Physical health and people with an intellectual disability: a qualitative exploration of their experience of trying to live healthier lives, and of the NHS learning disability annual health check

This thesis explores people with an intellectual disability’s efforts to live healthier lives. As a population they have unmet health needs, experience poorer physical and mental health outcomes, a higher prevalence of chronic health conditions, and an increased risk of premature death that is on average 16 years earlier than the general population. This thesis aims to contribute to the literature concerning the support offered to people with an intellectual disability as they seek to promote their health. The first chapter is a systematic literature review exploring how people with an intellectual disability experience trying to live healthier lives. Findings from 12 studies were critically evaluated and synthesised using a meta-ethnographic approach. Analysis resulted in the development of two interpretative themes summarising a reciprocal synthesis of an insider perspective held by participants with an intellectual disability, and an outsider perspective held by their carers regarding efforts to live and promote healthier lives. Each theme is explored and a line of argument synthesis presented, followed by recommendations for practice. The second chapter presents an Interpretative Phenomenological Analysis study seeking to understand the experience of the Annual Health Check process from the perspective of people with an intellectual disability. Twelve adults with an intellectual disability participated in semi-structured interviews. Analysis of the transcripts led to the development of three superordinate themes. Six subordinate themes are identified and discussed. Findings suggest that people with an intellectual disability attend Annual Health Checks with health- related goals. A satisfactory health check is characterised by an inclusive approach by all primary care staff that both supports these goals and communicates that the goal is shared. Clinical implications and areas for future research are discussed. The third chapter presents a reflective account of parallel experiences as a trainee, a clinician, and a novice researcher, and how they overlapped while completing a doctoral thesis. The authors personal experiences are described in relation to managing these different roles and the competing demands that come with them. The chapter concludes by reflecting on these experiences form the perspective of Acceptance and Commitment Therapy and how psychological distress is formulated within this approach to intervention