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Effectiveness of a Lifestyle Intervention for People With a Severe Mental Illness in Dutch Outpatient Mental Health Care

IMPORTANCE People with a severe mental illness (SMI) have a life expectancy reduced by 10 to 20 years compared with the general population, primarily attributable to cardiometabolic disorders. Lifestyle interventions for people with SMI can improve health and reduce cardiometabolic risk. OBJECTIVE To evaluate the effectiveness of a group-based lifestyle intervention among people with SMI in outpatient treatment settings compared with treatment as usual (TAU). DESIGN, SETTING, AND PARTICIPANTS The Severe Mental Illness Lifestyle Evaluation (SMILE) study is a pragmatic cluster randomized clinical trial performed in 8 mental health care centers with 21 flexible assertive community treatment teams in the Netherlands. Inclusion criteria were SMI, age of 18 years or older, and body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or greater. Data were collected from January 2018 to February 2020, and data were analyzed from September 2020 to February 2023. INTERVENTIONS Weekly 2-hour group sessions for 6 months followed by monthly 2-hour group sessions for another 6 months, delivered by trained mental health care workers. The intervention targeted overall lifestyle changes, emphasizing establishing a healthy diet and promoting physical activity. TAU (control) did not include structured interventions or advice on lifestyle. MAIN OUTCOMES AND MEASURES Crude and adjusted linear mixed models and multivariable logistic regression analyses were performed. The main outcome was body weight change. Secondary outcomes included changes in body mass index, blood pressure, lipid profiles, fasting glucose level, quality of life, self-management ability, and lifestyle behaviors (physical activity and health, mental health, nutrition, and sleep). RESULTS The study population included 11 lifestyle intervention teams (126 participants) and 10 TAU teams (98 participants). Of 224 included patients, 137 (61.2%) were female, and the mean (SD) age was 47.6 (11.1) years. From baseline to 12 months, participants in the lifestyle intervention group lost 3.3 kg (95%CI, −6.2 to −0.4) more than those in the control group. In the lifestyle intervention group, people with high attendance rates lost more weight than participants with medium and low rates (mean [SD] weight loss: high, −4.9 [8.1] kg; medium, −0.2 [7.8] kg; low, 0.8 [8.3] kg). Only small or no changes were found for secondary outcomes. CONCLUSIONS AND RELEVANCE In this trial, the lifestyle intervention significantly reduced weight from baseline to 12 months in overweight and obese adults with SMI. Tailoring lifestyle interventions and increasing attendance rates might be beneficial for people with SMI. TRIAL REGISTRATION Netherlands Trial Register Identifier: NTR6837

Effectiveness and experiences of the SMILES' Workshops

Between 1 March 2021 and 30 April 2023, a consortium (consisting of in the Netherlands: the National Library of the Netherlands (Koninklijke Bibliotheek -KB), The Hague University of Applied Sciences, the Netherlands Institute for Sound and Vision in Hilversum; in Belgium: Media & Learning Association in Leuven and Public Libraries 2030 in Brussels; and in Spain: Fundación Platoniq in Barcelona) carried out an Erasmus+-funded research project on news media literacy among young people. It involved Dutch, Belgian and Spanish young people aged 12-15. The acronym SMILES, which stands for 'innovative methodS for Media & Information Literacy Education involving schools and librarieS', was chosen for the project title. The main goals of the SMILES project are: • Forming pairs between librarians and secondary school teachers in the three European countries, who were empowered through train-the-trainer workshops to teach secondary school students about news media literacy in relation to disinformation; • Helping students use digital technologies more safely and responsibly with a focus on recognising reliable and authentic information versus becoming more resilient to disinformation; • Developing five building blocks serving as teaching materials for Dutch, Belgian and Spanish pupils aged 12-15 with the aim of making them recognise disinformation and making them more resilient against it; • A scientific evaluation of the effectiveness of the implemented lessons through impact measurement using 'pre-knowledge tests' and 'post-knowledge tests'; • A strengthening of existing collaborations and creation of new collaborations between schools and libraries in the three partner countries. The SMILES project was implemented through three work packages. In the first work package, five so-called 'Baseline studies', or literature reviews, were conducted. The focus was on what the different educational approaches in Spain, Belgium and the Netherlands are with regard to disinformation and how these approaches can be linked. Based on these studies, the five building blocks were developed in the second work package. In addition, the teaching pairs were offered the training programme developed by SMILES through a 'train-the-trainer methodology' to safely and responsibly deploy the use of digital media tools during lessons with students. Also, based on the disinformation literature, the knowledge tests were designed to conduct an impact measurement of the train-the-trainer workshops and lessons among the trainers (teaching pairs) and students, respectively. These knowledge tests contained statements on disinformation that were answered correctly or incorrectly by respondents. The number of correctly answered statements prior to the lessons was compared with the number of correctly answered statements after the lessons. In this way, an attempt was made to prove a positive learning effect of the deployed lessons. In the third work package, the results from the pre-knowledge tests and the post-knowledge tests were analysed. In addition to these quantitative analyses, qualitative results were also used to analyse and look at the extent to which the training provided to trainers (teaching pairs) and the lessons with the five building blocks for students proved effective in teaching, recognising and becoming more resilient to disinformation, respectively. In doing so, we also reflect on whether the methodology tested has been effective in the three countries: what are the best practices and where do we see areas for improvement?

“I may smile, but I hate it right now“ - Exploring participants’ emotions during group work.

Erasmus+ Project SMILES baseline study: Joint summary report

In Intellectual Output 1 of the SMILES project, researchers from Belgium (Flanders), Netherlands and Spain conducted desk research to describe the current developments for each country around disinformation, particularly those related to the Covid-19 pandemic. In part 2 of the research, they identified training initiatives, courses and media literacy training tools for each country that are specifically focused on the combat against or promotion of resistance to existing disinformation. Each identified activity or tool was characterised by a fixed set of characteristics (appendix 1). In the second stage of this research, some experts for each country were interviewed. Among other things, they were asked for recommendations and tips for interventions that will be developed in Intellectual Output 2 of the SMILES project. All research results were reported in separate country reports. This joint report lists the highlights of the separate country reports. It will end with recommendations for the interventions to be developed in Intellectual Output 2.

Resultaten taxi survey september 2017

Erasmus+ Project SMILES baseline study part 3

The aim of part 3 is the development of basic instruments to measure respondent resilience to disinformation. Cases and examples of disinformation that will be used in the instruments will be taken from a COVID-19 context when applicable. People who are resilient to COVID-19 disinformation are supposed to be ‘media or information literate’. Therefore, the construct that is aimed to be measured with the instruments is Media and Information Literacy, abbreviated as MIL. Instruments that will be developed must be adaptable for different target groups (pupils, library staff and teachers). The basic instruments will therefore contain for instance scales that can be modified to measure the effectiveness of the train-the-trainer workshops as well as that of fake news workshops in secondary education. Final instruments will be used in the IO3 phase to make recommendations for improvement. Analyses of results of those final assessments will be performed for each country separately. Because the basic instruments that will be developed in output 1 are intended to be used as pre- and post-tests in output 2, the focus will be on the impact of the interventions. For evaluating the processes during the interventions and the participant experiences, extra instruments should be developed.