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. 2025 Jul 6:6:26334895251351663.
doi: 10.1177/26334895251351663. eCollection 2025 Jan-Dec.

Barriers and facilitators of inpatients and healthcare professionals prior to the implementation of a Multidisciplinary Lifestyle-Focused Approach in the Treatment of Inpatients With Mental Illness (MULTI+): The MULTI+ Study II

Myrthe M E van Schothorst  1   2 , Natascha M den Bleijker  1   3 , Peter N van Harten  1   2 , Nanne K De Vries  4 , Jeroen Deenik  1   2   3
Affiliations

Barriers and facilitators of inpatients and healthcare professionals prior to the implementation of a Multidisciplinary Lifestyle-Focused Approach in the Treatment of Inpatients With Mental Illness (MULTI+): The MULTI+ Study II

Myrthe M E van Schothorst et al. Implement Res Pract. .

Abstract

Background: Despite the efficacy of lifestyle interventions for the physical and mental health of people with mental illness, there is little change in clinical care. Understanding barriers and facilitators of implementation can help interpret intervention effectiveness and aid implementation. This cross-sectional study identifies barriers and facilitators before implementing a multidisciplinary lifestyle approach in the treatment of inpatients with mental illness (MULTI+). Additionally, we analyze associations between barriers and facilitators, and recipients' health and demographic characteristics.

Method: This study used baseline data from an open cohort stepped wedge cluster randomized trial. The Measurement Instrument for Determinants of Innovations was used to investigate barriers and facilitators associated with the innovation (MULTI+), user (recipients and deliverers), and organization. Data was collected through semi-structured interviews for recipients and an online survey for deliverers. We explored associations between barriers and facilitators, and recipients' health and demographic characteristics through multiple regression models.

Results: We included 134 recipients and 125 deliverers. Perceived barriers to implementing MULTI+ included complexity, incomplete information, and incompatibility with current treatment. Recipients and deliverers reported personal barriers, including a lack of personal benefits, potential drawbacks, and insufficient knowledge. Facilitators such as the recognized importance of lifestyle-focused care, social support, and organizational commitment could enhance implementation. Being hospitalized for more than a year was negatively associated with determinants such as compatibility, patient relevance, and satisfaction (range between β = -.25 and β = -.45). Regression models indicated few other associations. Suggestions to address barriers were made.

Conclusions: This study is one of the first to analyze barriers and facilitators before the large-scale implementation of a multicomponent lifestyle-focused approach in mental healthcare. Recipients and deliverers experience barriers and facilitators across all domains. Addressing these factors through patient-level tailoring, structured training, the use of champions, and sustained organizational support may enhance implementation and sustainability.

Trial registration: ClinicalTrials.gov registration. Identifier: NCT04922749. Retrospectively registered 3rd of June 2021.

Keywords: barriers and facilitators; implementation; inpatients; lifestyle; mental illness; psychiatry.

Plain language summary

Obstacles and Supportive Factors for People With Mental Illness and Their Healthcare Professionals Before Introducing a Lifestyle Program in Inpatient Treatment. While we know that lifestyle programs can help improve the health of people with mental illness (MI), integrating these programs can be challenging. This study looks at what makes it easier or harder to use lifestyle programs, so they can be improved. This study is part of a larger study that looks at the impact of a lifestyle program (multidisciplinary lifestyle-focused approach in the treatment of inpatients with mental illness). We used data collected before the program started to understand barriers and facilitators. People with MI were interviewed, and healthcare professionals completed an online survey. We then analyzed factors that may influence the experience of people with MI, such as diagnosis or gender. There were 134 people with MI and 125 healthcare professionals that answered our questions. Things that made it harder for people with MI to use the program included finding the program complex, seeing few personal benefits and feeling that the program might not fit well with their current treatment. However, they believed lifestyle programs are important and should be part of their care. People hospitalized for longer thought it would be harder to engage than those hospitalized for a shorter time. Healthcare professionals reported that they did not know enough about the program and expected personal drawbacks. However, they felt supported by their team and believed the organization would be committed to the program. To improve integration, we suggest that the program be tailored to people's interests and goals, and healthcare professionals should receive clear roles, responsibilities, and training. It is also important that everyone participates. Following these recommendations may help the program work better and support long-term success.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Open Cohort Stepped Wedge Cluster Randomized Trial in Inpatient Psychiatric Wards in Three Clusters, Demarcated by the Dates of Implementation of MULTI+.
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References

    1. Almansour M., AlQurmalah S. I., Razack H. I. A. (2023). Motivational interviewing—An evidence-based, collaborative, goal-oriented communication approach in lifestyle medicine: A comprehensive review of the literature. Journal of Taibah University Medical Sciences, 18(5), Article 1170. 10.1016/j.jtumed.2023.03.011 - DOI - PMC - PubMed
    1. Aschbrenner K. A., Naslund J. A., Reed J. D., Fetter J. C. (2021). Renewed call for lifestyle interventions to address obesity among individuals with serious mental illness in the COVID-19 era and beyond. Translational Behavioral Medicine, 11(7), 1359–1364. 10.1093/tbm/ibab076 - DOI - PubMed
    1. Ball H., Yung A., Bucci S. (2022). Staff perspectives on the barriers and facilitators to exercise implementation in inpatient mental health services: A qualitative study. Mental Health and Physical Activity, 22, Article 100452. 10.1016/j.mhpa.2022.100452 - DOI
    1. Bauer M. S., Kirchner J. (2020). Implementation science: What is it and why should I care? Psychiatry Research, 283, Article 112376. 10.1016/j.psychres.2019.04.025 - DOI - PubMed
    1. Carpiniello B., Primavera D., Pilu A., Vaccargiu N., Pinna F. (2013). Physical activity and mental disorders: A case–control study on attitudes, preferences and perceived barriers in Italy. Journal of Mental Health, 22(6), 492–500. 10.3109/09638237.2013.815330 - DOI - PubMed

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