Zoekresultaten

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

Methods for environmental change; an exploratory study

Background: While the interest of health promotion researchers in change methods directed at the target population has a long tradition, interest in change methods directed at the environment is still developing. In this survey, the focus is on methods for environmental change; especially about how these are composed of methods for individual change ('Bundling') and how within one environmental level, organizations, methods differ when directed at the management ('At') or applied by the management ('From'). Methods: The first part of this online survey dealt with examining the 'bundling' of individual level methods to methods at the environmental level. The question asked was to what extent the use of an environmental level method would involve the use of certain individual level methods. In the second part of the survey the question was whether there are differences between applying methods directed 'at' an organization (for instance, by a health promoter) versus 'from' within an organization itself. All of the 20 respondents are experts in the field of health promotion. Results: Methods at the individual level are frequently bundled together as part of a method at a higher ecological level. A number of individual level methods are popular as part of most of the environmental level methods, while others are not chosen very often. Interventions directed at environmental agents often have a strong focus on the motivational part of behavior change. There are different approaches targeting a level or being targeted from a level. The health promoter will use combinations of motivation and facilitation. The manager will use individual level change methods focusing on self-efficacy and skills. Respondents think that any method may be used under the right circumstances, although few endorsed coercive methods. Conclusions: Taxonomies of theoretical change methods for environmental change should include combinations of individual level methods that may be bundled and separate suggestions for methods targeting a level or being targeted from a level. Future research needs to cover more methods to rate and to be rated. Qualitative data may explain some of the surprising outcomes, such as the lack of large differences and the avoidance of coercion. Taxonomies should include the theoretical parameters that limit the effectiveness of the method.

Urban facility management for healthy cities

Worldwide, sedentary behaviours and overweight are major health concerns. Most adolescents are insufficiently physically active and have overweight. Moreover, most work is sedentary or requires only light activity. And most people live in cities, a context which discourages participation in physical activity. How can we change this situation? An analogy between urban design and facility design is introduced to elucidate spatial properties that may be beneficial in both contexts. It is the purpose of this paper to use this analogy for the advancements of health and well-being of both workers and city dwellers.

Serious game for wellness

This paper introduces a creative approach aimed at empowering desk-bound occupational groups to address the issue of physical inactivity at workplaces. The approach involves a gamified toolkit called Workplace Vitality Mapping (WVM) (see Figure 1) designed to encourage self-reflection in sedentary contexts and foster the envision of physical vitality scenarios. This hybrid toolkit comprises two main components: A Card Game (on-site) for context reflection and a Co-design Canvas (Online) for co-designing vitality solutions. Through the card games, participants reflect on key sedentary contexts, contemplating their preferable physical vitality scenarios with relevant requirements. The co-design canvas facilitates the collaborative construction and discussion of vitality scenarios’ development. The perceptions and interactions of the proposed toolkit from the target group were studied and observed through a hybrid workshop, which demonstrated promising results in terms of promoting participants’ engagement experience in contextual reflections and deepening their systemic understanding to tackle the physical inactivity issue. As physical inactivity becomes an increasingly pressing concern, this approach offers a promising participatory way for gaining empathetic insights toward community-level solutions.

PreSchool@HealthyWeight: A preschool-based intervention for Early Childhood Education and Care (ECEC) teachers in promoting healthy eating and physical activity in toddlers

Developing a theory-driven method to design for behaviour change

Behaviour change design has much to gain with the integration of insights from the behavioural sciences in the design process. However, this integration needs to be done without hampering the creative process. In two rich design cases aimed at health and safety behaviour change, we describe our efforts to develop a method for theory driven design based on the Double Diamond. Our method attempts to integrate insights from the Persuasive by Design-model (PbD) for behaviour change into the entire design process. Our case studies demonstrate that our method indeed augments the integration of theory and evidence in our designs, but only if the Double Diamond process model is complemented with an evaluation phase, and insights from the PbD-model are derived using rich, well developed tools.