Telephone-delivered health behaviour change support for people with a mental health condition: the coaches' perspective.

BACKGROUND: People with a mental health condition experience a greater prevalence of chronic disease and reduced life expectancy compared to the general population. Modifiable health risk behaviours, such as physical inactivity and poor nutrition are major contributing factors. Population-level health coaching delivering behavioural change support via telephone for healthy eating, physical activity, and weight management is an opportunity utilised by this group to support improvement in healthy lifestyle behaviours. Health coaches offer a valuable perspective into the provision of services to this high-risk group. This study aims to qualitatively explore coaches' experiences in providing support to these participants, consider factors which may contribute to engagement and outcomes; and potentially inform future service improvement. METHOD: A qualitative study design was employed involving semi-structured telephone interviews with six coaches employed in a telephone-based behaviour change support service in New South Wales, Australia, between April and July 2019. Interview data was analysed using an inductive thematic analysis. RESULTS: Coaches believed that the service was of benefit to people with a mental health condition, however making changes to health risk behaviours was potentially more difficult for this group of service users. Coaches indicated that in supporting this group there was a greater focus on building confidence and readiness to change. They noted that improvement in mental health as a result of physical health changes was an additional 'measure of success' of particular relevance. Coaches expressed a desire to receive more mental health training to better deliver coaching to participants with a mental health condition. Program variables such as limited call length were posed as possible barriers to care. CONCLUSION: Further training and additional support for coaches, in additon to considering variations to aspects of service delivery may assist in improving engagement and outcomes for participants with mental health conditions. Examining mental health consumers' experiences when engaging with telephone coaching services would be an important area to address in further research.

Characteristics and service use of NSW Quitline callers with and without mental health conditions.

Introduction: Smoking rates remain higher for people with a mental health condition compared to the general population and contribute to greater chronic disease burden and premature mortality. Quitline services offer telephone-based smoking cessation support to the public and have been shown to be effective. There is limited research exploring the characteristics of smokers with a mental health condition who use the Quitline or the impacts of using the service on their smoking behaviors. Methods: This observational study aimed to compare demographic and smoking related characteristics, service use and quit attempts of callers to the New South Wales Quitline (2016-2018) with and without a mental health condition (N = 4,219). Results: At baseline, 40% of callers reported a current mental health condition. Desire to quit smoking was similar for both groups, however participants with a mental health condition had higher nicotine dependency and had made more quit attempts prior to engaging with the service. During program enrolment, quit attempts and 24 hours smoke free periods were similar, however participants with a mental health condition engaged in a greater number of calls and over a longer period with Quitline compared to those without. Discussion: The findings suggest Quitline efficacy for people with a mental health condition in making a quit attempt for at least 24 h. Increasing the use of Quitline services and understanding service use for this critical group of smokers will increase the likelihood that their quit attempts are transformed into sustained periods of smoking abstinence. Future research should explore whether tailoring of Quitline service provision for people with mental health conditions may increase the likelihood of quit success.

Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: study protocol for a randomised controlled trial.

BACKGROUND: People with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so. METHODS: A parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index. DISCUSSION: This study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry ACTRN12620000351910 . Retrospectively registered on 12 March 2020.

Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition.

BACKGROUND: People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. METHODS: Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. RESULTS: Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. CONCLUSION: Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019137197.

Examining service participation and outcomes from a population-level telephone-coaching service supporting changes to healthy eating, physical activity and weight: A comparison of participants with and without a mental health condition.

Population-level telephone coaching services provide accessible behaviour change support for modifiable health risk behaviours. The NSW Get Healthy Information and Coaching Service® (GHS) is a free telephone-based coaching service in Australia, supporting improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. This study compared measures of participation (such as program completion) and outcomes achieved immediate post-program (including changes in fruit and vegetable consumption, physical activity and weight) for GHS participants with and without a self-identified mental health condition (MHC). Secondary data analysis was conducted on service data collected at program intake and completion for individuals who enrolled in a coaching program between January 2018 and October 2019 (n = 5,629); 33% identified as having had an MHC. While those with and without an MHC had similar rates of completion, those with an MHC were less likely to complete a coaching program (31% vs 36%, p = .003). Participants with an MHC made significant positive changes to their fruit and vegetable consumption, physical activity (walking and moderate), weight and BMI, but not to waist circumference or vigorous physical activity. When comparing the magnitude of change for those with and without an MHC, individuals without made greater improvements to their weight (adjusted mean difference -0.623 kg, p = .034) and daily vegetable intake (adjusted mean difference -0.199 serves; p = .01). There were no differences for other variables. The GHS is an effective means of supporting behaviour change for people with an MHC who complete a coaching program. Further research should consider means of improving retention rates.

Awareness and use of telephone-based behaviour change support services among clients of a community mental health service.

OBJECTIVE: To determine the prevalence of, and factors associated with, awareness and use of telephone-based behaviour change support services among clients of a community mental health service. METHODS: Adult clients (n=375) of one Australian community mental health service completed a telephone interview and self-reported not meeting Australian National Guidelines for smoking, nutrition, alcohol consumption and/or physical activity. Descriptive statistics summarised awareness and use of the New South Wales Quitline® and Get Healthy Service® for participants with lifestyle risk factors addressed by each service. Chi-squares and logistic regressions explored associations between client characteristics, and service awareness and use. RESULTS: Awareness (16.1%) and use (1.9%) of the Get Healthy Service was lower than that of Quitline (89.1%; 18.1%). Television was the most common source of awareness (39.7% Get Healthy Service; 74.0% Quitline). In the regression models, persons in a relationship were more likely to have heard of the Get Healthy Service (OR:2.19, CI:1.15-4.18), and persons aged 36-50 were more likely to have used the Quitline (OR:5.22, CI:1.17-23.37). CONCLUSIONS: Opportunities exist for increasing awareness and use of both services, particularly the Get Healthy Service, among clients of community mental health services. Implications for public health: Strategies to optimise reach for this population group are recommended.

Characteristics of participants utilising a telephone-based coaching service for chronic disease health risk behaviours: A retrospective examination comparing those with and without a mental health condition.

The NSW Get Healthy Service® (GHS) is a free telephone-based coaching service in NSW, Australia, which supports behaviour change around healthy eating and physical activity. The aims of this study were to 1) assess the proportion of coaching participants within GHS who report having had a mental health condition, and 2) describe and compare the health risk profiles and confidence for behaviour change of coaching participants with and without a mental health condition. Secondary data analysis was conducted on information collected via participant self-report as a part of the coaching process for 11,925 participants who enrolled in a GHS coaching program for the first time between January 2015 and December 2017. Twenty six percent (n = 3106) of participants reported having had a significant mental health condition that required treatment from a health professional. Participants who reported a mental health condition were significantly less likely (54%) to be meeting guidelines for physical activity than participants without a mental health condition (64%); more likely to be overweight/obese (89%) compared to those without (81%); and reported lower confidence for changing exercise, nutrition and weight. There were no significant differences in proportions meeting fruit or vegetable intake recommendations. People with a mental health condition represent approximately a quarter of GHS participants. This group of participants presented higher levels of health risks and expressed lower confidence in behaviour change than program participants without such a condition. Future service planning and development may consider this variation in participant profiles.

Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services.

People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%-96%) and lowest for nutrition (17%, 95% CI:1%-35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889.