Barriers and enablers to delivering chronic disease preventive care in mental health settings: A scoping review protocol

Rebecca Trower; Gary Donohoe; Sophie Mahon; Oonagh Meade; Molly Byrne

doi:10.12688/hrbopenres.14053.1

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Study Protocol

Barriers and enablers to delivering chronic disease preventive care in mental health settings: A scoping review protocol

[version 1; peer review: 1 approved with reservations]

Rebecca Trower ^1,2, Gary Donohoe¹, Sophie Mahon¹, Oonagh Meade^1,2, Molly Byrne^1,2

Rebecca Trower ^1,2, Gary Donohoe¹, [...] Sophie Mahon¹, Oonagh Meade^1,2, Molly Byrne^1,2

PUBLISHED 15 Jan 2025

Author details Author details

¹ School of Psychology, University of Galway, Galway, County Galway, H91 TK33, Ireland
² Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, County Galway, H91 TK33, Ireland

Rebecca Trower
Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Gary Donohoe
Roles: Conceptualization, Supervision, Writing – Review & Editing

Sophie Mahon
Roles: Investigation, Writing – Review & Editing

Oonagh Meade
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Molly Byrne
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Individuals with mental health difficulties have a higher risk of chronic disease and a lower life expectancy than the general population due, at least in part, to higher rates of modifiable health behaviours including smoking, alcohol and drug consumption, inadequate physical activity, and poor diet. The delivery of preventive care by healthcare professionals in mental health settings is recommended to improve health and wellbeing and reduce the risk of chronic disease in this population. However, there are barriers to the implementation of preventive care within these settings.

Aim

This scoping review aims to identify and narratively synthesise the available evidence of the barriers and enablers of healthcare professionals delivering preventive care for all of these modifiable health behaviours (smoking, alcohol and drug use, physical activity, and diet) in mental health settings.

Methods

This review will be guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The following databases will be searched: Medline All, PsycINFO, Embase and CINAHL. Two independent reviewers will conduct initial title and abstract screening, followed by full-text screening for eligibility. Two independent reviewers will conduct data extraction. Data will be deductively analysed using the Theoretical Domains Framework (TDF) with results presented narratively.

Conclusion

This scoping review will provide a comprehensive overview of the factors influencing the delivery of chronic disease preventive care in mental health settings. The findings will inform future research, practice, and policy in these settings.

Keywords

health personnel, barriers and enablers, preventive care, health risk behaviours, mental health services

Corresponding author: Rebecca Trower

Competing interests: No competing interests were disclosed.

Grant information: Health Research Board [SPHeRE/2022/1].
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2025 Trower R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Trower R, Donohoe G, Mahon S et al. Barriers and enablers to delivering chronic disease preventive care in mental health settings: A scoping review protocol [version 1; peer review: 1 approved with reservations]. HRB Open Res 2025, 8:4 (https://doi.org/10.12688/hrbopenres.14053.1) First published: 15 Jan 2025, 8:4 (https://doi.org/10.12688/hrbopenres.14053.1) Latest published: 15 Jan 2025, 8:4 (https://doi.org/10.12688/hrbopenres.14053.1)

Introduction

Those with mental health difficulties have a higher prevalence of chronic disease, such as cardiovascular disease, diabetes, and respiratory diseases compared to the general population (Filik et al., 2006; Gladigau et al., 2014; Holt & Peveler, 2010). As a result, this population has a reduced life expectancy (Lawrence et al., 2013). There are many health behaviours that contribute to chronic disease risk such as smoking, alcohol and drug consumption, inadequate physical activity, and poor diet. Research has shown that the prevalence of smoking amongst adults with bipolar disorder, schizophrenia, and major depressive disorder is higher and the levels of smoking cessation are lower than the general population (de Leon & Diaz, 2005; Jackson et al., 2015; Weinberger et al., 2017) and people with mental health difficulties have higher levels of sedentary behaviours and significantly less physical activity compared to healthy controls (Vancampfort et al., 2017).

Preventive care is one way to reduce risk of chronic disease and involves addressing modifiable health behaviours such as smoking, alcohol and drug consumption, physical activity, diet, and weight management. The National Institute for Health and Care Excellence (NICE) (2014) guidelines recommend that healthcare professionals deliver behaviour change interventions to patients, to motivate and support them to make behaviour changes to improve their general health and wellbeing. A common framework used in preventive care is the 5 A’s framework in which healthcare professionals ask, advise, assess, assist, and arrange when providing preventive care to patients (Agency for Healthcare Research and Quality, 2012). Preventive care has been shown to be effective in reducing health risk behaviours such as smoking (Pbert et al., 2008), alcohol consumption (O’Connor et al., 2018), physical inactivity (Grandes et al., 2009), and poor diet (Marcus et al., 2001) across different healthcare settings and populations.

However, barriers to delivering preventive care in general healthcare settings have been identified. Studies indicate that healthcare professionals’ perceptions of knowledge, skills, professional role, time and resources, support, and negative emotions are the factors that influence whether they deliver preventive care (Keyworth et al., 2019; Meade et al., 2023). In mental health settings, similar concerns exist amongst healthcare professionals (Ball et al., 2022; Glowacki et al., 2019; Kelly et al., 2024) as well as more context specific barriers such as the perception that those with mental health difficulties are not interested in changing their health-related behaviours (Brown et al., 2015; Stumbo et al., 2018). In addition, the delivery of preventive care in mental health settings is likely to be more challenging as it is often not prioritised as a clinical goal, and clinicians find it difficult to determine when in the consultation is most appropriate to provide it (Fehily et al., 2023). Furthermore, clinicians in acute mental health settings must weigh up immediate risks, such as mental health risk, suicide risk, and harm to others when treating patients, making it more challenging for them to consider delivering chronic disease preventive care in these settings (Fehily et al., 2023). Despite this, chronic disease preventive care is critically important in mental health settings particularly due to higher mortality attributed to chronic illness amongst those with mental health difficulties (Walker et al., 2015).

While there has been some research exploring factors acting as barriers and facilitators to delivering preventive care in general healthcare settings, there is a gap in the literature for a synthesis of the factors that contribute to preventive care delivery unique to mental health settings. It is important to understand these barriers and enablers so that future research can address these, improve the delivery of preventive care in mental health settings, and improve physical health outcomes for this particularly at-risk population.

Aim and review question

The aim of this scoping review is to identify and narratively synthesise available evidence of the barriers and enablers of healthcare professionals delivering preventive care for all of these modifiable health behaviours (smoking, alcohol and drug use, physical activity, and diet) in mental health settings. A scoping review was chosen as the most appropriate design for the study as it will provide a comprehensive picture of the delivery of preventive care in mental health settings and findings will inform future research, practice, and policy in these settings. The Population Concept Context (PCC) framework which is used to guide the construction of clear and focused review questions and inclusion criteria (Peters et al., 2020) guided the development of the review question which is:

What are the barriers and enablers to healthcare professionals delivering chronic disease preventive care to patients with mental health difficulties in mental health settings?

Inclusion criteria

Participants:

Healthcare professionals working in inpatient, outpatient, or community mental health settings who work directly with patients diagnosed with mental health difficulties including but not limited to schizophrenia, bipolar, anxiety, psychosis, mood disorders or major depressive disorders. Studies that do not explicitly report on healthcare professionals’ barriers and enablers to delivering preventive care will be excluded.

Concept:

This scoping review will identify the barriers and enablers – including attitudes, perceptions, challenges, and beliefs to delivering preventive care in mental health settings. Preventive care is defined as care to support the improvement in modifiable chronic disease risk behaviours (smoking, alcohol and drug consumption, physical activity, diet) (Bailey et al., 2019; Centre for Disease Control and Prevention [CDC], 2024). Studies will be included if they report barriers or enablers or both for delivering preventive care in mental health settings.

Context:

As there has been no review conducted on the barriers and enablers to delivering preventive care for all of these modifiable health behaviours (smoking, alcohol and drug use, physical activity, and diet) in mental health settings, all mental health settings will be included (i.e., inpatient, outpatient, and community mental health settings). Studies from all countries will be included. Studies in any language other than English will be excluded.

Types of Sources:

Peer-reviewed published qualitative, quantitative, and mixed methods studies will be included. Reviews will also be included. Grey literature will be excluded.

Methods

The Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2020) will be used to guide the conduct of this scoping review.

Search strategy

An initial search of Google Scholar and Ovid Medline was conducted to identify relevant studies and develop a list of initial search terms. An information specialist (Research Services Librarian in University of Galway) was consulted to help develop and refine the full search strategy as seen in Table 1. The search will be systematically repeated in relevant databases including Medline All (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), and Embase (Ovid). Included studies will be forward and backward searched to ensure no relevant studies were omitted from the database search.

Table 1. Sample Search Strategy for OVID Medline.

exp Health Personnel/ OR healthcare professional* ti,ab. OR healthcare provider* ti,ab. OR health care provider* ti,ab. OR health care professional* ti,ab. OR clinician* ti,ab. OR psychiatrist* ti,ab. OR staff.ti,ab.

AND

“Attitude of Health Personnel"/ OR Health Knowledge, Attitudes, Practice/ OR Barrier*.ti,ab. OR challenge*.ti,ab. OR Facilitator*.ti,ab. or enabler*.ti,ab. OR Perspective*.ti,ab. or preference*.ti,ab.

AND

exp Health Risk Behaviors/ OR Healthy Lifestyle/ OR exp Smoking Cessation/ OR Exercise/ OR Diet, Healthy/ OR Alcohol Drinking/ OR physical activity.ti,ab. or physical inactivity.ti,ab. OR nutrition.ti,ab. OR diet.ti,ab. OR smoking.ti,ab. OR tobacco.ti,ab. OR alcohol consumption.ti,ab. OR drinking habit*.ti,ab. OR drug consumption.ti,ab.

AND

exp Mental Health Services/ OR community mental health centers/ OR community mental health services/ OR Hospitals, Psychiatric/ OR exp Mental Disorders/ OR Mental Health/ OR mental disorder*.ti,ab. OR mental illness*.ti,ab. OR mental healthcare setting*.ti,ab.OR inpatient.ti,ab. OR outpatient.ti,ab. OR psychiatric hospital*.ti,ab.

Study selection

Results of database searching will be uploaded to Rayyan Systematic Review Web-Tool (https://www.rayyan.ai), and duplicates removed. Title and abstracts, followed by full texts will be screened by two independent reviewers (RT and SM). Any disagreements between reviewers will be resolved through discussion, and if needed, a third reviewer. Included studies will be reported in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews Checklist (PRISMA-ScR) flow diagram. Included full text articles will be exported to NVivo qualitative analysis software (QSR International Pty Ltd., 2020) to facilitate deductive analysis using the Theoretical Domains Framework (TDF) (Cane et al., 2012; Michie et al., 2005).

Data extraction

Data will be extracted from included studies using a data extraction tool developed by the research team. Study characteristics such as author(s), title, year of publication, name of journal, country, study design, setting, sample size, and sample characteristics, as well as the fourteen domains of the TDF will be included in the data extraction tool. Two independent reviewers (RT and SM) will pilot the data extraction tool to ensure consistency. The data extraction tool may be revised as necessary during the data extraction process. Any changes made to the data extraction tool will be detailed in the final scoping review. Any disagreements between reviewers will be discussed and if no resolution can be found, a third reviewer will be consulted. The purpose of the scoping review is to describe barriers and enablers to the delivery of preventive care by healthcare professionals in mental health settings, therefore, a critical appraisal of the quality of the included studies will not be necessary.

Data analysis and presentation

The included study characteristics will be reported using summary statistics, narrative descriptions, and using tables and figures. The barriers and enablers of delivering preventive care will be deductively coded according to the fourteen domains of the TDF (Cane et al., 2012; Michie et al., 2005). The narrative findings of this review will be presented under each of the fourteen TDF domains. Reporting will be guided by the PRISMA-ScR checklist (Tricco et al., 2018).

Ethics and consent

Ethical approval and consent were not required.

Data availability

No data are associated with this article.

Software availability

RQDA (https://rqda.r-forge.r-project.org/) is a free alternative to NVivo.

Acknowledgements

We want to thank Rosie Dunne, Research Services Librarian in the University of Galway Library for her contribution to developing the database search strategy for this scoping review.

Faculty Opinions recommended

References

Agency for Healthcare Research and Quality: Five major steps to intervention (The "5 A's"). December, 2012. Reference Source
Bailey JM, Bartlem KM, Wiggers JH, et al.: Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Prev Med Rep. 2019; 16: 100969. PubMed Abstract | Publisher Full Text | Free Full Text
Ball H, Yung A, Bucci S: Staff perspectives on the barriers and facilitators to exercise implementation in inpatient mental health services: a qualitative study. Ment Health Phys Act. 2022; 22: 100452. Publisher Full Text
Brown CH, Medoff D, Dickerson FB, et al.: Factors influencing implementation of smoking cessation treatment within community mental health centers. J Dual Diagn. 2015; 11(2): 145–150. PubMed Abstract | Publisher Full Text | Free Full Text
Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012; 7(1): 37. PubMed Abstract | Publisher Full Text | Free Full Text
Centre for Disease Control and Prevention: Preventing chronic diseases: what you can do now. May 15, 2024. Reference Source
de Leon J, Diaz FJ: A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res. 2005; 76(2): 135–157. PubMed Abstract | Publisher Full Text
Fehily C, Jackson B, Hansen V, et al.: Increasing chronic disease preventive care in community mental health services: clinician-generated strategies. BMC Psychiatry. 2023; 23(1): 933. PubMed Abstract | Publisher Full Text | Free Full Text
Filik R, Sipos A, Kehoe PG, et al.: The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr Scand. 2006; 113(4): 298–305. PubMed Abstract | Publisher Full Text
Gladigau EL, Fazio TN, Hannam JP, et al.: Increased cardiovascular risk in patients with severe mental illness. Intern Med J. 2014; 44(1): 65–69. PubMed Abstract | Publisher Full Text
Glowacki K, Weatherson K, Faulkner G: Barriers and facilitators to health care providers’ promotion of physical activity for individuals with mental illness: a scoping review. Ment Health Phys Act. 2019; 16: 152–168. Publisher Full Text
Grandes G, Sanchez A, Sanchez-Pinilla RO, et al.: Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med. 2009; 169(7): 694–701. PubMed Abstract | Publisher Full Text
Holt R, Peveler R: Diabetes and cardiovascular risk in severe mental illness: a missed opportunity and challenge for the future. Pract Diabetes Int. 2010; 27(2): 79–84ii. Publisher Full Text
Jackson JG, Diaz FJ, Lopez L, et al.: A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disord. 2015; 17(6): 575–597. PubMed Abstract | Publisher Full Text
Kelly K, Moloney A, de Jong G, et al.: Healthcare practitioners’ perceptions of the barriers to prescribing or promoting exercise in the treatment of people with mental illness: a scoping review. Health Soc Care Community. 2024; 2024(1): 8894586. Publisher Full Text
Keyworth C, Epton T, Goldthorpe J, et al.: ‘It's difficult, I think it's complicated’: health care professionals’ barriers and enablers to providing opportunistic behaviour change interventions during routine medical consultations. Br J Health Psychol. 2019; 24(3): 571–592. PubMed Abstract | Publisher Full Text | Free Full Text
Lawrence D, Hancock KJ, Kisely S: The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013; 346: f2539. PubMed Abstract | Publisher Full Text | Free Full Text
Marcus AC, Heimendinger J, Wolfe P, et al.: A randomized trial of a brief intervention to increase fruit and vegetable intake: a replication study among callers to the CIS. Prev Med. 2001; 33(3): 204–216. PubMed Abstract | Publisher Full Text
Meade O, O’Brien M, Noone C, et al.: Exploring barriers and enablers to the delivery of making every contact count brief behavioural interventions in Ireland: a cross-sectional survey study. Br J Health Psychol. 2023; 28(3): 753–772. PubMed Abstract | Publisher Full Text
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National Institute for Health and Care Excellence: Behaviour change: individual approaches. January 02, 2014. Reference Source
O’Connor EA, Perdue LA, Senger CA, et al.: Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: updated evidence report and systematic review for the US preventive services task force. JAMA. 2018; 320(18): 1910–1928. PubMed Abstract | Publisher Full Text
Pbert L, Flint AJ, Fletcher KE, et al.: Effect of a pediatric practice-based smoking prevention and cessation intervention for adolescents: a randomized, controlled trial. Pediatrics. 2008; 121(4): e738–e747. PubMed Abstract | Publisher Full Text
Peters MDJ, Marnie C, Tricco AC, et al.: Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10): 2119–2126. PubMed Abstract | Publisher Full Text
QSR International Pty Ltd: NVivo (Version 12). [Computer software]. 2020. Reference Source
Stumbo SP, Yarborough BJH, Yarborough MT, et al.: Perspectives on providing and receiving preventive health care from primary care providers and their patients with mental illnesses. Am J Health Promot. 2018; 32(8): 1730–1739. PubMed Abstract | Publisher Full Text | Free Full Text
Tricco AC, Lillie E, Zarin W, et al.: PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7): 467–473. PubMed Abstract | Publisher Full Text
Vancampfort D, Firth J, Schuch FB, et al.: Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry. 2017; 16(3): 308–315. PubMed Abstract | Publisher Full Text | Free Full Text
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Author details Author details

¹ School of Psychology, University of Galway, Galway, County Galway, H91 TK33, Ireland
² Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, County Galway, H91 TK33, Ireland

Rebecca Trower
Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Gary Donohoe
Roles: Conceptualization, Supervision, Writing – Review & Editing

Sophie Mahon
Roles: Investigation, Writing – Review & Editing

Oonagh Meade
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Molly Byrne
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

Health Research Board [SPHeRE/2022/1].
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Published: 15 Jan 2025, 8:4

https://doi.org/10.12688/hrbopenres.14053.1

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© 2025 Trower R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Trower R, Donohoe G, Mahon S et al. Barriers and enablers to delivering chronic disease preventive care in mental health settings: A scoping review protocol [version 1; peer review: 1 approved with reservations]. HRB Open Res 2025, 8:4 (https://doi.org/10.12688/hrbopenres.14053.1)

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Reviewer Report 13 Feb 2025

Sonya Deschenes, UCD School of Psychology, University College Dublin, Dublin, Ireland

Hugh Fulham-Mcquillan, Psychology, University College Dublin (Ringgold ID: 8797), Dublin, Leinster, Ireland

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15432.r45244

Thank you for the invitation to review this manuscript. The manuscript describes a protocol for a systematic review on identifying barriers and enablers to delivering chronic disease preventive care in mental health settings. The protocol has many strengths, including the ... Continue reading

Thank you for the invitation to review this manuscript. The manuscript describes a protocol for a systematic review on identifying barriers and enablers to delivering chronic disease preventive care in mental health settings. The protocol has many strengths, including the plans for two independent reviewers to screen full-texts and conduct data extraction, and the consultation with a Research Services Librarian in the planning of the review. While the need for the scoping review is well justified and planned to a high standard, there are a few points that the authors could clarify, listed below.

In the first paragraph of the introduction section, examples are provided to justify the focus on smoking and physical inactivity, but justification for all health behaviours included in the review could be made.
The 5 A’s preventive care framework is discussed in the introduction, but it’s not clear how this framework will tie back to the scoping review.
In the ‘concept’ section, it is stated that “This scoping review will identify the barriers and enablers – including attitudes, perceptions, challenges, and beliefs to delivering preventive care in mental health settings.” Could the authors clarify if the review is limited to these points or if these are just examples (but are not limited to these)?
Will disagreements be resolved at the title/abstract phase, or full-text, or both?
The authors state that the scoping review will include primary articles as well as existing reviews. How will reviews be synthesised alongside individual research papers, especially if there is overlap between these?
Using a theoretical framework to guide the synthesis of the review can be considered a strength. However, to enhance clarity, the authors could provide more information about this framework in the introduction, including an overview of the specific domains it encompasses. Furthermore, the authors could clarify how identified barriers and facilitators that fall outside these domains will be handled.
The following search terms could be added to ensure greater representativeness of health care professionals working in mental health settings: psychologist; therapist; doctor; nurse; general practitioner.
Could potential barriers such as perceived time constraints be considered in the search terms?
The term ‘lifestyle’ could also be added to the search strategy.
‘Alcohol drinking’ could be entered as separate terms instead of as one.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Mental health and chronic conditions comorbidity; mental health epidemiology; psychosocial determinants of health

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

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Sonya Deschenes, UCD School of Psychology, University College Dublin, Dublin, Ireland

Hugh Fulham-Mcquillan, University College Dublin (Ringgold ID: 8797), Dublin, Ireland

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Reviewer Report

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13 Feb 2025 | for Version 1

Sonya Deschenes, UCD School of Psychology, University College Dublin, Dublin, Ireland

Hugh Fulham-Mcquillan, Psychology, University College Dublin (Ringgold ID: 8797), Dublin, Leinster, Ireland

17 Views Cite this report Responses(0)

Approved With Reservations

Thank you for the invitation to review this manuscript. The manuscript describes a protocol for a systematic review on identifying barriers and enablers to delivering chronic disease preventive care in mental health settings. The protocol has many strengths, including the plans for two independent reviewers to screen full-texts and conduct data extraction, and the consultation with a Research Services Librarian in the planning of the review. While the need for the scoping review is well justified and planned to a high standard, there are a few points that the authors could clarify, listed below.

In the first paragraph of the introduction section, examples are provided to justify the focus on smoking and physical inactivity, but justification for all health behaviours included in the review could be made.
The 5 A’s preventive care framework is discussed in the introduction, but it’s not clear how this framework will tie back to the scoping review.
In the ‘concept’ section, it is stated that “This scoping review will identify the barriers and enablers – including attitudes, perceptions, challenges, and beliefs to delivering preventive care in mental health settings.” Could the authors clarify if the review is limited to these points or if these are just examples (but are not limited to these)?
Will disagreements be resolved at the title/abstract phase, or full-text, or both?
The authors state that the scoping review will include primary articles as well as existing reviews. How will reviews be synthesised alongside individual research papers, especially if there is overlap between these?
Using a theoretical framework to guide the synthesis of the review can be considered a strength. However, to enhance clarity, the authors could provide more information about this framework in the introduction, including an overview of the specific domains it encompasses. Furthermore, the authors could clarify how identified barriers and facilitators that fall outside these domains will be handled.
The following search terms could be added to ensure greater representativeness of health care professionals working in mental health settings: psychologist; therapist; doctor; nurse; general practitioner.
Could potential barriers such as perceived time constraints be considered in the search terms?
The term ‘lifestyle’ could also be added to the search strategy.
‘Alcohol drinking’ could be entered as separate terms instead of as one.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Mental health and chronic conditions comorbidity; mental health epidemiology; psychosocial determinants of health

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

Respond to this report

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[1] Agency for Healthcare Research and Quality: Five major steps to intervention (The "5 A's"). December, 2012. Reference Source

[2] Bailey JM, Bartlem KM, Wiggers JH, et al.: Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Prev Med Rep. 2019; 16: 100969. PubMed Abstract | Publisher Full Text | Free Full Text

[3] Ball H, Yung A, Bucci S: Staff perspectives on the barriers and facilitators to exercise implementation in inpatient mental health services: a qualitative study. Ment Health Phys Act. 2022; 22: 100452. Publisher Full Text

[4] Brown CH, Medoff D, Dickerson FB, et al.: Factors influencing implementation of smoking cessation treatment within community mental health centers. J Dual Diagn. 2015; 11(2): 145–150. PubMed Abstract | Publisher Full Text | Free Full Text

[5] Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012; 7(1): 37. PubMed Abstract | Publisher Full Text | Free Full Text

[6] Centre for Disease Control and Prevention: Preventing chronic diseases: what you can do now. May 15, 2024. Reference Source

[7] de Leon J, Diaz FJ: A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res. 2005; 76(2): 135–157. PubMed Abstract | Publisher Full Text

[8] Fehily C, Jackson B, Hansen V, et al.: Increasing chronic disease preventive care in community mental health services: clinician-generated strategies. BMC Psychiatry. 2023; 23(1): 933. PubMed Abstract | Publisher Full Text | Free Full Text

[9] Filik R, Sipos A, Kehoe PG, et al.: The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr Scand. 2006; 113(4): 298–305. PubMed Abstract | Publisher Full Text

[10] Gladigau EL, Fazio TN, Hannam JP, et al.: Increased cardiovascular risk in patients with severe mental illness. Intern Med J. 2014; 44(1): 65–69. PubMed Abstract | Publisher Full Text

[11] Glowacki K, Weatherson K, Faulkner G: Barriers and facilitators to health care providers’ promotion of physical activity for individuals with mental illness: a scoping review. Ment Health Phys Act. 2019; 16: 152–168. Publisher Full Text

[12] Grandes G, Sanchez A, Sanchez-Pinilla RO, et al.: Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med. 2009; 169(7): 694–701. PubMed Abstract | Publisher Full Text

[13] Holt R, Peveler R: Diabetes and cardiovascular risk in severe mental illness: a missed opportunity and challenge for the future. Pract Diabetes Int. 2010; 27(2): 79–84ii. Publisher Full Text

[14] Jackson JG, Diaz FJ, Lopez L, et al.: A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disord. 2015; 17(6): 575–597. PubMed Abstract | Publisher Full Text

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Barriers and enablers to delivering chronic disease preventive care in mental health settings: A scoping review protocol

Abstract

Background

Aim

Methods

Conclusion

Keywords

Introduction

Aim and review question

Inclusion criteria

Methods

Search strategy

Table 1. Sample Search Strategy for OVID Medline.

Study selection

Data extraction

Data analysis and presentation

Ethics and consent

Data availability

Software availability

Acknowledgements

References

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Reviewer Reports

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Barriers and enablers to delivering chronic disease preventive care in mental health settings: A scoping review protocol

Abstract

Background

Aim

Methods

Conclusion

Keywords

Introduction

Aim and review question

Inclusion criteria

Methods

Search strategy

Table 1. Sample Search Strategy for OVID Medline.

Study selection

Data extraction

Data analysis and presentation

Ethics and consent

Data availability

Software availability

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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Are you a HRB-funded researcher?

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