Physical Health Improvement Intervention for People Admitted to Mental Health Service

Official title

Establishing Utility of a Physical Health Improvement Intervention in a Regional Mental Health Impatient Service: a Multimethod Study

Overview

This study aims to codesign and implement a physical health improvement behaviour change intervention for people being treated for a mental illness in a mental health inpatient unit of a regional hospital.

Detailed description

People in regional areas with mental illness suffer high prevalence of preventable chronic health conditions. Multi-morbidity in people with mental illness contributes to a reduced life expectancy of up to 20 years. Many physical diseases are preventable and/or reversable if risk factors are identified early, and the right health promotion tools and interventions are provided. Addressing such a complex issue for people with mental illness requires an approach which is adaptable, has been co-designed with clinicians and consumers and is comprehensive to target individualised health behaviours.

This research uses the Health Improvement Profile (HIP) tool to help clinicians (e.g. nurses, doctors) to assess patients physical health and identify risk factors or early signs of chronic disease. Using the Health Improvement Profile (HIP) tool during admission the clinicians will work with clients to implement the most suitable health promotion tools to help improve physical health.

Using implementation research methodology and following the Consolidated Framework for Implementation Research (CFIR) the study is broken into the following 4 stages:

* Identify * Adapt - codesign/adapt Health Improvement Profile (HIP) intervention and develop user training * Implement - into clinical areas to assist developing personalised Health Improvement Profile (HIP) * Evaluate - using both qualitative and quantitative data to determine feasibility of the Health Improvement Profile (HIP) and implementation in a regional health service

Interventions

• Other Health Improvement Profile (HIP)
  The Health Improvement Profile (HIP) is a comprehensive physical assessment conducted by a trained clinician which aims to link evidence based interventions for flagged abnormal health parameters. There are 27 health parameters assessed such as weight, Body Mass Index (BMI), blood pressure, blood glucose, cholesterol levels, and waist circumference, alongside questions on lifestyle factors like smoking, diet, and physical activity, as well as medication use and its side effects. Client particip
• Other Clinician Health Improvement Profile user training
  Clinician/staff participants will receive Health Improvement Profile user training on how to conduct the comprehensive physical assessments for 27 health parameters and how to link the evidence based actions to develop an individualised Health Improvement Profile for clients admitted to inpatient service. Training includes online videos simulating assessments and completing the Health Improvement Profile and face to face workshops.

Primary outcome measures

• Feasibility of Health Improvement Profile [Time frame: From admission (enrolment) to post discharge period of 3 months (12 weeks)]
• Feasibility: Time taken to recruit planned sample [Time frame: Immediately after the inclusion of the last participant]
• Feasibility: Retention [Time frame: at the follow-up assessment 3 months post discharge from inpatient service]
• Feasibility: Drop out rate [Time frame: At the follow-up assessment 3 months post discharge from inpatient service]
• Reason for dropping out [Time frame: immediately on drop out notification or at 3 month follow up]
• Feasibility: Adherence [Time frame: Immediately on completion of the post discharge period at 3 months (12 weeks)]
• Participant feedback [Time frame: Immediately after completion of the follow up period of 3 months (12 weeks)]

Secondary outcome measures (12)

• Clinician Confidence [Time frame: At completion of training, at the project interim point (3 months) and at end of project.]
• Client wellbeing [Time frame: Immediately at completion of the follow up period (3 months)]
• Biometric measure: Body Mass Index (BMI) [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period 3 months (12 weeks)]
• Biometric measure: Waist circumference [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Pulse [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Blood pressure [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Temperature [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Liver Function Test [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Liver Function Test [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Liver Function Test [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Liver Function Test [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]
• Biometric measure: Liver Function Test [Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)]

Eligibility criteria

Inclusion criteria

• This study is being carried out in an inpatient service therefore clinical staff must be registered by their professional governing body with a minimum of 6 months employment at the service or within the region to participate in stages 2 and 3. Graduate clinicians with less than 6 months working experience will be excluded from the study. Clinicians new to the region with less than 6 months working experience in location will be excluded from the study. Clinical roles within the facility include but not limited to:

• Nurses (enrolled or registered)
• Psychiatrists
• Psychologists
• Social Workers

Clients of the inpatient mental health service eligible to be included in the study must be:

• Over the age of 18 years
• Able to read, understand and speak English
• A current or previous user of the hospital's services
• A current or previous user of the inpatient services
• A carer of someone who is a current or previous user of the inpatient mental health service
• Able to provide consent
• Not an employee
• Not a health professional

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Werkkala C, Valimaki M, Anttila M, Pekurinen V, Bressington D. Validation of the Finnish Health Improvement Profile (HIP) with patients with severe mental illness. BMC Psychiatry. 2020 Mar 11;20(1):112. doi: 10.1186/s12888-020-02511-5. PMID 32160873
• Meepring S, Gray R, Li X, Chien WT, Li Y, Ho GWK, Kritkitrat P, Bressington D. Evaluating the efficacy of the Thai Health Improvement Profile intervention for preventing weight gain in people with early stage psychosis: A randomized controlled trial. Int J Nurs Stud. 2023 Oct;146:104570. doi: 10.1016/j.ijnurstu.2023.104570. Epub 2023 Jul 31. PMID 37597457
• White J, Gray R, Jones M. The development of the serious mental illness physical Health Improvement Profile. J Psychiatr Ment Health Nurs. 2009 Jun;16(5):493-8. doi: 10.1111/j.1365-2850.2009.01375.x. Epub 2008 Mar 9. PMID 19538607

Identifiers

NCT: NCT06996899 · H24039

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗