Title: Mixed-methods study to generate evidence to inform weight management interventions in adult secure care mental health inpatient settings
Funder: The Academy of Medical Sciences

Abstract: This project aims to use mixed-methods and stakeholder engagement to generate a novel evidence base. This will inform future co-development, implementation and evaluation of a weight management intervention for trialling amongst patients and staff in adult secure care mental health inpatient settings. The specific objectives are to identify priority areas for weight management intervention and potential barriers and facilitators, and to triangulate research findings to inform future interventions. Excess weight and associated morbidity and mortality are major challenges for patients with severe mental illness (including schizophrenia and bipolar disorder) and learning disability, particularly in secure care (patients who have committed a crime or have threatening behaviour). Multiple factors generate a potentially obesogenic environment, including antipsychotic medications, calorie-dense food provision, sedentary lifestyle, and limited understanding of health promotion amongst staff. These challenges will be addressed through four integrated workstreams involving mixed-method stakeholder exploration of priorities, barriers and facilitators for weight management in adult secure care services at Cumbria, Northumberland, Tyne & Wear NHS Trust. Firstly, a quantitative electronic survey of all staff in secure care will be undertaken. This will subsequently inform ethnographic observations of food and exercise behaviours on four inpatient wards. Emergent themes will then be explored through focus groups with service users, carers and multidisciplinary staff. Finally, these insights will be integrated using Triangulation Protocol. In future, our empirical findings will be assimilated with reviews of existing research and previous successful initiatives, to inform co-development of a weight management intervention for extensive implementation across secure care services.

Lay abstract: Overweight and obesity are very common in the UK population, leading to avoidable illnesses such as heart disease, diabetes and certain cancers. Unhealthy weight is even more widespread among patients with severe mental illness (including schizophrenia and bipolar disorder) and learning disability, reaching about 80% in secure care hospitals (patients who have committed a crime or have threatening behaviour). Many challenges make it more difficult for patients in secure care to maintain a healthy weight. These include restricted opportunities to exercise and eat well, low patient motivation, limited knowledge and understanding amongst staff, and medication that tends to lead to weight gain. Our research aims to address these problems by using different methods to explore first-hand with adult patients, staff and carers their priorities for tackling unhealthy weight, and what would make this easier and harder to achieve. Firstly, we will survey all staff with different roles working in secure care to investigate their views. Next, we will observe food and exercise behaviours on different occasions on four different wards. This will include events over the whole day, such as meal- and snack-times, buying food from the tuck shop and ordering takeaways, therapy activities and exercise opportunities. We will then use these findings to inform focus groups with patients, carers and staff. Finally, we will draw this learning together and compare the different insights, so they can be used in future to guide the development of weight management programmes, to be trialled amongst patients and staff in adult secure care.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH