Promoting exercise behaviour in a secure mental health setting: Healthcare assistant perspectives

Abstract

Individuals with severe mental illness engage in significantly less amounts of physical activity than the general population. A secure mental health setting can exacerbate barriers to exercise, and facilitate physical inactivity and sedentary behaviour. Healthcare assistants are intimately involved in the daily lives of patients and, therefore, should be considered integral to exercise promotion in secure mental health settings. Our aim was to explore healthcare assistants' perceptions of exercise and their attitudes to exercise promotion for adult patients in a secure mental health hospital. Qualitative semi-structured interviews were conducted with 11 healthcare assistants from a large UK-based secure mental health hospital. Topics included healthcare assistants' personal experiences of exercise within a secure facility, their perceptions of exercise as an effective treatment tool for mental health, and their perceived roles and responsibilities for exercise promotion. Thematic analysis was used to analyse the data. Three main themes were identified: (i) exercise is multi-beneficial to patients, (ii) perceived barriers to effective exercise promotion, and (iii) strategies for effectives exercise promotion. Healthcare assistants considered exercise to hold patient benefits. However, core organizational and individual barriers limited healthcare assistants' exercise promotion efforts. An informal approach to exercise promotion was deemed most effective to some, whereas others committed to more formal strategies including compulsory sessions. With education and organizational support, we propose healthcare assistants are well placed to identify individual needs for exercise promotion. Their consultation could lead to more efficacious, person-sensitive interventions.

Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals

“…Appendix B provides legends for all the tables in the paper. Twelve (12) of the 34 studies in this review, explored the perceptions of HCPs practising in Europe [53,[63][64][65][66][67][68][69][70][71][72][73], 10 were conducted in Australia and New Zealand [31,51,69,[74][75][76][77][78][79][80], five each from the UK [52,[81][82][83][84] and USA [85][86][87][88][89], two from Africa [75,90], and one from India [91]. The study designs were varied with 20 of the 34 included studies employing a cross sectional design [31,[65][66][67][68][70][71][72][73][74]76,79,…”

“…The study designs were varied with 20 of the 34 included studies employing a cross sectional design [31,[65][66][67][68][70][71][72][73][74]76,79,[85][86][87][88][89][90][91][92], the majority of which sampled the opinions of HCPs about PA promotion using questionnaires, 11 studies were qualitative (using semi-structured interviews and focus groups) [52,53,64,69,77,78,[80][81][82][83][84] while longitudinal [51], mixed [75], and multi method [63] designs were employed in one study each. Across the 34 included studies, 20 explored the perceptions of a homogenous group of HCPs [51,64,[67][68][69][70]72,[74][75][76][77][78][79]…”

“…HCPs' perceptions about key determinants of effective PA promotion including: PA knowledge, confidence in PA promotion, PA importance, role in promoting PA, PA assessment, how they promoted PA and the barriers and facilitators to effective PA promotion were extracted from all the 34 studies. The majority of studies (n = 27), recorded the perceptions of HCPs on how PA was promoted [ [31,69,73,74,76,79,80,82,89,90,92]; nine on facilitators to promoting PA [52,63,64,68,71,78,81,83,85,89]; eight on their assessment of PA [53,73,74,83,86,88,90,91] and three on the effectiveness of promoting PA [74,89,90]. Each of these key determining factors to PA promotion are described in more detail below.…”

Physical activity in secure settings: A scoping review of methods, theory and practise

“…It has been suggested that a ward environment conducive of exercise motivated staff would be useful to combat the obesogenic environment on a consistent basis ). Healthcare assistants (HCA's) who are intimately involved in patients' lives due to being on ward 24 hours a day (Cavendish, 2013) are well placed to support people with SMI in exercise participation due to having already established therapeutic relationships (Kinnafick et al, 2018;McAndrew et al 2013).…”

“…Studies have shown that formal training for ward staff in exercise and mental health is limited (Stanton, Happell & Reaburn, 2015). Whilst members of staff recognise the benefits of exercise in SMI (Kinnafick et al, 2018;Robson, Haddad, Gray & Cournay, 2012), confidence to deliver exercise sessions is low (Verhaeghe, De Measeneer, Maes, Van Heeringen & Annemans, 2011). It has been suggested that it would be useful to incorporate exercise training for psychiatric staff into professional development sessions (Stanton et al, 2015) and focus on behaviour change in SMI to target barriers unique to mental health consumers (Arbour- Duncan, Remington, Cairney & Faulkner, 2014).…”