This study aims to codesign and implement a physical health improvement behaviour change intervention for people being treated for a mental illness in a mental health inpatient unit of a regional hospital.
People in regional areas with mental illness suffer high prevalence of preventable chronic health conditions. Multi-morbidity in people with mental illness contributes to a reduced life expectancy of up to 20 years. Many physical diseases are preventable and/or reversable if risk factors are identified early, and the right health promotion tools and interventions are provided. Addressing such a complex issue for people with mental illness requires an approach which is adaptable, has been co-designed with clinicians and consumers and is comprehensive to target individualised health behaviours. This research uses the Health Improvement Profile (HIP) tool to help clinicians (e.g. nurses, doctors) to assess patients physical health and identify risk factors or early signs of chronic disease. Using the Health Improvement Profile (HIP) tool during admission the clinicians will work with clients to implement the most suitable health promotion tools to help improve physical health. Using implementation research methodology and following the Consolidated Framework for Implementation Research (CFIR) the study is broken into the following 4 stages: * Identify * Adapt - codesign/adapt Health Improvement Profile (HIP) intervention and develop user training * Implement - into clinical areas to assist developing personalised Health Improvement Profile (HIP) * Evaluate - using both qualitative and quantitative data to determine feasibility of the Health Improvement Profile (HIP) and implementation in a regional health service
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
25
The Health Improvement Profile (HIP) is a comprehensive physical assessment conducted by a trained clinician which aims to link evidence based interventions for flagged abnormal health parameters. There are 27 health parameters assessed such as weight, Body Mass Index (BMI), blood pressure, blood glucose, cholesterol levels, and waist circumference, alongside questions on lifestyle factors like smoking, diet, and physical activity, as well as medication use and its side effects. Client participant will collaborate with their clinician in developing an individualised Health Improvement Profile which identifies suitable health behaviours interventions to improve physical health. Health behaviours may be associated with diet, exercise, sleep, hygiene (including oral care) and mindfulness.
Clinician/staff participants will receive Health Improvement Profile user training on how to conduct the comprehensive physical assessments for 27 health parameters and how to link the evidence based actions to develop an individualised Health Improvement Profile for clients admitted to inpatient service. Training includes online videos simulating assessments and completing the Health Improvement Profile and face to face workshops.
Feasibility of Health Improvement Profile
Each Health Improvement Profile parameter has a column for recording the assessment result, followed by a column indicating the healthy 'green' range or indicating the unhealthy 'red' range (requiring action). The final column indicates the recommended action if the parameter falls into the 'red' range. Baseline assessment, (up to 27 assessment points for males and 26 assessment points for females) using the Health Improvement Profile (HIP) to identify the number of red flags, this is baseline assessment data which falls outside of normal healthy parameters. Baseline assessment will occur at pre intervention (at time of admission to the inpatient unit), during intervention use (at discharge from inpatient facility with a developed Health Improvement Profile) and post intervention (3months post discharge from inpatient facility) to determine physical health improvement against baseline assessment.
Time frame: From admission (enrolment) to post discharge period of 3 months (12 weeks)
Feasibility: Time taken to recruit planned sample
The time that was taken to recruit the planned sample size of participants
Time frame: Immediately after the inclusion of the last participant
Feasibility: Retention
Proportion of participants who completed the whole study by all participants who enrolled
Time frame: at the follow-up assessment 3 months post discharge from inpatient service
Feasibility: Drop out rate
Number of participants who dropped out , did not continue with health improvement profile after discharging from inpatient service
Time frame: At the follow-up assessment 3 months post discharge from inpatient service
Reason for dropping out
Feedback from participant to identify reason for dropping out
Time frame: immediately on drop out notification or at 3 month follow up
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Feasibility: Adherence
Proportion (percentage %) of recommended actions on the Health Improvement Profile (HIP) which the patient self reports as completing up to 3 months post discharge.
Time frame: Immediately on completion of the post discharge period at 3 months (12 weeks)
Participant feedback
Participant qualitative feedback using open ended questions on satisfaction with the Health Improvement Profile. Analysed using standardised thematic analysis of the qualitative feedback.
Time frame: Immediately after completion of the follow up period of 3 months (12 weeks)
Clinician Confidence
Participant qualitative feedback using open ended questions on confidence for clinicians undertaking the physical assessments and developing care plans
Time frame: At completion of training, at the project interim point (3 months) and at end of project.
Client wellbeing
Participant qualitative feedback using open ended questions via interview or focus group, on self general overall self reported wellbeing physically and mentally (no quantitative scale to be used), this is qualitative feedback on client wellbeing participating in the HIP project.
Time frame: Immediately at completion of the follow up period (3 months)
Biometric measure: Body Mass Index (BMI)
BMI (kg/m2) is calculated by dividing a person weight in kilograms by the square of their height in metres Outside of normal parameters (red flagged) Underweight \<18.50 Overweight ≥25.00
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period 3 months (12 weeks)
Biometric measure: Waist circumference
Measured in centimetres (cm) - measured by applying the tap measure midway between the top of the hip bone and bottom of ribs, in line with the belly button, wrap measuring tap around your waist. Outside of normal measure (red flagged) Female \>80cm Male \>94cm
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Pulse
Beats per minute (BPM) Outside of normal parameters (red flagged) \<60bpm/\>100bpm
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Blood pressure
Outside of normal parameters (red flagged) ≥140/90 millimeters of mercury (mm Hg)
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Temperature
Outside of normal parameters (red flagged) \<36°Celcius \>37.5°Celcius
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Liver Function Test
Outside of normal parameters (red flagged) Liver function test (LFTs) - components. • Alanine aminotransferase (ALT) IU/L;
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Liver Function Test
Outside of normal parameters (red flagged) Liver function test (LFTs) - components. • Alkaline phosphatase (ALP) IU/L;
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Liver Function Test
Outside of normal parameters (red flagged) Liver function test (LFTs) - components. • Gamma- glutamyl transferase (GGT) IU/L;
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Liver Function Test
Outside of normal parameters (red flagged) Liver function test (LFTs) - components. • Aspartate aminotransferase (AST) IU/L;
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Liver Function Test
Outside of normal parameters (red flagged) Liver function test (LFTs) - components. • Bilirubin mmol/L;
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Liver Function Test
Outside of normal parameters (red flagged) Liver function test (LFTs) - components. • Total Protein Prothrombin Time (PT) g/L.
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measures: Lipid Levels
Outside of normal parameters (red flagged) Total Cholesterol ≥6.2mmol/L LDL (bad cholesterol) ≥4.1mmol/L HDL (good cholesterol) \<2.1mmol/L Triglycerides ≥2.2mmol/L
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Glucose
Outside of normal parameters (red flagged) \<4.0 - \>7.0 millimoles of glucose per litre of blood (mmols/L)
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Respiratory Rate
Outside of normal parameters (red flagged) \>20 Respiratory rate per minute (rpm)
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Sleep
Outside of normal parameters (red flagged) Self reported: \<3hours per night \>8hours per night
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Smoking
Outside of normal parameters (red flagged) Self reported: Smoker - volume per day Passive smoker Non-smoker
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Alcohol
Outside of normal parameters (red flagged) Self reported: \>units per day
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Fluid intake
Outside of normal parameters (red flagged) Self reported: \<1litre/day \>3litres/day
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Caffeine intake
Outside of normal parameters (red flagged) Self reported: ≥600milligrams (mg) /day
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric Measure: Urine output
Outside of normal parameters (red flagged) Self reported: \<1litre/day \>2litres/day
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Bowel Function
Outside of normal parameters (red flagged) Bristol Stool Scale
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Reproductive Health
Outside of normal parameters (red flagged) Self reported: Sexual Transmitted Infection screening - recent/occasionally/never Female: menstrual cycle Regular 28day ovulation cycle (range:24---35 days) Male: prostate and testicular (self examination) recent/occasionally/never Sexual satisfaction: Satisfied/dissatisfied
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Diet
Outside of normal parameters (red flagged) Intake (serving) per day of protein, fruit, vegetables
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Exercise
Outside of normal parameters (red flagged) Self reported: minutes per day
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Eyes
Outside of normal parameters (red flagged) Self reported: Concerns/no concerns
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)
Biometric measure: Oral Health
Outside of normal parameters (red flagged) Self reported: Concerns/no concerns
Time frame: At commencement (admission) to inpatient unit and after completion of follow up period at 3 months (12weeks)