Supporting change in chronic disease risk behaviours for people with a mental illness: a qualitative study of the experiences of family carers

Abstract

BackgroundPeople with a mental illness experience greater chronic disease morbidity and mortality, and associated reduced life expectancy, compared to those without such an illness. A higher prevalence of chronic disease risk behaviours (inadequate nutrition, inadequate physical activity, tobacco smoking, and harmful alcohol consumption) is experienced by this population. Family carers have the potential to support change in such behaviours among those they care for with a mental illness. This study aimed to explore family carers’: 1) experiences in addressing the chronic disease risk behaviours of their family members; 2) existing barriers to addressing such behaviours; and 3) perceptions of potential strategies to assist them to provide risk behaviour change support.MethodsA qualitative study of four focus groups (n = 31), using a semi-structured interview schedule, was conducted with carers of people with a mental illness in New South Wales, Australia from January 2015 to February 2016. An inductive thematic analysis was employed to explore the experience of carers in addressing the chronic disease risk behaviours.ResultsTwo main themes were identified in family carers’ report of their experiences: firstly, that health behaviours were salient concerns for carers and that they were engaged in providing support, and secondly that they perceived a bidirectional relationship between health behaviours and mental well-being. Key barriers to addressing behaviours were: a need to attend to carers’ own well-being; defensiveness on behalf of the family member; and not residing with their family member; with other behaviour-specific barriers also identified. Discussion around strategies which would assist carers in providing support for health risk behaviours identified a need for improved communication and collaboration between carers and health services accessed by their family members.ConclusionsAdditional support from general and mental health services accessed by family members is desired to assist carers to address the barriers to providing behaviour change support. Carers have the potential to support and extend health service interventions aimed at improving the chronic disease risk behaviours of people with a mental illness but may require additional information, and collaboration from services. Further research is needed to explore these constructs in a large representative sample.

Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition

“…Further implementation research is required to identify and understand mental health service characteristics that impede on the provision of preventive care; and subsequently tailor practice change intervention strategies to address such characteristics within mental health services. From the carer perspective, a limited body of literature exists, however it suggests carers do expect holistic care from services accessed by their family members with a mental health condition [79,101]. Future research could seek to explore expectations of care provision further.…”

“…Further research is required to explore this trend and confirm is such findings are consistent among a larger sample. It may be that expectations of care provision were also influenced by carer knowledge of the positive impact on physical health to be gained from engaging in positive health risk behaviours [79,102]. Subsequent research is required to explore such a speculation.…”

“…It has been found previously that carers are aware of the bidirectional relationship between physical and mental health, and this has been associated with carer expectations of smoking cessation care provision by services accessed by people with a mental health condition [80]. Further, carers have also reported that their capacity to support their family member in making health behaviour change is impacted by the need to maintain their own physical health and well-being [79]. These two previous studies were limited by small sample sizes, and their lack of focus on physical activity and fruit and vegetable consumption specifically.…”

“…To date however, there has been limited research undertaken with family carers to understand their expectations regarding what type of care to address the chronic disease risk behaviours should be provided to people with a mental health condition by health and community services. Only two previous studies have focused on this issue relevant to inadequate physical activity and nutrition generally [78][79][80]. One qualitative study from the US of 13 carers of older adults with serious mental illness found that carers reported a need for guidance from health care professionals regarding strategies to promote weight loss by their family member [78].…”

“…The second study, an Australian qualitative study of 31 family carers, reported a desire by carers to be informed about any health service interventions which aimed to address the physical health of the person they cared for so that carers could support such interventions [79]. Additionally, carers reported a desire for services accessed by their family member to provide holistic care, due to their awareness of the bidirectional relationship between physical and mental health.…”