Perceptions from mental health nurses about health promotion: A qualitative study

Abstract

Introduction: Individuals with mental disorders are at an increased risk of being overweight or obese. The higher prevalence of these conditions is, at least partially, the consequence of less physical activity and more unhealthy eating habits than the general population. Growing attention is given to the implementation of health promotion interventions in mental health care, but a limited understanding of health promotion is a significant barrier to effective care. The aim of the study was to gain insight into the factors influencing the integration of physical activity and healthy eating into the daily care of individuals with mental disorders. Methods: A descriptive qualitative design using focus groups, based on a purposive sampling strategy was applied. Focus groups with mental health nurses (n=17) were conducted in three sheltered housing organizations in the Flanders region (Belgium) using a semi-structured guideline. Qualitative content analysis techniques were used to analyze the data. Results: Although physical and mental health benefits of physical activity and healthy eating were described, several barriers to integrate healthy lifestyle support into the daily care of patients were identified. Lack of time due to the complexity and variety of problems residents in sheltered housing are suffering from was considered as a substantial barrier. The majority of the respondents perceived themselves as inadequately trained to practice health promotion. So, involving other (mental) health professionals was regarded as required. Discussion: Health promotion activities for particular target populations such as individuals with mental disorders are complex interventions that are to be adapted to and offered next to other treatment aspects such as psychological and medication treatment. Nurse educational programs must teach nurses how to recognize the potential for health promotion opportunities, as well as how to develop and plan for health promotion, so that it becomes a recognized part of the treatment. Conclusion: The findings of the study resulted in a better understanding of the factors influencing the integration of health promotion activities into the daily care of individuals with mental disorders. Lessons learned: Health promotion targeting physical activity and healthy eating should be integrated into the daily care of people with mental disorders. Supporting the patient to make healthier lifestyle choices is yet not exclusively the responsibility of the mental health nurse. Other (mental) health professionals including psychiatrists, psychologists, general practitioners, dieticians… should also be involved. Limitations: A limitation of qualitative research is the impracticality of using large, representative samples to collect data. The purpose of such research is however not to generalize to larger populations but to gain insight and understanding by hearing from people in depth whereby meanings, experiences and visions of participants can be emphasized. Analysis of qualitative research in inpatient or outpatient settings may probably result in different findings. Suggestions for further research: Further research is required how to overcome the barriers identified form the current study.