Qualitative investigation of perceived barriers to and enablers of sport participation for young people with first episode psychosis

Abstract

Aims:The aim and objective of the study was building on a previous call for the development of sport-based life skills interventions for young people with first episode of psychosis (FEP) (Brooke, Lin, Ntoumanis, & Gucciardi, 2018), to explore the barriers and enablers to sport participation for young people with FEP. Method:We used a semi-structured interview format to conduct one-to-one interviews with young people (aged 16-25; n = 10) with FEP, and one-to-one interviews and focus groups with their clinicians (n = 33). Questions focused on barriers and facilitators (intrapersonal, interpersonal, psychological, environment, health/safety, logistical) to sport participation young people with FEP. Thematic analysis was used to analyse the data. Results: Four themes (and 11 sub-themes) emerged from the analysis: (a) the need for sport in FEP recovery (perceived benefits; resource gap); (b) barriers (logistical; psychological); (c) enablers (positive environmental expectations and experiences) and (d) programme design (sport programme/type; life skills training; application to barriers/enablers). Conclusion:The participants responded favourably to the idea of using sport to promote recovery post-FEP, and provided an insight into why sport is currently underutilized within FEP recovery efforts. The barriers, enablers, and specific suggestions for how to limit the barriers and strengthen the enablers are valuable for sport-based intervention design, and may be applicable to non-sport-based interventions for people with FEP. K E Y W O R D S early intervention, first episode psychosis, functional recovery, life skills, sports

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care

“…Focus group interviews also allowed exploration of factors affecting program adherence and barriers to participation, which were both logistical (cost, distance, and transport ease) as well as psychological (anxiety, low motivation, poor concentration, coping, and confidence related to mental health). These findings are consistent with several recent qualitative evaluations of health behavior programs with FEP groups which identified common features that were valued by participants and reported similar benefits from and barriers affecting participation and adherence (31,32,34,41,91,92).…”

“…Access to transport and program accessibility, as well as suitable attire and footwear, were identified as potential barriers to participation (32). The program was delivered at a city center location easily accessible to buses and trains, and/or parking.…”

“…Program recruitment was time consuming and required clinical team members to prioritize SHAPE involvement alongside other clinical roles. Young people with psychosis can experience many difficulties associated with their mental health including psychotic symptoms, social anxiety, and poor motivation (32). For some, the prospect of a group-delivered program was particularly daunting.…”

“…Efforts to improve physical health in SMI patients have encountered patient and service-level barriers to implementation of routine physical healthcare screening, monitoring, and intervention. Patient-level barriers are both practical (money to buy clothing/equipment, transport challenges) and psychological, including psychotic symptoms, anxiety, low motivation, and selfefficacy (31,32). Service-level barriers include lack of resources for equipment purchase, access to appropriate facilities, staff capacity, leadership engagement, organizational change, and financial policy strategies to support adoption and scaling up of successful intervention programs (33,34).…”

“…Gaughran et al (26) concluded: "The search for effective, pragmatic physical health interventions deliverable in health care services remains". A pragmatic approach, which considers barriers, social determinants of health and enablers of initial and ongoing participation, assumes particular importance when developing interventions for young people with psychosis (30)(31)(32). Further research is needed on effective strategies for program design and guidance for mental healthcare teams to support implementation and delivery of routine health behavior modification programs (35)(36)(37).…”