Welcome to the 22nd WCP Congress Program Scheduling

Abstract Body

Background. Lifestyle interventions can improve health-related outcomes in people with severe mental illness (SMI), but there is an underrepresentation of studies evaluating this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), the question arose whether multidisciplinary lifestyle-enhancing support could also be helpful for people with SMI living in sheltered housing (MULTI_sh).

Aims. Evaluating MULTI_sh in an effectiveness-implementation hybrid randomized controlled trial design (trial registration: NCT03157557).

Method. Six municipalities with sheltered housing facilities were randomly assigned to MULTI_sh (n=3) or treatment as usual (TAU, n=3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EQ-5D/WHOQoL-Bref) and psychopathology (BPRS-E) using multiple regression, adjusting for baseline values and municipalities (intention-to-treat and per-protocol). Implementation fidelity, barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation).

Results. Of 177 eligible patients, 74 (42%) could be included in analyses. Health outcomes did not substantially improve in MULTI_sh (n=45) compared to TAU (n=29). Analyses showed that MULTI_sh was not implemented as intended. The majority of patients and all healthcare professionals believed that patients’ lifestyle should be part of treatment, but implementation was largely (in)directly hindered by organisational factors (e.g., staff shortages, complexity, lack of time and difficulty getting patients involved).

Conclusions. MULTI_sh was not implemented as intended and no substantial health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing.