Chronic disease prevention for people with a mental health condition: exploring the potential of a population level telephone coaching service

People with a mental health condition experience a reduction in life expectancy, primarily as a result of a higher prevalence of chronic physical health conditions, than the general population. This inequity is associated with a higher prevalence of modifiable health risks, including physical inactivity, poor diet, and obesity. Previous reviews of lifestyle interventions suggest that they can be effective in improving health risks in this population, however most have focused on interventions delivered to individuals with severe mental illness, and outcomes for reviews including meta-analyses focused on anthropometric measures, such as weight and body mass index (BMI). One narrative review suggested potential effectiveness for physical activity and no reviews had synthesised impact on diet outcomes. There is a need to ensure that such lifestyle interventions are provided at a population-level, and widely available in order to address the inequity experienced by this group. There is a paucity of research examining whether population-level telephone support services for health risks such as physical activity, diet and weight, are being utilised by people with a mental health condition, and whether such services are effective in creating health behaviour change for this group. To address this gap, this thesis aimed to: 1. Identify use of a population-level telephone service providing support to improve physical activity, diet and weight (NSW Get Healthy Service®), by people with a mental health condition, including the representation of this group among coaching participants, their characteristics on intake (demographics, risk behaviours, health perceptions), and how these compare to coaching participants who do not have a mental health condition (Chapter 2). 2. Compare NSW Get Healthy Service® participation and outcomes for coaching participants with and without a mental health condition, including rates of program completion and health outcomes achieved (Chapter 3). 3. Describe the experiences of coaches of the NSW Get Healthy Service® in providing support to improve physical activity, diet and weight to people with a mental health condition, including perceived challenges both for themselves and for participants, as well as suggestions for improvement (Chapter 4). 4. Systematically review literature assessing the impact of lifestyle interventions to on physical activity, diet and weight among people with a mental health condition (Chapter 5). 5. Summarise the findings and contributions of Chapters 2 – 5, and identify implications for future research (Chapter 6). Four studies were undertaken to address these aims. Chapter 2 utilised routinely collected service data from the NSW Get Healthy Service® and identified that participants with a mental health condition comprise a quarter (26%) of service users, and enter a coaching program with elevated health risks and lower confidence compared to those without. Chapter 3 extended on these findings, indicating that participants with a mental health condition are slightly less likely to complete a coaching program than participants without a mental health condition, but that those who do complete experience similar improvements to their health risk measures. Chapter 4 reported the findings from qualitative interviews with coaches of the NSW Get Healthy Service®. Coaches identified a number of perceived challenges and benefits of the service for coaching participants with a mental health condition that are not currently captured in service data, as well as a desire to receive more training on the interplay between mental and physical health, particularly by individuals with a lived experience. Chapter 5 synthesised the findings of 57 randomised controlled trials of lifestyle interventions for people with a mental health condition that measured changes to physical activity, diet and/or weight using meta-analyses and narrative synthesis, finding improvements in most measures but also inconsistency in reporting of outcomes across studies. 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. This thesis has identified the potential benefit of population-level telephone services as a means of addressing modifiable health risks, specifically physical activity, diet and weight, for people with a mental health condition. The final chapter highlights a number of important areas for further research stemming from these findings. These include: an understanding of factors associated with retention in such lifestyle interventions; undertaking more rigorous trials to strengthen the evidence for the efficacy of such programs, including both short and long term outcomes; and the need for the consumer’s voice to be included in all stages of evaluation and potential modification of any programs designed to meet the needs of this group. Developing a greater understanding of the potential of such population-level telephone services in addressing modifiable health risks for people with a mental health condition may be an important avenue for reducing the inequity in health burden experienced by this group.