Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.
Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
BMC Psychiatry. 2023 Mar 1;23(1):130. doi: 10.1186/s12888-023-04517-1.
The rates of obesity and associated health problems are higher in people with serious mental illness (SMI), such as schizophrenia and bipolar disorder, than the general population. A primary care referral to a behavioural weight management programme can be an effective intervention, but people with SMI have reported barriers to engaging with them and bespoke options are rarely provided in routine practice. It is possible that adjunct support addressing these specific barriers could help. Here we report the development, feasibility and acceptability of an intervention to improve uptake and engagement with a mainstream weight management programme for people with SMI.
We worked with people with a lived-experience of SMI and used the person-based approach to develop the 'Weight cHange for people with sErious mEntal iLlness' (WHEEL) intervention. It comprised a referral to a mainstream weight management programme (WW®) to be attended once a week, in-person or online, for 12-weeks. The adjunct support comprised a one-off, online consultation called Meet Your Mentor and weekly, telephone or email Mentor Check Ins for 12-weeks. We assessed the feasibility of WHEEL through the number of programme and adjunct support sessions that the participants attended. We analysed the acceptability of WHEEL using a thematic analysis of qualitative interviews conducted at baseline and at 12-week follow-up. Our exploratory outcome of clinical effectiveness was self-reported weight at baseline and at end-of-programme.
Twenty participants were assessed for eligibility and 17 enrolled. All 17 participants attended Meet Your Mentor and one was lost to follow-up (94% retention). Nine out of 16 attended ≥50% of the weekly programme sessions and 12/16 attended ≥50% of the weekly check-ins. Participants reported in the interviews that the adjunct support helped to establish and maintain a therapeutic alliance. While some participants valued the in-person sessions, others reported that they preferred the online sessions because it removed a fear of social situations, which was a barrier for some participants. The mean change in self-reported weight was - 4·1 kg (SD: 3·2) at 12-weeks.
A mainstream weight management programme augmented with brief and targeted education and low-intensity check-ins generated sufficient engagement and acceptability to warrant a future trial.
与一般人群相比，患有严重精神疾病（SMI）的人群，如精神分裂症和双相情感障碍，肥胖率及相关健康问题更高。初级保健向行为体重管理计划转介可能是一种有效的干预措施，但患有 SMI 的人报告说他们参与这些计划存在障碍，而且常规实践中很少提供专门的选择。解决这些具体障碍的辅助支持可能会有所帮助。在这里，我们报告了一种干预措施的开发、可行性和可接受性，以提高患有 SMI 的人的主流体重管理计划的参与率和参与度。
我们与有 SMI 生活体验的人合作，使用基于人的方法开发了“体重改变对患有严重精神疾病的人”（WHEEL）干预措施。它包括转介到一个主流的体重管理计划（WW®），每周参加一次，面对面或在线，为期 12 周。辅助支持包括一次性的在线咨询，称为“与您的导师会面”，以及每周一次的电话或电子邮件导师检查，为期 12 周。我们通过参与者参加的计划和辅助支持课程的数量来评估 WHEEL 的可行性。我们通过在基线和 12 周随访时进行的定性访谈的主题分析来分析 WHEEL 的可接受性。我们探索性的临床有效性结果是自我报告的基线和计划结束时的体重。
有 20 名参与者被评估是否符合条件，有 17 名参与者入选。所有 17 名参与者都参加了“与您的导师会面”，但有 1 名参与者失访（94%的保留率）。9 名参与者参加了≥50%的每周课程，12 名参与者参加了≥50%的每周检查。参与者在访谈中报告说，辅助支持有助于建立和维持治疗联盟。虽然一些参与者重视面对面的课程，但也有一些参与者报告说，他们更喜欢在线课程，因为这消除了一些参与者对社交场合的恐惧。12 周时自我报告体重的平均变化为-4.1kg（SD：3.2）。
主流体重管理计划辅以简短且针对性的教育和低强度检查，可以获得足够的参与度和可接受性，值得进一步研究。
