Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis

Abstract

Background People living with severe mental illness (SMI) have a reduced life expectancy by around 15–20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. Aim To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. Methods CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. Results Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. Conclusions The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.

The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions

“…Our findings resonate with a recent qualitative evidence synthesis that explored facilitators and barriers to self-management of physical health among people with SMI [ 43 ]. This review synthesised findings from 21 studies and highlighted that SMI symptoms placed a high burden on service users who struggled with side effects of antipsychotic medication and found it difficult to get out of the house.…”

Acceptability and feasibility of continuous glucose monitoring in people with diabetes: protocol for a mixed-methods systematic review of quantitative and qualitative evidence

“…Regardless of the number of eligible qualitative studies, we will employ a framework to sample studies for inclusion in the analysis. We will follow methods proposed by Ames et al [44] which we have successfully deployed previously [45]. The aim will be to sample for maximum variation and data richness, considering study population and relevance to the review question.…”

User accounts on received diabetes and mental health care in a Danish setting – An interview study

“…Living with a mental illness (MI) shortens a person's lifespan by 15-20 years compared with the general population (Balogun-Katung et al 2021;Cohen et al 2018;Moore et al 2015). People with MI have a high prevalence of type 2 diabetes, often due to metabolic conditions and being overweight (Stenov et al 2020).…”

“…People diagnosed with type 1 or type 2 diabetes often experience fluctuating levels of mental distress affecting their quality of life and social functioning, which increases the risk of developing depression (Rønne et al 2020). Low health literacy levels are identified as psychological barriers among people with coexisting diabetes and MI, to selfmanagement diabetes-related activities (Balogun-Katung et al 2021) and health literacy is hampered by their MI and low priority to the diabetic condition (Mulligan et al 2018;Rønne et al 2020). People with both conditions face different challenges including polypharmacy, navigating different social and health care systems, and following diabetes-related recommendations such as engaging in physical activities, due to anxiety (Bellass et al 2021).…”

“…Living with a mental illness (MI) shortens a person's lifespan by 15–20 years compared with the general population (Balogun‐Katung et al . 2021 ; Cohen et al . 2018 ; Moore et al .…”