Health Care Delivery of Clinical Preventive Services for People With Disabilities A Systematic Review

Abstract

Background: People with disabilities are less likely than the general population to receive clinical preventive services. Purpose: To summarize barriers to and facilitators of receipt of preventive services and effectiveness of interventions to improve receipt of preventive services among people with disabilities. Data Sources: Five electronic databases through September 2024. Study Selection: Dual independent screening of abstracts and full texts for 20 recommended preventive services. Data Extraction: Single reviewer, with a second reviewer verifying accuracy. Data Synthesis: Among 11 586 references, 74 studies were included (60 on barriers and facilitators, 16 on interventions, and 2 on both barriers/facilitators and interventions). Most evidence was on screening for breast (n ¼ 48) and cervical (n ¼ 33) cancer. Barriers to and facilitators of breast and cervical cancer screening spanned all disability types and across environment, individual, provider, and health care levels. Six randomized controlled trials studied educational interventions for people with physical disabilities (n ¼ 2); cognitive, intellectual, or developmental disabilities (n ¼ 2); sensory disabilities (n ¼ 1); and serious mental illness (n ¼ 1), with mixed findings on effectiveness for different preventive services. Evidence on specific components or harms of interventions was limited. Limitations: High methodological or clinical heterogeneity and limited data for most preventive services and disability types. Conclusion: Barriers and facilitators for people with disabilities are described for breast and cervical cancer screening at the environment, individual, provider, and health care levels. Randomized studies on general educational interventions target the patient, the caregiver, and providers of people with specific disabilities. Research is needed on interventions that address barriers to and facilitators of receipt of preventive services for people with disabilities. Primary Funding Source: Agency for Healthcare Research and Quality. (Protocol registered at https:// effectivehealthcare.ahrq.gov/products/people-with-disabilities/protocol)