title: Incentives and barriers to lifestyle interventions for people with severe mental illness: a narrative synthesis of quantitative, qualitative and mixed methods studies.
abstract: OBJECTIVE
  To examine the evidence for incentives and barriers to lifestyle interventions for people with severe mental illness.
  
  
  BACKGROUND
  People with severe mental illnesses, particularly those with schizophrenia, have poorer physical health than the general population with increased mortality and morbidity rates. Social and lifestyle factors are reported to contribute to this health inequality, though antipsychotic therapy poses additional risk to long-term physical health. Many behavioural lifestyle interventions including smoking cessation, exercise programmes and weight-management programmes have been delivered to this population with promising results. Surprisingly little attention has been given to factors that may facilitate or prevent engagement with these interventions in this population.
  
  
  METHODS
  Eight electronic databases were searched [1985-March 2009] along with the Cochrane Library and Google Scholar. Electronic 'hand' searches of key journals and explosion of references were undertaken.
  
  
  METHODS
  A narrative synthesis of qualitative, quantitative and mixed-methods studies was undertaken.
  
  
  RESULTS
  No studies were identified that specifically explored the incentives and barriers to participation in lifestyle intervention for this population. Existing literature report some possible incentives and barriers including: illness symptoms, treatment effects, lack of support and negative staff attitudes as possible barriers; and symptom reduction, peer and staff support, knowledge, personal attributes and participation of staff as possible incentives.
  
  
  CONCLUSIONS
  Healthcare professionals, in particular nurses, should consider issues that may hinder or encourage individuals in this clinical group to participate in lifestyle interventions if the full benefits are to be achieved. Further research is needed to explore possible incentives and barriers from the service users' own perspective.
authors.affiliation: Research Fellow, Institute of Medical and Social Care Research (IMSCaR), Bangor University, Wrexham Technology Park, Wrexham, UK. seren.roberts@bangor.ac.uk
authors.forename: Seren Haf
authors.initials: SH
authors.lastname: Roberts
authors.forename: Jois Elisabeth
authors.initials: JE
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects; D001291:Attitude of Health Personnel; D003625:Data Collection / Q000379:methods; D005081:Exercise Therapy / Q000451:nursing / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D054624:Health Status Disparities; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009042:Motivation; D015404:Nursing Methodology Research; D009765:Obesity / Q000139:chemically induced / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010353:Patient Education as Topic; D036301:Qualitative Research; D020377:Self Efficacy; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents