Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial
Background Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-11-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472422006007/type/journal_article |
| _version_ | 1811156843247960064 |
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| author | Marij M. C. Smit Elze de Waal Diederik E. Tenback Jeroen Deenik |
| author_facet | Marij M. C. Smit Elze de Waal Diederik E. Tenback Jeroen Deenik |
| author_sort | Marij M. C. Smit |
| collection | DOAJ |
| description | Background
Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary lifestyle-enhancing support in people with SMI living in sheltered housing (MULTI_sh).
Aims
To evaluate the effectiveness and implementation of MULTI_sh (trial registration: NCT03157557).
Method
In an effectiveness-implementation hybrid cluster-randomised controlled trial, six municipalities with sheltered housing facilities in The Netherlands were randomly assigned to MULTI_sh (n = 3) or treatment as usual (TAU, n = 3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EuroQol 5D, WHOQoL-Bref) and psychopathology (Brief Psychiatric Rating Scale Expanded Version) using multiple regression, adjusting for baseline values and municipalities (intention to treat and per protocol). In addition, implementation fidelity and barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation).
Results
Of 177 eligible patients, 74 (42%) could be included in the analyses. Health outcomes did not substantially improve with MULTI_sh (n = 45) compared with TAU (n = 29). MULTI_sh was not implemented as intended. Most patients and all healthcare professionals believed that patients’ lifestyle should be part of treatment, but implementation was primarily (in)directly hindered by organisational factors (e.g. staff shortages, complexity of participation, lack of time and difficulty getting patients involved).
Conclusions
MULTI_sh was not implemented as intended and no clinical health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing.
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| first_indexed | 2024-04-10T04:57:53Z |
| format | Article |
| id | doaj.art-4235e03bdb1f42cbb45b26438e543286 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:57:53Z |
| publishDate | 2022-11-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-4235e03bdb1f42cbb45b26438e5432862023-03-09T12:29:24ZengCambridge University PressBJPsych Open2056-47242022-11-01810.1192/bjo.2022.600Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trialMarij M. C. Smit0Elze de Waal1Diederik E. Tenback2Jeroen Deenik3https://orcid.org/0000-0002-1463-8676GGz Centraal, Amersfoort, The Netherlands; and Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The NetherlandsGGz Centraal, Amersfoort, The Netherlands; and Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The NetherlandsCentre for Transcultural Psychiatry (CTP)Veldzicht, Balkbrug, The NetherlandsGGz Centraal, Amersfoort, The Netherlands; and School for Mental Health and Neuroscience, Maastricht University, Maastricht,The NetherlandsBackground Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary lifestyle-enhancing support in people with SMI living in sheltered housing (MULTI_sh). Aims To evaluate the effectiveness and implementation of MULTI_sh (trial registration: NCT03157557). Method In an effectiveness-implementation hybrid cluster-randomised controlled trial, six municipalities with sheltered housing facilities in The Netherlands were randomly assigned to MULTI_sh (n = 3) or treatment as usual (TAU, n = 3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EuroQol 5D, WHOQoL-Bref) and psychopathology (Brief Psychiatric Rating Scale Expanded Version) using multiple regression, adjusting for baseline values and municipalities (intention to treat and per protocol). In addition, implementation fidelity and barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation). Results Of 177 eligible patients, 74 (42%) could be included in the analyses. Health outcomes did not substantially improve with MULTI_sh (n = 45) compared with TAU (n = 29). MULTI_sh was not implemented as intended. Most patients and all healthcare professionals believed that patients’ lifestyle should be part of treatment, but implementation was primarily (in)directly hindered by organisational factors (e.g. staff shortages, complexity of participation, lack of time and difficulty getting patients involved). Conclusions MULTI_sh was not implemented as intended and no clinical health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing. https://www.cambridge.org/core/product/identifier/S2056472422006007/type/journal_articleSchizophreniasedentary behaviourexercisedietimplementation science |
| spellingShingle | Marij M. C. Smit Elze de Waal Diederik E. Tenback Jeroen Deenik Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial BJPsych Open Schizophrenia sedentary behaviour exercise diet implementation science |
| title | Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial |
| title_full | Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial |
| title_fullStr | Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial |
| title_full_unstemmed | Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial |
| title_short | Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial |
| title_sort | evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing effectiveness implementation hybrid randomised controlled trial |
| topic | Schizophrenia sedentary behaviour exercise diet implementation science |
| url | https://www.cambridge.org/core/product/identifier/S2056472422006007/type/journal_article |
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