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Vijayalakshmi U, Padmavati R, Raghavan V, Chandrasekaran S, Mohan G, Durairaj J, Currie G, Lilford R, Furtado V, Madan J, Birchwood M, Meyer C, Sood M, Chadda R, Mohan M, Shah J, John S, Iyer SN, Thara R, Singh S. Designing and implementing a physical exercise intervention for people with first episode psychosis using experience-based co-design: A pilot study from Chennai, India. Asian J Psychiatr 2024; 97:104072. [PMID: 38815437 DOI: 10.1016/j.ajp.2024.104072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Physical exercise can improve outcomes for people with first-episode psychosis (FEP). Co-designing physical exercise interventions with end users has the potential to enhance their acceptability, feasibility, and long-term viability. This study's objective was to use experience-based co-design (EBCD) methodology to develop a physical exercise intervention for FEP, and pilot test it. METHODS The study was conducted at the Schizophrenia Research Foundation's FEP program in Chennai, India. Participants(N=36) were individuals with FEP and their caregivers, mental health professionals (MHPs, and physical training experts. EBCD methodology included one-to-one interviews, focus group discussions, joint conferences, and co-design workshops. Two instructional videos were developed. Twelve FEP patients engaged in physical exercise with help of the videos over three months. They were followed up through weekly phone calls and in-person interviews to capture data on regularity, frequency, location of exercise, and comfort levels. RESULTS Several touch points emerged from the interviews, focus groups, and joint meetings including lack of motivation, knowledge about physical exercise; differing perspectives about physical exercise; limited resource, and time constraints. Two instructional videos demonstrating activities for participants incorporated strategies that addressed these touch points. Pilot data indicated that participants engaged with the physical exercise intervention over 3 months. CONCLUSION This was the first study to use co-design methodology to design a physical exercise intervention for first-episode psychosis. The intervention may have therefore been responsive to stakeholder needs and preferences. Results of this study highlight the potential of co-design in designing and adapting interventions. There is need for rigorous testing with larger samples.
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Affiliation(s)
- U Vijayalakshmi
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - R Padmavati
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India.
| | - Vijaya Raghavan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Sangeetha Chandrasekaran
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Greeshma Mohan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Jothilakshmi Durairaj
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Richard Lilford
- Institution of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vivek Furtado
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Maximilian Birchwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mohapradeep Mohan
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute; Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Sujit John
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute; Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - R Thara
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Conventry and Warwickshire Partnership Trust, Coventry, UK
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Rajan S, Mitchell A, Zavala GA, Podmore D, Khali H, Chowdhury AH, Muliyala KP, Appuhamy KK, Aslam F, Nizami AT, Huque R, Shiers D, Murthy P, Siddiqi N, Siddiqi K. Tobacco use in people with severe mental illness: Findings from a multi-country survey of mental health institutions in South Asia. Tob Induc Dis 2023; 21:166. [PMID: 38098747 PMCID: PMC10720264 DOI: 10.18332/tid/174361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION People with severe mental illness (SMI) tend to die early due to cardiovascular and respiratory diseases, which may be linked to tobacco use. There is limited information on tobacco use in people with SMI in low- and middle-income countries where most tobacco users reside. We present novel data on tobacco use in people with SMI and their access to tobacco cessation advice in South Asia. METHODS We conducted a multi-country survey of adults with SMI attending mental health facilities in Bangladesh, India, and Pakistan. Using data collected with a standardized WHO STEPS survey tool, we estimated the prevalence and distribution of tobacco use and assessed receipt of tobacco cessation advice. RESULTS We recruited 3874 participants with SMI; 46.8% and 15.0% of men and women consumed tobacco, respectively. Smoking prevalence in men varied by country (Bangladesh 42.8%, India 20.1% and Pakistan 31.7%); <4% of women reported smoking in each country. Smokeless tobacco use in men also varied by country (Bangladesh 16.2%, India 18.2% and Pakistan 40.8%); for women, it was higher in Bangladesh (19.1%), but similar in India (9.9%) and Pakistan (9.1%). Just over a third of tobacco users (38.4%) had received advice to quit tobacco. Among smokers, 29.1% (n=244) made at least one quit attempt in the past year. There was strong evidence for the association between tobacco use and the severity of depression (OR=1.29; 95% CI: 1.12-1.48) and anxiety (OR=1.29; 95% CI: 1.12-1.49). CONCLUSIONS As observed in high-income countries, we found higher tobacco use in people with SMI, particularly in men compared with rates reported for the general population in South Asia. Tobacco cessation support within mental health services offers an opportunity to close the gap in life expectancy between SMI and the general population. STUDY REGISTRATION ISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933 39.
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Affiliation(s)
- Sukanya Rajan
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alex Mitchell
- Department of Health Sciences, University of York, York, United Kingdom
| | - Gerardo A. Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Danielle Podmore
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | | | | | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi, Pakistan
| | | | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester City, United Kingdom
- Division of Psychology and Mental Health, The University of Manchester, Manchester City, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Bradford District Care National Health Service Foundation Trust, Bradford, United Kingdom
- Hull York Medical School, Hull, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Hull, United Kingdom
- Hull York Medical School, York, United Kingdom
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