Uptake of Annual Health Checks in Primary Care for People with Severe Mental Illness: A Systematic Review and Qualitative Synthesis

Background: People with severe mental illness (SMI), including schizophrenia and bipolar disorder, have worse physical health and increased risk of premature mortality than people without. While annual physical health checks in primary care can help address this risk, uptake remains low and the reasons are poorly understood. Aim: To synthesise qualitative evidence on the experiences of annual physical health checks in primary care among people with SMI, carers, and primary care providers. Design and Setting: Systematic review of peer-reviewed qualitative studies in primary care. Method: We searched MEDLINE, EMBASE, PsycINFO, and CINAHL from database inception to 26 June 2025, using key terms, to identify eligible studies from any geographical setting. The titles, abstracts, and full texts were screened independently by two reviewers. The data were extracted and analysed using a codebook thematic analysis. Results: Of n=2,463 records identified, eight studies were included, representing five countries (N=375 participants: n=239 people with SMI, n=15 carers, n=121 primary care providers,). Five themes were identified: (i) understanding of the purpose of annual health checks; (ii) individual, relational, and service-level barriers to uptake; (iii) quality of clinical interactions and impact on engagement; (iv) constraints on subsequent behaviour change; and (v) service-level design and workforce enablers to support uptake. Conclusion: Improving uptake of annual health checks for people with SMI requires coordinated action across individual, relational, and system-level factors. Interventions and service redesign informed by lived experiences of people with SMI may support more effective implementation in primary care.