Award Title: Increasing Physical Activity in a Medium Secure Service: The Development and Feasibility of a Physical ACTivity Intervention (IMPACT)
Funder: Department of Health and Social Care

Abstract: In the UK there are 3500 individuals detained in medium secure units. Service users in such settings have complex and serious mental illness (SMI), often with co-morbid physical health problems and a life expectancy of at least 10 years shorter than the general population. They often have low levels of physical activity. There is little evidence about physical activity interventions for medium secure service users in the United Kingdom.  Aims: We aim to co-produce, with medium secure service users, the content and delivery of an intervention to increase physical activity. We shall assess feasibility, acceptability and pilot data collection methods for outcomes relevant for a future randomised controlled trial.  Research questions    Can an evidence-based intervention aimed at increasing physical activity in medium secure services be co-produced?    Can this co-produced evidence-based intervention be implemented in medium secure services?    What are medium secure service users  and staffs  perceptions and experience of the physical activity intervention?  Is the intervention sufficiently developed to be evaluated in a future pilot Randomised Control Trial?      Plan of investigation: This is a 24-month mixed-methods study in four phases using the Medical Research Council Complex Interventions Framework.  Phase 1: To identify the barriers and facilitators in medium secure care to increased physical activity; we will co-produce a questionnaire for all service users to complete in two NHS medium secure units (N=90; N=102) and conduct staff focus groups in each unit (6-10 in each group, 12-20 in total).  Phase 2: To identify views on designing, delivering, establishing engagement and maintaining commitment to attend physical activity interventions, we will conduct a focus group with service users and key stakeholders with expertise in promoting physical activity and behavioural change within medium secure environments (6-10 participants).  Phase 3: To co-produce a physical activity intervention, we will conduct an intervention development group with service users, our patient and public representatives, staff from Phase 1 and service users and  key stakeholders from Phase 2 (6-10 participants). We will produce guidelines for training to facilitate consistent intervention delivery and replication.  Phase 4: 15-20 medium secure service users from each medium secure unit will participate in this phase. Using a quasi-experimental one arm, pre-test post-test design we will assess their physical activity levels pre and post-intervention. Pre-test, basic demographic data, information on current medication, body weight, physical activity, mood functioning; mental well-being and motivation will be collected. We will repeat measures after 3 months and then at follow up at 1 month and 3 months post-intervention. Qualitative data will be collected on acceptability, and pilot recruitment, participation, retention and causes of drop-out, data collection, and outcome measure to inform a future pilot randomised control trial.  Benefits: We anticipate that incorporating a co-produced physical health intervention into medium secure services could improve a service user s physical status and lower the risk of physical disorders such as cardiovascular disease and diabetes. Furthermore, it could reduce psychiatric symptoms, improve well-being and self-esteem in service users making it an interesting and promising treatment option in secure care.

Lay Abstract: Many people become overweight due to the effects of poor diet, and less active lifestyles. Being obese can affect people s heath and lead to type 2 diabetes and heart problems, People with severe mental health problems find it more difficult to live healthy lifestyles. They have a shorter life span by about 10-20 years and obesity rates up to four times higher than the general population.   Maintaining a healthy lifestyle is more difficult for people in medium secure mental health units. This type of service provides care and treatment to adults with severe mental health problems, who present a serious risk of harm to others and to themselves, and who are prevented leaving hospital. Service users in such units have often experienced chaotic lifestyles; problematic relationships, employment and substance use issues. Limited physical activity and weight gain is recognised as a major health problem for people in secure units   A recent audit of 83 service users in such a unit found only 18 had lost or maintained their admission weight whilst the remaining 65 had increased their weight since admission. This study will work with service users and professionals in two NHS medium secure units to design and evaluate a way of improving the levels of physical activity for service users.  What we will do:     Design a questionnaire for service users to understand what helps or hinders their participation in physical activities.   Explore with staff and service users in a discussion group what strategies may improve engagement, maintain commitment, avoid drop-out and overcome barriers to being physically active.   Hold a service user and staff discussion group to develop a physical activity intervention based on evidence from parts 1 and 2.   Evaluate the intervention for 3 months by collecting information about service-users  participation, body weight, physical activity, mood, mental well-being and motivation. We will also interview all service users and some staff.        How we plan to involve people:   The study involves genuine involvement and partnership working with service users. We have a service user on the team, and Creative Minds, a charity that develops creative activities to improve wellbeing in service users in such units. We will continue to work together with service user groups at both study sites so we co-produce a physical activity intervention that is relevant to the needs of people in such services. We will establish whether this is practical, acceptable and useful for the people it is aimed at (feasibility study). This type of study examines the practical issues in establishing such a study and therefore can iron out any of these problems before further funding is granted to do a much larger study.

Research Activity Codes: 7.1 INDIVIDUAL CARE NEEDS;3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health Categories: GENERIC HEALTH RELEVANCE;MENTAL HEALTH