The Other Twenty-Three Hours: Fitness Provider Perspectives On Enlisting Family Support for Health Behavior Change in Adults With Serious Mental Illness

Background and Purpose:  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.  One key to improving the effectiveness of healthy lifestyle interventions for people with SMI may be to broaden the focus from the individual to the social environmental context in which most health behaviors take place.  Social ecological models of health promotion recognize that decisions about engaging in health promoting behaviors are largely influenced by individuals in a person’s social network.  The role of social supports in enhancing the effectiveness of lifestyle interventions in people with SMI remains largely unexplored.  This qualitative study explored the perceptions of fitness providers (health mentors) delivering a healthy lifestyle intervention (In SHAPE) to adults with SMI regarding the potential of enlisting support from family to promote lifestyle goals. 

Methods:  In-depth semi-structured interviews were conducted with 10 health mentors delivering In SHAPE across five community mental health agencies, including one in Boston and four in New Hampshire.  In SHAPE is a healthy lifestyle intervention aimed at increasing physical fitness and weight loss in adults with SMI and embedded within public mental health centers.  Thematic analyses were conducted to analyze interview transcripts, which involved examination of text by identifying and grouping themes, followed by coding, classifying, and developing categories by two authors.

Results: The health mentors 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.  Specifically, health mentors believed that family members could support participant’s health goals by modeling healthy behaviors, positive reinforcement, and encouraging health behavior change. Health mentors suggested ways for increasing social support for participants’ health goals by increasing knowledge, improving communication, and facilitating shared health goals among family members. While the majority of health mentors thought that working with families and other natural supports could increase their effectiveness in facilitating participants’ health behavior change, they also felt that this would require additional training or active collaboration with other providers who have more experience collaborating with families. 

Conclusions: Family members and significant others may increase the potency of lifestyle interventions for people with SMI by extending support for behavior change into daily lives where health behaviors take place.  In a collaborative model of health promotion, fitness trainers could continue to use their expertise to help participants set and pursue cardiovascular fitness goals, while family specialists could focus on engaging significant others and facilitating a shared decision-making process aimed at choosing how to best support the participant in achieving his or her fitness goals.