Facilitators and barriers to adoption and maintenance of healthy diets and physical activity among the serious mentally ill: a qualitative systematic review

Objectives: The objective of this review was to examine the barriers and facilitators to adopting healthy dietary habits and active lifestyle behaviors, and the responses of the SMI population to different approaches that have been employed in addressing these challenges. Introduction: The SMI adult population are at higher risk of poor health and have mortality rates at least twice as higher from preventable diseases compared to that of the general population. Lack of physical activity and unhealthy eating are known factors that contribute to poor clinical outcomes in adults suffering from serious mental illness. Inclusion criteria: This systematic review included any qualitative studies that described the facilitators and barriers to healthy diets and physical activity among 18 years of age or older suffering from serious mental illness (SMI) residing in the community and are being treated with antipsychotic medication. Methods: This review followed the Joanna Briggs Institute (JBI) approach for qualitative systematic reviews. This review considered any qualitative studies published in full text, English language, and between 2006 when facilitators and barriers to adopting and maintaining healthy diets and physical activities among SMI living in the community were first examined and August 2018 when the search was completed. A three-part comprehensive search of databases for published and unpublished studies. Articles were screened for fit with the inclusion criteria, assessment of methodological quality by two independent reviewers was completed using the JBI critical appraisal tool. Results: Eighteen articles, representing studies conducted across eight countries and a total of 440 participants (378 individuals suffering from SMI and 62 providers), met the criteria for inclusion. A total of 169 findings were extracted and combined to form 12 categories based on similarities and meanings and then aggregated into 4 synthesized findings (meta-syntheses). 1) Social barriers—stigma and access are significant barriers to healthy eating and physical activity; 2) The disabling physical and psychological symptoms of mental illness, medication side effects and accompanying co-morbid conditions are significant barriers to healthy eating and physical activity; 3) Structured wellness/health promotion programs that include provider and family support and the opportunity to establish connections with others facilitate accomplishment of healthy eating and physical activity; and 4) Physical activity enhances enjoyment in life and well-being and can positively impact mental health symptoms. Conclusions: The major conclusion of this review is promoting structured physical activity and healthy eating, reducing social barriers and creating knowledge, a general awareness that physical activity and healthy eating prevent disease and SMI are an at-risk group with notable disparities in health outcomes and greater efforts must be taken to improve knowledge not only of those with SMI but their professional and family caregivers. Implications for practice: The current culture and standard of practice in the provision of services to the mentally ill needs to change—active measures to reduce stigma, provide integrated, supportive, and holistic care is needed.DNPIncludes bibliographical reference