Combining the strengths of UMIST and

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Evaluating health education groups for adults
with a diagnosis of schizophrenia

• PhD Student Tim Bradshaw
• Supervisor Professor Karina Lovell

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Content

• Background
• Systematic review
• Development of a health education intervention
• Methods used to conduct an exploratory
  investigation
• Results
• Future research questions

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Background (1)

• Life expectancy for individuals with
  schizophrenia is reduced (Allebeck, 1989)
• Approximately 62 of premature deaths are from
  natural causes (Harris and Barrowclough, 1998)
• Poor physical health may largely be explained by
• Lifestyle (Brown et al, 1999)
• Medication used to treat psychosis (Marder et al,
  2004)

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Background (2)

• UK Department of Health, (2006) have recently
  published guidelines regarding primary level
  health education services for adults with
  schizophrenia. This document cites examples of
  good practice programmes for smoking cessation,
  exercise and well being advice.
• However, the authors caution that few programmes
  have been shown to be sustainable and fewer
  still have been evaluated (Department of Health,
  2006, page 10).

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Systematic Review of Health Education
Interventions for adults with Schizophrenia
(Bradshaw et al, 2005)

• 16 studies located
• Smoking cessation n 7
• Weight management n 5
• Exercise n 3
• Nutritional Education n 1
• Problems with studies
• Methodological limitations
• Ethical issues
• Interventions focussed on discrete aspects of
  health related behaviour

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Developing a Health Education Programme (1)

• The findings of the systematic review and a
  review of the health education literature from
  studies conducted with other members of the
  general population were used to inform the
  development of a health education intervention
  specifically to meet the needs of adults with a
  diagnosis of schizophrenia

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Developing a Health Education Programme (2)

• Group programme designed to be delivered in ten,
  60 minute sessions
• Content contained information about diet,
  exercise and smoking and the relationship of
  these behaviours to physical health
• Intervention underpinned by the stages of change
  model (Prochaska and DiClemente, 1983)

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Intervention (1)

• Psycho-education
• Cognitive techniques
• Motivational enhancement
• Problem solving
• Behavioural approaches
• Goal setting
• Self monitoring
• Homework between sessions

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Interventions (2)

• Focus on socially inclusive activities
• Strategies to reduce problems associated with
  cognitive deficits

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Exercise quiz

• Taking regular exercise reduces the risk of
  having a heart attack?
• True / False
• Taking regular exercise reduces the risk of high
  blood pressure?
• True / False
• Taking regular exercise is good for the heart
  muscle because it decreases resting heart rate.
  
• True / False

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Exploratory investigation (1)

• Single group pre test post test design used to
  evaluate the effect, feasibility and
  acceptability of the intervention
• Participants with an ICD 10 diagnosis of
  schizophrenia or schizo-affective disorder were
  recruited from a local mental health service
• Aim was to recruit a minimum of 45 participants
• Groups were facilitated by the principal
  investigator and co-facilitated by practitioners
  working in routine practice

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Exploratory investigation (2)

• Data regarding the effect of the intervention on
  participants lifestyles were collected pre, post
  and at 6 months follow up using the Health and
  Lifestyle Interview (Cox et al, 1993)
• Feasibility was assessed by monitoring patterns
  of referral and attendance
• Data regarding the acceptability of the
  intervention was collected by conducting post
  intervention focus groups with all participants
  in the study and the practitioners who helped to
  deliver the groups

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Results (1)Recruitment and demographics

• 58 referrals were received
• 45 service users (32 men and 13 women) were
  eligible for the study and were offered the
  intervention
• Mean age 36.9 (sd 9.9) years
• 87 ethnically White British
• 91 single or divorced
• 87 economically inactive

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Results (2)Health and lifestyle profiles

• Participants reported 14 chronic medical problems
  the most common was diabetes (n 5, 11)
• Body mass indexes showed 80 were overweight or
  obese
• 62 reported taking only light levels of exercise
• Average portions of fruit and vegetables consumed
  per day 1.9 (sd 1.1)
• 56 smoked

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Results (3)Feasibility

• Seven health education groups were delivered,
  group size ranged from 4 9 (mean 6.4)
• Participants attended an average of 5.4 sessions
  (sd 2.8)
• 6 (13) failed to attend
• 10 (22) attended between 1 and 4 sessions
• 29 (65) attended 5 or more sessions
• All seven groups remained viable

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Results (4)Effect of the intervention

• Participants levels of exercise increased
  significantly (Friedman, F 13.02, df 2, p
  0.001). Effect size post (d 0.87) and follow
  up (d 0.77)
• Consumption of fruit and vegetables increased
  significantly (ANOVA, F (2, 88) 14.67,
  plt0.001). Effect size post (d 1.35) and follow
  up (d 1.19)
• No significant change in the number of cigarettes
  smoked per day (Friedman, F 2.59, df 2, p
  0.274)

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Results (5)Acceptability of the intervention

• Qualitative analysis of the focus group data
  showed the intervention was acceptable to the
  participants
• Specific themes identified were
• A preference for groups delivered in the early
  afternoon
• Community venues rather than hospital sites
• A group rather than individual intervention
• Participants liked the workbook that had been
  developed for the study
• They thought attending the health education group
  had helped to motivate them to make positive
  changes to their lifestyles

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Results (6)Acceptability of the intervention

• I didnt know about the fish thing, that really
  helped me I learned a lot about fish and I love
  fish now, Im always eating it because I feel
  like theres an incentive, I feel good after Ive
  eaten it

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Results (7)Acceptability of the intervention

• I used to look forward to it(the health
  education group). Something to look forward to
  every week, like a routine to get into and you
  were set up for the day then because youd think
  right Ive got my healthy living group today so
  Ill get motivated

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Future research questions

• Can the findings of this exploratory
  investigation be replicated in a larger
  randomised controlled trial?
• Investigation of factors mediating behaviour
  change e.g. health beliefs and perceived self
  efficacy
• Health education groups to be delivered by
  practitioners working in routine services

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Thank you for listeningAny questions?

• timothy.j.bradshaw_at_manchester.ac.uk