Participant Experiences with a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness

Background & Purpose. Reducing health disparities and improving quality of life for persons with serious mental illness (SMI) will require understanding what motivates individuals to participate in these interventions, how these interventions work, and identifying needed adaptations. Yet few studies have examined how people with SMI engage with and apply intervention components. This study explored the experiences of people with SMI living in supportive housing who participated in a peer-led healthy lifestyle intervention. We examined how participants engaged in the process of behavior change and applied intervention concepts in their daily lives.

Methods. Focus groups and interviews were conducted with 63 participants to explore their motivation for engaging with the intervention, challenges to behavior change, and how they integrated intervention strategies into their lives. Interviews were audio recorded, transcribed and analyzed using grounded theory.

Results. Participants in this sub-study were mostly racial/ethnic minorities (82.6%) and predominantly male (59.7%), with a mean age of 49 and BMI of 35. The most common psychiatric conditions included depression (77.8%) and schizophrenia/schizoaffective disorders (69.4%). On average, participants attended 20.6 of 22 PGLB sessions (range: 3 to 22). A grounded model summarized participants’ description of the cycle of behavior change and provided insight into their decision-making processes. Challenges to engaging in healthy lifestyle change were generally related to participants’ physical health, time constraints, lack of knowledge, difficulty breaking old habits/self-perceptions, mood state, and the social/physical environment. Participants applied many intervention strategies such as addressing problematic social cues, contexts, and food associations; planning ahead; starting with smaller changes; portion control; food substitution; mindful eating; and integrating changes within the course of their daily lives.

Conclusions & Implications. Participants reported various behavior changes with respect to eating and physical activity, and more limited shifts in self-monitoring. Findings from this study suggest that future interventions should expand support for self-monitoring, meal planning, tailored physical activity, and advocacy. Future interventions should also enhance participants’ understanding of the corresponding weight loss impact of changes and emphasize subjective wellness outcomes to maintain motivation.