Barriers and facilitators to healthcare access for adults with learning disabilities and autistic adults in England: A scoping review and meta-aggregation

<b>Background:</b> Adults with learning disabilities and autistic adults in England face significantly higher rates of premature mortality, 22 years earlier for those with learning disabilities and over 6 years earlier for autistic adults. Barriers to healthcare access contribute to missed diagnoses and treatments. There, the aim of this review was: What are the barriers and facilitators to healthcare appointment attendance for adults with learning disabilities and autistic adults in England? <b>Methods:</b> A systematic search across ten databases (March 2023; updated June 2024) identified 1,727 papers. Studies were included if they reported qualitative evidence on clinical appointment accessibility for autistic adults or adults with learning disabilities in England. Fifteen studies were included and critically appraised. Findings were synthesised using Joanna Briggs Institute meta-aggregation and interpreted through a socio-ecological lens. <b>Findings and Conclusions:</b> Facilitators included flexible booking systems, positive healthcare professional attitudes, and the ability to develop a positive and trusting relationship between HCPs and the person they were supporting. Barriers existed at individual, relational, organisational, and policy levels, including poor communication, inadequate appointment systems, and lack of professional knowledge. Recommendations include enhanced staff training, use of liaison nurses, flexible appointment systems, and accessible communication. Policy and structural changes are needed, though further evaluation of their impact is essential.