Developing a physical activity programme for people with severe mental illness using an Experience-based Co-design approach

The journey of recovery during severe mental illness (SMI) is enmeshed in a complex relationship with physical activity (PA) and sedentary behaviours (SB) that extends beyond symptoms amelioration. The current research project details an iterative (4 study) project framed within a Social Ecological Model, modifying and utilising a service development approach called Experience-based Co-design (EBCD) to develop a PA and SB programme for people with SMI, called the Move with Recovery programme which has been developed as a solution to challenges associated with PA implementation in mental health care. In Study 1 an examination of PA, SB and key factors that influence PA behaviour was undertaken. Study 1 (A) used self-report examination of PA levels (brief item measure -3Q) and the strength of barriers to PA in key biopsychosocial and ecological domains (DPAQ) with (n=105) outpatients with SMI. The findings indicate that 72% of participants did not meet the PA guidelines. No differences were seen between demographic and clinical variable groups in relation to activity levels using PA guidelines. Participants that did not meet the PA guidelines reported stronger barriers to PA in the psycho-social domains Beliefs in the consequences of physical activity and Motivation and goals (p=≤0.001). In Study 1(B) an examination of PA and SB was carried out using accelerometery in a sub-sample of (n=17) outpatients. Participants spent 7.8 hours/day in SB. Additionally, 22% of valid wear time accounted for Light PA, 5% for Moderate PA, and 0.5% for Vigorous PA. Reflecting Study 1(A), this suggests low levels of structured PA among participants and a need for increased PA. These details lay the context for detailed informing of the MWRP. Study 2 took a hermeneutic phenomenological approach to multi-stakeholder exploration of the experiences of PA in rehabilitation and recovery mental health services using interviews. Two salient themes: 'The challenge of being physically active in recovery' and 'Physical activity enables recovery', were identified across the diverse sample. This study is the first interpretivist phenomenologically informed multi-stakeholder inquiry of PA concepts for people in recovery from SMI. This study also directly informed Study 3 (co-design). Study 3 describes the co-design stage of a modified EBCD approach. The EBCD approach is a participatory, patient centred approach for health service development that is grounded in phenomenological inquiry, which encapsulates the recovery zeitgeist. Here, EBCD has been modified to align with an implementation science framework to make it suitable for developing a PA and SB programme for people with SMI. The findings from Study 1 and Study 2 are integrated into the iterative EBCD project using narrative trigger films of service user’s experience, providing influence to the multi-stakeholder co-design process. In this EBCD project, PA and SB priorities were identified and patient experiences were translated into Action points and co-designed into a 21 week PA programme prototype (Move with Recovery). This programme is co-deliverable, community-outreaching but with structures to support patients that relapse in their activity behaviour.