Consumer perspectives on involving family and significant others in a healthy lifestyle intervention

Learning, doing and sticking with it: A qualitative study on achieving clinically significant reduction in cardiovascular disease risk in a healthy lifestyle intervention for people with serious mental illness

People with serious mental illness (SMI; e.g. schizophrenia) have mortality rates two to three times higher than the general population, largely due to a higher prevalence of cardiovascular disease (CVD). Healthy lifestyle interventions can improve the health of people with SMI, but information about why these interventions work for some and not others is scarce. Our study aims to qualitatively explore differences in these two groups' overall experiences and application of the intervention. Data were drawn from a randomised effectiveness trial of a peer-led healthy lifestyle intervention. Qualitative data from interviews and focus groups with 21 participants were linked to their 12-month outcome data. Grounded theory was used to compare the experiences of participants who achieved clinically significant CVD risk reduction (i.e. clinically significant weight loss or clinically significant improvements in cardiorespiratory fitness) versus those who did not. Three qualitative themes: learning, change, sticking with it - differentiated participants who achieved CVD risk reduction and those that did not. Participants achieving CVD risk reduction described learning and applying specific knowledge and skills related to a healthy lifestyle when making health decisions, made healthy concrete changes to diet and physical activity, and stuck with those changes. Participants not achieving clinically significant CVD risk reduction reported surface-level learning about healthy lifestyle practices, difficulty sticking with healthy changes, and were more likely to report ambiguous or no changes. Our findings suggest that healthy lifestyle interventions for people with SMI should provide experiential in-vivo learning experiences while periodically assessing participants' understanding and then tailoring the intervention to their needs. It is important to build self-efficacy for health behaviour changes by creating early perceptions of success, which was found to enhance motivation and sustain behaviour change. Helping people with SMI develop and strengthen their support systems will also be an important factor for building and sustaining health behaviour changes.

Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD

OBJECTIVE

Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention.

DESIGN

Qualitative study.

SETTING

Face-to-face semistructured interviews conducted after the Warrior Wellness trial was completed.

PARTICIPANTS

Fifteen veterans (100% male, 93% African American or Black, 100% non-Hispanic or Latinx, average age = 68.7 years) who completed the Warrior Wellness exercise program.

MEASUREMENTS

Semistructured interviews were conducted using an interview guide that assessed veterans' experience in Warrior Wellness and recommendations for future intervention modifications. Interviews were subsequently transcribed and analyzed by thematic analysis.

RESULTS

Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains. Finally, veterans provided several suggestions for modifying the intervention such as increasing its duration, adding a nutritional component, and including significant others in enrollment.

CONCLUSIONS

This study offers valuable insights into the intervention and interpersonal factors that veterans view as important for their engagement in exercise, the perceived benefits of exercise, and the ways in which interventions designed for this population can be refined.

Qualitative analysis of social network influences on quitting smoking among individuals with serious mental illness

Objective: The prevalence of cigarette smoking among adults with serious mental illness (SMI) remains high in the United States despite the availability of effective smoking cessation treatment. Identifying social influences on smoking and smoking cessation may help enhance intervention strategies to help smokers with SMI quit. The objective of this qualitative study was to explore social network influences on efforts to quit smoking among adults with SMI enrolled in a cessation treatment program. Methods: Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. A convenience sampling strategy was used to recruit participants for social network interviews exploring the influence of family, friends, peers, and significant others on quitting smoking. A team-based analysis of qualitative data involved descriptive coding, grouping coded data into categories, and identifying themes across the data. Results: Social barriers to quitting smoking included pro-smoking social norms, attitudes, and behaviors of social network members, and negative interactions with network members, either specific to smoking or that triggered smoking. Social facilitators to quitting included quitting with network members, having cessation role models, and social support for quitting from network members. Conclusions: Similar to the general population, social factors appear to influence efforts to quit smoking among individuals with SMI enrolled in cessation treatment. Interventions that leverage positive social influences on smoking cessation have the potential to enhance strategies to help individuals with SMI quit smoking.

Consideration of Factors Influencing Weight Outcomes among U.S. Racial-Ethnic Minority Populations in the Social Work Literature

OBJECTIVE

This study explores the social work profession's empirical contribution to addressing factors influencing overweight and obesity outcomes among racial-ethnic minority populations in the United States. The high prevalence of obesity in U.S. adults and children, particularly in racial/ethnic minority populations, continues to be an important public health issue. The African American Collaborative Obesity Research Network (AACORN) Expanded Obesity Research Paradigm was used to assess the studies. Constructs in this paradigm identify conceptual and multilevel influences on obesity offering social work practitioners a comprehensive understanding of obesity-related factors in populations of color: cultural and psychosocial processes, historical and social contexts, and physical and economic environments.

METHODS

A systematic search of obesity-related, social work studies providing data for U.S. racial/ethnic minority populations was conducted in March through July 2013 with updated searches in February 2016 and July 2017.

FINDINGS

Identified studies were mostly cross-sectional, offering only a snapshot of factors associated with obesity among racial-ethnic minority populations. Articles addressing factors contributing to overweight/obesity were more likely to discuss cultural and psychosocial features and provided limited information about health behaviors embedded in the daily lives of racial-ethnic groups affecting obesity.

FUTURE DIRECTIONS

Given that social workers' interactions with clients occur in a variety of social services settings, they are in a unique position to assist with developing strategies for facilitating obesity prevention integrating conceptual features outlined by the AACORN paradigm. Practice and policy implications are discussed for social work professionals employed in community settings.

Educational nurse-led lifestyle intervention for persons with mental illness

Although persons with severe mental illness face an increased risk of mortality and of developing negative health outcomes, research has shown that lifestyle interventions can sufficiently support their health. In response, this study examined a nurse-led lifestyle intervention developed in cooperation with members of municipal and county councils to gauge its impact on the quality of life, cognitive performance, walking capacity, and body composition of persons with severe mental illness. Lasting 26 weeks and involving 38 persons with severe mental illness, the intervention prioritised two components: the interpersonal relationships of persons with severe mental illness, staff, and group leaders and group education about physical and mental health. Pre-post intervention measurements of quality of life collected with the Manchester Short Assessment of Quality of Life, cognitive performance with the Frontal Systems Behaviour Scale, walking capacity with a 6-min walk test, and body composition in terms of waist circumference and body mass index were analysed using a nonparametric test Wilcoxon signed-rank test. Results suggest that the intervention afforded significant improvements in the health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference for persons with severe mental illness. However, long-term studies with control groups and that examine parameters related to cardiovascular risk factors are essential to ensure the sustained impact of the intervention.

Preferences for Smoking Cessation Support from Family and Friends Among Adults with Serious Mental Illness

Engaging natural supports may be a promising strategy to promote the use of evidence-based smoking cessation treatment for individuals with serious mental illness (SMI) who smoke. This qualitative study explored preferences for support for quitting from family and friends among individuals with SMI who participated in cessation treatment. Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. Open-ended questions asked during a social network interview explored participants' preferences for more support for quitting smoking from family and friends. The qualitative data was coded and common themes were identified across the dataset. Three primary preferences emerged for smoking cessation support from family members and friends: 1) more practical support for quitting (e.g., financial help with purchasing cessation medications); 2) more emotional support for quitting (e.g., encouraging progress toward quitting); and 3) changing their own smoking behaviors in the presence of participants (e.g., don't smoke around them or offer them cigarettes). Individuals with SMI who participated in smoking cessation treatment at community mental health centers indicated several ways that family members and friends could support their efforts to quit smoking. Understanding how people with SMI want support from family and friends to quit smoking will inform strategies to leverage these natural resources to promote the use of evidence-based smoking cessation treatment and support smoking abstinence for this population.

Meta-Ethnography of Qualitative Research on the Experience of Being a Partner to an Individual with Schizophrenia Spectrum Disorder

Several qualitative studies explore the experience of being a partner to an individual with schizophrenia spectrum disorder, but these studies remain isolated "islands of knowledge." This meta-ethnography aimed to synthesize current qualitative studies using Noblit and Hare's method. Thirteen studies were identified for inclusion. Three overarching themes were revealed: unmet expectations of relationship, renegotiating relationship roles, and separation versus togetherness. Themes interacted as a cycle with separation versus togetherness as temporal endpoints. Partners also renegotiated relationships with mental health professionals to accommodate unmet expectations. Leverage points for intervention were identified.

Feasibility Study of Increasing Social Support to Enhance a Healthy Lifestyle Intervention for Individuals with Serious Mental Illness

OBJECTIVE

Healthy lifestyle interventions addressing obesity in people with serious mental illness (SMI) lead to modest weight losses that tend not to be sustained over time. By augmenting lifestyle interventions with family and peer support targeting health behavior change, greater weight loss might be obtained and sustained in this population. The purpose of this study was to assess the feasibility of increasing support from family and friends to enhance a healthy lifestyle intervention (In SHAPE) adapted for individuals with SMI.

METHOD

A sample of 7 dyads (14 total participants) participated in this small-scale open-feasibility trial of social support strategies to enhance health promotion. Weekly 1-hour health coaching sessions were augmented by sessions designed to increase support for healthy eating and exercise through active learning and didactic instruction. Feasibility was assessed by program participation and by examining participants' satisfaction and exploring suggestions for improving the model post-intervention.

RESULTS

The majority of participants (57%) nominated a friend, followed by adult child-parent pairs (28%) and sibling pairs (14%) to participate as support partners in the study. All participant-partner dyads (100%) completed 12 sessions within 16 weeks. Participants reported high satisfaction and perceived benefits from the program. Recommend modifications by the dyads included more interactive sessions, a combination of group and dyadic sessions, and hands-on cooking classes.

CONCLUSIONS

This formative research showed that the study design is feasible and that the intervention can facilitate social support for health behavior change in people with SMI. Further research is needed to evaluate the effectiveness of this intervention.

The other 23 hours: a qualitative study of fitness provider perspectives on social support for health promotion for adults with mental illness

Current efforts to reduce the increased risk of premature death from preventable cardiovascular disease among adults with serious mental illness (SMI) through lifestyle change have had limited success. Engaging informal support systems to promote healthy behaviors in everyday life may increase the effectiveness of health promotion interventions targeting this at-risk population. In-depth semistructured interviews were conducted with 10 fitness trainers serving adults with SMI in a health promotion program at community mental health centers to explore their perspectives on the potential of enlisting support from significant others for health behavior change. Trainers reported that the majority of participants had a relative or significant other who influenced their health behaviors, and they saw potential value in involving them in efforts to improve health outcomes by extending support into participants' daily lives. They did not feel qualified to work with families of individuals with mental illness, but they were willing to partner with providers who had experience in this area. Social workers who practice with families could play a critical role on health promotion teams addressing cardiovascular risk in adults with SMI by using their skills and experiences to engage families in supporting a relative through the process of health behavior change.

Perspectives of Overweight Latinos with Serious Mental Illness on Barriers and Facilitators to Health Behavior Change

Serious mental illness (SMI) and Latino ethnicity can produce a compounded health disparity, placing individuals at particularly high risk for excess morbidity and premature mortality. Culturally sensitive strategies are needed to improve health behaviors, including exercise and healthy eating within this population. The purpose of this qualitative study was to explore facilitators, barriers, and preferences for health behavior change among Latinos with SMI. Semi-structured interviews were conducted with 20 Latinos with SMI who were enrolled in a randomized trial evaluating the effectiveness of a motivational health promotion intervention, In SHAPE. The interviews explored perceived facilitators and barriers to health behavior change, focusing on the role of family, and exercise preferences. The primary facilitator identified by participants was having someone (either professional or significant other) to hold them accountable for engaging in healthy behaviors. A major barrier to making lasting health behavior change was cultural influences on food. Participants preferred aerobic exercises set to music that kept their minds occupied in contrast to strenuous activities such as weight lifting. This exploratory research provides insight into the perspectives, experiences, and preferences of Latinos with SMI participating in a health promotion intervention. Findings will be used to inform future health promotion efforts adapted to meet the needs of an ethnically diverse, underserved community.

A literary analysis of global female identity, health, and equity

Females' experiences of identity, health, and equity share similar features around the world. This literary analysis describes the narratives of 4 female protagonists from popular fiction novels to identify similarities between their personal and contextualized experiences. The impact these private realities and public structures have on female health will be used to demonstrate the universal ecological threats to women's health. In conclusion, we offer suggestions on how to incorporate the shared female movement from domination and separation toward liberation and connection into modern health care practices that emphasize shared decision making, open communication, and social activism.