Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
Adm Policy Ment Health. 2022 Jul;49(4):646-657. doi: 10.1007/s10488-022-01189-z. Epub 2022 Feb 3.
Persons with serious mental illnesses experience high rates of medical comorbidity, especially diabetes. This study examined initial implementation feasibility, acceptability, and appropriateness of a new 6-month Multicomponent Intervention for Diabetes risk reduction in Adults with Serious mental illnesses (MIDAS) among persons in residential care facilities (RCFs). We conducted a mixed-methods study using four types of quantitative and qualitative data sources (administrative data; structured facility-level observations; resident assessments including blood-based biomarkers, 24-h dietary recalls, and self-report physical activity; and focus groups/interviews with staff and participants), to assess evidence of and factors affecting intervention feasibility, acceptability, and appropriateness. It was feasible to provide a high percentage of MIDAS class sessions (mean 50 of 52 intended sessions delivered) and make nutrition-related RCF changes (substitutions for healthier food items and reduced portion sizes). Class attendance rates and positive feedback from residents and staff provided evidence of MIDAS acceptability and appropriateness for addressing identified health needs. The residents who attended ≥ 85% of the sessions had greater improvement in several desired outcomes compared to others. Implementing a fully integrated MIDAS model with more extensive changes to facilities and more fundamental health changes among residents was more challenging. While the study found evidence to support feasibility, acceptability, and appropriateness of individual MIDAS components, some challenges for full implementation and success in obtaining immediate health benefits were also apparent. The study results highlight the need for improving health among RCF populations and will inform MIDAS adaptations designed to improve intervention fit and effectiveness outcomes.
患有严重精神疾病的人患有多种合并症的比率较高，尤其是糖尿病。本研究检验了一项新的针对严重精神疾病患者的六个月多组分糖尿病风险降低干预（MIDAS）在居住护理设施（RCF）中的成年人中的初步实施可行性、可接受性和适当性。我们采用了混合方法研究，使用了四种类型的定量和定性数据源（行政数据；结构化设施水平观察；包括基于血液的生物标志物、24 小时饮食回忆和自我报告的体力活动在内的居民评估；以及与工作人员和参与者的焦点小组/访谈），以评估干预措施可行性、可接受性和适当性的证据和影响因素。提供 MIDAS 课程的高比例（计划提供的 52 节中的 50 节）和进行与营养有关的 RCF 改变（用更健康的食物代替并减少食物份量）是可行的。课程出勤率和居民及工作人员的积极反馈为 MIDAS 可接受性和适当性提供了证据，可用于解决确定的健康需求。与其他居民相比，参加了≥85%的课程的居民在几个期望的结果上有了更大的改善。实施完全集成的 MIDAS 模式，对设施进行更广泛的改变，对居民进行更基本的健康改变更具挑战性。虽然研究发现了证据支持个别 MIDAS 成分的可行性、可接受性和适当性，但也明显存在一些全面实施和获得即时健康益处的挑战。研究结果强调了改善 RCF 人群健康的必要性，并将为旨在改善干预适应性和效果结果的 MIDAS 适应提供信息。
