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Table 1 Views on the importance of CHD risk factor screening and obstacles to its success

From: Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care

  View expressed by *
Reasons cited for the importance of CHD screening in SMI CMHT GP SU N
• There is a high prevalence of smoking and weight problems among their own caseload with SMI   23
• Physical health is often neglected by services due to their focus on clients' mental health problems 20
• Side effects of antipsychotics, e.g. weight gain and metabolic 14
• Physical health can be neglected due to clients' poor motivation and social isolation – they need extra help and encouragement with this 13
• Research evidence indicates people with SMI are a high risk group for CHD   9
• Knowing about one's personal risk for CHD would enable clients to take timely preventative action (e.g. to make lifestyle changes)    8
• Regular screening would allay client's fears about their physical health    7
• Clients are aware of their own risk factors for CHD, especially smoking, family history, diet and weight    6
• Screening should be offered to everyone, regardless of SMI diagnosis 3
• Recent experience of clients with SMI dying due to undetected CHD    2
• The stress of having SMI may adversely affect the heart   2
• People with SMI are harder to engage and so need more assertive screening    2
• It is important for staff to recognise risk and be able to interpret any new physical symptoms as organic rather than psychological in nature    1
Perceived obstacles to/negative views of CHD screening     
• Lack of appropriate resources in existing services – e.g. time, trained staff   18
• Anticipation of low uptake rates by patients with SMI   17
• Perceived difficulty in making lifestyle changes amongst people with SMI, even if risk CHD factors are identified 15
• Patients dislike having blood tests    12
• Lack of funding for CHD screening services or it not being seen as a priority by Trust management 12
• A screening offer might be viewed as interference in patients' lives – they may feel defensive, anxious or paranoid   7
• Stigma: a perception that services such as smoking cessation can't deal with people with SMI 4
• CMHT services already "squeezed"    4
• Staff resistance to more changes in their role – CHD screening would be moving too far away from their mental health role    4
• Poor communication of results between primary and secondary care   3
• Lack of appropriate services to refer patients to if risk factors are identified – e.g. long waiting lists, narrow referral criteria, group sessions     3
• It would not be cost effective to screen all SMI patients, only those in high risk groups e.g. overweight   2
• Prior experience of low attendance when routine screening appointments were offered to people with SMI in line with the new GP contract     1
  1. * Note: Tick-boxes indicate which group(s) of participants expressed the view: CMHT = staff from community mental health team; GP = staff from general practice; SU = service users. Numbers (N) indicate the prevalence of each view within the total sample.