TY - JOUR
T1 - A qualitative exploration of park-based physical activity in adults with serious mental illness
T2 - Insights from peers and peer counselors
AU - Besenyi, G. M.
AU - Bramwell, R. C.
AU - Heinrich, K. M.
AU - Mailey, E. L.
AU - McEvoy, Joseph Patrick
AU - Davis, C. L.
N1 - Funding Information:
Physical activity (PA) is a modifiable behavior with a variety of health benefits for people with SMI (Firth, Cotter, Elliott, French, & Yung, 2015; Hallgren, Lundin, Tee, Burström, & Forsell, 2017; Quirk, Crank, Harrop, Hock, & Copeland, 2017; Rosenbaum, Tiedemann, Ward, Curtis, & Sherrington, 2015; Vancampfort, Stubbs, Ward, Teasdale, & Rosenbaum, 2015b; Ward, White, & Druss, 2015). These health benefits include reductions in anxiety and depressive symptoms and improved sleep, physical function, and mood (Piercy & Troiano, 2018). Long-term benefits of PA include improved quality of life and lower chronic disease risks. For example, 90 min of moderate to vigorous PA (MVPA) per week is linked to a 15% cardiovascular risk reduction and 20% obesity and related mortality reduction among people with schizophrenia (Firth et al., 2015). However, persons with SMI are significantly less likely to meet PA recommendations than the general population (Okoro et al., 2014). Persons with SMI often face unique challenges to engaging in PA compared to the general population including negative symptoms of mental illness (e.g., low motivation, fatigue), low physical capacity, lack of social support, cost/poverty associated with disability, and lack of access/unsupportive physical environments (Chen, Jung-Hsuan, Pellegrini, Tang, & Kuo, 2017; Firth et al., 2016; McDevitt, Snyder, Miller, & Wilbur, 2006; Romain, Longpré-Poirier, Tannous, & Abdel-Baki, 2020). Finding convenient and preferred ways to increase PA among people with SMI is important to facilitate healthy behavior change.Community parks provide accessible low cost settings for PA promotion for people with SMI (Bedimo-Rung, Mowen, & Cohen, 2005; Besenyi et al., 2014; Cohen et al., 2013; Maas, van Dillen, Verheij, & Groenewegen, 2009). The integration of park-based PA into mental health treatment and services is a novel approach to address diverse physical, mental, and social health outcomes while reducing common PA barriers. Beyond the benefits of PA, nature or park-based PA can provide added benefits to physiological, mental, cognitive, and social health (Christiana et al., 2021). For example, outdoor park-based PA is associated with increased social support, energy, self-esteem, mood, quality of life (QOL), and decreased tension, confusion, stress, anger, depression, and obesity (Barton & Pretty, 2010; Fan, Das, & Chen, 2011; Lachowycz & Jones, 2011; ThompsonCoon et al., 2011; Thompsonet al., 2012). In addition, PA in natural environments can be more enjoyable and sustainable than PA in other environments (Mitchell & Popham, 2008; Thompson Coon et al., 2011). For example, in a review of 11 controlled exercise trials, outdoor PA including walking and running was associated with greater motivation, satisfaction, and intention to repeat the activity compared to indoor PA (Thompson Coon et al., 2011). In addition, one study found that 47% of people with SMI preferred outdoor activities (A.J. Romain, Trottier, Karelis, & Abdel-Baki, 2020). Thus, outdoor PA may be an ideal strategy for sustainable behavior change among those with SMI. Given the ubiquity of parks nationwide, park-based PA is a scalable approach for chronic disease treatment and prevention (Bedimo-Rung et al., 2005; Cohen et al., 2013; Mowen, Kaczynski, & Cohen, 2008). Progressive outdoor PA interventions through health care providers, such as ‘Walk with a Doc’ and ‘Park Prescriptions,’ movements supported by the Centers for Disease Control and National Recreation and Parks Association, encourage health care professionals to prescribe local park visits to improve health among patients and families (Abbasi, 2016; Barrett, Miller, & Frumkin, 2014; Freeman, Curran-Everett, & Sabgir, 2014; National Recreation and Park Association, 2014; Sallis et al., 2015). Nonetheless, to date, no park-based PA programs have been adapted or evaluated among people with SMI.Data were collected Spring/Summer 2018 by trained researchers. Data collection occurred in-person on-site at behavioral health facilities in private rooms. We conducted six 1-h focus groups of 3–9 people per group with adults with SMI authorized for peer group treatment, three in Kansas (n = 14) and three in Georgia (n = 20). Using the PBA framework (Yardley et al., 2015), semi-structured focus group guides comprised of open-ended questions and probes elicited information regarding current PA behavior and park use (i.e., type, frequency, duration, intensity, setting, preferences), willingness to participate in park-based PA, PA participation motives/barriers, and recommendations for park-based PA interventions. We also conducted four 1-h focus groups of 3–6 PCs and social workers per group in Kansas (2 groups, n = 11) and in Georgia (2 groups, n = 8). Focus group guides elicited information from counselors about their knowledge and current promotion of PA as part of their regular job duties, willingness to lead PA activities in group settings, how elements of the Recovery Model (e.g., peer support) could be integrated into park-based PA activities, and feedback on intervention strategies (e.g., interest in leading PA activities, barriers for implementation). Focus groups were audio recorded on iPads and cell phones using a voice recording application. The primary interviewer recorded field notes during all focus groups. To protect participant anonymity, we choose not to collect demographic data for peers. In addition, because there were so few PCs across the two facilities, and PCs have lived experience with SMI, we did not collect demographic information or details about their qualifications or employment history that could identify them.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/10
Y1 - 2022/10
N2 - Statement of the problem: Park-based physical activity (PA) is associated with positive health outcomes (social support, energy, self-esteem, mood, less depression). Integrating park-based PA into peer-led mental health services is an innovative approach that can address health disparities in persons with serious mental illness (SMI). Yet, to date, few PA interventions capitalize on peer counselor (PC) capacity, and none have focused on park-based PA. The purpose of this qualitative study was to ascertain the perspectives of adults with SMI and their counselors about park-based PA to inform the development of a park-based PA intervention lead by PCs. Methods: In Spring/Summer 2018, we conducted six 1-h focus groups (FGs) with adults with SMI, and four 1-h FGs with PCs and social workers. Using the person-based approach framework, open-ended questions elicited information regarding peer PA behavior and park use, PA participation motives/barriers, and preference for park-based PA. PCs discussed knowledge and promotion of PA in peer group settings, willingness to lead PA activities, and feedback on intervention strategies. Results: Peer FGs averaged 49 ± 8 min. Peer data were coded into three overarching themes: current PA, motivators, and barriers. Peer counselor FGs averaged 60 ± 5 min. Data were coded into five themes: current peer group PA, barriers to peer group PA, motivators for peer group PA, PA intervention recommendations, and implementation barriers. Conclusion: Peers and PCs were interested in participating/leading in outdoor PA. Social support, motivation, PA self-efficacy, health concerns, weather, transportation, and PC training are important considerations for intervention development.
AB - Statement of the problem: Park-based physical activity (PA) is associated with positive health outcomes (social support, energy, self-esteem, mood, less depression). Integrating park-based PA into peer-led mental health services is an innovative approach that can address health disparities in persons with serious mental illness (SMI). Yet, to date, few PA interventions capitalize on peer counselor (PC) capacity, and none have focused on park-based PA. The purpose of this qualitative study was to ascertain the perspectives of adults with SMI and their counselors about park-based PA to inform the development of a park-based PA intervention lead by PCs. Methods: In Spring/Summer 2018, we conducted six 1-h focus groups (FGs) with adults with SMI, and four 1-h FGs with PCs and social workers. Using the person-based approach framework, open-ended questions elicited information regarding peer PA behavior and park use, PA participation motives/barriers, and preference for park-based PA. PCs discussed knowledge and promotion of PA in peer group settings, willingness to lead PA activities, and feedback on intervention strategies. Results: Peer FGs averaged 49 ± 8 min. Peer data were coded into three overarching themes: current PA, motivators, and barriers. Peer counselor FGs averaged 60 ± 5 min. Data were coded into five themes: current peer group PA, barriers to peer group PA, motivators for peer group PA, PA intervention recommendations, and implementation barriers. Conclusion: Peers and PCs were interested in participating/leading in outdoor PA. Social support, motivation, PA self-efficacy, health concerns, weather, transportation, and PC training are important considerations for intervention development.
KW - Anxiety
KW - Depression
KW - Exercise
KW - Peer-led intervention
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U2 - 10.1016/j.mhpa.2022.100466
DO - 10.1016/j.mhpa.2022.100466
M3 - Article
AN - SCOPUS:85135417466
VL - 23
JO - Mental Health and Physical Activity
JF - Mental Health and Physical Activity
SN - 1755-2966
M1 - 100466
ER -