- Title
- Lifestyle risk factors and lifestyle risk management in people with psychosis
- Creator
- Mucheru, Doreen
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The research presented in this thesis primarily focused on people with psychosis, however, reference has been made to people with other mental illnesses with similar socioeconomic, cognitive, clinical and functioning profiles. Lifestyle risk and lifestyle risk management in people with psychosis were investigated, with a primary emphasis on nutrition and physical activity behaviour, however smoking was also explored in one study. These three risk factors are collectively known as lifestyle risk factors and are the primary downstream factors that contribute to modifiable cardiovascular disease (CVD) risk. The first component of the research focused on the relationship between these lifestyle risk factors with modifiable CVD risk factors (dyslipidaemia, hypertension and hyperglycaemia) and potential confounders, to reveal the contributing factors of excess CVD risk in people with psychosis. The patterns of lifestyle risk factor co-occurrence or clustering were also assessed to enable the tailored design of interventions for this population. Interventions with a focus on lifestyle risk management for people with psychosis were examined as part of the research; this included programs available in the community setting and existing research trials. Review of literature highlighted a knowledge gap on the utilisation and effects of attending Australian community nutrition and physical activity programs for people with psychosis. Moreover, strategies that contributed to the efficacy of lifestyle intervention research trials had not been clearly identified and these trials did not show evidence for translation into the Australian community setting following research completion; therefore, the issues that affected intervention translation into Australian practice settings were unknown. International data from people experiencing psychosis and other mental illness was cited in the consideration of these topics. Epidemiological data from the Australian context was primarily from the Second Australian National Survey of Psychosis, known as Survey of High Impact Psychosis (SHIP), which was conducted in 2010, with 1,825 participants. Data from SHIP were analysed for two of the four studies included in this thesis. The first study from SHIP aimed to: Describe the relationship between lifestyle risk factors for CVD (nutrition, physical activity, and smoking) and dyslipidaemia, hypertension and hyperglycaemia, while controlling for potential confounders; Identify clustering patterns of lifestyle risk factors in study participants and describe demographic characteristics associated with different clusters of lifestyle risk factors. Results of the analyses between lifestyle risk factors with dyslipidaemia, hypertension and hyperglycaemia, were generally not reflective of patterns found in the general population, even after adjusting for clozapine use, sex and age. Although trained investigators applied valid and reliable research tools, SHIP was not a longitudinal study, which is a more appropriate design to elucidate the relationships that were investigated. Moreover, tools used to assess nutrition, physical activity and smoking relied on self-report and did not obtain broad research data, which could have impacted findings. Prospective longitudinal studies could add to current work by improving upon the issues that affected the research, along with pinpointing additional confounding variables that contribute to excess CVD. This study also found that clustered occurrence of the three lifestyle risk factors was associated with certain demographic variables. Persons with the greatest co-occurrence of all three lifestyle risk factors were younger; males; those lacking tertiary qualifications; and people relying on pensions for income (p<0.05). Additionally, samples with a mixed demographic profile across age, gender, education attainment, and financial situation primarily showed risk of poor nutrition (inadequate fruit and vegetable intake) and inadequate physical activity (p<0.05). Finally, those most likely to present with nutrition that was consistent with guidelines (fruit and vegetable), the highest physical activity and non-smoking behaviour (p<0.05), were women; people with tertiary qualifications; persons less likely to rely on government pensions; and those who were older (p<0.05). Consideration of how lifestyle risk factors cluster in the design of lifestyle interventions for people with psychosis will enhance program quality, because the risk factors targeted and advice provided will be adapted to meet participant needs. The second study from SHIP aimed to: Describe the self-reported attendance of community nutrition and physical activity programs in the government and non-government sector, and identify demographics associated with overall self-reported program attendance; Assess whether improved nutrition and physical activity outcomes were associated with program attendance. Program participation was only 5.3% in the government sector and 8.7% in the non-government sector. The overall attendance of programs had a significant relationship with participant diagnosis, and was positively associated with education qualifications (p<0.05). The low utilisation of programs could be increased by following the relevant Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines for physical health management, and advocacy efforts by front-line health professionals like general practitioners and case managers. Additionally, personal challenges that inhibit service access (like low education attainment or capacity) should be addressed to mitigate some of the vulnerability that is experienced by this group. Inadequate evidence on distinct nutrition and physical activity benefits associated with program utilisation, creates a case for further evaluation of these services, to ensure that optimal outcomes are achieved. The research component focusing on lifestyle intervention research trials, comprised of 2 main papers. The first paper was a systematic review and network meta-analysis which aimed to: Pool and rank the efficacy of lifestyle intervention strategies that target weight, body mass index (BMI), waist-circumference and waist-to-hip ratio in people with psychosis, by comparing the effect size on these weight outcomes; Stratify lifestyle interventions according to their inclusion of dietary information that adheres to Australian Dietary Guidelines (ADGs). The application of education, tailored advice or goal setting, and progress review, in both dietary and physical activity components of lifestyle interventions, produced the greatest decreases in weight (ES = -4.12, 95% CI=-7.772 to -2.760, p<0.000) and BMI (ES = -2.94, 95% CI=-1.78 to -0.357, p=0.003). Other essential intervention components that contributed to positive results were food and physical activity records, and supervised exercise. Inadequate reporting of waist circumference and waist-to-hip ratio outcomes limited generation of conclusions for these outcomes. Quality of the systematic review findings based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria ranged from low to very low. This was due to limitations in primary research studies that increased the risk of biased findings. The appraisal of dietary advice in lifestyle interventions using the ADGs generally showed compliance of studies, however, appraisals were (in some cases) hindered by vague and insufficient reporting in original research trials. Appropriate dietary approaches or advice for people with psychosis was therefore not identified in the study. In light of poor reporting in lifestyle intervention trials, the second paper from the systematic review aimed to: Critically appraise lifestyle intervention studies that target weight outcomes for people with psychosis, against the methods component of the Consolidated Standards of Reporting Trials (CONSORT) statement for randomised trials of nonpharmacologic treatments. Low utility of reporting guidelines in lifestyle interventions for people with psychosis was highlighted. This was evidenced by less than 50% of studies fulfilling reporting criteria for trial design, participants, interventions, outcomes, sample size, randomisation, blinding and statistical methods. Findings underline the vital importance of employing the CONSORT statement or similar guidelines to ensure that research reporting meets the quality standards that safeguard consistency and comprehensiveness. This will increase the usability of information from existing clinical trials, which will enhance the likelihood of people with psychosis benefiting from the research. The final component of the research was a qualitative study, conducted using semi-structured interviews in the context of a local Australian Community Managed Organisation (CMO) that delivers programs to people with mental illness. The study aimed to: Identify the factors that affect program access from the perspectives of both consumers and staff; Describe the elements that impact on program delivery from the perspective of staff. This study was designed to pinpoint issues that are likely to affect translation of lifestyle interventions into CMOs. Study aims and interview questions were based on implementation concepts highlighted in the “Integrated Promoting Action on Research Implementation in Health Systems” (i-PARIHS) knowledge translation framework. Themes on factors that affected program access (based on consumer and staff perspective) were (1) consumer financial status, domestic responsibilities, and health; (2) the design and delivery of programs; (3) structure and practices of the organisation; (4) attitude, skills and effort of staff involved in program delivery; and (5) social connections and stigma experienced by consumers during program access. Program delivery was influenced by consumer attendance and interest in prospective programs, availability and restrictions to the use of funding, as well as the organisational structure and practices. Further examination of the concerns which shaped program access and delivery revealed that most barriers could be managed through efforts from the CMO; therefore, alleviating the effect of these factors during prospective translation of lifestyle interventions into this setting may promote efficiency and decrease resistance to the process. The body of work presented in this thesis provides insight on the occurrence of lifestyle risk factors, specifically nutrition and physical activity behaviour, and the different interventions that are available for people with psychosis. The application of validated tools and processes for the synthesis of evidence enhances the quality and usability of findings by other parties. In addition, consideration of issues pertinent to prospective knowledge translation aims to inspire implementation of best-practice evidence, and maximise impact of research efforts in this field.
- Subject
- psychosis; llifestyle risk; nutrition; physical activity; lifestyle interventions; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1412526
- Identifier
- uon:36494
- Rights
- Copyright 2020 Doreen Mucheru
- Language
- eng
- Full Text
- Hits: 1078
- Visitors: 1405
- Downloads: 435
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 318 KB | Adobe Acrobat PDF | View Details Download |