Incentives and barriers to lifestyle interventions for people with severe mental illness: A narrative synthesis of quantitative, qualitative and mixed methods studies
Research Fellow, Institute of Medical and Social Care Research (IMSCaR), Bangor University, Wrexham Technology Park, Wrexham, UK. Journal of Advanced Nursing
(Impact Factor: 1.74).
02/2011; 67(4):690-708. DOI: 10.1111/j.1365-2648.2010.05546.x
To examine the evidence for incentives and barriers to lifestyle interventions for people with severe mental illness.
People with severe mental illnesses, particularly those with schizophrenia, have poorer physical health than the general population with increased mortality and morbidity rates. Social and lifestyle factors are reported to contribute to this health inequality, though antipsychotic therapy poses additional risk to long-term physical health. Many behavioural lifestyle interventions including smoking cessation, exercise programmes and weight-management programmes have been delivered to this population with promising results. Surprisingly little attention has been given to factors that may facilitate or prevent engagement with these interventions in this population.
Eight electronic databases were searched [1985-March 2009] along with the Cochrane Library and Google Scholar. Electronic 'hand' searches of key journals and explosion of references were undertaken.
A narrative synthesis of qualitative, quantitative and mixed-methods studies was undertaken.
No studies were identified that specifically explored the incentives and barriers to participation in lifestyle intervention for this population. Existing literature report some possible incentives and barriers including: illness symptoms, treatment effects, lack of support and negative staff attitudes as possible barriers; and symptom reduction, peer and staff support, knowledge, personal attributes and participation of staff as possible incentives.
Healthcare professionals, in particular nurses, should consider issues that may hinder or encourage individuals in this clinical group to participate in lifestyle interventions if the full benefits are to be achieved. Further research is needed to explore possible incentives and barriers from the service users' own perspective.
Available from: Tim Aubry
- "Otherwise, initial positivity may preclude realistic anticipation of future challenges. This notion of individualized treatment tailored to specific client needs is consistent with recommendations based on past research (Lucksted, McGuire, Postrado, Kreyenbuhl, & Dixon, 2004; Morris, Waxmonsky, May, & Giese, 2009; Roberts & Bailey, 2010). People who smoke do not want to be forced or shamed into quitting, but rather, want to make autonomous choices about treatment (Carter et al., 2001; Coleman, Murphy, & Cheater, 2000; Lawn et al., 2002). "
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People with severe mental illness are much more likely to smoke than are members of the general population. Smoking cessation interventions that combine counseling and medication have been shown to be moderately effective, but quit rates remain low and little is known about the experiences of people with severe mental illness in smoking cessation interventions. To address this gap in knowledge, we conducted a qualitative study to investigate factors that help or hinder the smoking cessation efforts of people with severe mental illness.
We recruited 16 people with severe mental illness who had participated in a clinical trial of two different smoking cessation interventions, one involving nicotine replacement therapy only and the other nicotine replacement therapy combined with motivational interviewing and a peer support group. We conducted open-ended, semi-structured interviews with participants, who ranged in age from 20 to 56 years old, were equally distributed by gender (eight men and eight women), and were predominantly Caucasian (n = 13, 81%). Primary mental illness diagnoses included schizophrenia/schizoaffective disorder (n = 6, 38%), depression (n = 5, 31%), bipolar disorder (n = 4, 25%), and anxiety disorder (n = 1, 6%). At entry into the clinical trial, participants smoked an average of 22.6 cigarettes per day (SD = 13.0).
RESULTS indicated that people with mental illness have a diverse range of experiences in the same smoking cessation intervention. Smoking cessation experiences were influenced by factors related to the intervention itself (such as presence of smoking cessation aids, group supports, and emphasis on individual choice and needs), as well as individual factors (such as mental health, physical health, and substance use), and social-environmental factors (such as difficult life events and social relationships).
An improved understanding of the smoking cessation experiences of people with severe mental illness can inform the delivery of future smoking cessation interventions for this population. The results of this study suggest the importance of smoking cessation interventions that offer a variety of treatment options, incorporating choice and flexibility, so as to be responsive to the evolving needs and preferences of individual clients.
Available from: Andrew Soundy
- "Previous research has identified that one significant and contributing factor to inactivity is the problem of social isolation (Vancampfort et al., 2012a). Being or feeling isolated influences an individual's everyday physical activity (Roberts & Bailey, 2011). Further to this, social isolation and a lack of desired relationships are reported by around a half of individuals with schizophrenia (Perese & Wolf, 2005). "
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Research is needed to understand how mental health physiotherapists use social support when promoting physical activity.
The aim of this study was to establish which dimensions of social support are used within physiotherapy sessions for individuals with schizophrenia.
A cross sectional international survey design of specialist mental health physiotherapists was undertaken.
Forty mental health physiotherapists provided in depth accounts of the four functional dimensions of social support (informational, tangible, esteem and emotional) and the one structural dimension (importance of group exercise). The results illustrate how these different dimensions of social support are used by physiotherapists to engage patients and identify the value of group work as a specific form of support. Specifically the importance of all types of support was reported and this helped to provide a detailed consideration to the skills that mental health physiotherapist have.
Providing social support is a significant part of the rehabilitation professionals’ role. The current results advance the current understanding of how social support is provided to individuals with schizophrenia in rehabilitation settings.
Available from: Robert charles Andrews
- "In order to overcome exercise barriers, other studies have found community-based exercise programmes ,  and group activities  to be the most useful programmes with people with disabilities or chronic health conditions stating that these programmes were helpful as they could exercise with patients of similar abilities and share their experiences of their illnesses . In contrast our T1DM patients preferred individually tailored exercise support, designed with consideration of their preferences, circumstances and fitness levels. "
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Regular physical activity has recognised health benefits for people with T1DM. However a significant proportion of them do not undertake the recommended levels of activity. Whilst questionnaire-based studies have examined barriers to exercise in people with T1DM, a formal qualitative analysis of these barriers has not been undertaken. Our aims were to explore attitudes, barriers and facilitators to exercise in patients with T1DM.
A purposeful sample of long standing T1DM patients were invited to participate in this qualitative study. Twenty-six adults were interviewed using a semi-structured interview schedule to determine their level of exercise and barriers to initiation and maintenance of an exercise programme.
Six main barriers to exercise were identified: lack of time and work related factors; access to facilities; lack of motivation; embarrassment and body image; weather; and diabetes specific barriers (low levels of knowledge about managing diabetes and its complications around exercise). Four motivators to exercise were identified: physical benefits from exercise; improvements in body image; enjoyment and the social interaction of exercising at gym or in groups. Three facilitators to exercise were identified: free or reduced admission to gyms and pools, help with time management, and advice and encouragement around managing diabetes for exercise.
Many of the barriers to exercise in people with T1DM are shared with the non-diabetic population. The primary difference is the requirement for education about the effect of exercise on diabetes control and its complications. There was a preference for support to be given on a one to one basis rather than in a group environment. This suggests that with the addition of the above educational requirements, one to one techniques that have been successful in increasing activity in patients with other chronic disease and the general public should be successful in increasing activity in patients with T1DM.
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