Background: People with severe mental illness (SMI) are at greater risk of earlier mortality due to physical health problems including cardiovascular disease (CVD). There is limited work exploring whether physical health interventions for people with SMI can be embedded and/or adopted within specific healthcare settings. This information is necessary to optimise the development of services and interventions within healthcare settings. This study explores the barriers and facilitators of implementing a nurse-delivered intervention ('PRIMROSE') designed to reduce CVD risk in people with SMI in primary care, using Normalisation Process Theory (NPT), a theory that explains the dynamics of embedding or 'normalising' a complex intervention within healthcare settings. Methods: Semi-structured interviews were conducted between April-December 2016 with patients with SMI at risk of CVD who received the PRIMROSE intervention, and practice nurses and healthcare assistants who delivered it in primary care in England. Interviews were audio recorded, transcribed and analysed using thematic analysis. Emergent themes were then mapped on to constructs of NPT.

Objectives. This study explored how health behaviours were supported and changed in people with severe mental illness by primary health care professionals trained in delivering behaviour change techniques (BCTs) within a cardiovascular disease risk reducing intervention.Design. Secondary qualitative analysis of 30 staff and patient interviews.Methods. We mapped coded data to the BCT Taxonomy (version 1) to identify BCT application. Thematic analysis was conducted to explore the barriers and facilitators of supporting and changing health behaviours. Themes were then interpreted using the Capability, Opportunity, Motivation, and Behaviour model to gain greater explanation behind the processes.Results. Twenty BCTs were identified. Staff and patients perceived that health behaviours were commonly affected by both automatic and reflective motivation, sometimes in turn affected by psychological capability, social, and physical opportunity. Staff and patients suggested that motivation was enhanced by both patient and staff ability to observe health benefits, in some cases patients' health knowledge, mental health status, and social support networks. It was suggested that engaging in/sustaining healthy behaviours was influenced by physical opportunities to engrain behaviours into routine.Conclusions. According to staff and patients, health behaviour change in this population was driven by complex processes. It was suggested that capability, opportunity, and motivation were in some cases enhanced by BCTs, but variable. Behaviour change may be optimized by individualized behavioural assessments, identifying drivers of behaviour and applying a range of BCTs may help to target individual needs. Patient peer-led approaches, techniques to encourage awareness of visible success, and normalizing health behaviours may increase behaviour change.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background: People with severe mental illness (SMI) are at greater risk of earlier mortality due to physical health problems including cardiovascular disease (CVD). There is limited work exploring whether physical health interventions for people with SMI can be embedded and/or adopted within specific healthcare settings. This information is necessary to optimise the development of services and interventions within healthcare settings. This study explores the barriers and facilitators of implementing a nurse-delivered intervention (‘PRIMROSE’) designed to reduce CVD risk in people with SMI in primary care, using Normalisation Process Theory (NPT).Methods: Semi-structured interviews were conducted between April-December 2016 with patients with SMI at risk of CVD who received the PRIMROSE intervention, and practice nurses and healthcare assistants who delivered it in primary care in England. Interviews were audio recorded, transcribed and analysed using thematic analysis. Emergent themes were then mapped on to constructs of NPT. Results: 15 patients and 15 staff participated. The implementation of PRIMROSE was affected by: 1) Coherence, where both staff and patients expressed an understanding of the purpose and value of the intervention, 2) Cognitive participation, including mental health stigma, staff confidence levels, staff knowledge and staff perceptions of the compatibility of the intervention to primary care contexts, 3) Collective action, including lack of patient engagement despite flexible appointment scheduling. Limited time and resources hindered implementation. Positive relationships between staff and patients facilitated implementation, and access to ‘in-house’ staff support was considered important. Staff skills, knowledge and training facilitated implementation. However, perceptions of the applicability of the intervention to real-world contexts and accessibility of resources sometimes prevented collective action. 4) Reflexive monitoring, where the staff commonly appraised the intervention by reporting its value and identifying ways of improving it. Conclusions: Future interventions for physical health in people with SMI could consider the following items to improve implementation: 1) training for practitioners covering interpersonal skills, mental and physical health, in order to overcome stigma, increase knowledge, confidence and facilitate positive relationships with patients and 2) enabling access to resources including specialist services, additional staff and time.

IAPT therapists can deliver CBT to advanced cancer patients, given therapists positive experiences evident in the present study. However, it was concluded that additional service and modifications of therapy may be needed before positive outcomes for both therapists and patients can be achieved.

Understanding factors that contribute towards physical activity and diet outcomes are important for health improvement in people with severe mental illness. Cross-sectional findings on factors associated with diet and physical activity outcomes provide limited information on what predicts changes or longterm outcomes in lifestyle behaviours in people with severe mental illness. A systematic review was therefore conducted to identify prospective studies with quantitative data on baseline factors associated with follow-up diet or physical activity related outcomes. MEDLINE, EMBASE, PsycINFO, CINAHL Plus and grey literature databases were searched from inception to March 2018. From 6921 studies, 5 were eligible for physical activity related outcomes and 2 for diet related outcomes. The follow-up duration was 4 weeks to 24 months and participants were mostly diagnosed with schizophrenia. Older age was commonly related to better physical activity related outcomes, whilst higher negative symptoms were related to poorer-related outcomes. Physical activity intentions and gender were unrelated to physical activity outcomes. There was a lack of data on factors influencing dietary outcomes. Although there were some common factors predictive of physical activity including older age and negative symptoms, more high-quality research is needed to determine the effect of sociodemographic, mental health, social, clinical, lifestyle and other factors on both physical activity and dietary outcomes.