Examining the Feasibility, Acceptability, and Adaptation of a Peer-Led Healthy Lifestyle Program for People with Serious Mental Illness in a Supportive Housing Agency

Purpose. Rates of obesity and other health conditions linked to cardiovascular disease are twice as high among people with serious mental illness (SMI) compared to the general population. Numerous modifiable risk factors (e.g., poor nutrition, lack of physical activity) contribute to these health disparities. Healthy lifestyle interventions can improve the health of people with SMI, but they have a limited reach since they are delivered in clinical settings (e.g., outpatient mental health clinics) by healthcare professionals. Expanding the settings and providers of these interventions can increase their accessibility and impact. The aims of this study are: 1) to examine the feasibility and acceptability of delivering the Peer-led Group Lifestyle Balance (PGLB), a healthy lifestyle intervention delivered by peer-specialists, and 2) to describe how to adapt PGLB for individuals with SMI living in supportive housing.

Methods. A convenience sample (N = 14) of supportive housing clients ages 18 years and older who were overweight/obese (body mass index, or BMI > 25) enrolled in this study. PGLB was delivered twice at a supportive housing agency, to 7 participants each time. Four PGLB-trained peer specialists co-facilitated groups once per week for 12 weeks. We conducted structured interviews with participants at baseline, 6 and 12 weeks. Analysis of interview data resulted in descriptive statistics of participants’ demographic and health characteristics and PGLB attendance. We also collected qualitative data including weekly field notes, audiotapes of PGLB sessions, and 2 focus groups with participants. Guided by a theoretical framework depicting the core components of healthy lifestyle interventions (e.g., self-monitoring, problem solving), we used directed content analysis to examine qualitative data and identify key PGLB adaptations for our population and setting of interest.

Results. The sample (N=14) was 50% female, mostly Latino and African American (65%), with an average age of 48 years (SD =16) and an average baseline BMI of 35 (SD = 7). Most participants were diagnosed with bipolar disorder, depression or schizophrenia. Participants on average attended 8 of 12 PGLB sessions (SD = 5); 21% attended 1-4 sessions, 21% attended 5-8 sessions and 57% attended 9-12 sessions. Qualitative analysis revealed several themes regarding PGLB feasibility, acceptability and adaptations. First, some core PGLB components benefitted participants as is, including setting weight loss goals and learning strategies to reduce calories and build healthy eating patterns. Second, participants responded positively to peer specialists as co-facilitators, and valued the support of other group members. Third, the most challenging components of the intervention were self-monitoring (e.g., monitoring weight, diet) and increasing programmed physical activity. Finally, several adaptations increased participants’ engagement, including tailoring dietary components to fit participants’ budget and food environments, and leveraging the peer-led, group format to build social support and manage negative social cues. 

Implications. Results suggest that this peer-led healthy lifestyle intervention can be adapted to be feasible and acceptable for people with SMI living in supportive housing. An effectiveness trial currently underway will expand this pilot work to a larger sample and explore how to best implement PGLB in this population and setting.