Community Mental Health Journal

, Volume 49, Issue 2, pp 207–212 | Cite as

A Qualitative Study of Social Facilitators and Barriers to Health Behavior Change Among Persons with Serious Mental Illness

  • Kelly Aschbrenner
  • Elizabeth Carpenter-Song
  • Kim Mueser
  • Allison Kinney
  • Sarah Pratt
  • Stephen Bartels
Original Paper


This qualitative focus group study was conducted to explore social facilitators and barriers to health behavior change in persons with serious mental illness engaged in a healthy lifestyle intervention. Six focus group interviews were conducted with a total of 30 clients stratified by “high” and “low” achievers in the program based on clinically significant weight loss or significant increase in fitness. Thematic analysis of focus group discussions revealed that emotional, practical, and mutual support from family members and significant others were social facilitators to health behavior change, while unhealthy social environments was a barrier. Participants in the “high” achiever group reported more mutual support for health behavior change than participants in the “low” achiever group. Results highlight the need for researchers and clinicians to consider the potential role of family and significant others as health supporters for persons with mental illness who could encourage healthy behavior in the social environment.


Serious mental illness Healthy lifestyle intervention Social support Health behavior change 



The authors thank the Dartmouth Medical School Department of Psychiatry Gary Tucker Junior Investigator Award for funding this study. The In SHAPE study was supported by grants R01 MH089811 and R01 MH078052 from the National Institute of Mental Health.


  1. Allison, D. B., Fontaine, K. R., Heo, M., Mentore, J. L., Cappelleri, J. C., Chandler, L. P., et al. (1999). The distribution of body mass index among individuals with and without schizophrenia. Journal of Clinical Psychiatry, 60, 215–220.PubMedCrossRefGoogle Scholar
  2. Beck, A. T., Rector, N. A., Stolar, N. M., & Grant, P. M. (2009). Schizophrenia: Cognitive theory, research, and therapy. New York: Guilford Press.Google Scholar
  3. Berkman, B. (1995). The role of social relationships in health promotion. Pychosomatic Medicine, 57, 245–254.Google Scholar
  4. Brown, S., Birtwistle, J., Roe, L., & Thompson, C. (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine, 29, 697–701.PubMedCrossRefGoogle Scholar
  5. Cabassa, L. J., Ezell, J. M., & Lewis-Fernandez, R. (2010). Lifestyle interventions for adults with serious mental illness: A systemative literature review. Psychiatric Services, 61, 774–782.PubMedCrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (1996). Physical activity and health: A report of the surgeon general. Retrieved from Centers for Disease Control and Prevention website:
  7. Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventive Chronic Disease, 3, 1–14.CrossRefGoogle Scholar
  8. Daumit, G. L., Goff, D. C., Meyer, J. M., Davis, V. G., Nasrallah, H. A., & McEvoy, J. P. (2008). Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study. Schizophrenia Research, 105, 175–187.PubMedCrossRefGoogle Scholar
  9. de Leon, J., & Diaz, F. (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research, 76, 135–150.PubMedCrossRefGoogle Scholar
  10. Dixon, L. (1999). Dual diagnosis of substance abuse in schizophrenia: Prevalence and impact on outcomes. Schizophrenia Research, 35, S93–S100.PubMedCrossRefGoogle Scholar
  11. Emmons, K. M., Barbeau, E. M., Gutheil, C., Stryker, J., & Stoddard, A. M. (2007). Social influences, social context, and health behaviors among working class, multi-ethnic adults. Health Education and Behavior, 34, 315–334.PubMedCrossRefGoogle Scholar
  12. Falba, T. A., & Sindelar, J. L. (2008). Spousal concordance in health behavior change. Health Services Research, 43, 96–116.PubMedCrossRefGoogle Scholar
  13. Faulkner, G., & Biddle, S. (1999). Exercise as an adjunct treatment for schizophrenia: A review of the literature. Journal of Mental Health, 8, 441–457.CrossRefGoogle Scholar
  14. Fraser, S. N., & Spink, K. S. (2002). Examining the role of social support and group cohesion in exercise compliance. Journal of Behavioral Medicine, 25, 233–249.PubMedCrossRefGoogle Scholar
  15. Gorin, A., Phelan, S., Tate, D., Sherwood, N., Jeffery, R., & Wing, R. (2005). Involving support partners in obesity treatment. Journal of Consulting and Clinical Psychology, 73, 341–343.PubMedCrossRefGoogle Scholar
  16. Hartmann, M., Bazner, E., Wild, B., Eisler, I., & Herzog, W. (2011). Effects of interventions involving the family in the treatment of adult patients with chronic diseases: A meta-analysis. Psychotherapy and Psychosomatics, 79, 136–148.CrossRefGoogle Scholar
  17. Hutchinson, D. S. (2005). Structured exercise for persons with serious psychiatric disabilities. Psychiatric Services, 56, 353–354.PubMedCrossRefGoogle Scholar
  18. Jones, D. R., Macias, C., Barreira, P. J., Fisher, W. H., Hargreaves, W. A., & Harding, C. M. (2004). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55, 1250–1257.PubMedCrossRefGoogle Scholar
  19. Kahn, E. B., Ramsey, L. T., & Brownson, R. C. (2002). The effectiveness of interventions to increase physical activity. American Journal of Preventive Medicine, 22, 73–107.PubMedCrossRefGoogle Scholar
  20. Krueger, R. A. (1994). Focus groups (2nd ed.). Thousand Oaks: Sage publications.Google Scholar
  21. Lee, D., Artero, E. G., Sui, X., & Blair, S. (2010). Mortality trends in the general population: The importance of cardiorespiratory fitness. Journal of Psychopharmacology Research, 24, 27–35.CrossRefGoogle Scholar
  22. Leon, A. C., Davis, L. L., & Kraemer, H. C. (2011). The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research, 45, 626–629.PubMedCrossRefGoogle Scholar
  23. McFarlane, W. R., Dixon, L., Lukens, E., & Lucksted, A. (2003). Family psychoeducation and schizophrenia: A review of the literature. Journal of Marital and Family Therapy, 29, 223–245.PubMedCrossRefGoogle Scholar
  24. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  25. Mitchell, A. J., & Malone, D. (2006). Physical health and schizophrenia [review]. Current Opinion in Psychiatry, 19, 432–437.PubMedCrossRefGoogle Scholar
  26. Mueser, K. T., & Bellack, A. S. (1998). Social skills and social functioning. In K. T. Mueser (Ed.), Tarrier N (Eds) Handbook of social functioning in schizophrenia (pp. 79–96). Boston, MA: Allyn & Bacon.Google Scholar
  27. Novak, S. A., & Webster, G. D. (2011). Spousal social control during a weight loss attempt: A daily diary study. Personal Relationships, 18, 224–241.PubMedCrossRefGoogle Scholar
  28. Okun, M. A., Ruehlman, L., Karoly, P., Lutz, R., Fairholme, C., & Schuab, R. (2003). Social support and social norms: Do both contribute to predicting leisure-time exercise? American Journal of Health Behavior, 27, 493–507.PubMedCrossRefGoogle Scholar
  29. Seidman, L. J., Cassens, G. P., Kremen, W. S., & Pepple, J. R. (1992). Neuropsychology of schizophrenia. In R. F. White (Ed.), Clinical syndromes in adult neuropsychology: The practitioner’s handbook. New York, NY: Elsevier Science.Google Scholar
  30. Stathopoulou, G., Powers, M. B., Berry, A. C., Smitts, J., & Otto, M. W. (2006). Exercise interventions for mental health: A quantitative and qualitative review. Clinical Psychology: Science and Practice, 13, 179–193.CrossRefGoogle Scholar
  31. Van Citters, A. D., Pratt, S. I., Jue, K., Williams, G., Miller, P. T., Xie, H., et al. (2010). A pilot evaluation of the In SHAPE individualized health promotion intervention for adults with mental illness. Community Mental Health Journal, 46, 540–542.PubMedCrossRefGoogle Scholar
  32. Verhaeghe, N., De Maeseneer, J., Maes, L., Van Heeringen, C., & Annemans, L. (2011). Effectiveness and cost-effetiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 8, 1–12.CrossRefGoogle Scholar
  33. Whitley, R., & Crawford, M. (2005). Qualitative research in psychiatry. Canadian Journal of Psychiatry, 50, 108–114.Google Scholar
  34. Williamson, D. F., Thompson, T. J., Thun, M., Flanders, D., Pamuk, E., & Byers, T. (2000). Intentional weight loss and mortality among over-weight individuals with diabetes. Diabetes Care, 23, 1499–1504.PubMedCrossRefGoogle Scholar
  35. Wing, R., & Jeffrey, R. W. (1999). Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. Journal of Consulting and Clinical Psychology, 67, 132–138.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Kelly Aschbrenner
    • 1
  • Elizabeth Carpenter-Song
    • 2
  • Kim Mueser
    • 1
  • Allison Kinney
    • 1
  • Sarah Pratt
    • 1
  • Stephen Bartels
    • 1
  1. 1.Dartmouth Center for Aging ResearchLebanonUSA
  2. 2.Dartmouth Psychiatric Research CenterLebanonUSA

Personalised recommendations