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Att främja förändrad livsstil bland personer med psykiskt funktionshinder: studier av metabola och psykologiska effekter, upplevd mening och hälsa
Umeå University, Faculty of Medicine, Department of Nursing.
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
To promote life style changes among persons with psychiatric disabilities : studies of metabolic and psychological effects, experienced meaning and health (English)
Abstract [en]

The overall aim of this thesis is to investigate if the somatic comorbidity and increased mortality among persons with psychiatric disability (residents in supported housing facilities) can be influenced. The thesis comprises four papers. Paper I describes the lived experience of health and body. Papers II and III examine the effects of a lifestyle programme on physiological markers (II) and on psychological and quality of life parameters (III). Paper (IV) illustrates the meaning of participating in a life style programme. The data in Papers I and IV comprises narrative interviews with residents (n=11). The studies in Papers II and III are focused on residents and were carried out with a randomized design. The randomization was performed on a group level (supported housing facility). The 12 month intervention consisted of study circles with a theoretical and practical application of dietary information and physical activity for two hours, on a twice weekly basis under the supervision of a study circle leader. The controls were offered an aesthetic study circle and met once a week. The data in Paper II comprises physiological quantitative data from both residents (n=41) and staff (n=41) and in Paper III questionnaires on symptoms and quality of life completed only by residents (n=41). The data was analysed with Qualitative description (I), Phenomenological-hermeneutics (IV), and for papers II and III relevant statistical calculations were used. Health is described in paper I as “having a life as others have” and discloses the losses of important life domains (family, work, security) and the experiences of being deviant and stigmatized. Health is described as “absence of psychological and physical problems” and its hampering effects on quality of life and self-esteem. Health is understood as a phenomenon that could “be influenced by one self”, and there is an insight that health is manageable. Participating in a life style intervention (paper II) meant a significant improvement in risk factors for metabolic syndrome among the residents in comparison with controls. No differences were seen on weight, BMI and improved physical capacity. In paper III a significant positive increase in the Sense of Coherence compared to controls was seen. However no effect was seen on quality of life, psychosocial function or on reduction of symptoms in comparison with controls. Participating in a lifestyle intervention can be understood as the gaining of insights that health can be improved and that the daily life is partly given a changed content (paper II). The participation is also described as meaning an increased sense of closeness and equality in relation to the staff and sometimes a painful insight of their life situation. Participating is also described as entailing a hope that one’s life situation can be affected. In summary this thesis shows that there is some possibility of influencing the physical health (reduced risk of metabolic syndrome) among persons with psychiatric disability by participating in a 12 month intervention programme. The intervention does not show any effects on measures such as quality of life, psychosocial function and presence of symptoms. However, the participants describe that the participation had a meaning in a number of respects. This is a finding that is confirmed by the positive change in sense of coherence. The need to develop preventive care for persons with psychiatric disability and the importance of monitoring the treatment with neuroleptics and its side effects on physical health is an important clinical implication. Furthermore the importance of the responsibility of the care staff is emphasized as well as the importance of supporting a change in lifestyle.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2009. , 91 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1277
Keyword [en]
community psychiatric nursing, life style intervention, lived experience, health, metabolic syndrome, psychiatric illness, randomized controlled trail, sense of coherence
Keyword [sv]
Personer med psykiskt funktionshinder, omvårdnad, socialpsykiatri, hälsa, metabolt syndrom, livsstil, RCT, KASAM, livsvärld
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-25947ISBN: 978-91-7264-822-7 (print)OAI: oai:DiVA.org:umu-25947DiVA: diva2:235218
Distributor:
Institutionen för omvårdnad, 90187, Umeå
Public defence
2009-10-09, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-21 Created: 2009-09-14 Last updated: 2011-10-06Bibliographically approved
List of papers
1. Experiences of health among persons with psychiatric disabilityparticipating in a life style intervention
Open this publication in new window or tab >>Experiences of health among persons with psychiatric disabilityparticipating in a life style intervention
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Persons with psychiatric disabilities describe health in similar ways to others, although the prevalence of ill-health and risk factors are larger than in the general population.

Aim: To describe the experience of health and body in order to enable the creation of health interventions for this group of users.

Design: The first author interviewed five women and six men with psychiatric disabilities, aged 26 to 53, participating in a life style programme.

Method: The transcribed interviews were analysed by qualitative description.

Result: The categories Health is having a life as others have disclosed losses of important life domains and experiences of being different, and “Health is absence of psychological and physical problems” describes their symptoms and its hampering effects on quality of life and self-esteem. The category “Health is being able to influence one’s own health” reveals a sense of hope that health is manageable.

Conclusion: Not having a life or being as others causes a sense of being different and stigmatization, which might affect self esteem, quality of life and possibilities for recovery. Health is to be spared physical and psychological problems as the lack of energy which affects motivation and the ability to gain a quality of life. But health is also described in terms of a conviction that it can be affected through knowledge and self-management of symptoms.

Clinical implications: Health intervention programmes should be designed in such a way that promotes motivation and self-management as it is an important factor in recovery. Carers should also promote and support clients to find activities, relationships and sites where symptom relief can be experienced.

Keyword
Psychiatric disability, health, qualitative description, health education, health
National Category
Psychiatry
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-25937 (URN)
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2010-01-14Bibliographically approved
2. Physical health: a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff
Open this publication in new window or tab >>Physical health: a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff
2008 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6, 486-495 p.Article in journal (Refereed) Published
Abstract [en]

The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities, and their caregivers. Their satisfaction with the intervention was also assessed. Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known. Few randomized controlled trials have been aimed specifically at lifestyle issues among persons with a psychiatric disability. This trial includes clients with psychiatric disabilities living in supported housing and their staff. Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005-2006 in Sweden. The supported housing facilities with residents and staff were randomly assigned to either a health intervention programme or a control programme with an aesthetic content. The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c, P-glucose, P-insulin, lipids, blood pressure, physical working capacity, body mass index, Heart Score were investigated and participants' satisfaction assessed. There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up. The participants expressed satisfaction with the programme. The results indicate that health interventions on lifestyle issues when involving carers are appreciated, feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities.

Identifiers
urn:nbn:se:umu:diva-25946 (URN)10.1080/08039480801985179 (DOI)18843564 (PubMedID)
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2011-05-18Bibliographically approved
3. Influence of a life style intervention among persons with a psychiatric disability: a cluster randomised controlled trial on symptoms, quality of life and sense of coherence
Open this publication in new window or tab >>Influence of a life style intervention among persons with a psychiatric disability: a cluster randomised controlled trial on symptoms, quality of life and sense of coherence
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11-12, 1519-1528 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: The aim of this study was to investigate how a life style intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities.

 Background: Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at life style interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities.

Design: a cluster randomised controlled trail.

Methods: Forty one persons with a DSM- ІV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12 month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance.

Results: A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up.

Conclusions: Structured activities in the form of life style intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence.

Relevance to clinical practice: Improving physical health with life style programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

Place, publisher, year, edition, pages
Malden: Wiley-Blackwell, 2010
Keyword
Psychiatric disability, physical health, health intervention, Sense of Coherence, psychosocial factors, RCT.
National Category
Psychiatry
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-25941 (URN)10.1111/j.1365-2702.2009.03010.x (DOI)000277710000006 ()
Note

Publicerad under den felaktiga titeln:

Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence

Erratum publicerat i Journal of clinical nursing 19(2010): 17-18, s. 2669

Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2017-05-26Bibliographically approved
4. Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.
Open this publication in new window or tab >>Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.
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2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, 357-364 p.Article in journal (Refereed) Published
Abstract [en]

Lifestyle changes that affect physical and psychological health are described in research literature; however, the meaning of participating in a lifestyle intervention programme together with the staff has not been described. This study illuminates meanings of participating in a lifestyle programme as experienced by persons with psychiatric disabilities. The first author interviewed five women and six men with schizophrenia and depressive syndrome, aged 26-53, participating in a lifestyle programme. The transcribed interviews were analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. Meanings of participating in a lifestyle programme include my health can be improved as both the physical effects and the obstacles are considered and the daily life is partially given a changed content in new experiences and by participating in something to take pride in. The meanings of participating together with the staff mean an increased sense of closeness and equality with the staff expressed in changes in relationships and the difference between the two groups being revealed and also in becoming aware of the life situation, an insight into the loss of a healthy life but also hope for the future is expressed. The conclusions that could be drawn from this study are that a lifestyle intervention affects health and other important life areas such as the content of daily life and the relationship with the carers, which appears to affect the sense of hope and the ability to see new possibilities. Carers should find situations and activities where the residents and carers participate under equal conditions giving the residents the opportunity to leave the sick roll, experience equality and develop good relationships.

Place, publisher, year, edition, pages
Wiley, 2011
Keyword
Persons with psychiatric disabilities, community psychiatric nursing, phenomenological hermeneutics, nurse–patient relationship, health education, lived experience
National Category
Psychiatry Nursing
Identifiers
urn:nbn:se:umu:diva-41039 (URN)10.1111/j.1471-6712.2010.00834.x (DOI)000290589300020 ()21029143 (PubMedID)
Available from: 2011-03-16 Created: 2011-03-16 Last updated: 2017-12-11Bibliographically approved

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Output format
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