Correlates of Attendance in a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness Living in Supportive Housing

Background and Purpose. Healthy lifestyle interventions can improve the physical health of people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder). However, studies have reported challenges in achieving high rates of attendance in these interventions, reducing their reach and participant exposure to intervention components. This study aimed to describe attendance of a peer-led healthy lifestyle intervention in supportive housing that targeted enrollment of racial and ethnic minorities with SMI, who are often underrepresented in prior trials, and to identify demographic, health or mental health factors associated with attendance.

Methods. This study utilized data from a Hybrid Type I effectiveness trial to describe attendance in the Peer-Led Group Lifestyle Balance (PGLB) program. PGLB is a manualized, 22-session, phased healthy lifestyle intervention that sought to facilitate weight loss by supporting individuals living with SMI to develop a healthier diet and increase physical activity. The sample was comprised of participants (n=155) who met criteria to participate in the RCT and were randomized to the intervention group. Multivariate logistic regression analysis was conducted to identify baseline demographic, mental health, and physical health variables associated with attending at least one session of PGLB. Exploratory bivariate analyses were also conducted for three additional indicators of attendance: total sessions attended among participants who attended at least one session, attendance by intervention phase, and percentage of group sessions attended.

Results. Of participants randomized to PGLB, mean age was 48.43, 42.48% were female, 81.94% were racial/ethnic minorities and 83.23% attended at least one session (i.e., were attenders). Among attenders, mean session attendance was 15.66 (SD = 8.04) of 22 total sessions. Results from multivariate logistic regression analysis indicated that female participants, those with at least a high school education, and those with a diagnosis of schizophrenia were 3.49 (95%CI: 1.18-10.38), 3.64 (95% CI: 1.34-9.9) and 3.25 (95% CI: 1.18-8.95) times, more likely to attend at least one PGLB session. In contrast, the odds of attending PGLB were significantly lower for those who reported any drug use (OR=0.23, 95% CI: 0.07-0.78) and for those who rated their health as good or excellent (OR=0.24, 95% CI: 0.07-0.77). No variables were significantly associated with our other three attendance indicators in the exploratory bivariate analysis.

Conclusions and Implications. PGLB was successful in engaging a majority racial and ethnic minority population with SMI, with findings indicating that there were lower rates of non-attendance compared to prior studies. Study findings suggest that if peer-led healthy lifestyle interventions seek to further expand their reach, interventions may need to be further adapted through tailored motivational strategies and supports for certain subgroups of people with SMI (e.g., males, those with lower levels of education, those using drugs, higher self-rated health) to improve their participation in healthy lifestyle interventions.