Placing physical activity in mental health care: a leadership role for mental health nurses

Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals

BACKGROUND

Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation.

OBJECTIVE

Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care.

METHODS

Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings.

RESULTS

Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described.

CONCLUSIONS

The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks.

A qualitative evaluation of an exercise practitioner in an outpatient child and adolescent mental health service

BACKGROUND

Physical activity interventions can confer a range of physical and mental health benefits among young people with mental disorders. In some contexts, such as Ireland, integrated physical activity is not easily available within child and adolescent mental health services. Therefore, an interagency pilot intervention was established in a child and adolescent mental health service in Ireland with the integration of a novel exercise practitioner into the multidisciplinary mental health team.

OBJECTIVE

A qualitative evaluation was conducted to understand the impact of the pilot intervention and to understand issues of implementation that arose throughout.

METHODS

In-depth qualitative interviews with service users' parents/guardians (N = 3) and a single focus group with existing service providers (N = 3), framed by the RE-AIM framework were conducted to evaluate the pilot intervention. Data were analysed using thematic analysis to explore themes.

RESULTS

Three overarching themes were identified. These were as follows: (i) Making changes toward healthier physical activity behaviours; (ii) An intervention of therapeutic holism; and (iii) The integrated service delivery.

CONCLUSIONS

This research provides insight on the value of a novel integrated exercise practitioner in outpatient young persons' mental health services in Ireland, indicating an enhanced and complimentary therapeutic service. These findings will be helpful for integrating Exercise Practitioners in this setting going forward.

Relationship between Physical Activity and Health Outcomes in Persons with Psychotic Disorders after Participation in a 2-Year Individualized Lifestyle Intervention

People with psychotic disorders have a significantly increased risk of physical diseases and excessive mortality rates. The aim of the study was to investigate relationships between changes in physical activity, levels of salutogenic health, and glycated hemoglobin among people with psychotic disorders after participation in an individualized lifestyle intervention. The results from analyses showed that self-reported increased physical activity was positively associated with the level of salutogenic health and negatively associated with the level of HbA1c on an individual level. The results indicate that coordinated, individualized, holistic and health-promoting nursing care is crucial to enabling enhanced lifestyle within this vulnerable target group.

Impact of structured physical activity program on the level of functional ability of Persons with Mental Illness

BACKGROUND

A structured physical activity program has many health benefits. Physical activity improves the functional ability of a patient with mental illness as an adjunctive treatment. This study aimed to evaluate the efficacy of a physical activity program on the level of functional ability of patients with mental illness.

MATERIALS AND METHODS

A pre-experimental research design and one group pre-post design were adopted. Thirty-one in-patients with mental illness who met the inclusion criteria were recruited for the study using convenient sampling. Baseline data were collected using sociodemographic and illness profiles developed by the researcher and validated by the experts. Functional ability and illness severity were assessed using the standardized World Health Organization Disability Assessment Schedule (WHODAS) (36-item version) and the Clinical Global Improvement Scale. Pretest, i.e., intervention with structured physical activity, was administered for 40 consecutive days. A posttest was given 30 days after the intervention ended to assess the impact of the structured physical activity program on the level of functional ability among the study participants.

RESULTS

The impact of structured physical activity on functional ability was measured using the WHODAS 2.0, a 36-item version. The paired Sample t-test and the Wilcoxon Rank test analyzed the data. There was a significant improvement in the overall functional ability of study participants at P = 0. 001.

CONCLUSION

The study findings support that structured physical activity substantially impacts functional ability among patients with mental illnesses.

Inclusion of physical activity in nurse practitioner programs: A national perspective

BACKGROUND

Physical activity (PA) provides a multitude of health benefits, creating an avenue for disease prevention and management. Health care providers play a crucial role in helping patients become more active, yet little is known about the preparation of primary care nurse practitioners (NPs) to aid in this effort.

PURPOSE

To examine the amount and type of PA training offered in primary care NP programs in the United States.

METHODOLOGY

A cross-sectional study design was used. Eligible programs' websites were reviewed, and an online survey of program leaders assessed details regarding the inclusion of PA training, barriers, and future plans.

RESULTS

Data extracted from 1,067 NP program websites revealed that 81.7% of websites (n = 264) with course descriptions contained one or more general health promotion keywords, whereas only 0.6% (n = 2) included a PA-specific keyword. Two-hundred institutions (53.2%) completed the program leader survey, of which 45.0% reported no inclusion of PA training. Among institutions providing PA training, 82.2% (n = 88) and 55.1% (n = 59) reported the inclusion of aerobic activity and strength training recommendations, respectively. Forty-one institutions (46.1%) felt that their institution prepared students to effectively counsel patients on starting a PA program.

CONCLUSIONS

Although some NP programs include PA content, most provide no or less-than-adequate PA training.

IMPLICATIONS FOR PRACTICE

The current state of PA training in NP programs may hinder health promotion and disease prevention efforts. Programs should dedicate sufficient time and attention to preparing future NPs to promote PA behaviors. A multifaceted, multistakeholder approach is needed to facilitate widespread adoption of PA inclusion.

Improving Practices of Mental Health Professionals in Recommending More Physical Activity and Less Sedentary Behaviour to Their Clients: An Intervention Trial

We investigated the effects of increasing physical activity (PA) and reducing sedentary behaviour (SB) of mental health professionals on their attitudes towards and practices in recommending more PA and less SB to their clients. A 4-week pre-post intervention trial was conducted involving 17 mental health professionals. The participants who increased their own physical activity during the intervention increased the frequency of recommending more PA (p = 0.009) and less SB (p = 0.005) to their clients. A relatively simple, low-cost intervention, consisting of group behaviour change counselling, goal setting and positive feedback, may improve the practices of mental health professionals.Supplemental data for this article is available online at https://doi.org/10.1080/01612840.2021.1972189 .

The Association between Physical Activity and Selected Parameters of Psychological Status and Dementia in Older Women

Physical activity has an unquestionable impact on broadly understood human health. One interesting issue related to this is the importance of movement on mental health and cognitive functioning. Research shows that regular physical activity improves the cognitive functioning of adults and people with mental disorders. Regular physical activity can be an important and powerful protective factor in cognitive impairment and dementia in the elderly, and exercise is an important non-pharmacological treatment for mild cognitive impairment or neurodegenerative diseases. This study aims to present the impact of physical activity on selected cognitive functions in physically active women over 60 years of age. The research was carried out in a group of 110 generally healthy women from the area of western Poland over 60 years of age, who were divided into four groups based on the intensity of their physical activity. A pedometer (sport watch) and a physical activity diary were used to measure physical activity. Body Mass Index was assessed. Selected cognitive functions were assessed using the MMSE test, motor and psychomotor skills were measured, and Luria's auditory memory test and recall test, a clock drawing test, and a GDS test were performed. There were statistically significant relationships between the level of physical activity and the effectiveness of cognitive processes. These results show that about 5000 steps a day is enough to see a positive effect on the mental health and cognitive functioning of this group of the elderly population. The women had an average BMI of 28.1 ± 4.7. BMI, indicating an overweight condition (over 30 kg/m2), was observed in 31% of women. The results of this study lead the authors to conclude that physical activity positively influences cognitive function and can be recommended for all seniors who do not have other serious comorbidities that would prevent them from playing sports.

The Effect of Aerobic Exercise on the Quality of Life of Male Patients Who Suffer from Chronic Schizophrenia: Double-Blind, Randomized Control Trial

Background: Chronic schizophrenia is a long-term and severe mental disorder. Aerobic exercises can reduce the symptoms of mental disorders, particularly schizophrenia, through improving the patient's quality of life (QoL). Objectives: The current study aimed to investigate the effect of aerobic exercise on the QoL of male schizophrenics hospitalized at the Razi Psychiatric Center in Tabriz from 2015 to 2016. Methods: In this randomized controlled trial, 68 patients who met the inclusion criteria were randomly allocated into groups of intervention (n = 34) and control (n = 34). The intervention group has benefited from the aerobic exercise 24 sessions for 8 weeks, 12 hours in total. The control group simultaneously enjoyed the fresh air. The Schizophrenic Quality of Life Scale (SQLS) was completed before and after intervention in both groups. The data were analyzed in SPSS20 using the t-test and chi-squared test. Results: The mean age of participants was 37.82 ± 7.14 years. No significant differences were found between the demographic characteristics of the two groups. This study showed that no significant difference was found in the quality of life in both groups before intervention (P ≤ 0.37), but there was a significant difference after the intervention (P = 0.001). Aerobic exercises reduce patient's mental disorders and promote their QoL (P < 0.05). Conclusions: Regular aerobic exercise can reduce the symptoms of male patients with schizophrenics, which in turn improves all dimensions of QoL

Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV

BACKGROUND

Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation.

METHODS

Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study.

RESULTS

Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI.

CONCLUSIONS

This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

Perception of physical health by patients with severe mental illness and their family caregivers: A qualitative study

PURPOSE

The aim of this study is to determine the perceptions of both individuals with severe mental illness and their family caregivers regarding the physical health status of patients.

DESIGN AND METHODS

A descriptive qualitative design was implemented, and 11 individuals with severe mental illness and 12 caregivers were analysed.

FINDINGS

Two main themes emerged as a result of the content analysis: a "physical health-related barriers" theme and a "need for better physical health" theme.

PRACTICE IMPLICATIONS

Patients and their family caregivers experience a number of barriers and difficulties related to maintaining and improving physical health. Psychiatric nurses should recognize these barriers and assist in empowering both patients and their family caregivers to overcome them.

A Qualitative Examination of the Physical Activity Needs of People with Severe Mental Illness

It is recognised that physical activity has a positive impact on quality of life, social well-being and overall health of people with severe mental illness. However, there is a lack of theory informed programmes that support people with mental illness to adopt regular physical activity behaviour. The aim of this case study was to identify determinants of long-term physical activity among people with severe mental illness that may then inform the development of more suitable physical activity programmes. Semi-structured interviews were conducted with 15 people (13 men and 2 women) with a mean age of 36.7 [standard deviation (SD)=11.8] who had a diagnosed mental illness and were attending a physical activity programme run by a mental health non-governmental organisation. Interview data was analysed using the documentary method to emphasise the perspective of people with severe mental illness. Three participation types were generated in the context of individuals' physical activity orientation and social background-first 'rehabilitative orientated' (physical activity as a supportive measure to re-enter the labour market and develop a daily routine); second 'social-orientated' (social well-being within the group as the primary motive); finally, 'trust-orientated' (a sense of trust that encourages participation). Based on these type-specific categories, it is suggested that different settings (mental health care centres and sport clubs) might be needed to attract and maintain the physical activity engagement of people with severe mental illness. In the context of sport clubs, it is recommended that coaches undergo training in mental health literacy.

Losing to Gain: The Effects of a Healthy Lifestyle Intervention on the Physical and Psychosocial Well-being of Clients in a Community-based Mental Health Setting

Individuals with severe and persistent mental illness (SPMI) encounter both poorer physical health and psychosocial well-being in comparison to the general population. Obesity, hypertension, heart disease, and diabetes can result from the symptoms of mental illness, the side effects from psychotropic medications, as well as disparities associated with being mentally ill. Mental health nurses are in a prime position to implement healthy lifestyle interventions (HLIs). This study tested a HLI (physical exercise and nutrition) and examined the effects on physical and psychosocial outcomes in clients obtaining mental health services at a community-based facility. Key findings included a decrease in anxiety and depressive symptoms at 3 months and consistent improvement in self-efficacy for exercise in the intervention group. Bridges and barriers to achieving optimal results in physical and psychosocial well-being were identified. Findings from this study offer insight into designing and executing more effective HLIs with individuals who have SPMI.

The impact of disability type and visibility on self-concept and body image: Implications for mental health nursing

WHAT IS KNOWN ON THE SUBJECT?: Physical appearance, as in the case of individuals with physical disabilities who use a cane, walker or wheelchair, also influence others' reactions and as a result, may lead to one's negative or positive feelings and thoughts. A disability that is not observable by others, as in the case of individuals with psychiatric disabilities (mental illnesses), may also have a negative impact on one's feelings and thoughts, due to stigma associated with psychiatric disabilities. To date, research has mainly focused on the way persons with a noticeable type of disability think about themselves. It is also important to evaluate the impact of disability type on ones' feelings and thoughts, and compare persons with visible and invisible disabilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We asked 119 adults (over the age of 18 years) with different types of disabilities to complete a set of questionnaires and found that those who had a disability that was not observable by others (a psychiatric disability) felt more negative about themselves and their body than those who had a disability that was observable by others (a physical disability). The study extends the current knowledge on the impact of disability type and its visibility on the way persons with disabilities think about themselves. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that healthcare services should be modified to address the psychological needs of people with different types of disability. Mental health nurses should identify practices in the community that will improve the feelings and thoughts of consumers with disabilities, and especially those who cope with a psychiatric disability. Abstract Introduction Individuals with disabilities often face stigma and discrimination, which may negatively affect their self-concept. To date, research has mainly focused on the psychological implications of living with a noticeable physical disability. Less attention has been given to individuals with invisible psychiatric disabilities as a stigmatized subgroup in the disability community. Aim To evaluate the impact of disability type and its visibility on the self-concept and body image. Method A cross-sectional quantitative study design was implemented to compare the self-concept and body image of individuals with visible physical disabilities and individuals with invisible psychiatric disabilities (n = 119). Pearson correlations, ANOVA and multiple linear regression models were performed. Results Individuals with invisible psychiatric disabilities reported lower levels of self-concept and body image compared to individuals with visible physical disabilities. Gender, family status and the severity level of the disability were found to be associated with self-concept and body image. Discussion The study extends the current knowledge by showing that disability visibility might play a protective role for persons with physical disabilities compared to persons with psychiatric disabilities. Implications for Practice Mental health nurses should apply practices to enhance the self-concept and body image of consumers with invisible psychiatric disabilities.

Promoting exercise behaviour in a secure mental health setting: Healthcare assistant perspectives

Individuals with severe mental illness engage in significantly less amounts of physical activity than the general population. A secure mental health setting can exacerbate barriers to exercise, and facilitate physical inactivity and sedentary behaviour. Healthcare assistants are intimately involved in the daily lives of patients and, therefore, should be considered integral to exercise promotion in secure mental health settings. Our aim was to explore healthcare assistants' perceptions of exercise and their attitudes to exercise promotion for adult patients in a secure mental health hospital. Qualitative semi-structured interviews were conducted with 11 healthcare assistants from a large UK-based secure mental health hospital. Topics included healthcare assistants' personal experiences of exercise within a secure facility, their perceptions of exercise as an effective treatment tool for mental health, and their perceived roles and responsibilities for exercise promotion. Thematic analysis was used to analyse the data. Three main themes were identified: (i) exercise is multi-beneficial to patients, (ii) perceived barriers to effective exercise promotion, and (iii) strategies for effectives exercise promotion. Healthcare assistants considered exercise to hold patient benefits. However, core organizational and individual barriers limited healthcare assistants' exercise promotion efforts. An informal approach to exercise promotion was deemed most effective to some, whereas others committed to more formal strategies including compulsory sessions. With education and organizational support, we propose healthcare assistants are well placed to identify individual needs for exercise promotion. Their consultation could lead to more efficacious, person-sensitive interventions.

Self-reported physical activity levels of the 2017 Royal Australian and New Zealand College of Psychiatrists (RANZCP) conference delegates and their exercise referral practices

Background: Physical activity (PA) significantly improves physical health and clinical symptoms across mental disorders. Accredited Exercise Physiologists (AEPs) are trained to lead PA interventions for people with mental illness, but referrals to AEPs are low.Aims: To determine the knowledge and attitudes of delegates attending the 2017 Royal Australian and New Zealand College of Psychiatrists (RANZCP) conference toward physical health monitoring and exercise interventions for people with mental illness.Methods: A cross-sectional survey of RANZCP delegates investigated knowledge and attitudes toward PA for people with mental illness, self-reported PA, and their understanding of AEP's role within mental health settings. A subgroup of delegates underwent fitness assessments.Results: Seventy-three delegates completed surveys and 24 underwent fitness assessments. Delegates demonstrated good knowledge regarding associations between PA and cardiovascular disease risk. Delegates were less knowledgeable of AEP's role within mental health settings. Forty-six participants (63%) did not meet the Australian recommended guidelines for PA. No association between referrals to AEPs and self-reported PA or fitness measures were evident.Conclusions: Promoting PA participation for mental health professionals, coupled with education on the important role AEPs play in the multidisciplinary treatment of mental health consumers is vital to improve health outcomes for this vulnerable group.

The next step: a strategic focus on physical activity and sedentary behaviour in Irish mental health care

People with severe mental illnesses have dramatically reduced life expectancy compared with the general population, which is largely attributed to physical comorbidity. Physical activity and sedentary behaviour interventions offer a safe and viable therapeutic resource for multi-disciplinary mental health care teams. The accumulating evidence supporting the role of these interventions has changed the focus of mental health strategy in some countries, with new developing roles for certain mental health professionals in this field. However, in Ireland the absence of specialised exercise practitioners places a leadership role for mental health nurses in this regard. National mental health strategy in Ireland should prioritise physical activity and sedentary behaviour interventions, make recommendations for the integration of specialised exercise practitioners in all mental health multidisciplinary teams, and recommend the provision of training and awareness for mental health nurses and other multidisciplinary professionals who are already well placed to address this issue.

Health Risks among People with Severe Mental Illness in Psychiatric Outpatient Settings

Life expectancy is greatly reduced in patients with schizophrenia, and cardiovascular diseases are a leading cause of mortality. The aim of this cross-sectional study was to investigate the prevalence of overweight, obesity, and cardiovascular disease (CVD) risk and to investigate the relationships between self-rated health, sense of coherence, CVD risk, and body mass index (BMI) among people with severe mental illness (SMI) in psychiatric outpatient settings. Nearly 50% of the participants were exposed to moderate/high risk of CVD and over 50% were obese. The results showed no statistically relationships between the subjective and objective measures (Bayes factor <1) of health. The integration of physical health into clinical psychiatric nursing practice is vital.

The opinions of Turkish mental health nurses on physical health care for individuals with mental illness: A qualitative study

WHAT IS KNOWN ON THE SUBJECT

Individuals with mental illness have significantly higher mortality and morbidity than the general population due to physical illnesses. Mental health nurses play a key role in providing care for common physical problems and protecting and promoting healthy lifestyles. Little is known from previous studies in the international literature about the attitudes, behaviours and thoughts of mental health nurses on providing physical health care.

WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE

Mental health nurses mostly focus on the existing physical health problems of individuals with mental illness. However, mental health nurses do not include practices of disease prevention and physical health promotion for individuals with mental illness. The desire to see positive changes in individuals with mental illness, receiving positive feedback, feeling useful and happy, and feeling satisfied with their profession motivate mental health nurses in terms of providing physical health care.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

The knowledge and skill required of mental health nurses to provide physical health care need to be increased. Institutions should employ expert nurses who are able to guide mental health nurses to provide physical health care. It is important to provide adequate physical infrastructure and human resources to provide better physical health care in mental health services.

ABSTRACT

Background Mental health nurses play an important role in improving the physical health of individuals with mental illnesses. However, there are limited studies of their attitudes and practices about physical health. Therefore, there is a need for qualitative studies to clarify the issue.

AIM

The aim of this study was to determine mental health nurses' opinions about physical health care for individuals with mental illness.

METHODS

This study was carried out in Turkey. A qualitative descriptive approach was taken in the study. The sample consisted of twelve mental health nurses selected by purposeful sampling. In-depth interviews were conducted using a semi-structured interview format. A thematic analysis was used to evaluate the interviews.

RESULTS

Four main themes were determined. (1) The barriers to physical healthcare theme included barriers related to patients, illness and treatment, barriers related to patients' caregivers, barriers related to health professionals and barriers related to the healthcare system. (2) The physical healthcare practices theme included common physical health problems and current nursing practices. (3) Motivators theme included the desire to see positive changes in a patient, receiving positive feedback, feeling useful and happy, having a sense of conscience and feeling satisfied with their profession. (4) The needs for better physical healthcare theme included the nurses' recommendations for better physical health care.

CONCLUSION

Mental health nurses believe that the physical health care provided to individuals with mental illness is not adequate. Many barriers to providing care for physical health, such as having psychiatric symptoms that are not seen as a priority by patients and health personnel, were determined.

IMPLICATIONS FOR PRACTICE

Mental health nurses should integrate physical healthcare practices into their routine care. In addition, mental health nurses' knowledge and skills about physical health care should be improved.

Impact of nurse-led behavioural counselling to improve metabolic health and physical activity among adults with mental illness

The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non-communicable disease. This repeated-measures, single-group intervention trial evaluated the effects of a 19-week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face-to-face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self-report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically-significant changes were demonstrated between baseline and post intervention for participants' waist circumference (P = 0.035) and waist-to-height ratio (P = 0.037). Non-significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse-led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an 'open door' policy to allow for attendance interruptions, such as hospitalization.

Strategies to Promote Walking Among Community-Dwelling Individuals With Major Mental Disorders

Individuals with major mental disorders could benefit from low cost, functional ways to support healthy lifestyles. Walking is a popular, preferred, accessible, and safe physical activity for many people. Walking is free, requiring no specialized equipment or membership fee, and is important to support engagement in other daily living activities. The current study explores the benefits of walking and strategies for promoting walking among community-dwelling individuals with major mental disorders. Key issues include strengthening engagement, tracking progress, and sustaining participation to achieve goals related to walking. The authors propose ways that nurses can support increased walking behavior for improved health and well-being in this population. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 25-32.].

Mental health nursing students' views on their readiness to address the physical health needs of service users on registration

There is substantial evidence that people (service users) living with a serious mental illness experience poorer physical health than the general population and die prematurely from life-threatening illnesses. Mental health nurses are best placed to address the physical health needs of service users but evidence points to numerous challenges, including a deficit in their proficiency to meet these needs. Nurse education and mental health services are being reshaped to better equip nurses with the skill set to meet the care needs of service users. The aim of the present study was to gain an in-depth insight into final-year mental health nursing students' views (MHNS) of their preparation to address the physical health needs of service users. Using a qualitative exploratory approach, the views of final-year MHNS learning experiences of physical care were explored through a focus group and in-depth interviews. The focus group generated broad issues, which were then explored in semistructured, individual interviews. The transcribed audio-taped data were analysed using a framework approach to identify the emerging key themes. The themes identified were the comprehensiveness of physical care content, delivery and method of teaching, exposure to physical care in practice, and confidence to address physical health needs. The findings of the present study indicate that there is a need to enhance both the theoretical and practical components of preregistration education for MHNS on physical care.

Clinician perspectives and practices regarding the use of exercise in the treatment of adolescent depression

Initial evidence suggests that exercise is an effective method in reducing symptoms of depression amongst adolescents. It is important to examine clinician attitudes and practices regarding the incorporation of exercise in mental health treatment, and to examine potential facilitators and barriers to exercise prescription. An online survey was conducted amongst mental health clinicians (N = 125) working in the treatment of adolescent depression. Clinicians held favourable attitudes towards exercise, most frequently ranking exercise as the second most important treatment for adolescent depression following cognitive behaviour therapy. The majority of clinicians were found to prescribe exercise "always" (24.3%) or "most of the time" (43.4%). Significant positive relationships were found between confidence to prescribe exercise and knowledge surrounding exercise prescription and clinician exercise prescription rates, however no significant relationship was identified between clinician levels of exercise and exercise prescription. The most frequently endorsed barriers to exercise prescription included the belief that exercise prescription should be implemented by an exercise professional, a lack of knowledge surrounding exercise prescription for adolescent depression, and the belief that depressed adolescents will not adhere to an exercise program. Overall, clinicians held positive attitudes towards exercise in the treatment of adolescent depression, and often recommended exercise as part of treatment.

Implementation in action: how Australian Exercise Physiologists approach exercise prescription for people with mental illness

BACKGROUND

Accredited Exercise Physiologists (AEPs) are trained to deliver exercise and physical activity interventions for people with chronic and complex health conditions including those with mental illness. However, their views on exercise for mental illness, their exercise prescription practices, and need for further training are unknown.

AIMS

To examine the way in which Australian AEPs prescribe exercise for people with mental illness.

METHODS

Eighty-one AEPs (33.3 ± 10.4 years) completed an online version of the Exercise in Mental Illness Questionnaire. Findings are reported using descriptive statistics.

RESULTS

AEPs report a high level of knowledge and confidence in prescribing exercise for people with mental illness. AEPs rate exercise to be at least of equal value to many established treatments for mental illness, and frequently prescribe exercise based on current best-practice principles. A need for additional training was identified. The response rate was low (2.4%) making generalisations from the findings difficult.

CONCLUSIONS

Exercise prescription practices utilised by AEPs are consistent with current best-practice guidelines and there is frequent consultation with consumers to individualise exercise based on their preferences and available resources. Further training is deemed important.

Physical health promotion for young people at ultra-high risk for psychosis: An application of the COM-B model and behaviour-change wheel

People with psychotic illnesses, such as schizophrenia, have high rates of unhealthy lifestyle factors, such as smoking and physical inactivity. Young people who seek help for mental health care, particularly those at high risk for psychosis, often also display high rates of these unhealthy behaviours. Although healthy living interventions have been applied to people with established psychosis, no attempt has been made to offer them to young people at risk for developing psychosis, despite potential benefits to mental and physical health. We propose that the COM-B model (consisting of capability, opportunity and motivation) and behaviour-change wheel might be an appropriate framework that mental health nurses and other health professionals could apply. Using a systematic and theoretically-based approach to intervention development could result in effective methods of health promotion in this group. Further training and development for mental health nurses could encourage a greater integration of mental and physical health care.

Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies

There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty-four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal-setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.

Motivation for physical activity and exercise in severe mental illness: A systematic review of cross-sectional studies

Individuals with severe mental illness (SMI) are less physically active than the general population. One important barrier contributing to this inactivity is lack of motivation. The aim of this paper is to systematically review all cross-sectional literature on motivation for physical activity among people with SMI and to use the results as basis for guidance on how mental health nurses can facilitate motivation for physical activity. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they included participants with SMI and reported data on motivation for physical activity. In total, 21 articles were included and over half them were published in 2011 or later. The present results indicate preliminary evidence of how the motivational processes do not differ between individuals with SMI and the general population, and that they are independent of diagnosis, medication, age, gender, and body mass index. Results from the current systematic review can give some tentative guidance on how to facilitate motivation for physical activity within mental health-care. However, there is still a great need for developing and examining practical strategies that can enhance adoption and adherence of physical activity among people with SMI.

Exercise for adolescents with depression: valued aspects and perceived change

INTRODUCTION

Despite systematic reviews demonstrating an association between exercise participation and reduced depressive symptoms in young people, there is no qualitative research exploring the experience of depressed adolescents who have engaged in an exercise intervention.

AIMS

To explore the experience of depressed adolescents who had recently engaged in a preferred intensity exercise intervention.

METHOD

The participants (n = 26) were recruited through health and social care services, were all in treatment for depression, and were purposefully sampled for interview following engagement in a preferred intensity exercise intervention, which was being evaluated via a pragmatic randomized controlled trial. A thematic approach was undertaken to analyse and organize the data.

RESULTS

Numerous beneficial changes were reported by participants alongside specific aspects of the intervention that were valued.

DISCUSSION AND IMPLICATIONS

The findings suggest that preferred intensity exercise can lead to feelings of improved mood, enjoyment and achievement, alongside benefits that transcend depressive symptom reduction. Considering mental health nurses are in key positions to promote exercise in this population, the current findings provide vital information for this purpose.

Implementing evidence-based physical activity interventions for people with mental illness: an Australian perspective

OBJECTIVES

Physical activity (PA) and exercise is increasingly being recognised as an efficacious component of treatment for various mental disorders. The association between PA and cardiometabolic disease is well established, as is the strong link between mental illness, sedentary behaviour and poor cardiometabolic health. Examples of successful integration of clinical PA programs within mental health treatment facilities are increasing. The aim of this review was to summarise the evidence regarding PA and mental illness, and to present examples of clinical exercise programs within Australian mental health facilities.

METHODS

A narrative synthesis of systematic reviews and clinical trials was conducted.

RESULTS

Evidence supporting the inclusion of PA programs as an adjunct to treatment for various conditions was presented; including depression, schizophrenia, anxiety disorders, post-traumatic stress disorder and substance abuse. In light of the available evidence, the inclusion of clinical PA programs within mental health treatment, facilitated by dedicated clinicians (exercise physiologists / physiotherapists) was justified.

CONCLUSIONS

PA is a feasible, effective and acceptable adjunct to usual care for a variety of mental disorders. There is a clear need for greater investment in initiatives aiming to increase PA among people experiencing mental illness, given the benefits to both mental and physical health outcomes.

Participation in and Satisfaction With an Exercise Program for Inpatient Mental Health Consumers

PURPOSE

This study examines attendance at, and satisfaction with, a group exercise program in an inpatient mental health setting.

DESIGN AND METHOD

Thirty-two inpatients completed discharge surveys to evaluate group activities. Data were analyzed for participation and satisfaction.

FINDINGS

More inpatients (n = 16, 50%) rated exercise as "excellent" compared with all other activities. Nonattendance rates were lowest for cognitive behavioral therapy (n = 2, 6.3%), highest for the relaxation group (n = 6, 18.8%), and 12.5% (n = 4) for the group exercise program.

PRACTICE IMPLICATIONS

Group exercise programs delivered by highly trained personnel are well attended and achieve high satisfaction ratings by inpatient mental health consumers.

Scoping review of research in Australia on the co-occurrence of physical and serious mental illness and integrated care

The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area.

Cardiovascular health promotion and consumers with mental illness in Australia

People with serious mental illness (SMI) have increased risk of cardiovascular disease and premature death, yet research on nurse-provided health promotion in mental health services remains under-developed. This paper informs efforts to improve the nursing role in physical health of consumers with SMI by establishing what nurse perceptions and background influence their care. Members of the Australian College of Mental Health Nursing were invited to participate in an online survey on their views on physical health care in mental health services. Survey questions included: (a) nurse-consumer collaboration in preventative care and (b) sub-sections of the Robson and Haddad Physical Health Attitude Scale to measure nurse perceived barriers to encouraging lifestyle change of consumers with SMI and frequency of nurse physical healthcare practices. Structural equation modelling was applied to investigate antecedents to physical health care, as well as relationships between antecedents. A national sample of 643 nurses reported regular engagement in health promotion (e.g. advice on diet). There was statistical support for a model depicting perceived consumer-nurse collaboration as a dual-determinant of nurse perceived barriers and self-reported health promotion to consumers with SMI. Perceived barriers to consumer lifestyle change did not predict health promotion. The effects of nurse-consumer collaboration were significant, but small. Perceived consumer-nurse collaboration in preventative care may positively influence the amount of health promotion by nurses in mental health. Perceived barriers to consumer adherence with a healthy lifestyle did not have an impact on nurse-delivered health promotion.

Investigating the exercise-prescription practices of nurses working in inpatient mental health settings

Nurses working in mental health are well positioned to prescribe exercise to people with mental illness. However, little is known regarding their exercise-prescription practices. We examined the self-reported physical activity and exercise-prescription practices of nurses working in inpatient mental health facilities. Thirty-four nurses completed the Exercise in Mental Illness Questionnaire - Health Practitioner Version. Non-parametric bivariate statistics revealed no relationship between nurses' self-reported physical activity participation and the frequency of exercise prescription for people with mental illness. Exercise-prescription parameters used by nurses are consistent with those recommended for both the general population and for people with mental illness. A substantial number of barriers to effective exercise prescription, including lack of training, systemic issues (such as prioritization and lack of time), and lack of consumer motivation, impact on the prescription of exercise for people with mental illness. Addressing the barriers to exercise prescription could improve the proportion of nurses who routinely prescribe exercise. Collaboration with exercise professionals, such as accredited exercise physiologists or physiotherapists, might improve knowledge of evidence-based exercise-prescription practices for people with mental illness, thereby improving both physical and mental health outcomes for this vulnerable population.

Factors influencing cardiometabolic monitoring practices in an adult community mental health service

People with serious mental illness are reported to live up to 25 years less than the general population. Cardiovascular disease and diabetes risk factors, as well as mental health, treatment, lifestyle, service provision, and socioeconomic factors, all contribute to this health inequity. Cardiometabolic monitoring (CMM) is one strategy used to attend to some cardiometabolic risk factors. The present study aimed to explore factors that influence decisions to undertake CMM in an Australian adult community mental health service. A CMM audit tool was designed to capture demographic, clinical, and care-provision factors. A 6-month retrospective file audit from the total population of consumers of an adult community mental health service was undertaken, where no existing CMM guidelines or practices were in place. The study findings confirmed a higher prevalence of cardiometabolic disorders in the study population compared to the general population. Complete CMM occurred in 24% of the study population (n = 94). No consumer demographic, socioeconomic, or clinical characteristics, or care-provision factors, were found to be predictors of complete CMM. The random manner in which CMM was observed to occur in the study highlights the need for standardized CMM guidelines and capacity-building strategies to improve current CMM practices.

Motivation does not come with an ending--it's the beginning of something new: experiences of motivating persons with psychiatric disabilities to physical activity

Despite strong evidence for the positive relationship between physical activity and mental health, physical activity is used far too little to promote health in mental health care. Fourteen caregivers working in community mental health services were interviewed about their experiences of motivating adult persons with psychiatric disabilities to be physically active, and data were analysed using a phenomenological-hermeneutical approach. Three themes emerged: (1) An approach of conscious acts, (2) Companionship as a joint creation, and (3) Understanding as a way to create meaning. The interpreted meaning of motivating to physical activity was expressed as a dynamic way of being, relating, and understanding.

Self-reported health, health behaviors, attitudes, and beliefs of regional mental health consumers

PURPOSE

This article reports baseline data from a randomized controlled trial investigating the impact of a specialist cardiometabolic healthcare nurse on physical health care.

DESIGN AND METHODS

Survey of community-based mental health consumers randomized to a cardiometabolic health nurse intervention.

FINDINGS

Findings show a high prevalence of respiratory conditions, hypercholesterolemia, hypertension, and low quality of life. Participants reported regular blood pressure but infrequent cholesterol and blood glucose testing. Few received advice about smoking cessation, diet, or physical activity. Participants were mostly satisfied with physical healthcare provision; however, positive health behaviors are lacking.

PRACTICE IMPLICATIONS

An individualized intervention based on knowledge and attitudes may be necessary.

Physical (in)activity and depression in older people

BACKGROUND

Knowledge about characteristics explaining low level of physical activity in late-life depression is needed to develop specific interventions aimed at improving physical health in depressed people above the age of 60.

METHODS

This cross-sectional study used data from the Netherlands Study of Depression in Older Persons (NESDO), a longitudinal multi-site naturalistic cohort study. People aged 60 and over with current depression and a non-depressed comparison group were included, and total amount of PA per week was assessed with the short version of the International Physical Activity Questionnaire (IPAQ). Depression characteristics, socio-demographics, cognitive function, somatic condition, psycho-social, environment and other lifestyle factors were added in a multiple regression analysis.

RESULTS

Depressed persons >60y were less physically active in comparison with non-depressed subjects. The difference was determined by somatic condition (especially, functional limitations) and by psychosocial characteristics (especially sense of mastery). Within the depressed subgroup only, a lower degree of physical activity was associated with more functional limitations, being an inpatient, and the use of more medication, but not with the severity of the depression.

LIMITATION

This study is based on cross-sectional data, so no conclusions can be drawn regarding causality.

CONCLUSIONS

This study confirms that depression in people over 60 is associated with lower physical activity. Patient characteristics seem more important than the depression diagnosis itself or the severity of depression. Interventions aimed at improving physical activity in depressed persons aged 60 and over should take these characteristics into account.

What determines whether nurses provide physical health care to consumers with serious mental illness?

People with serious mental illness (SMI) have heightened rates of chronic physical disease. This study aimed to identify what nurse and organisational factors predict physical health care provided by nurses in contact with consumers with SMI, through a survey in Australia (N=643). Statistical analyses revealed that physical health care could be accounted for in terms of nurse views on consumer health, rights and nurse role ideal ('nurses should be involved in physical health care'), and organisational factors. However, organisational factors may be more important in determining physical health care than views and perceptions about consumers, roles and ideals.

Development, validation and initial outcomes of a questionnaire to investigate the views of nurses working in a mental health setting regarding a cardiometabolic health nursing role

People with serious mental illness experience disparities in primary health care. One solution is a specialist nursing position responsible for the coordination of the primary care of people with serious mental illness. However the views of nurses regarding this proposed role are only beginning to emerge. This study reports the readability, factorability, internal consistency and responses from a questionnaire regarding the views of nurses working in a mental health setting regarding the proposed role. The questionnaire was determined to have adequate readability, and internal consistency. Nurses are positive towards the development of the role however the cost-effectiveness should be considered.

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: baseline physical health outcomes from a randomised controlled trial

People with serious mental illness (SMI) are more likely to have poorer health and poorer health behaviours, and therefore are at greater risk for cardiometabolic health comorbidities compared to those without SMI. Referral to a specialist cardiometabolic health care nurse may result in increased detection of poor cardiometabolic health in at-risk individuals. In this article, we present the results of the physical health measures of people with serious mental illness who have accessed a community mental health service in a regional centre and argue for the need for a multidisciplinary approach. Our data show the high prevalence of obesity, hypertension, low activity, smoking and nicotine dependence, alcohol misuse disorders, and poor diet among people with serious mental illness. The high prevalence of at-risk factors for poor cardiometabolic health in people with serious mental illness adds support for the role of a specialist cardiometabolic health care nurse in the detection and referral for multidisciplinary treatment to improve the physical health outcomes for people with serious mental illness.

Proposed nurse-led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental health

AIMS AND OBJECTIVES

To identify nurse perceptions on the potential value of general and specific nursing approaches to improving physical health outcomes of people with serious mental illness.

BACKGROUND

People diagnosed with serious mental illnesses experience heightened rates of physical illnesses and can be supported better via healthcare system prevention and management. Nurses working in mental health are a critical part of a system-wide approach to improving physical health care, but there is little known on their views on specific approaches within Australia (e.g. screening for risks, stigma reduction).

DESIGN

A national, cross-sectional and nonrandom survey study delivered online.

METHODS

Members of the Australian College of Mental Health Nurses (n = 643), representing nurses employed in mental healthcare services across Australia (71·6% from public mental health services). Participants were asked to rate the potential of nine nurse-based strategies for improving physical health (options: 'yes', 'no', 'not sure') and the potential value of 10 nursing and general strategies for improving physical health (rating from 'negative value' to 'significant value').

RESULTS

There was a high endorsement of all nine nurse-based strategies for physical health (e.g. lifestyle programmes, screening, linking services), although there was less support for reducing antipsychotics or advocating for fewer side effects. Participants mainly viewed all strategies as of moderate to significant value, with the most promising value attached to colocation of primary and mental care services, lifestyle programmes and improving primary care services (reduce stigma, train GPs).

CONCLUSIONS

Australian nurses working in mental health services view a range of nurse-based strategies for improving physical healthcare services and standards as important.

RELEVANCE TO CLINICAL PRACTICE

Nurses collectively need to work with consumers, health agencies and the general public to further define how to organise and implement physical health integration strategies, towards more comprehensive health care of people with serious mental illness.

Moving toward reclaiming life: lived experiences of being physically active among persons with psychiatric disabilities

There is abundant documentation in research about the significant relationship between physical activity and mental health, but there is still more to be learned about what can enhance motivation to become more physically active. Fourteen persons with psychiatric disabilities were interviewed about their experiences of being physically active, and data was analyzed using a phenomenological-hermeneutic method. Five themes emerged: Capability for Living, Liberation from a Heavy Mind, Companionship in Being in Motion, Longing for Living One's Life, and Struggling with Limitations. The interpreted meaning of being physically active was to be moving toward reclaiming one's life.

Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia

People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse-based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health-care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health-care settings in Australia.

Health behaviors as conceptualized by individuals diagnosed with a psychotic disorder

The purpose of this study is to describe health behaviors as conceptualized by individuals diagnosed with a psychotic disorder. Data were collected by qualitative interviews (n = 20) and were analyzed using phenomenography. Mental well-being took priority over physical health and guided health behaviors. Social relations were significant, and when they proved insufficient, health care professionals were utilized as a substitute. Some relied on religion, complementary treatments, and folk beliefs for health. Interventions not dependent on mental well-being, and assisting individuals to participate in appropriate networks could have advantages. Interventions adapted to the individual's financial situation and cultural values are useful as issues related to these areas can obstruct implementation of health behaviors. Implementing the findings of this study in nursing research and education will prepare nurses to meet the varying health needs of different individuals.

An exercise prescription primer for people with depression

A substantial body of evidence supports the value of exercise in the treatment of people with depression. The guidelines for exercise prescription, however, are limited, and based on those developed for healthy populations. This article explores the evidence for exercise in the treatment of depression and the role mental health nurses may play in the delivery of this information. A model of exercise prescription is put forward based on the available evidence and taking into account the challenges faced by mental health nurses and people with depression.

Is cardiovascular or resistance exercise better to treat patients with depression? A narrative review

OBJECTIVES

There is growing evidence regarding the efficacy of exercise as a treatment strategy for patients with depression. This paper summarises the benefits of both cardiovascular and resistance exercise for patients with depression.

DESIGN

A narrative review design was employed. Supporting literature for the individual and combined benefits of both modalities are presented. Studies comparing both modalities are then discussed.

RESULTS

The outcomes of the review indicate that there is evidence for the efficacy of both cardiovascular exercise and resistance exercise, either independently or combined, in the treatment of depression across the range of severity levels and age groups.

CONCLUSION

Exercise interventions for the treatment of depression appear worthwhile and well tolerated. Exercise preference, access to resources and social support may shape the choice for the patient. The role of primary and allied health professionals in guiding this choice is discussed. Implications for clinical practice and further research are presented.

Psychological and physical self-management of people with schizophrenia in community psychiatric rehabilitation settings: a qualitative study

This study had three objectives: to explore the psychological and physical self-management behaviours of people with mental illness; to identify their motivations for their self-management behaviours; and to develop a framework to understand the generative processes of healthy vs. unhealthy conditions. The participants were eight persons with schizophrenia who were attending psychiatric rehabilitation centres. We conducted semi-structured interviews with the participants on their observations regarding public health nurses' counselling with them. The data were analysed qualitatively. Six categories of health self-management behaviours were identified. The primary motivations that led to the participants' behaviours were 'getting a job in the near future' or 'maintaining my current level of living'. The use of their own methods caused unhealthy conditions when health management was excessively strict or there was a discrepancy between their and care providers' recognition of the appropriate level of self-management.