Understanding incentives & barriers to attending a Healthy Living Group for people with Severe Mental Illness (SMI) in Wrexham
It is well recognised that people with severe mental illnesses (SMI) such as schizophrenia have a poorer health state than the general population with increased mortality and morbidity rates. Social and lifestyle factors along with long-term antipsychotic medications are reported to contribute to this health inequality. A variety of behavioural lifestyle and healthy living interventions such as smoking cessation, exercise and weight management programmes have been developed for this reason and with good effect. However, research into those factors that may facilitate or prevent engagement with these interventions in limited.
Method This is a mixed method study utilising both qualitative and quantitative techniques. Participant observations and semi-structured interviews were undertaken to yield qualitative data. Whilst a survey of mental healthcare professionals, analysis of routine data/case notes review was undertaken to yield quantitative data.
Results Analysis of the qualitative data from the semi-structured interviews identified 5 key themes; weight management, social networking, information and communication, role of healthcare professionals and perceived benefits. Participant observations highlighted: environment; facilitator style; group ownership; group cohesion; information and learning; and, incentives and barriers.
Analysis of the quantitative data was limited due firstly to poor completion rates of self-rated questionnaires and difficulties in retrieving workbooks from members, and secondly to inconstancies in the timing of routine tests and missing data from non attendance. Despite the limitations we can report a decrease in physical activity and function, and an increase in anxiety and depression symptoms over time.
Overall there was some weight loss and loss to waist circumference with a small reduction in BMI shown. However there were no gains to Blood Pressure or cholesterol levels or coronary heart disease risk. The survey of healthcare professionals (n = 28) indicates that overall they were satisfied with the service. The group was viewed favourably in relation to benefitting their clients. The key issue was lack of information about the Healthy Living Group and accessibility to their clients.
Additional qualitative comments were provided which related to lack of information; intervention content and delivery; illness as a barrier to attendance and benefits of the group.
Discussion Evidence suggest that lifestyle interventions for people with severe mental illnesses especially schizophrenia are beneficial. However, few studies explore the possible incentives and barriers to these interventions.
This study is the first to explicitly examine the incentives and barriers to lifestyle interventions for this clinical group. Participants viewed the healthy living group favourably overall and provided rich data about the factors that motivated or prevented them from attending the group.
Participants were motivated by losing weight, making friends, knowledge gained, advice given, and helpful and approachable staff. The participant observations supported many of the findings of the interviews about those factors which seemed to benefit, motivate or hinder participation. Healthcare professionals also seemed to value the intervention with many favourable comments provided about the benefits of the group.
However, the study was not able to provide strong evidence of the physical health benefits of the group. Though there was evidence of some weight loss, there were also findings counter to those expected. These findings require careful interpretation due to important limitations in the data available for analysis. These are considered and discussed.