Understanding Implementation Fidelity of Physical Health Screening in Mental Health Nursing: A Mixed Methods Study

Abstract

Physical health screening for patients with schizophrenia spectrum disorders is suboptimal despite patients' poor physical health and nurses' willingness to conduct assessments. However, this inadequate service provision is poorly understood. The purpose of this study was to describe nurses' adherence to conducting screening with the Finnish Health Improvement Profile and related factors. An explanatory, sequential two-phase mixed-methods design was used. A quantitative method was used to describe nurses' adherence and a qualitative approach to describe moderating factors. The data were collected and analyzed separately and later integrated into one dataset. Generally, screening was implemented as intended regarding content adherence despite very few nurses conducting the screening. Analysis identified four main themes related to adherence. Comprehensiveness of policy description included complexity and duration; strategies to facilitate implementation included fragmented information, instructions, nurses' fragmented work tasks, management and equipment; quality of delivery included preparedness and nurses' confidence and skills; and participant responsiveness included nurses' enthusiasm in screening, nurses' engagement in screening, patient willingness to participate, patient's refusal to participate, patient's cognitive capacity and collaborative screening. For successful screening, the utility and feasibility of the screening tool would need to be reevaluated after addressing some of the barriers identified as moderating factors.