Project Background: The relatively high rates of morbidity and mortality found among individuals with SMI have led to prioritization by Mental Health QUERI, and other groups, of prevention and health promotion in addition to improved coordination of physical health care for this population. Although promising health promotion interventions have been developed, they are intensive and none seem to successfully address the challenge of improving reach and enrollment while minimizing attrition. We conducted a pilot evaluation of a novel low-demand intervention that may be an acceptable introduction to health promotion, the Get Moving and Get Well! (GMGW) program. Participants in past versions of GMGW have described benefits beyond those expected. We began investigation of a 12-week GMGW program as an effective and relatively low-demand intervention to promote self-efficacy and physical health in Veterans with SMI through increasing Veteran behavioral activation.
Project Objectives: The objectives of the study were to: (a) determine the effects of participation in the 12-week GMGW program on a measure of behavioral activation; (b) determine the effects of GMGW on measures of self-efficacy, physical activity, general physical and mental health, and mood; and (c) determine the effects of participation in the class on measures of intent to engage and actual engagement in more intensive physical health programs.
Project Methods: In order to inform a future clinical trial, we completed the development of a 12-week manualized GMGW class, assessed its acceptability, feasibility and time burden, and evaluated effects of the intervention on key outcome measures. To achieve the aims of the study, we randomly assigned participants to either GMGW or Humor and Health (an engaging attention control condition). All participants completed both baseline and follow-up assessment. Baseline measures assessed behavioral activation, self-efficacy, physical activity, physical and emotional health, mood, and intent to engage in health promotion activities before beginning the class. These measures were repeated at the end of the 12-week class, along with questions to assess the acceptability of the interventions. A chart review examined actual engagement in health promotion interventions between a participant's entry into the program and 6 months later. We looked for the emergence of trends for differences in expected directions and response patterns within and between groups to inform us about effect sizes for the measures and permit a power analysis for the future clinical trial. We planned to use repeated measures analysis of variance, controlling for any variables that differ significantly between the intervention and control groups, to test the hypothesis that GMGW participants will have greater improvements on the measures at the end of the 12-week intervention than the control participants. Due to our small sample size and variability of the scores on the measures at both baseline and follow-up, we also closely examined the two groups descriptively. Finally, we compared the number of participants with evidence of participation in new health promotion activities in their medical record. We used a chi-square test of equal proportions, but again, due to small sample size, we examined this descriptively.
Findings: Due to initial attrition (e.g., moving, deciding not to participate, being unable to contact after consent) 29 of the 33 Veterans who provided informed consent began the program. Due to additional attrition, 20 participants (10 from each group) completed both baseline and follow-up assessment. Of those 20 Veterans, 55% were male and the mean age was 54.6 with the groups being almost identical with regard to these characteristics. The groups also did not differ on race, marital status, education, or income. There were no between-group differences in behavioral activation, self-efficacy, physical activity, physical and emotional health, mood, and intent to engage in health promotion activities. Scatter plots of change scores by group were examined in order to more precisely describe results of the intervention; again, no differences were noted. Although no significant differences were found between the two groups regarding either the number of participants who began a new health behavior, or the overall number of new health behaviors for each group descriptively, a difference was noted in the expected direction. The chart review found 17 new health behaviors in the GMGW group and 7 new health behaviors in the attention control over the 6-month period. Additionally, 8 GMGW participants began one or more new health behaviors whereas 5 began one or more new health behaviors in the attention control. There was no difference in attrition between the two groups and no difference in acceptability of the interventions. When specifically examining responses by GMGW participants, none disliked GMGW, all found it helpful to their physical and mental health, and all would recommend it to a friend with similar problems, with 7 of the 10 highly recommending the class. Overall, GMGW is acceptable to Veterans and the investigation of GMGW as an intervention is feasible.
Impact: Individuals with serious mental illness (SMI) have greater physical illness morbidity and mortality than the general population, but typically do not enroll in nor complete health promotion interventions. This pilot study suggests that the GMGW intervention is feasible and acceptable. Although not reaching significance, the results of the study suggest that further research is warranted, particularly to determine whether GMGW could serve as a low-intensity "gateway" program to other physical health interventions. This study will inform a full-scale trial in order to improve engagement in health promotion for this medically vulnerable population.
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Grant Number: I21HX001350-01
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