27.1 CLIENTS’ EXPERIENCES WITH A PEER-LED HEALTHY LIFESTYLE INTERVENTION IN SUPPORTIVE HOUSING

Abstract

Background: 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 these interventions. 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 effectiveness trial, focus groups (n = 15) and individual interviews (n= 6) were conducted with participants who completed a year-long peer-led healthy lifestyle intervention for people with SMI with a BMI of 25 or above. Participants (N = 60) attended an average of 20 of 22 intervention sessions. Focus groups and interviews explored participants' motivations for attending, how they used intervention content, challenges faced in making healthy lifestyle changes, and suggestions for program improvement. All data were audiotaped, transcribed, and examined using grounded theory. Strategies for rigor and trustworthiness included generating an audit trail, prolonged engagement with participants, and researcher peer-debriefing. Results: Participants were mostly male (60%), Black (72%) with a mean age of 49 and mean baseline BMI of 35. Most common psychiatric diagnoses were depression (78%), schizophrenia/schizoaffective disorder, (66%), and bipolar disorder (51%) while most common medical conditions were high blood pressure (45%), diabetes (38%), and high cholesterol (37%). Reasons for participating in the intervention included wanting to lose weight, recent diagnosis of diabetes, or wanting to live a healthier lifestyle. Participants reported developing greater understanding of health issues and need to change behaviors. They described attempting behavior change amidst numerous challenges related to the physical and social environment (e.g., temptation of unhealthy foods), dietary restrictions and cultural preferences constraining food choice, affective states and fatigue (e.g. stress eating), physical health conditions (e.g., arthritic pain), competing priorities, and lack of familiarity with certain health behaviors (e.g. what to do at the gym). Despite these challenges, they shared how they applied intervention concepts, including portion control, mindful eating, healthier food choices, self-monitoring of diet and exercise, and physical activity. Specific examples included preparing foods differently (e.g. boiling rather than frying chicken), substituting healthier foods into their diets (e.g. fruits), planning proactively (e.g., healthy snacks), removing cues for mindless eating, and finding ways to integrate physical activity into daily routines (e.g., using stairs instead of elevators). Participants expressed positive views of the intervention and feedback was guided by desires to enhance opportunities for experiential learning. Suggestions included maintaining the frequency of sessions (rather than tapering as designed), extending the duration of the intervention beyond one year, and adding more collaborative structured activities for cooking and physical activity. Overall, as participants engaged in healthy dietary changes and increased their physical activity, we observed significant improvements in the proportion who achieved clinically significant: weight loss (≥5% weight loss from baseline), improvements in cardiorespiratory fitness, and overall reductions in cardiovascular risk over the course of the 12-month intervention. Conclusions: Participants described specific ways in which they integrated intervention concepts into their daily lives to improve their health. 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 experiential learning for cooking and physical activity.