Supporting healthy lifestyle habits in persons with mental disorders : The development of a nurse-led lifestyle intervention

Persons with mental disorders have an increased risk of developing health problems. One reason for this is poor lifestyle habit support. The aim of this thesis was to develop and evaluate a nurse-led lifestyle intervention for persons with mental disorders. Two versions of the intervention were conducted in the municipality (versions I, II) and one in a primary healthcare setting (version III). The educational elements of the intervention were led by nurses and practically executed by nursing staff (study II and III). In study IV education was both led and executed in practice by nurses. Data were collected through focus groups, individual interviews, and measurements. Study I, a qualitative development study, showed that, when motivating for lifestyle changes, it was important to structure daily life and provide emotional support. Loneliness, lack of knowledge and support, and general resources were identified as barriers to lifestyle changes. Version I contained health education for nursing staff and individual lifestyle habit support to persons with mental disorders, which included physical exercises and cognitive support. Study II was a qualitative acceptability study of the intervention (version I) and its assessment tools. The intervention with its relational, educational, and supportive dimensions and the assessment tools was promising. In Study III (version II), a quantitative pilot study, persons with mental disorders received health education together with the nursing staff. The intervention provided improvements to various degrees in health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference. Study IV (version III), a qualitative study, included health education and individual lifestyle habit support for young adults with mental illness. The young adults experienced challenges including psychiatric symptoms, loneliness, and a lack of social understanding. The thesis results showed that the core components of the intervention with interpersonal relationships, where nursing staff played an important role, and further components such as health education and health discussions, in addition to cognitive support, worked well together to support lifestyle habit changes. Those components already exist and may therefore be easy to implement into daily nursing practice in different housing conditions and with individuals of different ages and needs for mental health care support. Group education was a way not only to develop new health strategies but also to establish social relationships. The intervention may also be modified to work with other groups of persons who need more explicit lifestyle habit support. However, to better determine the efficacy and sustainability of the intervention, larger studies over a longer time should be conducted.