage their health in between AHCs, and what support they receive. This research aimed to explore this. Methods: People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross‐sectional thematic analysis was undertaken. Results: Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self‐management of health, the personal context, and addressing health inequities. Four main themes emerged from follow‐up interviews: follow‐up, supporting the self‐management of health, the need for reasonably adjusted health services, and going for another health check. Conclusion: A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.</p> <p>Keywords: annual health checks; follow‐up; health action plans; health conditions; intellectual disabilities; self‐management</p> <hd id="AN0176717642-2">INTRODUCTION</hd> <p>People with intellectual disabilities have poorer health and higher mortality rates than the general population (Emerson et al., [<reflink idref="bib10" id="ref1">10</reflink>]), partly due to inequitable healthcare (Emerson et al., [<reflink idref="bib10" id="ref2">10</reflink>]). Since people with intellectual disabilities can struggle to identify and communicate symptoms of ill health (Alborz, [<reflink idref="bib1" id="ref3">1</reflink>]), and experience difficulties with navigating the healthcare system, the annual health check (AHC) identifies and treats medical conditions early (Hoghton, [<reflink idref="bib17" id="ref4">17</reflink>]). An AHC should include a personalised Health Action Plan detailing the person's health needs, actions required by whom and when (Gates et al., [<reflink idref="bib14" id="ref5">14</reflink>]). With the person's permission, the plan 'should be shared with relevant health and social care agencies involved in supporting the person' (LeDeR Programme, [<reflink idref="bib21" id="ref6">21</reflink>]). Health Action Planning and its emphasis on 'what a person with an intellectual disability can do to be healthy' (Hoghton, [<reflink idref="bib17" id="ref7">17</reflink>], p. 34) suggest support for the self‐management of health, although guidance for General Practitioners (GPs) (Hoghton, [<reflink idref="bib17" id="ref8">17</reflink>]; Royal College of General Practitioners (RCGP), [<reflink idref="bib35" id="ref9">35</reflink>]) does not explicitly state this.</p> <p>To be eligible for an AHC in Wales, you must be aged 18 years or over and be registered as using the services of the local authority (NHS Wales, [<reflink idref="bib27" id="ref10">27</reflink>]). There are similar initiatives in other countries of the United Kingdom, as well as outside of the United Kingdom, such as in Australia. The AHC was first introduced in Wales in 2006 as a directed enhanced service (DES) to be provided by GPs. The uptake of the AHC in Wales year‐on‐year has tended to remain below 50% with considerable variation in the take‐up rate across local health boards (Public Health Wales and NHS Wales Shared Services Partnership, [<reflink idref="bib32" id="ref11">32</reflink>], [<reflink idref="bib33" id="ref12">33</reflink>]). There have also been concerns raised regarding the quality of health checks (Williams, [<reflink idref="bib38" id="ref13">38</reflink>]). While examples exist of initiatives to improve uptake and quality in Wales, there is a lack of published research into the initiatives designed to address these issues (Robertson et al., [<reflink idref="bib34" id="ref14">34</reflink>]).</p> <p>AHCs have been the focus of several studies as identified in a systematic review published by Robertson et al. ([<reflink idref="bib34" id="ref15">34</reflink>]). The review concludes that health checks have consistently led to the detection of unmet health needs and targeted actions to address those needs. However, Robertson et al. ([<reflink idref="bib34" id="ref16">34</reflink>]) identified that there is little evidence regarding the extent to which health checks lead to health gains, including how health issues identified at the health check are followed up and addressed over time. The few quantitative studies (Bollard, [<reflink idref="bib2" id="ref17">2</reflink>]; Hunt et al., [<reflink idref="bib18" id="ref18">18</reflink>]; Martin et al., [<reflink idref="bib24" id="ref19">24</reflink>]; Martin et al., [<reflink idref="bib25" id="ref20">25</reflink>]) that have looked at follow‐up after the health check do not indicate <emph>how</emph> the identified health need was followed up and addressed over time or how the follow‐up process was perceived by people with intellectual disabilities and where relevant their supporters. Instead, the studies tend to report whether the issue went on to be addressed using simple statements such as 'severity of seizure reduced' (Bollard, [<reflink idref="bib2" id="ref21">2</reflink>], p. 1217). Furthermore, the criteria used to determine whether identified health needs had been addressed are not always robust. For example, in Martin et al.'s (2004) study some patients identified weight gain as a problem and their concern was recorded as 'addressed' if suitable eating advice or a diet sheet had been provided. However, providing a patient with eating advice or a diet sheet says little about whether the patient goes on to benefit from the intervention.</p> <p>Research carried out among the general population has shown that there are potential benefits to individuals in managing their health, such as fewer emergency attendances and admissions (Deeny et al., [<reflink idref="bib8" id="ref22">8</reflink>]). Literature on the self‐management of health for people with intellectual disabilities tends to focus on the self‐management of single health conditions, such as asthma (Lorig et al., [<reflink idref="bib22" id="ref23">22</reflink>]), diabetes (Maine et al., [<reflink idref="bib23" id="ref24">23</reflink>]) or cardiovascular disease (Young et al., [<reflink idref="bib40" id="ref25">40</reflink>]), rather than general self‐management (Friedman et al., [<reflink idref="bib12" id="ref26">12</reflink>]). Some studies have evaluated the effectiveness of disease self‐management programmes for people with intellectual disabilities and findings suggest that such programmes may need adapting for this group (Maine et al., [<reflink idref="bib23" id="ref27">23</reflink>]; Wilson & Goodman, [<reflink idref="bib39" id="ref28">39</reflink>]). Friedman et al. ([<reflink idref="bib12" id="ref29">12</reflink>]) analyzed data from Personal Outcome Measures surveys (<emph>n =</emph> 1341) to explore self‐management of health and found that its impact for people with intellectual disabilities can be wide‐ranging. When people with intellectual disabilities were supported to self‐manage their health, they 'transformed from passive recipients to active directors', health professionals were more likely to address healthcare issues and interventions were more likely to be effective (Friedman et al., [<reflink idref="bib12" id="ref30">12</reflink>], p. 600). However, despite these findings, there remains a gap in the literature about how the self‐management of health may be linked with the AHC.</p> <p>This study addressed the following research questions:</p> <p></p> <ulist> <item> How are health issues identified within AHCs for people with intellectual disabilities followed up and addressed over time?</item> <p></p> <item> How do people with intellectual disabilities self–manage health conditions identified within AHCs?</item> <p></p> <item> What support do people with intellectual disabilities receive to assist them with the self‐management of health conditions?</item> </ulist> <hd id="AN0176717642-3">METHOD</hd> <p></p> <hd id="AN0176717642-4">Design</hd> <p>To answer the research questions, a longitudinal qualitative approach was taken. Longitudinal qualitative research is a methodology where qualitative data are collected from the same participants at different points in time (Grossoehme & Lipstein, [<reflink idref="bib15" id="ref31">15</reflink>]), which can provide valuable insights into the phenomena under investigation.</p> <hd id="AN0176717642-5">Participants and recruitment</hd> <p>Purposive heterogeneous sampling was used to identify and recruit participants. Participants were purposively selected on the basis that they were an adult with an intellectual disability, resided in Wales (and within the health board areas that were the focus of this study). They also needed to have had a recent AHC. Participants were recruited from four health boards, including rural, urban, and post‐industrial areas where the uptake and quality of health checks may vary. They were identified and recruited from third‐sector organisations that work with people with intellectual disabilities and/or their families, with organisations making initial contact with potential participants following an invitation from the researcher. Heterogeneous sampling was used to illuminate the diversity of experience among people with intellectual disabilities to achieve a greater understanding of the research topic.</p> <p>It was originally anticipated that around 15–20 people with intellectual disabilities would be recruited to the study. However, recruitment stopped after 12 participants had been recruited as it was felt that data saturation had been achieved. There was no dropout, with all 12 participants having participated in each stage of the study.</p> <p>Table 1 shows the variation in the sample for this study in terms of personal characteristics.</p> <p>1 TABLE Personal characteristics of the sample (total = 12).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Personal characteristics</th><th align="left"><italic>N</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Age</td></tr><tr><td align="left">18–29</td><td align="left">3</td></tr><tr><td align="left">30–44</td><td align="left">2</td></tr><tr><td align="left">45–59</td><td align="left">5</td></tr><tr><td align="left">60+</td><td align="left">2</td></tr><tr><td align="left">Sex</td></tr><tr><td align="left">Male</td><td align="left">7 (18–60 years)</td></tr><tr><td align="left">Female</td><td align="left">5 (20–64 years)</td></tr><tr><td align="left">Ethnicity</td></tr><tr><td align="left">White (British)</td><td align="left">4</td></tr><tr><td align="left">White (Welsh)</td><td align="left">7</td></tr><tr><td align="left">White (English)</td><td align="left">1</td></tr><tr><td align="left">Specific conditions associated with intellectual disability</td></tr><tr><td align="left">Down syndrome</td><td align="left">3</td></tr><tr><td align="left">Autism</td><td align="left">3</td></tr><tr><td align="left">Cerebral palsy</td><td align="left">1</td></tr><tr><td align="left">Level of disability (based on level of support required)</td></tr><tr><td align="left">Mild/moderate</td><td align="left">10</td></tr><tr><td align="left">Severe/profound</td><td align="left">2</td></tr><tr><td align="left">Living arrangements</td></tr><tr><td align="left">Supported living</td><td align="left">3</td></tr><tr><td align="left">Living with family member/s</td><td align="left">6 (1 living in a residential college by the end of the study).</td></tr><tr><td align="left">Living independently</td><td align="left">1 (1 living in supported living by the end of the study)</td></tr><tr><td align="left">Other</td><td align="left">2 (Both living in adapted flat)</td></tr></tbody></table> </ephtml> </p> <p>As well as participants with intellectual disabilities, there were a number of significant others that were involved in the interviews. Table 2 provides further details.</p> <p>2 TABLE Significant others that took part in the interviews.</p> <p> <ephtml> <table><tbody valign="top"><tr><td align="left">Where informed consent could not be obtained:Participants were primarily people with intellectual disabilities. However, two people acted as proxy respondents for people with intellectual disabilities who were non‐verbal and/or had limited communication. In the results section, these proxy respondents can be identified as Participant 11 (the person's support worker) and Participant 4 (the person's mother).One person, identified as Participant 7 in the results section, had a level of communication that meant that they could be interviewed with a consultee providing support. This consultee was the participant's father.Where informed consent could be obtained:Two participants asked that a supporter be present for emotional support. A third participant asked that a supporter accompany them to act as a translator as they were partially deaf and reliant on lip‐reading. Two of these supporters were present at the person's health check. Only one supporter was present for all three interviews.For the most part, supporters gave participants the space to speak freely, assisting where appropriate. For example, participants would sometimes call upon supporters to help them recall past experiences which they had both shared. This helped to create a more detailed picture of events. However, there was a concern that a supporter's voice might prevent the participant's from being heard and this was mitigated by redirecting the conversation back to the participant and checking in with the participant (e.g., asking the participant if there was anything else they would like to talk about).A decision was made to include supporter data in the analysis as supporters might also be the people that AHC outcomes are directed at.In the results section, these three participants and their supporters are as follows:Participant 1 was interviewed with his advocate for the first interview.Participant 8 was interviewed across all three interviews with their supported living services manager present.Participant 6 was interviewed with his sister for the first two interviews.Participants 2, 3, 5, 9, 10, and 12 were interviewed without any supporters present.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0176717642-6">Ethics</hd> <p>Approval for this study was granted by the Faculty of Life Sciences and Education Ethics Committee at the University of South Wales and an NHS Research Ethics Committee.</p> <p>Accessible information was provided to support capacity. Where individuals were judged unable to give informed consent to participation, a Personal or Nominated Consultee guided the researcher on the advisability of involving the person in the study (Department of Health, [<reflink idref="bib9" id="ref32">9</reflink>]). Consultees were provided with all relevant information about the study and about the role of a consultee. Where an interview was not possible, the consultee was required to act as a participant.</p> <hd id="AN0176717642-7">Procedure</hd> <p>In‐depth, semi‐structured interviews were undertaken with the same 12 participants at three different time points.</p> <p>In‐depth, semi‐structured interviews were used as they enabled the researcher to remain focused on key topics that they wished to address, while still allowing participants to talk about their experiences openly and in a meaningful way (Joffe, [<reflink idref="bib19" id="ref33">19</reflink>]). The first interview stage took place as soon as possible after the AHC to explore people's experiences of the health check, any issues identified, and what actions had been proposed. A checklist was undertaken at the first interview stage to capture which aspects of health had been covered at the health check. The Welsh Health Check (Kerr, [<reflink idref="bib20" id="ref34">20</reflink>]) was used as a template for this and required a 'yes', 'no', or 'don't know' response. It was produced in an Easy Read format and shared with participants to aid understanding. In addition, open‐ended, follow‐up questions were asked to further explore people's experiences of the health check, as well as whether any targeted actions had been taken to address any issues identified at the health check.</p> <p>Six months after the first interview stage, the same people, and where relevant their supporters, were interviewed again. They were then interviewed one last time at 11 months as participants should have been preparing for their next health check. The follow‐up interview stages explored whether any planned actions had been taken, their perceptions of these, and what they had (or had not) achieved. The interviews also looked at how health conditions were being self‐managed, what may have changed, as well as how people were being supported to self‐manage their health. At the final interview stage, participants were asked about the next health check. Schedules for interviews two and three were modified in line with the individual's circumstances as revealed via the first interview.</p> <p>For all three interviews, cue cards representing key topic areas and any difficult concepts were produced for participants who benefited from a visual aid to support understanding and/or to aid conversational flow. Photosymbols software (Photosymbols Ltd., [<reflink idref="bib30" id="ref35">30</reflink>]) was used to produce the cards.</p> <hd id="AN0176717642-8">Analysis</hd> <p>The interviews were transcribed verbatim onto a computer before analysis. A recurrent cross‐sectional thematic analysis was used to analyse the longitudinal data. This is because it is best suited to research questions that compare discrete time points (Grossoehme & Lipstein, [<reflink idref="bib15" id="ref36">15</reflink>]). Thematic analysis was employed as it is well suited to the exploration of people's views, ideas, and experiences (Braun & Clarke, [<reflink idref="bib4" id="ref37">4</reflink>]). Since it is not bound to any pre‐existing theoretical framework, it can be used within a range of theories and epistemological approaches. In this case, a critical realist approach was taken which acknowledges how people interpret experience within a broader social context but focuses on the data and reflects 'reality' (Braun & Clarke, [<reflink idref="bib3" id="ref38">3</reflink>]). The identified themes were strongly linked to the data, which is broadly consistent with an inductive approach to analysis. Communication difficulties, as well as the longitudinal nature of the research, and the potential for memory degradation, meant that asking participants for validation after the analysis had been carried out may have proven too difficult. To address this, a semantic approach was taken where the researcher remains close to the meaning overtly articulated by the participant; hence, drawing out themes that are explicitly identified.</p> <p>Data analysis was coded by hand. The data from all participants were analysed as a single unit using thematic analysis across three separate time points using Braun and Clarke's ([<reflink idref="bib3" id="ref39">3</reflink>]) framework.</p> <p>Work conducted to ensure the robustness of the themes included discussion of the analysis at supervision meetings, which led to many revisions of the themes; keeping a reflexive journal and checking in with participants at the beginning of each interview to check that the researcher's understanding of what had been said at the previous interview matched theirs.</p> <hd id="AN0176717642-9">RESULTS</hd> <p></p> <hd id="AN0176717642-10">Interview stage one</hd> <p>The findings of the checklist exercise suggested inconsistency in the breadth to which the AHC was completed for participants. The areas least likely to have been checked were height (needed to ascertain BMI), sensory checks (vision and hearing); whether the participant was registered with a dentist, and whether the participant required relationships and/or contraception advice. No participant reported that a Health Action Plan had been shared with them.</p> <p>The main themes for the thematic analysis for Interview Stage One were: going for the health check, issues identified and actions taken, supporting the self‐management of health, the personal context, and addressing health inequities.</p> <hd id="AN0176717642-11">Going for the health check</hd> <p>How the health check consultation was carried out appeared to be an important factor in shaping people's experiences of the health check. Some had the first part of the health check performed by the practice nurse and the latter part performed by the GP which seemed popular with participants. Those who felt satisfied reported that they were invited to an AHC every year and that their consultations were longer and more thorough:</p> <p>They go through everything...[It] did take a good amount of time...up to about an hour (Participant 5)</p> <p>Participants appeared less satisfied with their AHC if many checks and/or key checks had not been carried out. Even for those participants who relayed positive experiences not all checks appeared to have been undertaken:</p> <p>Good thing, yeah, but they didn't do it all. (Participant 9)</p> <p>Participants also reported feeling less satisfied with their health check if there was a perceived lack of GP knowledge, skills, and understanding of the health needs of people with intellectual disabilities and/or if not enough time had been allocated for the consultation:</p> <p>It was like just hurry up and let's just get out of here (Father of Participant 7)</p> <p>Whether reasonable adjustments were made to accommodate participants' needs also seemed to affect participants' experience of the health check. There were some examples of reasonable adjustments having been made with more invasive procedures such as blood tests and vaccinations. There were also instances where reasonable adjustments had not been made. One participant reported not being able to access a flu vaccination clinic due to transport issues:</p> <p>She said why don't you make another appointment... I said I'm not going down there on a Saturday... you see it's too far from me (Participant 8)</p> <p>A good quality health check should check to see whether people can access cancer screening (Hoghton, [<reflink idref="bib17" id="ref40">17</reflink>]; RCGP, [<reflink idref="bib35" id="ref41">35</reflink>]). One female participant with Cerebral palsy had received a bowel cancer screening test kit, but was unable to use it:</p> <p>I can't do it...because my hands are not very good...I can't take it out of the toilet (Participant 10)</p> <p>The participant did not tell the GP this at the AHC and the GP did not check to see whether she was able to use it.</p> <p>Inadequate equipment appeared to be an issue for a small number of participants:</p> <p>He doesn't like standing on anything...The scales weren't adequate (Participant 11, support worker).</p> <p>Communication between health professionals and participants was another important issue. Some participants wanted to consult with the GP on their own. However, this did not mean that they always felt able to speak for themselves. One female participant reported that the GP assumed that she would not be able to answer questions for herself, so answered for her. She perceived this to mean that the GP did not see her as a 'person':</p> <p>They don't let me answer the questions on the form. They do it. They see my disability before me. (Participant 10)</p> <p>Supporters were perceived by participants as playing a key role in facilitating communication and/or providing emotional support. However, it was important to people that the GP's attention was directed at them and that they were in control of whether and when the supporter spoke on their behalf:</p> <p>It's not [all] to my Dad... she's very good at interacting with me as well (Participant 2)</p> <p>In general, participants reported that GPs gave clear explanations; however, some participants recommended greater use of alternative forms of communication, such as Easy Read information or using photographs to aid understanding and ease anxiety.</p> <p>[Points to Easy Read material] Like, you've got there...help me to relax (Participant 9)</p> <p>The nature of the interaction between the GP and/or nurse appeared to be another important communication issue for participants. Some participants reported that the GP and/or nurse had an excellent manner toward them:</p> <p>She treated [him] with the utmost respect (Participant 4, mother)</p> <p>Others voiced criticisms:</p> <p>I was scared to ask [questions] (Participant 1)</p> <p>Participants wanted to receive the results of any tests following the health check irrespective of whether follow‐up action was required:</p> <p>I would still like my results...it gives me peace of mind (Participant 3)</p> <p>Many participants reported that they wanted to see a GP who was familiar to them and with whom they felt they had a positive relationship. Whilst some regularly saw the same GP and valued the positive relationship that they had with them, others expressed concerns about seeing locum GPs for their AHCs:</p> <p>They put me in with a locum and I don't know them, and they don't know me (Participant 10)</p> <p>Usually, when a practice is not signed up to the DES, the person is signposted to another surgery so that they can access an AHC (NHS England, [<reflink idref="bib26" id="ref42">26</reflink>]). Dissatisfaction with the health check led some participants to suspect that surgeries may not have been signed up to deliver the DES. This was confirmed by one surgery after the participant's advocate made a complaint about the poor quality of the check:</p> <p>She told me that she would look into this with the possibility of introducing this scheme (Advocate of Participant 1)</p> <p>While participants could see that many aspects of the AHC needed improvement, there were also perceived benefits. For example, some participants viewed them as an opportunity to talk to the GP about any health concerns. Others saw them as a means of checking that everything is okay with their health:</p> <p>I like them. I like knowing if things are good and if things are not (Participant 12)</p> <hd id="AN0176717642-12">Issues identified and actions taken</hd> <p>This theme concerns any health issues that were identified at the AHC, as well as any actions that were taken.</p> <p>Some participants reported that issues were identified at the AHC, including the detection of new diseases such as gout and hypertension, as well as other more commonly identified conditions including eczema and a build‐up of ear wax. Actions taken after the AHC to address these issues included being prescribed medication, being advised to make lifestyle changes, being referred for blood tests, and vaccinations, or to the practice nurse for the monitoring of long‐term health conditions:</p> <p>Did see a nurse...got to see her again in the future, if it [blood pressure] goes high, (Participant 9)</p> <p>A few participants were referred for further tests/investigations within secondary care:</p> <p>They found blood in my urine...I went down the hospital and they had a look through the camera (Participant 10)</p> <p>Perceptions of actions taken at the AHC varied:</p> <p>He said you should relax more...I can't relax that's the trouble. (Participant 9)</p> <p>...</p> <p>She actually gave us some [eczema] shampoos and shower gels and things like that, which was really good (Participant 4, mother)</p> <p>While many participants varied in their perceptions of actions taken at the AHC in some cases participants did not feel that enough time had passed for them to be able to make a judgement on the effectiveness of these:</p> <p>We've used it (prescribed treatment) a couple of times...we'll have to wait and see (Participant 4, mother)</p> <hd id="AN0176717642-13">Supporting the self‐management of health</hd> <p>This theme was about the self‐management of health; in particular, how participants self‐managed any health issues identified at the AHC, as well as what support participants received (or did not receive) with the self‐management of health.</p> <p>Some participants relayed wanting to improve their fitness levels and/or make positive changes to their diet as a preventative measure to help improve their physical and mental well‐being. A few participants were able to do this without being given appropriate advice and/or support by the GP.</p> <p>Others reported struggling to make these changes without the appropriate advice and/or support:</p> <p>I don't know how [I'm] going to do it. (Participant 9)</p> <p>Some participants reported that they had been asked by their GP to make changes to their diet to help manage specific health conditions. Some seemed to think this would be difficult. One participant described how he was finding the new diet a bit restrictive:</p> <p>Um...I like to change my food every day. (Participant 6)</p> <p>It was reported that family members provided support at appointments, helped with monitoring weight, and with preparing and cooking healthy food:</p> <p>I try and do the meals...stews, which is good for him, because I put more veg in there (sister of Participant 6)</p> <p>It was reported that supporting the health of participants was also a source of anxiety for some family members:</p> <p>If he goes on to the injection B12 he's going to find it a lot, lot harder, he could not even prick his finger, imagine if he's got to have an injection every three months (sister of Participant 6)</p> <p>A few participants reported that no advice and/or support had been offered at the AHC regarding the management of their health. One reported that the GP did not ask about his asthma at the AHC, had never had his asthma medication reviewed, and acknowledged that he did not always use his asthma inhalers properly:</p> <p>I'm supposed to take the brown one to prevent it, but I keep forgetting (Participant 1)</p> <hd id="AN0176717642-14">The personal context</hd> <p>This theme captured the diversity of health experiences among participants.</p> <p>People with intellectual disabilities are not a homogenous group; hence, participants had unique health experiences and challenges. Their views of their health and their health needs were complex and included psychosocial aspects (such as bereavement), which may not always be identified in an AHC as it is primarily a medical tool. One participant described how they would have liked to have talked to their GP about the death of their mother, but felt unable to:</p> <p>I did...about my mum...I had no time because there was a lot of people there...might get a bit upset. (Participant 9)</p> <hd id="AN0176717642-15">Addressing health inequities</hd> <p>Participants referred to the health inequities experienced by people with intellectual disabilities and the need to address these:</p> <p>They need learning (Participant 10)</p> <p>People with Down's syndrome and/or their families specifically referred to the continuing stigma around Down's syndrome:</p> <p>I feel that the medical profession doesn't just have an ignorance of Down's syndrome, they actually have a fear and contempt of it, and it starts from the very moment of conception (Participant 4, mother)</p> <hd id="AN0176717642-16">Follow‐up interview stages</hd> <p>The main themes for the thematic analysis for Interview Stages Two and Three were: Follow‐Up, Supporting the self‐management of health, The need for reasonably adjusted health services, and Going for another health check.</p> <hd id="AN0176717642-17">Follow‐up</hd> <p>This theme concerned whether issues identified at the AHC had been followed up and addressed, and participants' perceptions of this.</p> <p>By interview two it seemed that some of the issues identified at the health check had been appropriately followed up and/or addressed, especially around the monitoring of health conditions:</p> <p>They do blood tests quite regular up there (Participant 5)</p> <p>...</p> <p>It's still high [blood pressure]...They're going to see me in September (Participant 9)</p> <p>However, there appeared to be a lack of follow‐up when participants were asked to make lifestyle changes to manage long‐term health conditions.</p> <p>There were several barriers to referral reported by participants, such as cancelled appointments, GP lack of knowledge of referral routes and poor inter‐agency communication, and a lack of reasonable adjustments:</p> <p>I phoned them up a few times, didn't I? [Participant 7: Yeah, you did] (Father of Participant 7)</p> <p>By the third interview for a few participants planned actions had still not been carried out. One participant, a support worker, relayed how it had been nearly a year since the person he supports had been referred to the community nursing team to have a blood test. According to the participant, the referral had bounced back and forth between the surgery and the community nurse:</p> <p>You just bounce back and forth... the doctor refers it back to the community nurse and then the nurse comes out, it doesn't work and then it bounces back to the surgery (Participant 11)</p> <p>The participant believed that a lack of reasonable adjustments had contributed to the problem:</p> <p>[He's] not even prepared for it...the nurse turns up and he refuses...you could avoid all that if you just had the time to plan (Participant 11)</p> <hd id="AN0176717642-18">Supporting the self‐management of health</hd> <p>This theme was about the self‐management of health; in particular, what may have changed in terms of self‐management, as well as what support participants received (or did not receive) with the self‐management of health.</p> <p>Many participants referred to long‐term physical health issues that required ongoing management, controlled with the use of medication, changes to lifestyle, and/or other therapies.</p> <p>Their accounts revealed that GPs may not have been aware of some of the barriers that people with intellectual disabilities may face in understanding and following advice given at the AHC to help with the management of long‐term health conditions. Two participants reported that the dietary information that was given to them by the GP at the AHC was inaccessible, meaning that they required support from a family member to help them to read and understand the information provided:</p> <p>I can't [read it]. My father helps me with that. (Participant 9)</p> <p>...</p> <p>I don't follow the diet sheet...I can't (Participant 6)</p> <p>One also described how he struggled to understand some of the more specialist terminology used by the practice nurse to check his blood pressure:</p> <p>Some of it bit too bigger words, don't understand...jargon they call it (Participant 9)</p> <p>He reported that he would not have felt comfortable or had the confidence to tell the nurse that he was struggling to understand what was being said.</p> <p>For participants without a diagnosed health condition but who wanted to lose weight and/or exercise little health promotion advice was given.</p> <p>Self‐management support appeared to come mostly from family members or paid carers, which varied in terms of the amount and nature of the support provided. Some family members interviewed needed information and advice to support the person they cared for to live healthily. The father of one participant indicated that he could benefit from some support from a health professional to help the person he cared for to lose weight:</p> <p>Quite possibly, get some ideas on how to do things... because we both want it, don't we? p. 6 (The Father of Participant 7)</p> <p>Many participants seemed determined and could participate in self‐management so long as they had the right support and opportunities:</p> <p>She [participant's aunt] has me walking places, I've noticed now, 'Go and get this, Go and get that, walking's good for you'...I'm like, 'Yeah, alright.' (Participant 12)</p> <p>A few participants' responses to self‐management were not immediate and changed over time. One participant was diagnosed with hypertension at his AHC. He initially questioned how easy it would be to make changes to his lifestyle to help lower his blood pressure:</p> <p>With difficulty I reckon (Participant 9)</p> <p>Six months on, he seemed determined to lose the weight and was taking responsibility for the food that he ate:</p> <p>I've cut down on my fatty foods; I eat more healthy foods like this [points to fruit and veg, etc. in the picture]...Apple, broccoli, banana...(Participant 9)</p> <p>By the third interview, he was continuing to maintain the changes. This was not the case for all participants. There were participants who appeared to require ongoing support to maintain lifestyle change:</p> <p>You put on a little bit didn't you? So we're trying to get you back on track (Supported living services manager of Participant 8)</p> <p>Many participants described ongoing issues with their mental health in the months following the AHC. All participants' mental health needs were being treated with prescribed medication either by a GP or a psychiatrist, with only one being offered non‐medical support for their mental health:</p> <p>They do mindfulness...and we've got some leaflets for [him] and we're thinking we may be able to support [him] with going to classes and getting help with [his] anxiety (Supported living services manager of Participant 8)</p> <hd id="AN0176717642-19">The need for reasonably adjusted health services</hd> <p>The same participants who experienced barriers to accessing cancer screening, dental, and/or eye services at interview one continued to do so in the ensuing months.</p> <p>However, one participant was able to access dental services between interviews two and three once he had acquired some support:</p> <p>Yeah, X [advocate] is going with me (Participant 1)</p> <hd id="AN0176717642-20">Going for another health check</hd> <p>This theme is about how participants were preparing for their next AHC, including their overall perspectives regarding their next check. By interview three, two participants said they had been for another health check, while one reported having been invited to one. Most reported that they felt happy about going for another health check; however, those participants who had been dissatisfied with their health check or aspects of it, wanted a different GP at the next health check and/or improvements to be made:</p> <p>A different doctor...I like seeing my doctor, a lady doctor (Participant 1)</p> <p>Most participants said that they were usually invited to their health check by letter, but only one participant said that they received an appointment letter produced in Easy Read format. Not all participants were able to read and make sense of invitation letters not produced in Easy Read format:</p> <p>Just words and so I keep it for the staff to have a look at (Participant 8)</p> <p>Most participants said they were willing to chase up delayed appointments either themselves or through a family member. One father reported that he would not be willing to chase up an appointment on behalf of his daughter as he felt that the AHC was not that useful:</p> <p>Probably not...It achieved absolutely nothing and [we have] coped the last three years without it (Father of Participant 7)</p> <p>A few participants reported experiencing difficulties accessing their next health check:</p> <p>[The reception staff had] no clue what I was talking about....I thought, oh come on... They haven't rung me back. (Participant 4, mother)</p> <p>Some participants with intellectual disabilities said that they had health issues that they wished to raise with their GP at their next health check. Families and paid carers also seemed to have concerns that they wished to discuss at the next health check on behalf of those they supported.</p> <hd id="AN0176717642-21">DISCUSSION</hd> <p>A detailed and critical evaluation of the UK and international literature revealed that this was the first study to specifically focus on how the issues identified at the health check were followed up and addressed over time from the perspectives of people with intellectual disabilities (and where relevant their supporters). It is also the first study to consider how people with intellectual disabilities self‐manage health issues identified at the health check, as well as what support they may receive to do this. In doing so, this qualitative study captures the health check experience from the perspective of the person with the intellectual disability, helping health professionals and policymakers to better understand their needs. This longitudinal study advances the literature by highlighting that the AHC should be viewed as a process rather than as a one‐off event and as part of a wider system to support health and well‐being. This is important because while the AHC does lead to the identification of unmet needs and targeted actions to meet these needs, there are limitations in thinking of the AHC as an isolated experience. For example, what happens after the AHC also determines improvements in terms of health outcomes and this research has helped to shed light on this. If issues identified at the AHC are not followed up and addressed in a timely and appropriate manner, if people are not adequately supported to self‐manage their health in between health checks, then health needs are likely to be partially addressed.</p> <p>Contrary to a Welsh study by Perry et al. ([<reflink idref="bib29" id="ref43">29</reflink>]), where there were no issues reported about the way the health check consultation was carried out, participants who partook in this research seemed to vary in their experiences of the AHC consultation and how satisfied they felt with it. Even for those participants who had positive experiences to report, not all checks were reported to have been undertaken, suggesting that health checks are not always being conducted in line with the Welsh check protocol (Kerr, [<reflink idref="bib20" id="ref44">20</reflink>]). There may, therefore, be an issue with the quality of some health checks. There was also confusion around whether practices were signed up to the DES for some participants.</p> <p>Many participants had issues identified because of their AHC. These included health conditions such as gout and hypertension, as well as more commonly identified health conditions such as eczema or a build‐up of ear wax. It can be concluded from this that people with intellectual disabilities have unmet health needs and that the AHC can provide a means of identifying them, a finding that is consistently shown in the research literature (Robertson et al., [<reflink idref="bib34" id="ref45">34</reflink>]). Actions were taken to address participants' needs, which also supports previous research findings (Robertson et al., [<reflink idref="bib34" id="ref46">34</reflink>]). However, not one participant reported that a Health Action Plan had been shared and/or co‐produced with them. This suggests that there may be an issue with the Health Action Planning process in Wales, which could have implications for how issues identified at the AHC are then followed up and addressed.</p> <p>Some participants reported that health issues identified at the health check were dealt with in a timely and appropriate manner. For example, where health conditions identified at the health check required monitoring participants reported that they had attended follow‐up appointments with the practice nurse in between health checks. However, there appeared to be a lack of follow‐up by the practice nurse and/or GP when participants were asked to make lifestyle changes to manage long‐term health conditions, with participants describing struggling to make or sustain healthy choices. This is concerning given that people with intellectual disabilities experience high rates of long‐term health conditions (Carey et al., [<reflink idref="bib5" id="ref47">5</reflink>]; Cooper et al., [<reflink idref="bib6" id="ref48">6</reflink>]) and a lack of clinical follow‐up has been found to contribute to premature mortality in this population (Heslop, [<reflink idref="bib16" id="ref49">16</reflink>]).</p> <p>Other participants said that they wanted to eat more healthily and/or improve their fitness levels to prevent health conditions from developing. However, very little advice was given regarding health promotion, especially weight management. There is a growing body of evidence showing that people with intellectual disabilities do not use and engage fully in health promotion activities to the same extent as people without intellectual disabilities and that this is not simply a lifestyle choice (Davis et al., [<reflink idref="bib7" id="ref50">7</reflink>]; Ouellette‐Kuntz et al., [<reflink idref="bib28" id="ref51">28</reflink>]). People with intellectual disabilities are at increased risk of being overweight or obese compared to the general population (Public Health England, [<reflink idref="bib31" id="ref52">31</reflink>]), with a poor diet and lack of exercise key factors. This can cause significant health risks and major health problems. For example, Tyrer et al. ([<reflink idref="bib36" id="ref53">36</reflink>]) found that people who were physically inactive or sedentary were more likely to experience multimorbidity. The AHC is a good opportunity to talk about any weight issues and to plan how the person can be supported to stay at a healthy weight. GPs may need additional training and support in this area.</p> <p>A key aspect of the AHC is to refer people with intellectual disabilities to other services. However, there were several barriers to referral reported by participants including a lack of reasonable adjustments. For some, this led to planned actions not taking place. The <emph>Confidential Inquiry into Premature Deaths of People with Learning Disabilities</emph> (CIPOLD) reported that for some there was significant difficulty or delay in specialist referral, with a lack of reasonable adjustments to facilitate healthcare (Heslop, [<reflink idref="bib16" id="ref54">16</reflink>]). The problems with the referral process evidenced by this study suggest that in some cases the AHC may only be partially addressing people's health needs, with potentially serious implications for a person's health.</p> <p>Friedman ([<reflink idref="bib11" id="ref55">11</reflink>]) states that 'although self‐management of health is important, many people with intellectual and developmental disabilities are not given the ability to do so' (Tools for Self‐Management: Disparities in Self‐Management section, 2018). The findings from this study would seem to support this, with some participants reporting that GPs did not appreciate that they may be struggling to understand and/or follow the advice given at the AHC. Participants relayed finding verbal and/or written information at the AHC or at follow‐up appointments inaccessible. Some reported not having the confidence and/or not feeling comfortable to ask for further help in this regard. It is therefore unclear what opportunity is being given to people with intellectual disabilities in Wales to support the self‐management of health. Furthermore, only one participant was treated in ways other than medication for their mental health, suggesting that GPs may not always be making people with intellectual disabilities aware of the different options available to them.</p> <p>All participants required at least some support with self‐managing their health. Support for the self‐management of health in between AHCs appeared to mainly come from family members and/or paid carers. This meant that the repercussions of receiving poor support for the self‐management of health within poor primary care appeared to be greater for those people with intellectual disabilities who lived relatively independently, without any support from relatives or social care services. While family members and/or paid carers were reported as providing support in many ways, they differed in the amount and kind of support that they were able or willing to provide. Paid carers participating in this study seemed to be actively involved in trying to support the self‐management of health, but it cannot be assumed that this will be the case for all paid carers. With the right opportunities and support, some participants reported having better control over their health, leading to improvements in health status. This was also found to be the case with Friedman et al.'s ([<reflink idref="bib12" id="ref56">12</reflink>]) study.</p> <p>The need to focus on AHCs, including the 'subsequent development of Health Action Plans' has been recognised in the Welsh Government's recently published Learning Disability Strategic Action Plan 2022–206 (Welsh Government, [<reflink idref="bib37" id="ref57">37</reflink>], 3.5, p. 9). The recommendations of this study, based on the findings of this research, will therefore be key to ensuring that AHCs meet the health needs of people with intellectual disabilities in Wales.</p> <hd id="AN0176717642-22">Limitations</hd> <p>This study aimed to obtain an in‐depth understanding of an issue rather than to generalise to a larger population of interest. While the findings are tentative in terms of the extent to which they might be transferable, there was a commonality of experience to suggest wider relevance and applicability of findings.</p> <p>Not all health boards were represented in this study, but participants were recruited from a mixture of geographical areas across Wales. This included both urban and rural areas.</p> <p>The researcher was unable to recruit anyone from a BAME background to the study despite asking stakeholder organisations to assist with this. There is some evidence to show that people with intellectual disabilities from a BAME background may face double discrimination within the healthcare system (Fulton & Richardson, [<reflink idref="bib13" id="ref58">13</reflink>]). More research is needed to determine how these disparities may play out in terms of healthcare for people with intellectual disabilities. Additionally, while participants were recruited from supported living services, no one was recruited from a residential home or a home for older persons. This was because organisations had limited contact with these services. Therefore, this sample is unlikely to be representative of all people with intellectual disabilities or all service providers.</p> <hd id="AN0176717642-23">Recommendations</hd> <p>This study highlights that the AHC should be viewed as a process rather than as a one‐off event, and as part of a wider system to support health and well‐being. This is important because what happens after the AHC in terms of follow‐up, and how people are supported to self‐manage their health, can determine health outcomes. A wider system of support should include the facilitation of Health Action Planning with the person (and where relevant their supporter), as well as support for the self‐management of health in between health checks. This may require looking at the skill base and ensuring that there is adequate staff to support the GP. Furthermore, it would be useful for policymakers to consider the expansion of non‐medical interventions for people with intellectual disabilities so that there is a range of non‐medical options available for healthcare professionals to improve a person's mental and/or physical well‐being.</p> <hd id="AN0176717642-24">AUTHOR CONTRIBUTIONS</hd> <p> <bold>Dawn Cavanagh:</bold> conducted the original study and wrote the paper. <bold>Ruth Northway and Stuart Todd:</bold> Assisted with design of study; secured ethical approval; data analysis; drafted and edited paper.</p> <hd id="AN0176717642-25">ACKNOWLEDGEMENTS</hd> <p>Thank you to the following collaborating organisations without whom this project would not be possible: Mencap Cymru, Learning Disability Wales, Carmarthenshire People First, Cardiff People First, Cwm Taf People First, Mirus, Diverse Cymru, Action for Children and The Down's Syndrome Association. The author of this paper would also like to acknowledge the contribution of all research participants for their time and for talking so candidly about their experiences. This research was funded via a Knowledge Economy Skills Scholarship (KESS), supported by European Social Funds (ESF) through the Welsh Government, in partnership with Mencap Cymru. The views expressed in this publication are those of the author and not necessarily those of KESS 2 or Mencap Cymru.</p> <hd id="AN0176717642-26">CONFLICT OF INTEREST STATEMENT</hd> <p>The author declares no conflict of interest.</p> <hd id="AN0176717642-27">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are openly available in University of South Wales Student Theses at https://pure.southwales.ac.uk/en/studentTheses/annual-health-checks-for-people-with-learning-disabilities-an-exp.</p> <ref id="AN0176717642-28"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref3" type="bt">1</bibl> <bibtext> Alborz, A. (2005). The role of health check programmes in improving access to mainstream NHS healthcare services for people with learning disabilities. 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Cavanagh; Ruth Northway and Stuart Todd</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib17" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib14" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib21" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib35" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib27" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib32" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib33" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib38" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib34" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib18" firstref="ref18"></nolink> <nolink nlid="nl12" bibid="bib24" firstref="ref19"></nolink> <nolink nlid="nl13" bibid="bib25" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib22" firstref="ref23"></nolink> <nolink nlid="nl15" bibid="bib23" firstref="ref24"></nolink> <nolink nlid="nl16" bibid="bib40" firstref="ref25"></nolink> <nolink nlid="nl17" bibid="bib12" firstref="ref26"></nolink> <nolink nlid="nl18" bibid="bib39" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib15" firstref="ref31"></nolink> <nolink nlid="nl20" bibid="bib19" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib20" firstref="ref34"></nolink> <nolink nlid="nl22" bibid="bib30" firstref="ref35"></nolink> <nolink nlid="nl23" bibid="bib26" firstref="ref42"></nolink> <nolink nlid="nl24" bibid="bib29" firstref="ref43"></nolink> <nolink nlid="nl25" bibid="bib16" firstref="ref49"></nolink> <nolink nlid="nl26" bibid="bib28" firstref="ref51"></nolink> <nolink nlid="nl27" bibid="bib31" firstref="ref52"></nolink> <nolink nlid="nl28" bibid="bib36" firstref="ref53"></nolink> <nolink nlid="nl29" bibid="bib11" firstref="ref55"></nolink> <nolink nlid="nl30" bibid="bib37" firstref="ref57"></nolink> <nolink nlid="nl31" bibid="bib13" firstref="ref58"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Annual Health Checks for People with Intellectual Disabilities: An Exploration of Experiences, Follow-Up and Self-Management of Health Conditions
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Dawn+E%2E+Cavanagh%22">Dawn E. Cavanagh</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5204-9485">0000-0002-5204-9485</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ruth+Northway%22">Ruth Northway</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8420-733X">0000-0001-8420-733X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Stuart+Todd%22">Stuart Todd</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1640-2111">0000-0003-1640-2111</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. 2024 37(3).
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  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Examinations%22">Physical Examinations</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Management%22">Self Management</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Conditions%22">Health Conditions</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/jar.13233
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1360-2322<br />1468-3148
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this. Methods: People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken. Results: Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check. Conclusion: A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1421446
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1421446
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    Identifiers:
      – Type: doi
        Value: 10.1111/jar.13233
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
    Subjects:
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Physical Examinations
        Type: general
      – SubjectFull: Access to Health Care
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Self Management
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Health Conditions
        Type: general
    Titles:
      – TitleFull: Annual Health Checks for People with Intellectual Disabilities: An Exploration of Experiences, Follow-Up and Self-Management of Health Conditions
        Type: main
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      – PersonEntity:
          Name:
            NameFull: Dawn E. Cavanagh
      – PersonEntity:
          Name:
            NameFull: Ruth Northway
      – PersonEntity:
          Name:
            NameFull: Stuart Todd
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          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2024
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            – Type: issn-print
              Value: 1360-2322
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              Value: 1468-3148
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              Value: 37
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              Value: 3
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            – TitleFull: Journal of Applied Research in Intellectual Disabilities
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