"Is It a Challenge? Yes...Is It Possible? Yes": Clients' Experiences with a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness

Study Aims: Obesity and related conditions (e.g., type-2 diabetes) disproportionately impact people with serious mental illness (SMI) compared to the general population. Healthy lifestyle interventions that improve dietary habits and increase physical activity can help address these health disparities in people with SMI. Yet few studies have examined how people with SMI engage with and use apply intervention components. The aim of this qualitative study is to examine the experiences of people with SMI participating in a peer-led healthy lifestyle intervention delivered in three supportive housing agencies.

Methods: As part of an NIH-funded randomized effectiveness trial, 13 focus groups were conducted with participants enrolled in a year-long peer-led healthy lifestyle intervention for people with SMI with a BMI of 25 or above. Focus group participants (N = 44) attended an average of 20 of 22 intervention sessions (range 9-22). Focus groups explored participants’ motivations for attending, how they used intervention content, challenges faced in making healthy lifestyle changes, and suggestions for program improvement. Focus groups were audiotaped, transcribed, and examined using content analysis. Strategies for rigor and trustworthiness included generating an audit trail, prolonged engagement with participants, and researcher peer-debriefing. 

Results: Participants were mostly male (58%), non-Hispanic (90.7%), and African-American (67%) with a mean age of 48 and mean BMI of 35. Most common psychiatric diagnoses were depression (72%), schizophrenia/schizoaffective disorder, (67%), and bipolar disorder (49%) while most common medical conditions were high blood pressure (44%), diabetes (35%), and arthritis (33%). Reasons for participating in the intervention included wanting to lose weight, recent diagnosis of diabetes, or wanting to live a healthier lifestyle. Participants described developing a more positive outlook and understanding towards health and feeling more confident in their ability to make behavior changes during the intervention. They mentioned ways in which they used intervention components, including portion control, mindful eating, healthier food choices, self-monitoring of diet and exercise, and increasing physical activity. For example, they had begun to prepare foods differently (e.g. boiling rather than frying chicken) and integrated healthier foods into their diets (e.g. fruits, vegetables). Participants also discussed challenges in these domains, especially for changing eating habits established in childhood and often embedded in their culture, and self-monitoring of diet and physical activity. While some joined local gyms, others felt more intimidated and expressed the need for more guidance in how to work out at gyms. Overall, participants described the intervention in positive terms, emphasizing the peer specialist’s unwavering support as integral. Suggestions to improve the intervention included maintaining the frequency of sessions (rather than tapering as designed), extending the duration of the intervention beyond one year, and adding more structured physical activity time where participants are taught how to work out at the gym.

Conclusions: Participants described specific ways in which they integrated intervention concepts into their daily lives. Their feedback regarding challenges and suggestions for improvement highlight the need for future healthy lifestyle interventions to consider the frequency and duration of the intervention, and to increase support and assistance to engage in physical activity.