Abstract

Background

Individuals with schizophrenia experience physical illnesses that reduce their life expectancy compared to the general population, for example diabetes mellitus, hypertension and obesity. These illnesses are associated with unhealthy lifestyles and medications for treating schizophrenia such as clozapine which is an oral antipsychotic. It is crucial to help clients taking clozapine to address their diet and physical activity because this medication is associated with weight gain and other health problems. Motivational Interviewing (MI) is a counselling method shown to be effective for improving health-related behaviours. Although MI has been applied to people living with schizophrenia, there are few studies using MI to help individuals taking clozapine manage lifestyle behaviours.

Aims and Objectives

The aim of this thesis was to investigate the feasibility, usefulness, and staff and clients’ acceptability of an MI intervention designed to improve dietary habits and physical activity patterns of service users attending a community clozapine monitoring clinic.

Methods/Design

A mixed methods design was used, underpinned by the Promoting Action on Research Implementation in Health Sciences (PARIHS) framework. A 20 week-long feasibility study with follow-up at 28 weeks was undertaken with 30 participants from a clozapine clinic. Participants were randomly allocated to usual care or MI intervention groups. Study outcomes were weight and self-reported diet (Fat and Fibre Barometer Questionnaire) and physical activity (International Physical Activity Questionnaire). These outcomes were assessed at baseline, endpoint (20 weeks) and follow-up (28 weeks). Semi-structured interviews were undertaken at endpoint and a Study Feedback Questionnaire at follow-up.

Results

In this feasibility study, a tailored MI intervention was observed to be useful and acceptable by staff and clients. Although this was not a definitive trial MI participants improved their diet and physical activity patterns. MI participants achieved greater weight reduction from baseline weight of 3.9kg at endpoint, compared with an increase of 1kg for the TAU group, and a reduction of 3.5kg at follow-up, compared to an increase of 1.6kg for the TAU group. The adjustments made to the design of the study and the MI intervention demonstrate the feasibility of undertaking future research in this area. Implementation data suggests that MI can be integrated within the clozapine clinic enabling people who use the clinic to make lifestyle improvements.

Conclusion

Findings are promising for the use of MI in this population and could inform a full randomised controlled trial. Indications are that MI can easily be incorporated into routine care.